Ankle Replacement or Fusion: Which Procedure is Best for You

Arthritis comes in many forms and affects different joints, but regardless of the type, it hurts. Ankle arthritis is no exception. Many people today are counting their steps as part of their fitness program, and patients with ankle arthritis know that every step can be painful.

Arthritis occurs when the cartilage (the smooth white stuff that allows two bones to glide smoothly on each other in a joint) thins and wears out, and a person is left with bone rubbing on bone. The joint can be swollen and stiff, and weight-bearing activities can be uncomfortable. Working, walking, recreation and overall quality of life are affected.

Most people are familiar with hip and knee arthritis and the common treatments for those: joint replacement. People are less familiar with what their options are when they come to see me for ankle arthritis.

The most common surgery performed for patients with ankle arthritis is a fusion. The arthritic joint is removed and the two bones (tibia and talus) in the ankle joint are fused together. That eliminates the pain from bone rubbing on bone, but it also eliminates motion at that joint. People often ask, “how will I walk if my ankle doesn’t move?” I tell them that they still can walk because our foot is full of other joints that still move, so some motion through the foot joints remains. Patients are often so stiff before the fusion from their arthritis, that the lost motion isn’t even noticeable. What they do notice is the pain relief.

For young patients, laborers or people who are “hard on their joints,” this is the best option. Once healed, it is durable and does not carry any activity restrictions. It also cannot wear out. However, a fusion isn’t a perfect option. There is the motion loss, longer recovery times and stress that it places on the other joints in the foot.

The alternative to fusion is ankle replacement. Like hip and knee replacements, the arthritic joint surfaces are removed and replaced with metal, and a smooth plastic piece is placed between them. This simulates the joint space and the cartilage that provides gliding motion.

Patients with inflammatory arthritis should take it easier and accept certain activity restrictions. If not, ankle replacement may be right for them. Every year, more and more studies are published about the outcomes from ankle replacement and the function it restores, as well as the pain relief it provides. New designs and new techniques are constantly emerging to help improve the durability of replacements.

When I meet people affected by ankle arthritis, we talk about both options. No two cases are alike; therefore, the solution isn’t always the same. We explore their lifestyle, hobbies and medical history. I also look at the other joints in their foot to see if they have arthritis in other places. There is no one-size-fits all solution for ankle pain, so we work together to figure out what the best plan is for their situation.

Regardless, I tell everyone that surgery for ankle arthritis is a big deal. It permanently changes an ankle, whether it is a fusion or replacement. I am there every step of the way to help guide that decision. I want my patient’s decision to have surgery to bring about the best possible outcome for their situation.