Ankle Arthrodesis, or Fusion
Ankle arthrodesis is the procedure where the bottom end of the two leg bones, the tibia and fibula, are made to grow together with the bone on top of the foot, the talus. This is the common surgical technique used to treat ankle arthritis. It can also be used for treating ankle deformities and instability problems.
Surgery to get two different bones to grow together is called Arthrodesis, or Fusion. It is not common for Ankle arthrodesis surgery to also require a Bone Graft, though that may be necessary in some complex cases.
This surgery requires hospitalization for at least one night, and often two. You will require a general anesthetic or spinal anesthetic.
During the surgery two incisions will be made, and you will be left with scars about the inside and outside of the ankle.
The bone ends are prepared by removing any remaining cartilage, and the bones put together and held with some combination of screws, wires or plates. Sometimes the fibula is cut and a piece of it removed. You may notice this when you see post-operative Xrays.
Day of Surgery
At the end of the surgical procedure the wounds are covered and a short leg plaster splint is applied. That dressing gives support to the ankle, holding it securely. That should be left in place until I change it at the first post-operative office visit. Yo
u should keep your foot and ankle elevated as much as possible to minimize swelling.
You will be given crutches or a walker at the hospital, and I want you to not put any weight on that leg for 6 weeks. In the hospital a physical therapist will instruct you in using the crutches or walker. Do not walk on the splint.
When your pain is under control, and you can safely get around without putting weight on the ankle, you may go home. Look here for things to watch after Inpatient surgery.
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and take out the skin staples or stitches.
I will then put your leg into a short leg cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is usually at the 6 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will then have you go into a CAM Walker, and you will wear that for protected weightbearing for an additional 6 weeks. You must wear it when you do any walking.
I will ask to see you next after an additional 6 weeks, the 3 months point after surgery. I will have you get an Xray then to make sure that the arthrodesis is healing satisfactorily, and there are no problems with the metal implants. I will allow you to go into a regular shoe then.
Most people “wean” off the CAM Walker and back into a regular shoe. This takes a variable amount of time, and depends on how comfortable the regular shoe feels. It may take a few days, or up to a month.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. It generally takes 9 – 12 months for complete healing to occur.
The goal of the surgery is to leave you with a painless ankle that will allow normal walking. How successful that will be is variable. It is usually possible to make the ankle pain-free for daily activities. Most patients will have some degree of soreness that is hopefully mild. Most patients will notice discomfort when the weather changes.
Loss of ankle motion will put a restriction on the types of shoes you can wear. Generally a flat shoe will be okay. I sometimes prescribe a custom shoe, usually with a “rocker-bottom” sole, to help with walking. I generally wait until 6 months after surgery before deciding if that will be helpful.
You will notice that the ankle is thicker on the surgical side that the opposite side when everything has healed. The leg will also be about ¾ - 1 inch shorter. These are both due to the removal of bone during the surgery.
Most people have some difficulty walking up or down inclines.
It usually takes about one year for maximum improvement to occur.
Complications can occur with any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this surgery include the possibility of the bone not healing, or non-union, and implant problems.
It is possible that other joints in the foot can develop arthritis as a result of ankle arthrodesis. This is due to an increase in stress put on them by blocking motion at the ankle. That usually does not become apparent for over 10 years after the ankle arthrodesis surgery.