Ankle Fusion or Ankle Replacement?
Choosing the Right Ankle Surgery
When persistently painful ankle arthritis from a chronic ankle injury or ankle fracture makes walking, exercise, or climbing stairs unbearable, it’s time to consider your treatment options. Ankle fusion and ankle replacement can relieve ankle pain and restore pain-free mobility and an active lifestyle when nonsurgical treatments aren’t effective. Here's what you need to know if you are considering one of these ankle surgeries.
The Difference Between Ankle Fusion and Ankle Replacement
Ankle fusion or ankle replacement may be recommended when end-stage arthritis is diagnosed; this means that the ankle cartilage has worn away, and bone painfully rubs against bone.
Ankle fusion (also referred to as arthrodesis) involves removing any remaining cartilage from the worn-out ankle joint allowing the bones to fuse together, often with a combination of plates and/or screws and bone graft. Ankle fusion is an effective option for pain relief, particularly in younger patients or those who otherwise do not meet indications for ankle replacement (e.g., neuropathy). Fusion limits your ankle’s range of motion, can change how you walk and also tends to lead to arthritis in surrounding joints over time. Recovery tends to be longer with ankle fusion than with ankle replacement.
Ankle replacement (also referred to as arthroplasty) is a joint-sparing procedure. The procedure replaces the arthritic ankle joint with a metal and plastic prosthesis, and research has shown that it more closely restores normal gait (walking) than ankle fusion. Most patients return to their pain-free, active lifestyles. While the artificial ankle can wear out and may need to be replaced, research shows 90% are still functioning well 10 years after surgery.
When to Consider Ankle Replacement Surgery
Total ankle replacement is often the treatment of choice for people who want to continue their active lifestyles and appropriate indications are met. Because the artificial ankle joint is designed to more closely mimic the natural movement of the ankle, you can walk with a more natural gait and generally maintain a greater range of motion than with ankle fusion. Some patients who have previously had an ankle fusion may be candidates for conversion to ankle replacement surgery.
When to Consider Ankle Fusion
Most people who choose ankle fusion want a permanent solution to their ankle pain so they don’t have to think about it again. Ankle fusion is also recommended to people for whom total ankle replacement is not an option. This may be because the person is overweight or has another condition such as severe nerve damage; paralysis; a history of infection or diabetes; or avascular necrosis -- a condition in which the blood supply to the joint is cut off, which causes the ankle bone tissue to die.
Which Ankle Surgery is Right for You?
That depends, and it’s a decision best made with your doctor’s guidance. Each ankle surgery has pros and cons, and not every procedure is suitable for every person. Your orthopaedic foot and ankle surgeon will evaluate your overall health, age, and activity level to help you decide whether ankle replacement or ankle fusion is the best option for you.
Experience Counts When Choosing a Foot and Ankle Surgeon
Surgeons tend to do the surgeries in which they have the most experience. That’s why asking your surgeon how many ankle fusions or ankle replacements they have performed is an important question when considering surgery.
Duke foot and ankle surgeons routinely perform high volumes of both ankle surgeries, including revision procedures. Because they have extensive experience with the latest artificial ankle joints, they may be able to recommend total ankle replacements to people who would otherwise not be considered candidates.
Often patients seek second opinions because they have been told they need an ankle fusion by a doctor elsewhere who may not be familiar with the latest research on ankle replacement. Duke has been involved with the research and development of ankle replacement implants and choose the most appropriate one for each patient.
