Fusion & Reconstructions

What is an Ankle Fusion?

An ankle fusion is an effective surgical option for the treatment of painful end stage ankle arthritis.  This pain relieving procedure is performed by surgically joining the tibia (shin bone) and talus (ankle bone) with screws eliminating all motion in the joint.  This is a reliable operation that relieves pain and vastly improves a patient’s lifestyle and function.

What is the alternative to an Ankle Fusion?

Total ankle replacement is an alternative procedure that replaces the damaged ankle joint with an artificial implant and is used to treat the pain of ankle arthritis while still maintaining motion.

Whilst ankle replacement surgery is becoming more common, in certain situations such as significant deformity, neuropathy (absent sensation), large body mass, and younger patients ankle fusion may be preferred.

What are the advantages to an Ankle Fusion?

The main advantage of an ankle fusion is that it is strong, reliable and it relieves the pain associated with ankle arthritis.  Ankle fusion has traditionally been the “gold standard” when it comes to the definitive treatment of ankle arthritis.  It can be used in many situations where a total ankle replacement is contra-indicated such as high body mass patients, severe deformity, neuropathy (absent sensation) and younger patients.

What are the disadvantages of an Ankle Fusion?

Ankle fusion’s main disadvantage is the loss of motion in the ankle joint that is required to relieve the pain.  This increases the stress on the adjacent joints in the foot and ankle and often results in the development of arthritis in these joints leading to further pain and stiffness in the foot and ankle over the long term.  Furthermore, if you have arthritis in both ankles, bilateral fusions are often disabling resulting in difficulty carrying out certain tasks, such as rising from a chair. 

Do I qualify for an Ankle Fusion?

Dr. Chow will take a thorough history for which he needs to consider multiple factors to ensure that the appropriate operation is offered to you.  Factors for consideration are age, activity level, type of arthritis, degree of deformity, quality of adjacent skin and if arthritis is present in both ankles. 

 

A physical examination will be undertaken to evaluate the flexibility of the foot and ankle and isolate any other areas of pain and tenderness.

Weight bearing x-rays of the foot and ankle are reviewed for evidence of osteoarthritis and the bony alignment of the foot and ankle.  A CT scan and MRI may be required to further investigate the foot and ankle prior to surgery. 

 

There are clear indication and contraindications for ankle fusion surgery however often patients fall into a grey area for which the ideal operation is not clear.  Dr. Chow will take all factors into consideration and work with you to offer the most appropriate operation for your individual situation.   

How is Ankle Fusion surgery performed?

There are many different surgical techniques that can be utilized to perform an ankle fusion however the main goal of all the different techniques is to provide you with a painless, functional ankle that can return you to normal activities.

Dr. Chow will consider many different factors from your history and individualize the technique that best fits your ankle. 

Ankle fusions can be performed through arthroscopic “keyhole” surgery and open surgery.  Arthroscopic surgery is ideal for patients with minimal deformity however is not always suitable for all patients.  Open surgery involves an incision to visualize the joint and allows for better deformity correction. 

Often a combination of arthroscopic and open fusion is performed to utilize the benefits of both techniques.  Bone graft is harvested from the knee or hip and placed into the fusion site to help encourage the healing of the fusion site.  Finally, after the joint is prepared plates and screws are placed to hold the shin bone (tibia) and ankle bone (Talus) together while they fuse. 

What should I expect after Ankle Fusion surgery?

You should expect to stay 2-3 nights in hospital for observation, pain relief and physiotherapy.  You will be non-weightbearing for 10 weeks in a moon boot and commenced on blood thinners to prevent clot formation.  It is recommended to elevate your foot as much as possible while keeping the dressings dry and intact for the first 2 weeks until your first post-operative visit.  At 2 weeks your sutures will be removed, and wounds will be reviewed for evidence of infection.  At 6 weeks post operatively, an x-ray is performed to monitor the fusion and gentle physio is commenced.  Expect to return to most activities at 6 months and up to 1 year for a full recovery. 

Potential complications of Ankle Fusion surgery

All surgical procedures involve inherent risk of complications.  However, these risks are generally uncommon and quite infrequent.  These include anesthetic complications, wound infections, deep infections, nerve injuries, tendon injuries, bleeding, fracture, stiffness, chronic regional pain syndrome, blood clots, fusion not healing, mispositioning, and development of arthritis in other joints of the foot and ankle. 

Patients can minimize the risk of complications by carefully following post-operative instructions.

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