Question 1

Will I still be able to walk normally after ankle fusion?

Accepted Answer

You will be able to walk, but gait WON'T be completely normal. WHAT TO EXPECT: Pain relief 90-95% (this is primary goal - eliminate arthritic pain). Walking ability restored for daily activities (shopping, household tasks, walking dog). Can walk unlimited distances once healed (6-9 months). GAIT CHANGES (permanent): (1) No ankle up/down motion - ankle fused in fixed position (neutral). Compensation occurs at subtalar joint (below ankle) and midfoot (these joints move more to compensate). (2) Shorter stride length on fused side. (3) Subtle limp (most people develop slight asymmetry - often not noticeable to others but patient aware). (4) Walking speed 10-20% slower than normal (not usually functionally limiting). (5) Uneven ground more challenging - ankle can't adapt to terrain (subtalar joint compensates but less effectively). ACTIVITIES POSSIBLE: Level ground walking unlimited. Stairs possible (may need handrail). Golf, swimming, cycling (stationary bike) usually tolerated. Light hiking on even trails. ACTIVITIES DIFFICULT/IMPOSSIBLE: Running (biomechanically very difficult with fused ankle). Jumping, sports requiring agility (basketball, tennis, soccer). Climbing ladders (safety concern - cannot dorsiflex ankle to balance). Walking on sand or very uneven terrain. COMPARISON TO PRE-FUSION ARTHRITIS: Most patients with end-stage ankle arthritis already have very limited ankle motion (less than 10° up/down) and limping gait due to pain. Fusion eliminates pain while only modestly worsening already-limited function. Patients typically report IMPROVED walking ability post-fusion compared to pre-fusion arthritic state (because pain eliminated).

Question 2

Should I get ankle fusion or total ankle replacement?

Accepted Answer

DECISION depends on age, activity level, bone quality, and surgeon experience. NO UNIVERSALLY CORRECT ANSWER - both have pros/cons. ANKLE FUSION (arthrodesis) ADVANTAGES: (1) Most reliable pain relief (90-95% good-to-excellent). (2) Most durable - lasts lifetime (no wearing out, no revision surgeries typically). (3) Higher success rate than replacement (90-95% fusion vs 75-85% good outcomes replacement at 10 years). (4) Allows heavier activity than replacement once healed. (5) Lower revision rate (10-15% vs 20-30% for replacement at 10 years). FUSION DISADVANTAGES: (1) Eliminates ankle motion permanently. (2) Adjacent joint arthritis risk (20-30% at 10-20 years). (3) Limp and gait changes. (4) Cannot run/jump. TOTAL ANKLE REPLACEMENT (arthroplasty) ADVANTAGES: (1) Preserves ankle motion (allows more normal gait). (2) Can walk downhill/stairs more normally. (3) Less stress on adjacent joints (theoretically - evidence mixed). REPLACEMENT DISADVANTAGES: (1) Limited lifespan - implants wear out, typically 10-15 years survival (70-80% at 10 years, 60-70% at 15 years). (2) Revision surgery likely if young (implant outlasts patient unlikely under age 60). (3) Activity restrictions permanent (no running, jumping, heavy labor - implant cannot tolerate). (4) Higher complication rate (loosening, subsidence, wear, instability). (5) More expensive ($15,000-25,000 vs $8,000-15,000 fusion). GENERAL RECOMMENDATIONS: FUSION if: (1) Age under 55 years and active (manual labor, want to do heavier activities). (2) Significant deformity (greater than 15° varus/valgus). (3) Poor bone quality, previous infection, avascular necrosis. (4) Single-sided ankle arthritis (can compensate with other ankle). REPLACEMENT if: (1) Age over 60-65 years, lower-demand lifestyle. (2) Bilateral ankle arthritis (fusing both ankles very disabling). (3) Already fused hindfoot joints (need ankle motion for walking). (4) Patient priority preserving motion over durability. AUSTRALIAN CONTEXT: 80-90% of ankle arthritis surgery in Australia is fusion (replacement still evolving, limited surgeon experience, cost considerations). Most Australian orthopedic surgeons recommend fusion as gold standard unless specific indication for replacement.

Question 3

What happens if the ankle fusion doesn't heal (non-union)?

Accepted Answer

NON-UNION (failed fusion) occurs in 10-15% of ankle fusions overall (30-40% in smokers). Bone doesn't heal/fuse across joint - painful unstable ankle persists. SYMPTOMS of NON-UNION: (1) Persistent pain at ankle 4-6 months post-surgery (should be improving by this time). (2) Painful clicking or movement at ankle (should be solid/immobile if fused). (3) Pain worse with walking, relieved by rest. (4) Unable to progress weight-bearing or return to normal activities. DIAGNOSIS: X-rays at 3-4 months show NO bony bridging across fusion site (lucent line persists, hardware visible but no solid bone). CT scan (gold standard) shows persistent gap at fusion interface. TREATMENT of NON-UNION: (1) CONSERVATIVE (rarely successful): Prolonged immobilization (additional 2-3 months), bone stimulator (electrical or ultrasound stimulation - 30-40% success rate for non-unions). (2) REVISION FUSION SURGERY: Remove hardware, repeat bone surface preparation (remove scar tissue down to bleeding bone). Add bone graft (usually autograft from iliac crest hip - provides bone cells and growth factors superior to allograft). Consider alternative fixation (e.g., switch from screws to intramedullary nail for more rigid fixation and compression). Success rate of revision fusion 70-85% (lower than primary fusion). (3) BELOW KNEE AMPUTATION: Last resort if multiple failed fusions, infection, severe bone loss. Rare - less than 5% of non-unions. RISK FACTORS for NON-UNION: (1) SMOKING - MOST IMPORTANT modifiable risk factor (triples non-union rate). (2) Diabetes, peripheral vascular disease - impaired healing. (3) NSAIDs (ibuprofen, naproxen) during fusion healing - delay bone healing (avoid first 3 months post-op). (4) Inadequate fixation or positioning. (5) Infection. (6) Poor bone quality (osteoporosis). PREVENTION: QUIT SMOKING (6 weeks before surgery, 3 months after minimum). Optimize medical conditions (diabetes control, nutrition). Avoid NSAIDs during healing. Comply with weight-bearing restrictions. If non-union occurs, revision surgery usually successful (70-85%) but requires additional recovery time (another 4-6 months).

Medical Disclaimer

Ankle Fusion (Arthrodesis)

📖What is Ankle Fusion (Arthrodesis)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention