Ankle fusion

Overview

Ankle fusion, also known as ankle arthrodesis, is often done to treat ankle arthritis. The surgery aimed at alleviating the pain linked to an arthritic joint. This procedure involves the fusion of ankle bones using screws or plates. During the surgical procedure, your surgeon removes the cartilage from the ends of the ankle bones. Subsequently, these bones are carefully aligned to encourage them to heal together, effectively fusing. As a result, the ankle joint loses its mobility entirely. This transformation takes an ankle that was previously afflicted by discomfort and stiffness and turns it into an ankle that doesn’t bend but is considerably less painful. This alleviation could potentially enable you to engage in activities of significance to you, experiencing minimal to no discomfort. Before choosing ankle fusion as a treatment option, researching non–surgical options for ankle arthritis is advised. 

For individuals with mild to moderate arthritis, healthcare professionals commonly recommend exploring alternative treatments initially. These options might encompass corticosteroid injections and pain relievers. Additionally, physical therapy could be suggested, along with specialized footwear or orthotic inserts. Ankle fusion surgery might be proposed by a medical expert if the symptoms reach a level of severity where they disrupt daily activities and persist. It’s advisable to engage in a discussion with your healthcare provider to thoroughly understand the available choices. 

Reasons for undergoing procedure

Arthritis can impact the two joints in the foot. Over time, the previously smooth cartilage that covers the bone surfaces undergoes gradual erosion. The ankle joints can become subject to pain, swelling, and inflammation due to various forms of arthritis, which encompass: 

• Osteoarthritis develops as a result of wear and tear on the joints over time.
• Post–traumatic arthritis develops after a serious ankle injury, like a fracture.
• Rheumatoid arthritis is an autoimmune disease that damages the joints.

When ankle arthritis is severe enough to cause symptoms including severe pain, stiffness, and inflammation, ankle fusion may be required.

Risk

The primary concern linked to ankle fusion is the occurrence of nonunion, a condition where the ankle bones do not successfully amalgamate. Ankle fusion could potentially heighten the risk of developing arthritis within the foot and adjacent joints, as these particular joints will now bear increased stress.

Every surgical procedure carries corresponding risks. In the case of ankle fusion, the potential risks includes the following: 

• Infection
• Nerve damage
• Bleeding 
• Blood clot
• Inadequate fusion of bones
• Misalignment of the bones
• Development of new arthritis in neighboring joints

The risk of complications can be impacted by variables such as age and general well–being. For instance, factors like smoking or having low bone density could elevate the likelihood of specific complications. Individuals with poorly managed diabetes might also face an increased risk of issues. Engaging in a conversation with their healthcare provider about the risks most pertinent to their situation can offer valuable guidance. 

Before the procedure

In order to adequately get ready for the surgery, patients should have a consultation with their healthcare provider. It’s of utmost importance to inform the healthcare provider about all medications being taken, including over–the–counter options like aspirin. Certain medications, such as blood thinners, might need to be discontinued prior to the procedure. For individuals who smoke, it’s recommended to quit smoking before surgery, as it can hinder the healing process. Patients who require support in quitting smoking should seek guidance from their healthcare provider.

Prior to the procedure, the specialist will conduct imaging test such as CT scan, ultrasound, x–rays, or MRI. 

Patient are advised not to consume any food or liquid after midnight on the night before the surgery. Patients need to inform the healthcare provider for any changes in the health status such as sickness and fever. 

The individual may need to make arrangements within their home to aid in their recovery. This is due to the fact that the injured foot will be temporarily unable to support regular walking. It’s recommended to plan for transportation from the hospital, such as having someone available to drive them home. 

During the procedure

The healthcare provider overseeing the patient’s case will offer a comprehensive explanation of the specific surgical approach. An orthopedic surgeon, supported by a team of specialized medical professionals, will perform the ankle fusion procedure. The entire surgical process is expected to span few hours and therefore you can expect:

• Spinal anesthesia might be administered to ensure you experience no sensation from your waist downward. Sedation could be administered concurrently to promote relaxation. An alternative is to deliver general anesthesia, which efficiently reduces discomfort and induces sleepiness throughout the surgical operation. 
• Throughout the surgical process, a healthcare provider will closely monitor vital signs such as heart rate and blood pressure.
• The surgeon is going to create an opening by cutting through the skin and muscle around your ankle, and there is a possibility of another incision being made on your foot. The surgeon will make a tiny incision when minimally invasive surgery is done. Subsequently, they will employ a small camera equipped with a light to assist in performing the surgical procedure.
• Any remaining cartilage in the affected joint will be removed by the surgeon. They will next use the necessary tools to align and set the bones in the proper arrangement. 
• The surgical team will then continue by stitching or stapling the layers of skin and muscle that surround the ankle and foot. 

After the procedure

Engaging in a conversation with the healthcare provider about post–surgery expectations is recommended. Upon regaining consciousness, the leg will probably be elevated and secured with a brace to restrict movement. Once feasible, the patient can resume regular eating habits. Additional X–rays might be necessary to assess the procedure’s outcome. Generally, a hospital stay lasting a few days is expected. 

While the surgical incision might not be immediately apparent, it is crucial to promptly notify the healthcare provider in case there is a surge in pain, the onset of a high fever, or the occurrence of chills.

Immediate post–operative pain might be experienced, and pain medications can be employed to alleviate discomfort. Within a few days, the intensity of pain is expected to diminish. Resting and consistently elevating the leg following the surgery can be beneficial in managing the situation. 

It is likely that the patient may need to wear a splint for a few weeks following the surgery. For a number of weeks, using crutches may also be necessary. The healthcare provider will provide specific instructions on how to move the foot during the recovery phase. It’s crucial to understand that complete weight bearing on the foot won’t be achievable for a few months.

Outcome

Patient could have pain at the surgical site for at least 2 weeks. In about 90% of ankle fusion surgeries, the bones successfully fuse, while in the other 10%, this outcome is not achieved. It is recommended to speak with a healthcare provider to address any worries that may have and to get their professional opinion on the likelihood of a successful outcome.

Attending all scheduled follow–up appointments is crucial for the healthcare provider to oversee the patient’s healing progress. Approximately two weeks after surgery, a cast or boot might replace the splint. The cast may then be removed after a few several weeks. To sustain strength in the leg and ankle, physical therapy sessions spanning few months may be required. The journey to resuming regular activities might span several months. 

Having someone to assist during the initial two weeks after ankle fusion surgery could be beneficial. Prioritizing a lot of rest with the foot elevated is essential during this phase. 

It’s recommended to make necessary home preparations ahead of the surgery. If there are stairs, it might be necessary to install ramps. Adjusting the bedroom to be on the ground level, adding railings near the toilet and bathtub, and obtaining a shower chair are also significant factors to take into account

Engage in regular activities during the recovery phase won’t be feasible. It’s crucial not to apply any weight on the healing foot until receiving approval from the surgeon. Prior to resuming activities, it’s recommended to consult with the surgeon. 

After the bones have successfully fused and healed, the individual should be able to progressively reintegrate a range of activities, including walking, hiking, and cycling. Nevertheless, it’s important for the patient to acknowledge that activities involving running or jumping may no longer be feasible due to the fused ankle.