Why Have Surgery?
Arthrodesis of the ankle is typically performed on patients with severe and debilitating ankle pain. Sometimes, the ankle is deformed. The cartilage may be damaged or completely destroyed. This damage typically results from degenerative arthritis.
After undergoing joint fusion surgery, patients often report that their pain is greatly alleviated. The joint becomes more stable and properly aligned. The patient can place weight on the joint again.
Are You a Good Candidate?
Candidates for ankle joint fusion surgery have already tried other methods of pain management, including pain medications and heat/cold therapy. When less invasive treatments fail, and you are still in pain, you may consider surgical options.
Since arthrodesis of the ankle reduces joint mobility, your doctor will likely evaluate you for total ankle replacement first. If you and your doctor decide that an ankle replacement is not right for you, consider ankle arthrodesis instead.
Good candidates for ankle arthrodesis do not suffer from nerve problems, are not diabetic, and do not smoke. The risk of the surgery failing is higher among people who fit one or more of those descriptions. You must also be able to limit your movements severely during the initial recovery period.
Once you have decided to undergo arthrodesis of the ankle, talk to your surgeon about what you need to do to prepare. You'll likely have a complete physical exam. You'll review your other medical conditions with your surgeon, as well as disclose any medications (including over-the-counter drugs or supplements) that you take.
In addition, make arrangements to have someone drive you home from the hospital. Ensure that someone will be available to stay with you at home to help prepare meals and perform other chores.
The night prior to surgery, do not consume any foods or liquids.
After placing you under general anesthesia, the surgeon will make one incision on each side of your ankle, and locate the bumps on the inside and outside of your ankle. These are called the malleoli. The surgeon will remove these to allow access to the joint.
After the joint is opened up, the surgeon can remove the joint surfaces. If the ankle has a deformity, he will reshape the bones as needed. He may also need to perform a bone graft if you have suffered from bone loss. He will then secure the joint with two to three screws, which allow the joint to fuse together. Finally, he will close the incisions.
Recovery and Results
Typically, you can expect a hospital stay of two to three days. You will need to keep your ankle elevated during much of this time to help reduce the swelling. After the swelling subsides, the doctor will apply a plaster cast. The cast will cover your entire lower leg, down to your toes. Expect to wear the cast about three to four months.
You must not place any weight on that leg for the first six weeks. A physical therapist will help you adjust to using crutches or a wheelchair. The doctor will see you regularly during the first weeks to ensure the joint is fusing properly.
Most ankle fusions are successful. In some cases, the bones may shift in the cast, fusing in an incorrect position. If this happens, you may need additional surgery; however, this is not always the case. Expect to have drastically limited mobility in your ankle.
Talk to your surgeon about the risks of this surgery. Occasionally, the surgery may fail and additional procedures are needed. Some patients may be slower to heal. Some patients may also develop arthritis in bones that are next to the ankle, due to the increased stress on these areas. Rarely, the screws may break and require replacement.