Ankle fusion vs. Ankle replacement: how do you choose the right surgical option?

Our feet and ankles play a prominent role in support, balance, and mobility. Should something interfere with their normal function it can have a significant impact on daily life.

The two most common causes of severe ankle pain and stiffness are arthritis or a previous serious ankle injury. Both osteoarthritis and rheumatoid arthritis can lead to debilitating ankle pain, with a corresponding decrease in the range of motion in the joint. Should you be suffering from ankle pain or stiffness, non-surgical options such as physiotherapy or medication can often help. However, when ankle pain is severe and/or long-term, you may be advised to have ankle surgery to help reduce the pain as much as possible.

The two most common surgical options for long-term ankle pain are ankle fusion (also called ankle arthrodesis) or ankle replacement, and on this page we will examine each surgical option, as well as their advantages. Once you have this information, you will know the right questions to ask yourself, and your Circle doctor, before making a decision on the surgical option that would be best for you.

An ankle fusion is a surgical procedure that permanently fixes the bones of your ankle joint together. By fixing them in place, movement is reduced, significantly lowering any pain caused by the bones rubbing on each other.

Under surgery, any damaged joint surfaces in the ankle are removed and then screws are used to fix the tibia (the larger of the two bones in your lower leg) with the talus (this is the bone that makes up the lower part of the ankle joint, it is located above your heel bone).

Ankle fusion can reduce or relieve pain in your ankle long-term, and the procedure itself would ordinarily be expected to last a lifetime. It is a common procedure, with recovery and rehabilitation usually very well-managed. Recovery includes 12 weeks in a cast or boot and then you can return to comfortable footwear. , although iIf you have your procedure at a Circle hospital, you will benefit from dedicated physiotherapy-guided rehabilitation to help get you mobilising safely again as soon as possible.

As this operation permanently fixes the position of your ankle, it reduces the range of motion in the joint and this can affect mobility. Sometimes this can cause you to alter the way you walk, which can in turn lead to increased wear and tear in other parts of your foot and lower limb.

An ankle replacement is a surgical procedure to replaces the affected ankle joint with a prosthesis. Under general anaesthetic, an incision is made at the front of the ankle and the surgeon will then cut away any damaged or worn out joint surfaces. Once this is done, the prosthesis will be inserted. This prosthesis consists of two pieces of metal with a piece of hard plastic between them to allow movement.

Once this procedure has been carried out your leg will be put in plaster or a brace, and this will need to stay on until you have healed sufficiently, usually for around 6 weeks in most cases. Most people will spend 1-22-3 days in hospital following ankle replacement surgery, to give enough time for our Circle physiotherapy team to help you get up and walking with crutches safely.

As it is a direct replacement for the joint rather than fixing bones into position, it has the advantage over ankle fusion surgery of allowing a greater range of motion. This means that your ordinary gait won’t be affected as it would be following ankle fusion surgery. Ankle replacement is less successful if there is deformity in the joint and if there is deformity this may mean that a fusion is the best choice.

One other potential risk to be aware of is that an ankle replacement may wear out over time, although this is more common in extremely active people. While you will be able to return over time to gentle exercise, such as walking, cycling or swimming, vigorous exercise involving lots of impact, such as running or squash, should be avoided.

If you are struggling with long-term ankle pain, why not talk to us about how we can help? Contact the friendly team at Circle today, who will be happy to book you an appointment with an orthopaedic surgeon at a time of your choosing.

At your appointment, you will be able to talk about your symptoms with them. They will expertly assess your ankle joint to determine the cause of your pain and will then be able to discuss potential treatment options with you. Should they think ankle fusion or ankle replacement surgery would be of benefit to you, they will talk this through with you thoroughly and answer any questions you may have.

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