Ankle Fusion Surgery Benefits and Recovery Tips

Ankle fusion surgery is a procedure in which bones in your ankle are fused into one piece to relieve pain. Also known as ankle arthrodesis, the surgery is usually done to treat severe degenerative ankle arthritis.

During ankle fusion surgery, inflamed cartilage is removed and ankle bones are fastened together. This will decrease pain, but there are side effects such as limited mobility.

This article will cover the types of ankle fusion surgeries, benefits, and what to expect long-term following surgery. It also explains alternatives to ankle fusion surgery.

What Is Ankle Fusion Surgery?

Ankle fusion surgery involves fusing ankle bones into one piece to relieve pain.

Once swollen and degenerating cartilage in the ankle joint are removed, the ankle bones are then positioned so they can fuse together to form an immobile unit that doesn't depend on cartilage for stability.

Ankle fusion surgery can be performed with an ankle arthroscopy, which uses a small incision and the aid of a camera for visualization, or it can be an open procedure. The surgery is done with local or spinal anesthesia.

Benefits of Ankle Fusion Surgery

Pain relief is the goal of ankle fusion surgery. Arthritis is a chronic inflammatory disease of the joints, and associated inflammation and cartilage degeneration can lead to severe pain and joint swelling.

Ankle fusion surgery may be able to diminish pain to the point that you are able to decrease your use of pain medications and get more physically active.

Who Should Get Ankle Fusion Surgery

Persons who have severe arthritis of the ankle may benefit from ankle fusion surgery. Common forms of arthritis include:

• Osteoarthritis
• Post-traumatic arthritis
• Rheumatoid arthritis

What Happens During Ankle Fusion Surgery

Before Surgery

Before your surgery starts, you will have your vital signs checked, including your respiratory rate, heart rate, and temperature. Blood work may also be done.

You will then have anesthesia, which might be local anesthesia with a nerve block or spinal anesthesia. This will involve an injection of medication that prevents you from feeling pain in your ankle.

Your ankle will be cleansed with a sterile solution and a drape will be placed around the area to prevent contamination of the surgical site.

Arthroscopic Surgical Procedure

If you're having an arthroscopic joint procedure, your surgeon will make a small incision and insert a thin tube equipped with a camera into your ankle.

During the procedure, the following will take place:

1. Your surgeon will perform a debridement, which is the removal of cartilage and debris from your ankle.
2. They will create a level bone surface on the top and bottom of the ankle joint to prepare for the optimal alignment of the bones. Then the bones will be placed in the proper position for the fusion.
3. Metal implants—usually large screws—are used to hold the bones in this position. This hardware is placed into the bones, typically with an accessible portion positioned to protrude from the skin so it can be removed later on.
4. Once your surgeon is finished working on your ankle joint, the arthroscope or any other surgical tools will be removed. If you have had a great deal of edema, you might have a small drain placed in your ankle to collect fluid and prevent buildup.
5. The area will be cleaned again and incisions closed with sutures or staples. A sterile bandage will be placed over the area, and your ankle will be wrapped with gauze and a compression bandage.
6. You will also have a hard cast or a splint placed to immobilize your foot so the bones won't move and to reduce swelling-induced pain.

Open Procedure

If you will have an open procedure, your surgeon will make a larger incision and can look directly at the structures in your ankle. The procedure is otherwise the same as that performed arthroscopically.

Risks and Complications

Ankle fusion surgery comes with several risks you should consider. Short-terms risks include:

• An infection of the skin or bone
• Bleeding or a hematoma
• Blood clots, especially due to immobility after surgery
• Damage to nearby structures in the ankle
• Inflammation of the ankle
• An allergic reaction to the metal used to fuse the ankle bones

One of the long-term risks of ankle fusion surgery is problems with bone healing, which can lead to foot instability or bone deformities, which interfere with your ability to walk. This can cause severe pain and disability requiring surgical revision.

Recovery From Ankle Fusion Surgery

Recovery at the Hospital

After your procedure, your foot will be elevated while you lie in a hospital bed. You will be observed in a post-operative area for signs of pain, bleeding, infection, or drainage from your wound.

If you have a drain, it will be monitored for concerns such as excess bleeding or infectious fluid.

Your medical team will ask you about your pain and might give you pain treatment while you are in the hospital.

You will likely have to remain in the hospital for a day after your procedure. During this time, your medical team will show you how to use crutches or a walker, which you will probably need once you have been discharged.

Once it's determined that you are healing well and your pain is well managed, you will be sent home with instructions and a prescription for pain medication to take if needed.

At-Home Care and Long-Term Recovery

Follow-Up Care

Once you've been discharged from the hospital, you will need to follow up with your healthcare provider so they can evaluate your recovery. Your medical team will evaluate your ankle to see if it is healing well and to look for any signs of complications (such as a blood clot, infection, or inadequate wound healing).

You should also describe any pain you have and make sure you tell your healthcare provider how much pain medication you have been using. This will help them assess your healing, whether you are having more pain than expected, and possibly adjust your medication if needed.

Most of the time, all of your surgical hardware will be removed at one of your follow-up appointments, but your healthcare provider might leave one or more pieces in place for joint stability.

Removal is done in the office with a very rapid pull on the hardware so that each screw, pin, or rod is pulled out in one piece. This can be uncomfortable or painful for a few seconds, but pain medication isn't typically necessary.

Over time, the bone will grow to fill the space that the hardware once occupied.

At-Home Care

While recovering at home, it's important to be patient and follow any discharge plan you have been given. This includes instructions on wound care, pain control, and management of swelling.

You will most likely have to stay off your feet for eight to 12 weeks after your surgery. Thereafter, you will be able to walk while wearing a boot or cast to protect your ankle. Physical therapy may also be recommended.

You will probably need modified or specially-designed shoes that have a slip-resistant sole and/or provide ankle joint support to prevent twisting. Your healthcare provider or therapist will let you know which type of shoe you should buy or whether you need custom shoes.

Additionally, because ankle fusion limits motion, you can develop pain or arthritic changes in either foot down the road as you place uneven pressure on your feet while walking. A splint or other supportive foot device may help you avoid these issues.

Lifestyle Adjustments

After ankle fusion surgery, the permanent limitation of foot movement could mean you can't walk as much as you used to. The lack of flexibility in your ankles will also inhibit your ability to run, bike, and participate in certain sports that require ankle flexibility.

However, you can walk as long as it doesn't cause discomfort. You can also participate in sports and physical activities like weight lifting, rowing, core training, and aerobic exercises that don't rely on running or jumping.

Other Options for Ankle Pain

Other options can help achieve the goals of ankle fusion. They're worth discussing with your healthcare provider so, among other things, you can feel confident about your choice to proceed with surgery.

Non-Surgical Treatments

Many people who have mild or moderate arthritis of the ankle can find relief with non-surgical options. Anti-inflammatories, a hot or cold pack, an ankle wrap, or an ankle support can all potentially reduce painful swelling and inflammation.

Because ankle fusion reduces the range of ankle motion, these more conservative treatments should be tried (and proven to provide inadequate symptom relief) before surgery is considered.

Ankle Replacement Surgery

Ankle replacement surgery is an option that's often weighed against ankle fusion surgery.

In general, ankle fusion surgery is preferred if you don't want the risk of potentially having another surgery to replace a worn-out ankle replacement (they have limited lifespans).

On the other hand, ankle replacement surgery is often recommended if you want to maintain joint flexibility.

Summary

You'll need to consider a number of factors as you decide whether ankle fusion surgery is right for you. Issues that should play a role in your decision include:

• Limitations to your activity level
• Use of pain medications
• Readiness to go through recovery

If you decide to have ankle fusion surgery, you should know that it's generally considered a safe procedure, but you will have to adjust to the permanent limitation of your ankle motion.