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Ankle Arthrodesis: Surgical Ankle Fusion Explained

Ankle arthrodesis is a surgical procedure to permanently fuse the ankle joint. It is used to relieve chronic pain caused by severe arthritis or joint instability.

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Things worth knowing about "Ankle arthrodesis"

Ankle arthrodesis is a surgical procedure to permanently fuse the ankle joint. It is used to relieve chronic pain caused by severe arthritis or joint instability.

What is Ankle Arthrodesis?

Ankle arthrodesis, also known as ankle fusion, is a surgical procedure in which the bones of the upper ankle joint are permanently fused together. The two main bones involved are the tibia (shinbone) and the talus (anklebone). By eliminating movement in the joint, the procedure aims to relieve chronic pain and restore stability to the foot and ankle.

Indications – When is Ankle Arthrodesis Performed?

Ankle arthrodesis is typically recommended when conservative treatments such as medication, physiotherapy, or orthotics no longer provide sufficient relief. Common indications include:

Advanced ankle osteoarthritis: Severe cartilage degeneration in the ankle joint
Post-traumatic arthritis: Arthritis developing after ankle fractures or ligament injuries
Rheumatoid arthritis with significant joint involvement
Chronic ankle instability
Avascular necrosis of the talus (loss of blood supply to the bone)
Severe deformities or malalignment of the foot and ankle

Surgical Procedure

The procedure is performed under general or spinal anaesthesia. The surgeon removes the remaining cartilage from the joint surfaces, positions the bones in the optimal alignment, and then fixes them in place using screws, plates, or intramedullary nails until bony fusion occurs.

Surgical Techniques

Arthroscopic arthrodesis: Minimally invasive approach using small incisions and a camera
Open arthrodesis: Traditional approach with a larger incision, often used for complex cases
Intramedullary nail fixation: A nail is inserted through the heel, talus, and tibia to provide stable fixation

Recovery and Rehabilitation

After surgery, the foot must be immobilised for several weeks. A typical recovery timeline includes:

0–6 weeks: Non-weight-bearing period, use of a cast or walking boot
6–12 weeks: Gradual return to weight-bearing with physiotherapy support
3–6 months: Full bony consolidation and return to daily activities

Physiotherapy plays a key role in strengthening the surrounding muscles and restoring walking ability.

Benefits and Risks

Benefits

Significant to complete pain relief
Restored stability and walking ability
Durable long-term results

Possible Risks and Complications

Non-union (pseudarthrosis): Failure of the bones to fuse completely
Wound infection
Nerve or blood vessel injury
Deep vein thrombosis
Increased stress on adjacent joints: The subtalar and midfoot joints may experience greater load after fusion
Hardware-related pain from screws or plates

Ankle Arthrodesis vs. Total Ankle Replacement

An alternative to arthrodesis for eligible patients is total ankle replacement (ankle arthroplasty). While a prosthesis preserves joint motion, arthrodesis provides greater stability and is often preferred in younger, physically active patients or those with complex deformities. The choice between the two procedures depends on age, activity level, bone quality, and the extent of joint damage.

References

Coester LM et al. – Long-term results following ankle arthrodesis for post-traumatic arthritis. Journal of Bone and Joint Surgery, 2001; 83(2): 219–228. PubMed PMID: 11216685.
Gougoulias N, Khanna A, Maffulli N – How successful are current ankle replacements? A systematic review of the literature. Clinical Orthopaedics and Related Research, 2010; 468(1): 199–208.
Thevendran G et al. – Nonunion of the ankle. Foot and Ankle Clinics, 2014; 19(1): 1–16. PubMed PMID: 24548510.

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