Arthroscopic ankle fusion
- Time in hospital: one night
- Surgery time:
- Typical post op schedule:
9 weeks touch weight bearing
3 weeks partial weight bearing
Time to return to full activities 6-9 months
Introduction
Fusion (or arthrodesis) of a joint means causing the two bone surfaces to heal to one another the same way that the fractured surfaces of a broken bone heal together. Although movement is lost, so is any arthritic pain. Occasionally fusion is carried out because the joint has collapsed or angulated creating an intolerable limb posture but pain is the commonest reason.
Success depends upon good preparation of the surfaces and solid surgical fixation (usually with screws) at the correct angle for a good posture. Preparation involves removal of the remaining cartilage and roughening of the underlying bone so that it resembles a fracture surface.
In the ankle, preparation can be done by arthroscopy. Fixation screws can be inserted through small incisions, the route guided by xray. Therefore a whole ankle fusion can be done arthroscopically. This avoids the need for the usual incisions so reduces the risk of skin healing problems including infection. It is technically more specialised than a normal ankle fusion and takes a little longer to do.
Arthroscopic ankle fusion is carried out under general anaesthetic. Local anaesthetic is injected around the nerves supplying the area. The small wounds are sutured and a partial cast (backslab) applied from toes to just below the knee. The foot is rested up overnight and walking with crutches begins the following morning. No weight is put on the leg. Most patients go home the following morning. Two weeks after surgery, the sutures are removed and the backslab replaced by a below-knee cast. Only enough WB for balance is allowed. Depending on technical aspects of the surgery the cast can sometimes exchanged for a removeable boot after the first 6 weeks. If the check x-ray at 12 weeks shows good healing, full weight bearing can start, reducing the amount of external ankle support week by week.
Ankle fusion is a big undertaking but under the right circumstances and without complications (the success rate is in the order of 95%) it can make a great difference to quality of life. If the other joints in the foot and rest of both legs are in good condition, patients can lead a completely normal life including sports. There is barely any limp when walking at a relaxed pace because much of the foot movement occurs at other foot joints. Naturally, one can run better and walk faster with a mobile healthy anklejoint but compared to a stiff, painful ankle, a rigid painfree one is much better to live with. You should see this procedure as an investment of 6 to 9 months of trouble and inconvenience to lose the your pains and regain a level of activity formerly lost.