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.
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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