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An ankle fusion is a surgical procedure usually done when an ankle joint becomes worn out and painful, or degenerative. Ankle fusion is sometimes called ankle arthrodesis.

Image showing ankle joint after traditional ankle fusion surgery.

The most common cause of degenerative arthritis of the ankle is an ankle fracture. Many years after a serious fracture, the joint may wear out and become painful. A joint that is out of balance after it heals from a fracture can wear out faster than normal. Other types of arthritis can lead to a painful ankle joint as well. Rheumatoid arthritis can destroy the ankle leading to a painful joint.

What does the doctor hope to accomplish with ankle fusion surgery?

An ankle fusion removes the surfaces of the ankle joint and allows the tibia to grow together, or fuse, with the talus. Before the development of artificial joints this was the primary operation available to treat an extremely painful joint. In some cases, fusion is still the best choice.

Ankle fusion is a good alternative for treating a worn out joint. This is especially true if the patient is young and very active. An ankle fusion, if successful, is not in danger of wearing out like an artificial ankle. A fusion keeps the ankle joint from moving during walking and other activities, therefore ankle fusion adds stress to adjacent joints.

Ankle Fusion Surgery Procedure

Several different operations have been developed to perform an ankle fusion. The basic procedure in each operation remains the same, however. The most common way that an ankle fusion is done is by making an incision through the skin to open the joint. Once the joint is opened, the articular cartilage surfaces of the joint must be removed.

Once the articular cartilage is removed on both sides of the joint, the body will try to heal the two surfaces together just as if it were fractured or broken.

Once the cuts are made the bones must be held in place while they fuse. This can be done using large metal screws and metal plates if necessary. The screws are usually under the skin and are not removed unless they begin to rub and cause pain.

In some cases, especially if the fusion is being done because of an infection or a failed initial fusion, an apparatus called an 'external fixator' is used to hold the bones together while they heal. This apparatus has metal pins that are inserted through the skin and into the bone. The metal pins are connected to metal rods and bolts outside the skin that hold the bones in position while the ankle fuses. The fixator is removed after the bones have healed, usually in twelve to fifteen weeks.

Image showing an external fixator being used for stabilization of the ankle.

Some surgeons have performed ankle fusions with the help of the arthroscope. The arthroscope is a miniature TV camera that is inserted into the ankle joint through a small incision. Using the arthroscope to watch, other instruments are inserted into the ankle joint to remove the cartilage surface. The cartilage surface is removed using a small rotary cutting tool. Once the surfaces are prepared, screws are placed through small incisions in the skin to hold the bones together as they heal, or fuse. This procedure is not significantly different from the open procedure except that the incisions are smaller.

As with any medical treatment, individual results may vary. Only an orthopaedic surgeon can determine whether an orthopaedic implant is an appropriate course of treatment. There are potential risks, and recovery takes time. The performance of the new joint depends on weight, activity level, age and other factors. These need to be discussed with your doctor.