What is an Ankle Fusion?
Ankle fusion (arthrodesis) is still an excellent alternative for patients with severe ankle arthritis. A fusion procedure is preformed by gluing together the bones of the ankle (the tibia and talus) usually with screws. This procedure causes stiffness of the ankle but still allows for some up and down motion of the foot through the maintained motion of small joints of the middle of the foot. In addition, the joints under the ankle (subtalar and hindfoot joints) are able to demonstrate some additional compensatory motion to allow for some continued up and down motion of the ankle and foot. The great majority of the side to side motion of the ankle and foot is maintained after this procedure.
Ankle Fusion vs. Ankle Replacement
For many patients with ankle arthritis, particularly those with multiple previous surgeries and / or previous fractures or trauma to the ankle or foot, the ankle joint may already have a severe restriction in the range of motion present. In this scenario, ankle replacement may not restore normal range of motion. For such patients, a fusion may be a better option.
Mobility After Ankle Fusion
After ankle fusion, most patients report a dramatic improvement in pain relief and function. In addition, with appropriate shoes or shoe wear modifications, many patients walk may walk without any limp. The disadvantages of the fusion are the stiffness of the ankle and the potential to develop painful arthritis to the adjacent joints of the foot over time.
Minimally Invasive Ankle Fusion Surgery
Most ankle fusions can now be performed arthroscopically (thorough two small incisions in the skin using a camera and a shaver) in a minimally invasive technique. The bones are prepared to glue together through the camera, and then 2 to 3 screws are placed across the ankle joint site to allow for healing. When this is possible, patients are casted and off their foot for four weeks and then allowed to bear weight in a boot for an additional 8 weeks. At this point, patients are allowed to return to shoe wear and increase activity as tolerated. With this minimally invasive technique, a failure of healing (nonunion) is rare.
Ankle Fusion Complications
In some scenarios, because of severe misalignment of the ankle or because of previous failed surgery of the ankle, an arthroscopic minimally invasive fusion is not possible. In these cases, an open incision is utilized to prepare the bone surfaces, and the joints are glued together with a similar technique as that described above. The healing is slightly longer with this technique.
Arthroscopic Ankle Arthrodesis in Chicagoland
Dr. Vora has lectured and published on this type of minimally invasive procedure and teaches this procedure to other foot and ankle surgeons and orthopaedists from both the United States and around the world. If you would like more information or to schedule an appointment, please contact our Chicago or Libertyville offices.