Ankle Fusion or 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. 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.

Total ankle replacement is often the treatment of choice for people who want to continue their active lifestyles. 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 and experience less pain and a greater 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.

Most people who choose ankle fusion want a permanent solution to their ankle pain so they don’t have to think about it 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 or 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. 

That depends, 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 activity level to help you decide whether ankle replacement or ankle fusion is best for you. 

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 they have 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. Because they have extensive experience with all of the latest artificial ankle joints, they are also able to recommend total ankle replacements to people who would otherwise not be considered candidates. This results in positive patient outcomes.

Often patients seek 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. Duke has 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.