Ankle Replacement or Fusion?

Options for Surgical Management of Ankle Arthritis

Managing Ankle Athritis

Fortunately, ankle arthritis is less common than arthritis of the hip or knee, but when it does occur the problem can life changing. If the pain and limitations are severe enough, surgery may be the only way to achieve a satisfactory outcome. With technical advances over the past several decades, and the ability to do detailed research online, many patients come to the office with questions about which brand of ankle replacement is the best one for them. While that is certainly a valid question – and very interesting to ankle orthopedists – it is putting the cart before the horse. The discussion about managing ankle arthritis begins not with which type of of ankle replacement is best, but whether surgery is right for the patient and which type of procedure will achieve their goals.

What is Ankle Fusion?

Although one can make comparisons between arthritis of the ankle and knee, the ankle is different in many ways and more complex. Unlike the knee, the ankle has neighboring joints in the hindfoot – below the ankle – which play a large part in the motion of the joint. The oldest surgery for any arthritic joint is a fusion, where bone heals across the joint. Fusion in the hip or knee is exremely rare in the as the extreme joint and gait stiffness that result can be avoided with modern joint replacement technologies. However, a fusion of the ankle can do very well since the hindfoot joints maintain flexibility. The average ankle fusion still has some motion, and many patients with ankle fusions walk with no limp at all. In many cases, an ankle fusion can work just as well as an ankle replacement.

What is Ankle Replacement?

Anatomic graphic of an ankle repalcement prosthesis

Total ankle replacement replaces the arthric joint surfaces at the ends of the tibia and talus bones with metal and low-friction plastic components.

As in any joint replacement, ankle replacements use metal components and low-friction plastics to replace the arthritic joint surfaces at the end of the bones – in this case the tibia and talus. While both ankle fusion and ankle replacement offers tremendous pain relief for patients with arthritis, the ankle replacement offers improvement in motion as well. In the past, ankle replacements tended to wear out too quickly to offer long-term satisfaction for patients and surgeons. However, improvements in surgical technique and joint prostheticd technology have made significant improvements on the longevity of these joint replacements. 

There are different types of ankle replacements, and most are more similar than different. Some are inserted from the front, and others from the side. Our surgeons have experience with all of the current designs, as well as experience with complex revision surgeries, including revision of failed replacements and converting fusions to joint replacements.

Which Surgery is Right for Me?

Making the decision to have surgery, and choosing the procedure that's right for you, is a decision that should only be made after thorough discussion with your foot and ankle surgeon. While the ultimate choice will be yours to make, your surgeon's guidance will be based on a thorough disgnostic review and confirmation of your goals for post-operative function and mobility.

Clin Orthop Relat Res. 2004 Jul;(424):80-8.
Takedown of ankle fusion and conversion to total ankle replacement.
Greisberg J1, Assal M, Flueckiger G, Hansen ST Jr.