Ankle fusion is arguably the most definitive way to treat ankle arthritis. It is a very good operation that has withstood the test of time. Surgeons have been performing ankle fusions with good results for decades. The operation is indicated for end-stage ankle arthritis that has failed other conservative treatment modalities such as activity modification, anti-inflammatories, and bracing.
The operation involves removing what remains of the damaged articular cartilage and allowing the tibia and talus bones to fuse together with bone thereby eliminating the ankle joint. The surgery generally involves using internal hardware such as an intramedullary rod, a metal plate, or screws to accomplish a successful fusion. The operation is generally reliable in relieving pain but also sacrifices ankle motion. It may be that the decrease in motion at the ankle joint is compensated for by motion in other joints of the foot. Many patients find it to be a very successful operation in relieving their pain and don't miss the motion as much as they thought they would. Sometimes the ankle arthritis was so severe prior to surgery that the patient already has very little motion at the ankle joint.
When the ankle successfully fuses it provides a very strong and stable platform for walking and may last longer than an ankle replacement. In fact, often times ankle replacements eventually are taken out and the ankle joint is then fused. Ankle fusion surgery is a very good choice for patients with active lifestyles that may not allow them to take care of an ankle replacement, specifically those patients who are younger and perform high impact activities. Patients with ankle joint infections, patients with severe deformities, or patients who are too overweight for an ankle replacement may also be good candidates for an ankle fusion. The downside of an ankle fusion is the loss of motion which may cause excessive wear on neighboring joints in the foot with time. There are multiple methods for performing an ankle fusion and I will be happy to discuss which way I think would be best for you depending on your personal circumstances.
Sometimes patients will spend the night in the hospital after an ankle fusion. This is determined on a case by case basis. You will receive nursing care on the floor from the highly skilled nurses. Dr. Kemp or one of his associates will see you each day. A physical therapist may also come to assist you in safely walking with crutches or a walker without putting weight on your surgical ankle. Much of the time after surgery is spent resting and elevating your leg to avoid swelling. You will be discharged from the hospital on post-op day 1 with a prescription for pain medicine to help control your pain.
Your ankle is usually immobilized for 12 weeks in a cast to promote bone healing. You will not be able to put weight on your ankle during the first six weeks and will need to use crutches, a walker, or a knee roll-a-bout to mobilize. You will be discharged home in a splint and then we will see you in office at 1 week to check your wound and place a cast. At three-weeks, sutures are usually removed and a new non-weight bearing cast is placed. Typically, at six weeks following surgery, the cast is changed to a walking cast or a walking boot. You will be seen again at twelve weeks after surgery and transitioned into shoe. The length of follow-up after the twelve-week visit may vary depending on how well you're doing. Typically, office visits after surgery are 1 week, 3 weeks, 6 weeks, 12 weeks, 6 months and sometimes one year.