Ankle > Arthritis > Treatments

   Ankle Fusion

Treatment Introduction

If arthritis has progressed to the point where moving your ankle is difficult and walking more than a couple of blocks causes pain, you may be a candidate for ankle fusion surgery. In this procedure, the cartilage from your shinbone (tibia) and anklebone (talus) is removed so the bones can be fused together. Those who choose this option lose motion in the ankle joint, which greatly limits the ability to engage in sports and activities. However, the pain is relieved and you can continue walking. And the other joints in your foot can still bend up and down, so your foot is not completely fixed in a rigid position. This surgery is usually considered a good option for older patients who have suffered debilitating ankle pain. Younger patients may decide on ankle fusion surgery if they are suffering from severe arthritis, but it is typically performed on patients over 50.

Preparing for Surgery

The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   If possible, discontinue the use of any anti–inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the procedure.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher infection and complication rate overall.

   If possible, practice walking with your crutches so you are ready to use them after surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or an assistant about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your ankle may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). An IV (intravenous) line may be inserted into your arm at this time. You will then walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your short leg cast or splint when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Ankle fusion surgery can take between two and three hours to perform. Spinal anesthesia typically is given to numb you from the waist down, and you usually are sedated so you sleep through the procedure.

   Your surgeon may have to make multiple incisions. An incision about 10 to 12 centimeters long is made on the outside part of your foot. Usually a smaller incision, about four to six centimeters, is made on the inside part of your ankle.

   Whatever cartilage surface remains on the top of your anklebone (talus) and the bottom of your shinbone is removed. The bone surface will only fuse to another bone surface.

   Your shinbone and talus are contoured so that your foot points out exactly 90 degrees from your shinbone.

   Two or three long screws are drilled from different directions through the two bones to fix your ankle in position. The screws usually cross each other to provide better stability.

   Your incisions are closed with stitches and your ankle is placed into a post-surgery splint. Bandages are wrapped around the splint to immobilize your ankle.

   You are taken to the recovery room where you will wake up from the anesthesia.

After ankle fusion surgery, you will be transported to the recovery room where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your ankle will be elevated and immobilized in a splint when you wake up. The post-surgery ankle splints usually are made of a "U-shaped" plaster splint on the inside and outside of your ankle that wraps around your heel. This immobilizes your ankle, but it can be removed more easily than a short leg cast. You will not be able to see the two incisions wrapped in the splint, and there usually is minimal bleeding after surgery. Ankle fusion can cause a substantial amount of pain, and adequate pain medications will be prescribed for you. You ordinarily are hooked up to an intravenous (IV) patient-controlled analgesia (PCA) device, which delivers pain medications in safe amounts when you push a button. Some patients may be prescribed oral or intramuscular pain medications. You usually can have visitors no sooner than 30 minutes after surgery if your physician feels you are in a stable condition. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you are ready to leave the recovery room and be transported to the hospital ward for further post-operative care. In some cases, you may be transported to a ward for intensive care or heart monitoring if you have special post-operative medical needs. Most patients spend two to three days in the hospital before going home.

After ankle fusion surgery, most healthy patients remain in the hospital for two to three days. However, some patients may require a longer stay due to pre-existing medical problems or medical issues that may arise after surgery. There are small risks of infection after major ankle surgery. Though it happens in less than five percent of patients, your ankle’s blood supply may not be as good as other body parts and you may be prone to infection. Because you cannot see your incision inside the cast, it is important to notify your physician if you feel discomfort. Each patient is different and may have different criteria for being able to go home. In general, the length of your hospital stay is based on the amount of pain management you need. You will receive fluids and medications, through an intravenous (IV) line until you can drink an adequate amount of fluids without nausea or vomiting. Most patients can drink something the night after surgery and eat something more substantial the following morning. Be sure to ask for pain medications as soon as you feel pain coming on, because medications are most effective on pain that is building rather than on pain that is already present. Your nurses will not give you more than your doctor has prescribed and what is considered to be safe. Physicians prescribe crutches to help you move around without putting weight on your ankle. The day after surgery, you typically meet a physical therapist who teaches you about using crutches and helps you walk around the hospital. You will likely be unable to bear weight on your ankle for six to eight weeks after surgery. Your physician may have X-rays taken of your heel and ankle before you leave the hospital. You should arrange for someone to drive you home when you are discharged.

For four to five days after ankle fusion surgery, you should keep off your feet, elevate your ankle above heart level, and move around the house as little as possible. You should try to rest and avoid too much movement for at least a week. Crutches usually are prescribed for about eight weeks so you can keep your body weight off your ankle. Rest as much as possible with your ankle elevated. This helps blood drain away from your ankle and controls swelling. The more weight you put on your ankle, the greater your chances of disrupting the healing process in your anklebones. Household tasks that require you to be on your feet may be difficult for eight weeks. It can be helpful to have someone around the house to help with any physical chores. The dressing covering your wound inside your post-surgery ankle splint usually does not need to be changed until the splint is removed about 10 to 14 days after surgery. A typical follow-up schedule after you leave the hospital may go as follows:

   Ten to 14 days – Stitches are removed and your ankle is put into a short leg cast. Casts need to be kept dry when bathing.

   Two weeks later – Return for a check-up. Possibly receive X-rays and, if necessary, a new cast.

   Eight weeks after surgery – If your physician sees signs of healing in your ankle, you usually can start bearing some weight while using your crutches. Weight bearing increases as you can tolerate the pain.

   Ten to 12 weeks after surgery – The cast is removed and you receive a removable brace that can be worn inside your shoes. When the cast comes off, you usually are used to bearing weight on your ankle, but you may continue using a cane as needed if your ankle hurts or feels weak. Your physician may provide with you with shoe modifications to make walking easier.

Depending on how well you are able to strengthen your own foot and lower leg, your physician may prescribe physical therapy to help you feel comfortable walking.

Though your arthritic ankle joint has been fused in surgery, the other bones in your foot still bend a little. You should be able to walk and get around. After 10 to 12 weeks in a cast, your leg muscles usually feel weak and you may need a few months of exercise before your leg feels strong again. Most of the strength you need to feel stable on your feet can be achieved by walking and weight bearing on your own. Try to walk a few blocks a day. Increase the length of your walks as your leg feels stronger. If you have difficulty, a physical therapist can help you start walking again on your fused ankle. Most patients can restore muscle strength and feel comfortable walking within four months after surgery.

After ankle fusion surgery, you no longer have cartilage in your ankle. Though arthritis can no longer trouble your ankle joint, you may have to worry about preventing arthritis in your other foot joints. With the ankle joint fused, more stress is placed on the bones in your foot. It typically takes years for other foot joints to become arthritic, but if you feel pain in your foot, you should visit your physician. Maintaining cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better than occasional, heavy exercise. After your ankle has been fused, stationary cycling is a great way to maintain cardiovascular fitness. You will probably not be able to run on your fused ankle, which makes returning to sports difficult. However, your ankle pain should go away and you will be able to walk around town, through the park, and in general be comfortable getting around. You should be able to play golf and do other light, walking activities.