Joint fusion, medically referred to as arthrodesis, is usually the last resort for patients with severe osteoarthritis. Ankle fusion specifically affects the ankle joint area around the malleoli. The primary goal of such a procedure is pain relief. However, complications may also occur. For this reason, joint fusion is considered the final option in the treatment of osteoarthritis.
Here you will find further information as well as selected arthrodesis specialists and centers.
Ankle fusion (arthrodesis) is a surgical procedure that stiffens the ankle joint so that it is no longer movable. This measure is extreme and therefore the last resort to provide pain relief for patients with advanced ankle osteoarthritis (joint degeneration of the ankle).
Fusion of the ankle joint, like any other form of osteoarthritis, is characterized by the destruction of cartilage within the joint. Patients in the late stage of the disease are often unable to move. Inflammation and joint effusion additionally cause severe pain. As a result, any movement in the affected ankle becomes impossible.
If replacement of the damaged joint with an ankle prosthesis is not feasible, then as a last option the joint must be fused. The procedure was originally developed for these patients.
However, the procedure can theoretically be performed on any major joint in the body (shoulder, hip, knee, hand, foot).
The decision on who qualifies for such a procedure is made by a specialist.
Ankle arthrodesis using two screws © Richman Photo | AdobeStock
During the patient history and physical examination, physicians first assess:
Malalignments and other joint changes are evaluated to determine whether surgical correction may be possible and indicated.
To visualize the joint surfaces, an X-ray is usually ordered. However, magnetic resonance imaging (MRI) and computed tomography (CT) are also helpful in assessing the joints involved.
With the help of arthroscopy, physicians are able to look inside the joint and, for example, smooth joint surfaces or begin minor debridement procedures.
Ankle arthrodesis is usually performed when conservative therapies such as physical therapy, orthopedic interventions, or pain medication no longer provide sufficient relief. Common reasons include advanced joint degeneration, severe deformities, unstable fractures, infections, or sequelae of injuries. The goal of the surgery is to eliminate pain, restore stability of the foot, and improve quality of life – even though mobility in the affected joint is permanently restricted. Fusion of the subtalar joint can also be performed.
The procedure is most often performed openly through a large incision. In some cases, a minimally invasive arthroscopic approach is possible.
Joint fusions generally follow a similar protocol.
Within the joint, the surgeon removes and reshapes the destroyed joint surfaces and bone segments that form the joint.
The two bone ends are then firmly connected, similar to fracture treatment, using osteosynthesis. The surgeon may use:
The talus (ankle bone) is fixed with screws within the ankle mortise (formed by the fibula and tibia). The bones then grow together permanently. Loss of mobility is compensated by the midfoot joints.
After the procedure, the joint is closed and immobilized for a period of time. Once bony stability is restored, therapy is considered complete, and the patient can usually resume daily activities.
Ankle fusion is a complex procedure depending on the extent of joint damage. It can cause damage to the soft tissues of the foot, such as:
Postoperative wound pain is common in the days following surgery but is generally manageable with appropriate pain medication. Often, the joint is immobilized with a splint or other devices during healing.
The procedure can also damage adjacent structures and tissues. This may result in:
Secondary osteoarthritis may also occur if adjacent joints are affected.
Since ankle fusion is usually performed openly, there is also a risk of wound infections, which are often painful and can prolong healing. A wound infection may also promote wound healing disorders and, in unfavorable cases, contribute to further malalignments.
The prognosis of ankle arthrodesis depends primarily on whether complications occur. Infections and malalignment within the joint are rare but possible and can delay recovery.
In addition, widely prevalent comorbidities influence the prognosis of arthrodesis. These include, for example:
All of these factors, particularly common in older age, impair the long-term success of the surgery.
Treatment of advanced ankle osteoarthritis requires specialized clinics and experts. Board-certified foot surgeons and joint specialists, as well as clinic centers specializing in endoprosthetics, are your points of contact.
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