Ankle Fusion Surgery: An Overview

What Is Ankle Fusion Surgery?

Ankle fusion surgery, also known as ankle arthrodesis, is a surgical procedure that aims to treat conditions such as arthritis, injury, or congenital deformities. The surgery aims to fuse the bones in the ankle joint together to reduce pain and associated symptoms and improve stability. This surgery is usually considered when conservative treatment cannot reduce the ankle pain associated with severe cases of arthritis.

What Are the Benefits of Ankle Fusion Surgery?

• Reduces Pain: Ankle fusion eliminates pain caused by arthritis, injury, or other conditions.

• Improves Balance and Stability: By fusing the ankle bones, the joint becomes more stable, reducing the risk of falling. The joint will be less prone to further injury.

• Reduces Risk of Arthritis: Fusing the bones of the ankle can prevent the development of future arthritis at the same site.

• Decreases the Disability: Surgery improves the patient's ability to perform daily and weight-bearing activities.

How Does Ankle Fusion Surgery Differ From Ankle Replacement Surgery?

Ankle fusion surgery involves fusing the bones of the ankle joint to eliminate pain and increase stability. This procedure removes the damaged joint surfaces and is followed by fusing the remaining bones with screws, plates, or a combination of both. This fusion makes the joint permanently immobile.

Ankle replacement surgery, also known as ankle arthroplasty, involves replacing the damaged bones and joint surfaces with artificial components to restore the function of the ankle joint. The result is a more mobile joint, but it requires more maintenance and has a higher risk of future wear and tear.

The advantage of ankle fusion over ankle replacement is that ankle fusion possesses greater longevity and has fewer restrictions on physical activity during recovery.

Who Is Eligible, and When Should Ankle Fusion Surgery Be Considered?

Ankle fusion surgery is a common surgical treatment in end-stage ankle arthritis. End-stage arthritis usually has severe pain, swelling, and stiffness over the ankle, causing difficulty walking. There are three types of ankle arthritis which includes:

• Osteoarthritis is a common degenerative joint disease that affects the bones and cartilage in a joint, causing pain and limited mobility. It is called "wear and tear" arthritis, which can develop due to aging, overuse, injury, or obesity.

• Rheumatoid Arthritis (RA) is an autoimmune disease where the body's immune system attacks the lining of the joints (synovium), causing inflammation and swelling and eventually leading to joint damage. Since it is a systemic disease, it can affect other parts of the body and joints.

• Post-traumatic Arthritis: This condition occurs when previous injuries like a fracture happen at the ankle joint.

What Happens Before, During, and After an Ankle Fusion Surgery?

Before the Surgery: The patient will undergo a thorough evaluation, and the surgeon will review the medical history. The patient will be advised to stop taking certain medications and will be prepared for the procedure. The patient will also be given preoperative instructions, like being asked to fast for a certain period before the surgery.

During the Surgery:

• The patient will be given general anesthesia to ensure they are unconscious and pain-free.

• Incision: The surgeon will make an incision over the ankle joint, usually along the medial or lateral side.

• Removal of damaged tissue: The surgeon will remove any damaged or diseased tissue, such as cartilage or bone spurs.

• Repositioning of bones: The bones in the ankle joint will be repositioned and held together with screws, pins, or plates to ensure proper alignment.

• Bone grafting: The surgeon will use bone grafts, taken from another part of the body or a donor, to help promote healing and fusion of the bones.

• Closure of incision: The incision will be closed with sutures or staples, and a splint or cast will be applied to protect the incision site and promote healing.

The surgery typically takes several hours to complete. The patient will be advised to keep the affected leg elevated (keep the ankle above the heart by sitting in a reclined position or lying down) and to use crutches to avoid putting weight on the foot. Painkillers will be prescribed for shorter periods.

After the Surgery: The patient will need to undergo a period of rehabilitation and physical therapy to regain strength and mobility. These methods may include exercises to improve the range of motion and help prevent blood clot development. In addition, the patient may need crutches or a walking boot for several weeks to months after the procedure.

What Are the Different Types of Ankle Fusion Surgery?

Ankle fusion surgery can be mainly classified into two types which include:

• Open Ankle Fusion Surgery: This type is usually done in moderate to severe cases of ankle deformity. The surgeon will place an incision and uses surgical tools to remove the damaged cartilage. This technique may require longer hospitalization and a recovery period.

• Arthroscopic Ankle Fusion Surgery: This procedure is lesser invasive than open ankle fusion surgery. It is usually performed in minor ankle deformity cases or patients with an increased chance of developing wound complications like diabetes or other immunocompromised conditions. The surgeon places a smaller incision and inserts the instrument fitted with a camera called an arthroscope and tools through the incision.

What Are the Possible Risks After Ankle Fusion Surgery?

Ankle fusion surgery has specific risks, which include:

• Nonunion: It happens due to incomplete fusion of bones in the ankle joint. It is the major risk associated with ankle fusion surgery. The risk is relatively low since the success rate is more than 90 percent. Smoking increases the chance of nonunion. Smoking should be stopped before the surgery.

• Arthritis in Other Parts of Joints: After an ankle fusion, the lack of movement increases stress on other joints in the foot, potentially leading to a higher rate of arthritis in those joints. These discomforts may occur over several years and may not necessarily cause symptoms.

Rarely, surgeries may have potential complications related to anesthesia, infection, nerve and blood vessel damage, bleeding, or blood clots.

How Long Is the Recovery Period for Ankle Fusion Surgery?

• The patient will be sent back home to begin healing after surgery.

• The patient needs to elevate the affected foot to minimize swelling for the first one to two weeks.

• The patient must use braces, supportive boots, crutches, or a knee scooter.

• Patients are advised not to perform weight-bearing activities for three to four months. After three to four months, they can return to their everyday life.

• As the ankle heals, physical therapy will begin. A physical therapist can suggest exercises to help walk smoothly and improve ankle strength.

• Usually, it takes four to nine months to recover fully. During recovery, the patient should come for regular checkups with the surgeon. X-rays will be taken to monitor the bone alignment and healing process.

Conclusion:

Ankle fusion surgery is a surgical procedure performed in patients with underlying conditions like injuries, arthritis, or any congenital deformities. The success of the surgery depends on several factors, like the patient's overall health, the severity of the condition, and compliance with the rehabilitation and physical therapy plan. In most cases, the patient will experience a significant reduction in pain and discomfort after the surgery.