Ankle Fusion/Arthrodesis

An ankle arthrodesis is an operation that glues together or fuses the ankle joint. The ankle joint is responsible for more than 75% of the up and down movement of the ankle. With the ankle fused, no further upward movement is present but a limited amount of downward movement is possible. The in and out movement of the heel joint is not affected by an ankle fusion. An ankle fusion is indicated for patients with painful end-stage ankle arthritis. The arthritis can be the result of osteoarthritis, posttraumatic arthritis, arthritis from systemic cause such asrheumatoid arthritis, or even avascular necrosis.

When considering an ankle fusion, it is important to assess the joints surrounding the ankle joint including the subtalar joint and the talonavicular joint . The reason for this is that these joints will be subject to more motion and more force once the ankle joint has been fused. The status of these joints is important in assessing how successful an ankle fusion is likely to be. If these joints have full range of motion and no evidence of arthritis good results can be expected with a successful ankle fusion. If there is significant arthritis or stiffness involving these joints then the results of an ankle fusion may be less predictable.

Procedure

The ankle fusion is performed by removing any remaining cartilage from the tibial and talar surfaces of the ankle joint. The underlying bone is then prepared with a combination of instruments to create fresh bony surfaces that can knit together in a similar manner to the way a fracture would heal. These surfaces are then fixed in position with strong screws or plates. The actual position of the ankle joint is critical in performing a successful ankle fusion. The joint should be positioned in neutral dorsiflexion [right angles to the lower leg] and in slight hindfoot valgus [the heel angled slightly to the outside]. This allows the most motion through the surrounding joints.
The ankle is often approached through an incision on the outside [lateral] aspect of the ankle. It is common to require another incision at the front of the ankle as well. It is also common in order to approach the ankle to cut the smaller bone of the lower leg [the fibula] and reposition that so that it is included in the fusion mass.
As well, it is common to augment the ankle fusion with bone graft. This can be taken from just below the knee or from the pelvis. The cellular elements in the bone graft help improve the chance of the rate of ankle fusion.

Recovery

You are likely to stay in hospital for up to three nights. You will wear a fibreglass cast for 12 weeks. Guided by your foot specialist, you will begin a limited amount of weight bearing after six weeks, but the emphasis is upon resting and elevating your leg during the first three months.

Foot specialist plays a critical role in recovery of mobility and strength. At six months, you may have returned to daily activities and by 12 months, resumed the full range of more active pursuits.

Most patients will be able to walk normally, but can experience difficulty running, as the ability to push off with the toes is lost. For this reason, shoes are often fitted with a rocker sole.

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