Candidates for ankle fusion typically suffer from ankle arthritis that has led to the degeneration of the ankle joints, reducing patients’ quality of life. Ankle fusion should be considered as a last resort for improving quality of life and reducing joint pain after exhausting non-surgical options.
Patients who suffer from neurological or vascular illnesses that interfere with healing or recovery may not be good candidates for ankle fusion. Additionally, some patients have insufficient quantity or quality of bone for fusion.
Like other surgeries, ankle fusion requires a complete physical examination with some kind of imaging (X-ray, MRI) of your affected ankle by your primary care provider and/or orthopedic surgeon before surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with certain general surgery protocol such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Your home should be modified to be more comfortable and ensure a safe and rapid recovery. It is a good idea to move your bed to the first floor and to get rid of hazards such as loose rugs.
Immediately after your procedure, you should keep the fused ankle elevated to minimize swelling. Depending on if your procedure is performed arthroscopically or using an open incision, an overnight hospital stay may be required. Your doctor will prescribe medication for pain relief, or maybe install a “pain pump,” which automatically dispenses medication for 1-3 days after the procedure. Full fusion of the ankle bones for weight bearing may take 6-8 weeks, but can take up to 10-12 weeks in some patients. During this time, patients should use crutches, walkers, or other ways to get about without placing weight on the healing ankle. Swelling and pain are expected in the first few weeks postoperative, but can be managed with pain medication and continuing to keep the ankle elevated above the heart.
Any stitches or staples will be removed 2 weeks after surgery. You can expect to wear a cast or boot and may begin weightbearing on your affected ankle 2-6 weeks postoperative. A formal physical therapy program (beginning a week after surgery) will also help you as you learn exercises to maintain a pain-free range of motion. Patients are generally able to stop using a boot or any kind of aid 12 weeks after surgery, with a gradual return to more vigorous activity.
As with any surgery, there are risks of complications related to infection, damage to nerves and blood vessels, bleeding and blood clots, or adverse reactions to anesthesia. Risks specific to ankle function include nonunion, which is when the ankle bones fail to fuse together. This occurs in less than 10 percent of ankle fusion surgery cases, and necessitates a second ankle fusion surgery. After ankle fusion surgery, loss of motion in the ankle is expected. Loss of motion due to fusion of the ankle joints can also add stress to the other joints in the foot, which may lead to an increased rate of arthritis in the other joints in the long term.