Ankle Fusion (Arthrodesis) Surgery Guide

Goals of the surgery

Ankle fusion, also known as ankle arthrodesis, is a procedure that aims to elevate pain and discomfort felt within the ankle. The goal of this surgery is to remove worn down cartilage (a tough, elastic tissue) from between the bones of the ankle (tibia and talus) and fuse them into one bone. The procedure eliminates joint motion, thereby reducing pain coming from the arthritic joint.

Ankle arthrodesis (ankle fusion) is performed for two main reasons:

• Arthritis of the joint, because of a previous injury that has damaged the joint or from conditions such as osteoarthritis or rheumatoid arthritis.
• There may be a severe deformity of the rear part of the foot, such as a flat foot, high-arched or "cavus" foot, a club foot, or other deformities in which the ankle joint is also deformed, unstable, or damaged.

Cost of ankle fusion surgery

Ankle fusion surgery is bespoke and personalised towards the needs of each individual patient, and the surgical technique needed can differ. Therefore, it is not possible to give an exact quote without being assessed first. For example, some patients may be able to have their surgery arthroscopically (keyhole), and others may need to have an open operation (through a larger incision). Other factors that can influence the cost include the number of follow up appointments, necessary physiotherapy appointments, the type of anaesthesia used, and how many scans are required. The package price usually costs between £8000 and £10000.

Ideal candidates of ankle arthrodesis surgery

Patients may be considered suitable for ankle fusion surgery if they:

• Are young (usually under 60) and/or very active
• Have a severe foot deformity
• Have a very unstable ankle resulting in mobility issues or repeat injuries
• Have had an infection in the ankle or the bones around it
• The bone under the ankle (the talus) has collapsed

If a patient is not suitable for ankle arthrodesis surgery, they may be considered for an ankle replacement. The surgeon will make the patient aware of their options and likely outcomes within the consultation.

Ankle arthritis

If patients have mild or moderate ankle arthritis, the surgeon may advise other treatments first. These may include pain medicines and corticosteroid injections, special shoes or shoe inserts and/or physiotherapy. Sometimes the arthritis may only be limited to small areas, in which case an ankle arthroscopy and debridement (trimming of the worn cartilage) may be an option. If the patient continues to have severe symptoms that interfere with their daily activities, the surgeon may advise an ankle fusion surgery. The surgeon will clearly outline these options during a consultation.

The ankle fusion surgery procedure

Ankle fusion surgery is typically performed using an arthroscopic (telescope) technique. This involves making a small incision to insert a small camera into the ankle allowing the surgeon to access the treatment area with minimal and smaller incisions and therefore reduce scarring and improve recovery times. The procedure is most commonly performed under a general anaesthetic, but it can be performed with a regional anaesthetic (similar to an epidural) and sedation.

By using specialised instruments, the surgeon can remove the joint surface to allow the two bones to fuse together as they heal to form one bone. The bones are then held rigidly by two metal screws inserted from the inner part of the calf just above the ankle joint. The procedure involves four small cuts of approximately 1cm around the ankle.

In some cases, patients with foot deformities may have a tight Achilles tendon (“heel cord”) or weak muscles or both. During the surgery, the Achilles tendon may be lengthened by making three small incisions in the calf and stretching the tendon.

It’s important to know that sometimes additional procedures are required to achieve the result desired.

What will happen at an initial ankle fusion consultation with an orthopaedic surgeon?

The orthopaedic surgeon will assess the ankle and ask patients to describe their symptoms and how it affects their life. An X-ray of the foot may also be performed on the day if one has not been taken recently. Surgery may not necessarily be recommended initially, and non-surgical treatments may be advised. If this is the case, a comprehensive plan will be given.

If surgery is considered the best option, the surgeon will discuss how the surgery will be performed, including the techniques, anaesthetic to be used, aftercare planned and, the risks and complications.

Taking a complete list of medications is helpful as the surgeon will give advice if any need to be stopped before surgery.

Any questions the patient has will be answered within the consultation, it’s a good idea to write everything done prior to meeting the surgeon so nothing is forgotten.

Preparing for ankle arthrodesis surgery

Getting everything in order will make the recovery period much more comfortable. There are various things patients can do to prepare.

Before your ankle arthrodesis surgery, patients may need imaging tests. These may include CT scans, ultrasounds, X-rays, or magnetic resonance imaging (MRI). Patients should ensure there is enough time within their schedule to allow for any necessary tests.

General foot care and hygiene

• Keeping the foot clean, including cleaning between toes every day
• Treat any infections such as athlete’s foot

General health

• Stop smoking
  • This is shown to slow the healing of soft tissue and bones and can slow down the healing process, particularly when trying to get bones to fuse.
• Weight-loss
  • For patients that are overweight, weight loss will help reduce pressure on the foot

Prepare the home

• Patients will need to have their foot raised for a few weeks following surgery; having extra pillows for lying down or having a footstool will help
• Considering the best way to bathe
  • Bandages will not be able to get wet for a few weeks following surgery. It is best to discuss with the surgeon or nurse how best to wash, sometimes waterproof bags can be recommended to protect the foot from splashes
• Stock up on groceries
• Mobility will be affected, especially in the first few weeks; having everything needed such as crockery in easy to reach places will help
• Moving any unnecessary appointments (such as hairdressers)

Patients should ensure they have someone to pick them up from the hospital. They will not be able to drive for some time after the surgery, so should make sure that any transport needs are taken care of.

Planning childcare, pet care and time off work will allow patients to have a smooth recovery period and know that everything is being taken care of while they rest their ankle.

Patients can typically expect to spend two to three days in the hospital before they are able to return home.

Ankle fusion surgery aftercare and recovery

The patient will wake up on the ward with their leg elevated and in a brace to keep it from moving. Patients can expect to spend a few nights in the hospital following the procedure. So they are advised to take things to keep boredom at bay.

Patients may experience some pain right after the surgery. Pain medicines may help to relieve the pain. It may be helpful to rest and elevate the leg as much as possible right after the surgery. After the ankle fusion procedure, patients will likely need to wear a splint, plaster or brace for a couple of weeks. They might also need to use crutches for several weeks and patients won’t be able to put their full weight on it for a few months.

Walking

Patients should not walk on the foot for at least two weeks after surgery. The surgeon will advise when patients can start putting some weight on their ankle.

Returning to work

Patients can typically go back to work within three-four weeks of surgery. In a manual job with a lot of dirt or dust around and a lot of pressure on your foot, patients may need to take anything up to 6 months off work. How long patients are away from work will depend on the physical demands of the job.

Driving

Most patients prefer not to drive until the plaster is off, they can wear a shoe and are able to fully weight bear. If patients cannot safely make an emergency stop, their insurance may not cover them in the event of an accident.

Playing sport

After the plaster cast is removed patients can typically start increasing the exercises they do, this is usually after four months. Patients are advised to start with walking or cycling, building up to more vigorous exercise as comfort and flexibility allow. It is important for patients to be prepared that certain intense physical activities may not be possible following the surgery, but it varies from patient to patient. The surgeon will be able to discuss likely outcomes and recovery timeframes within the consultation.

Risks and complications

As with any surgery, there are associated risks that patients should be aware of. If patients are overweight, smoke or are not active, they are at greater risk of developing complications after surgery and it may take longer to recover. Patients may want to discuss with their GP what they can do to improve their health before surgery.

Risks related to ankle arthrodesis:

• Risks include stiffness or persistent pain in the ankle.
• Nerves may be damaged in very few cases, which could lead to chronic pain
• There is a very low risk of a blood clot forming in the leg, also known as deep vein thrombosis (DVT). All patients will be assessed for their risk of developing blood clots.
• Infections occur rarely and if they do, can usually be treated by antibiotics. Occasionally, wounds can become more deeply infected and require further surgery.
• The arthroscopy may find problems that cannot be treated by keyhole surgery. In these particular cases, patients may require further surgery or an alternative treatment.

It is important to remember that most complications are minor and can be easily and successfully treated. Patients can discuss any concerns they have in consultation and the surgeon will make patients aware of all risks of the ankle fusion surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.roh.nhs.uk/patient-information
• https://www.bofas.org.uk
• Understand.com
• https://www.esht.nhs.uk

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Before publishing, all the information is reviewed by a surgeon specialised within the relevant field.