Ankle Fusion Surgery

What is Ankle Fusion Surgery?

Ankle fusion surgery, or ankle arthrodesis, is a procedure to permanently join (fuse) the bones in the ankle joint. This surgery eliminates movement in the joint to reduce pain caused by severe arthritis or injury. The procedure creates a single solid bone by fusing the bones, preventing friction between damaged joint surfaces.

The surgery is typically performed using screws, plates, or rods to hold the bones in place while they fuse. Over time, the bones grow together, forming a stable and pain-free structure.

Indications for Ankle Fusion Surgery

Ankle arthrodesis is recommended to treat severe end-stage arthritis that has not responded to conservative treatment measures such as medications or injections. 

The other indications include 

• ankle infections
• ankle deformity 
• neurological ankle instability (such as Charcot), and 
• tumours.

Benefits of Ankle Fusion Surgery

The key benefits of ankle fusion surgery include:

• Pain relief: The procedure significantly reduces or eliminates chronic pain by eliminating the movement of damaged joint surfaces.
• Improved stability: A fused ankle provides a strong, stable platform for walking and other activities.
• Increased mobility: While the joint no longer moves, many patients can walk longer distances or engage in activities they avoided before surgery due to pain.
• Durability: Fusion is a long-term solution, often lasting a lifetime, unlike joint replacement, which may require revision.
• Alignment correction: The surgery can correct deformities or misalignments, improving overall leg and foot mechanics.

Types of Ankle Fusion Surgery

There are several techniques used for ankle fusion, depending on the specific needs of the patient:

• Open Ankle Fusion: A traditional approach involving a larger incision to access the joint, allowing the surgeon to view and prepare the bones directly.
• Combined Procedures: Dr Graff may combine open and arthroscopic techniques for cases involving severe deformities or complex conditions.
• External Fixation: An external frame may sometimes hold the bones in place, especially for patients with infection or poor bone quality.

Alternative Options to Ankle Fusion Surgery

For patients who are not ready for ankle fusion or want to explore other treatments, alternative options include:

• Non-Surgical Options:
• Physical Therapy: Strengthening muscles around the joint to improve support and reduce pain.
• Orthotics and Braces: Devices to stabilise and offload pressure from the joint.
• Medications: Anti-inflammatory drugs or pain relievers to manage symptoms.
• Steroid Injections: Reducing inflammation and pain within the joint.
• Surgical Alternatives:
• Ankle Replacement Surgery: Replacing the damaged joint with a prosthetic implant to maintain movement while relieving pain. Dr Graff does not perform this procedure but can refer you to someone who does.
• Osteotomy: Re-aligning bones to redistribute weight and relieve pressure on the joint.
• Joint Debridement: Removing damaged tissue and bone spurs from the joint to improve function.

Evaluation Before Ankle Fusion Surgery 

Ankle conditions should be evaluated for proper diagnosis and treatment. 

Accurate diagnosis comprises of:

• A detailed medical history,
• A physical examination, and
• Imaging tests such as X-rays, Doppler tests, and MRI.

Ankle Fusion Surgery Procedure

The approach for an open technique can be either:

• from the anterior (front) aspect, or
• lateral (side) aspect of the ankle. 

The joints are then fused with the help of screws, wires, plates, or rods. 

Bone grafting is recommended in cases of substantial bone loss. It involves using a graft from the patient (autograft, usually the fibula bone) or donor tissue (allograft). 

The recovery time following fusion will depend on the technique employed and the patient's health status.

The Hospital Stay

• Unless you have a circular frame, you wake up with a half-plaster (back slab) or a boot. 
• Your foot will be elevated overnight, and you will have antibiotics through a drip. 
• You will need blood-thinning medications to prevent blood clots and vitamin C to help wound healing for 6-8 weeks.
• You will stay in the hospital for 2-5 days with antibiotics, blood thinners, regular paracetamol, regular laxatives, and stronger painkillers to take if and when required.
• You will be only allowed to touch your foot to the ground for 6 weeks 
• Depending on your balance and strength, you may need rehabilitation post-operatively
• Buying a second-hand knee scooter pre-operatively (you can search online) and practising at home before the surgery can be helpful; please bring it into the hospital with you. It is easier to use a knee scooter than crutches

When You Go Home

• You will need medications for pain relief; regular paracetamol (2 tablets four times a day) is recommended, as well as strong painkillers, especially at night before bed. These can have side effects of drowsiness, nausea and constipation, and other tablets to help with these side effects may be required. 
• You will need blood thinning medications for 12 weeks to prevent blood clots.
• You will need to take vitamin C 1g daily for 12 weeks
• You will need a shower chair and bags to keep the plaster dry 
• You will need to attend your post-op appointment in 2-3 weeks, where the wounds will be checked and your plaster changed to a waterproof cast if your wounds are healed
• After this, you will be able to shower with a shower chair and get the plaster wet

Ankle Fusion Surgery Rehabilitation

All patients are different. These timelines are only guides; some patients may progress faster or slower than others.

0 - 2 Weeks

• You will be in a back slab for 2-3 weeks
• You can only touch your foot to the ground for balance.
• Please keep your foot elevated and out of bed for toilet only
• You will need to bag the leg for showers
• Please take regular Panadol with meals and before bed
• Please take blood-thinning medications and 1g of vitamin C daily for 12 weeks

2 - 3 Weeks

• Post-op appointment with Dr Graff: dressings are changed, and an x-ray is taken
• You will then go into a full cast or a boot full-time for another 3-4 weeks
• You will still need to elevate the foot at rest

6 Weeks

• You will have an appointment with Dr Graff and an x-ray
• The cast will be removed, and you can start weight-bearing in a boot for 6 weeks
• You can continue static/isometric strengthening

12 Weeks

• You will have another appointment with Dr Graff and an x-ray. If the xrays show fusion, then you can start the range of motion of the foot and knee and weight bearing without the boot
• You will still have ongoing swelling, so you may not fit into normal shoes, but you can wear normal shoes if you can fit into them (It would be good to wear rocker bottom shoes with a lace-up ankle brace postoperatively)
• You can start swimming and cycling

6 Months

• You will have another appointment with Dr Graff and an X-ray
• You will be feeling more ‘yourself’ and improved pain relief in the ankle

12 Months

• You will have another appointment with Dr Graff and an X-ray
• If the bones are fused, you may be discharged

When can I drive?

• Left foot 6 weeks (if driving an automatic)
• Right foot 12 weeks

When can I return to work?

• Seated work at 2-3 month
• Prolonged standing 9-12 months
• Heavy labour work 12-18 months

Ankle Fusion Surgery Prognosis

Approximately 90% of individuals report significant, long-term pain relief following the procedure. However, the fusion results in a permanent loss of ankle joint motion, which can alter gait and potentially increase stress on adjacent foot joints. Despite this, many patients return to daily activities with improved function and comfort.

Ankle Fusion Risks and Complications

Ankle arthrodesis is usually a safe procedure, but complications are uncommon. However, apart from general complications related to any surgery, complications after ankle arthrodesis can include infection, nerve damage, unresolved pain, non-union of bones, excessive swelling and stiffness, and irritation from foreign material such as pins or screws.

Implications of Delaying Ankle Fusion Surgery

Postponing recommended ankle fusion surgery can lead to the following:

• Progressive Pain: Ongoing joint deterioration may result in escalating pain levels.
• Decreased Mobility: Worsening joint damage can limit movement and daily activities.
• Development of Deformities: Delay may cause structural changes, complicating future surgical interventions.
• Adjacent Joint Issues: Compensatory changes can place additional stress on surrounding joints, potentially leading to further complications.

Timely surgical intervention can prevent these adverse outcomes and improve overall prognosis.

Useful Websites

• St Vincent’s Private Hospitals: Provides detailed information on ankle fusion procedures, recovery times, and patient care.SVPH
• Macquarie University’s Lighthouse: Features articles on advancements in ankle joint treatments, including 3D-printed ankle joints Lighthouse

These resources offer valuable insights into the procedure, patient experiences, and advancements in surgical techniques.

Contact Us

If you want more information or have any questions or problems, please contact Dr Graff at admin@christygraff.com or call the rooms at 0493 461 133.

Ankle Fusion Surgery Information Sheet