Ankle Fusion or Ankle Replacement?

Choosing the Right Ankle Surgery

By Karen Doss Bowman
November 01, 2016
choosing ankle fusion or ankle replacement surgery


When persistent 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 motion when nonsurgical treatments aren’t effective. Orthopaedic foot and ankle surgeon, Dr. Selene G. Parekh, M.D., explains 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, the ankle cartilage has worn away, and bone painfully rubs against bone.

Ankle fusion (arthrodesis) involves cleaning the worn out ankle joint and fusing the bones together with screws, plates and bone grafts. Ankle fusion relieves pain, but it also limits your ankle’s range of motion, Parekh explained. The limited mobility can change how you walk, and that can cause wear and tear, and ultimately painful arthritis, in other parts of your ankle, knee, and foot. Recovery is longer with ankle fusion than ankle replacement. Patients can spend up to 10 to 12 weeks in a cast. Because the ankle joint is locked in place, physical therapy is not part of the recovery process.

Ankle replacement is a newer option. The procedure, also known as ankle arthroplasty, replaces the arthritic ankle joint with a metal and plastic prosthesis. The recovery period is shorter than ankle fusion – typically three to six weeks in a cast followed by physical therapy. People regain a much wider range of motion; most return to 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, Dr. Parekh said. 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, experience less pain and more range of motion. That spares the other parts of your knee and ankle that can wear out following ankle fusion. Some patients who have had an ankle fusion may be candidates for ankle replacement surgery to restore movement and function.

When to Consider Ankle Fusion

“People who choose ankle fusion want to be done with their ankle pain,” Dr. Parekh said. Because it is a permanent solution, he explained, “they don’t want to have to think about the ankle 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, 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, Dr. Parekh said, 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 your activity level to help you decide whether ankle replacement or ankle fusion is best 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 he or she has performed is an important question when considering surgery.

Duke foot and ankle surgeons routinely perform high volumes of both ankle surgeries, as well as revisions from ankle fusion to ankle replacement. They are also able to recommend total ankle replacements to people who would otherwise not be considered candidates for ankle replacement because they have extensive experience with all of the latest artificial ankle joints. This results in positive patient outcomes.

“Often patients come to us for 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,” Dr. Parekh said. “We have been involved with the research and development of ankle replacement devices, and have access to all the prosthetics. We can pick the most appropriate one for each patient.”

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Ankle Replacement Surgery