Ankle Arthrodesis

The ankle joint connects a lower leg bone (tibia) to a foot bone (talus) and is responsible for supporting body weight during standing and walking. Although arthritis of the ankle is less common than arthritis of the hip or knee, it most often develops after a previous injury such as an ankle fracture or repeated ankle sprains. Injury can disrupt the smooth cartilage surface of the joint and alter how forces pass through the ankle, leading over time to cartilage wear, inflammation, stiffness, and pain. As arthritis progresses, the ankle may lose motion and develop deformity, making walking increasingly difficult and painful. 

When ankle arthritis becomes severe and pain and loss of function persist despite nonoperative treatments (e.g. activity modification, bracing, medications, or injections), surgical fusion of the ankle joint may be considered to reduce pain and improve stability.^1-3

Ankle arthrodesis is a surgical procedure that permanently fuses the ankle joint by allowing the tibia (leg bone) and talus (foot bone) to heal together as one bone. The goal is to relieve pain by eliminating motion at the arthritic joint while restoring a stable, well-aligned foot for walking.

During surgery, the damaged cartilage lining the ankle joint is completely removed, the ankle is carefully realigned, and the bones are held together with metal hardware until they fuse. The foot is positioned in a neutral, functional alignment to support balance and a more natural walking pattern. There are two main surgical approaches used for ankle arthrodesis, and the choice depends on factors such as the amount of deformity, bone quality, and surrounding soft tissue: 

● Open approach: A larger incision is performed at the ankle, allowing the surgeon to directly see the joint and correct significant deformity by stabilizing the ankle using screws, plates, or rods. This technique is more commonly used when deformity is severe or when additional correction is required.
● Arthroscopic approach: Smaller  incisions are performed, as a camera and specialized instruments are used to remove the joint cartilage and fix the bones together, usually with screws, without fully opening the ankle. This approach is generally reserved for patients with minimal deformity and good bone alignment. ‍

Studies have shown that open and arthroscopic approaches provide similar long-term pain relief and fusion rates, with a lower risk of wound complications and infection in some patients receiving the arthroscopic approach.^3-5

Ankle arthrodesis is generally associated with significant improvements in function and pain relief. However, as with any surgery, complications can occur. The most common ones consist of:
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● Wound complications (≈ 2–4%): delayed wound healing or wound breakdown at the surgical incision
● Nonunion (≈ 5–9%): failure of the ankle bones to fuse
● Malunion or malalignment (≈ 1–2%): healing of the ankle in a suboptimal position
● Delayed union (≈ 1–2%): slower progression toward bone fusion
● Tibial stress fracture (< 5%): stress-related fracture of the tibia above the fusion site
● Adjacent joint arthritis: degenerative changes in nearby foot joints that may or may not cause symptoms
● Revision surgery (≈ 3.5–6%): need for additional surgery for hardware removal or due to other abovementioned complications ^4,6-9

The rates of each complication vary depending on the surgical technique and patient factors. As for other surgeries, general risks related to surgery and anesthesia may include infection, bleeding, blood clots, allergic reactions, cardiopulmonary complications, and wound-healing issues. Any other general surgical and anesthesia-related risks will be discussed with you prior to surgery if applicable.

Before surgery, your surgeon will examine your foot and review your x-rays (or advanced imaging if needed) to better visualize and assess the joint. Ankle arthrodesis is usually performed under regional anesthesia (e.g. nerve block, epidural, or spinal), sometimes with sedation, or under general anesthesia, often depending on patient-specific factors.¹⁰ After surgery, your foot will be immobilized in a below-knee splint or cast to maintain proper alignment and protect the surgical site.¹¹ Pain is usually managed with acetaminophen and anti-inflammatory medications.

Patients may return home within a short hospital stay after ankle arthrodesis.¹² Keeping the leg elevated during the first one to two weeks helps reduce swelling and supports wound healing. 

No weightbearing is typically allowed for the first 6 weeks to protect the fusion while the bones begin to heal, after which gradual progression to protected weightbearing in a boot or cast may be started as x-rays are obtained. 

Solid fusion is usually achieved by 3-4 months after the procedure, at which point many patients may typically return to basic daily activities (e.g. walking, standing, light household tasks). Return to full activities usually occurs after 4-5 months. In post-injury patients, 68–73% of patients at mid- to long-term follow-up participate in sports, but typically at a lower intensity than pre-injury levels. Functional improvement typically continues up until the first year following surgery.<sup>9,13-15

‍</sup>Regular follow-up visits with your surgeon throughout recovery are important to confirm healing, adjust weightbearing progression, and safely guide your return to activity at each stage.

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