I have to go for a ankle fusion but i am getting mixed messages from people. Some say go with the fusion others with the replacement. The doctor doing the surgery does not feel he can do the replacement only a fusion as there are not ligaments to attach it to. I broke it over 35 years ago and because it was not fixed correctly it has been rubbing all these years and now it is bone on bone with severe arthritis. please advise your thoughts
Regards Patricia
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replied January 3rd, 2012
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Both procedures are used for bone on bone traumatic arthritis. The are both done for pain control, not necessarily to increase function. Most patients will have an increase in function, due to the decrease in their pain.

The ankle arthrodesis (fusion) is a tried and true procedure which has been done for decades. As with any procedure there are pros and cons, risks and benefits. This procedure stands up to most any stress applied to it. So, for the young, heavy, active patient, this would be the procedure of choice. But, you give up motion in the tibiotalar joint (ankle). You still have motion in the subtalar joints, the hind and midfoot, and the metatarsals/phalangeal. Some liken it to having a short leg cast on, but in actuality, there is a bit more motion than that, because the all the joints are not fused, just the tibiotalar. But, you do lose motion.

This procedure is fairly easy to do and has a high success rate. Most patient do not need to have anything else done. This will serve them for the rest of their life.

The ankle total joint is being done more commonly now. It did actually come out a couple a decades ago, but the early model had a lot of design flaws in them, and unfortunately, had a high rate of failure. Most of these problems have been corrected, so the success rate is a lot better.

The patients who are candidates for this procedure are usually older, sedentary, and preferably at or close to a normal BMI. The prosthesis will usually last around 15 years or so, if taken care of. If the prosthesis wears out, it is usually possible to replace it again, but not always. It might have to be converted to an arthrodesis, but even this would be difficult. This is because of the bone cuts (bone lost) that have to be made to put in the prosthesis.

You retain motion with this procedure. While it is good motion, some patients (usually the younger ones) tend to be disappointed because they expected a new ankle, meaning a "normal 20 year old's ankle". But, it is more motion than you have from a fusion.

The rehab for a replacement is a little more complex than for a fusion. You have to protect the joint, so heavy impact loading activities are usually not recommended. Walking, swimming, biking, elliptical trainer, golf, etc are great activities.

You also have to protect an artificial joint from infection, especially in the first two years after placement. So, some surgeons recommend antibiotic prophylaxis for any procedures that might cause bacteremia (bacteria in the blood), such as dental cleaning, surgery, and procedures in the GI or GU tracts.

These are technically demanding procedures, that must be done just right. There does have to be the proper soft tissue restraints (ligament, fascia, etc) for the joint to work, as these prostheses are unrestrained. So, if the patient has massive soft tissue loss or incompetent ligaments, the procedure would not be able to be done, unless they can be reconstructed.

This procedure probably needs to be done by an orthopedic surgeon who has fellowship training in foot and ankle surgery or in total joint surgery. It should not be done by a surgeon who does total joints once in a while. Again, it is becoming more common of a procedure, so you can find more surgeons who are doing them. It used to be, that they were only done in large centers, like the academic institutions, Mayo Clinic, Campbell Clinic, Cleveland Clinic, etc. Just be sure that the surgeon is well versed in ankle total joints.

So, if you are the least bit unsure of what you want to do, postpone the fusion till you have gotten all of your options laid out. You will probably have to see another surgeon, to see if you are a candidate for the total ankle. If you are not in a large city, some of the places that do replacements will evaluate your case from records and x-rays first, before making you travel a long distance for an exam. If, from the records, you look like a possible candidate, then you would go see the surgeon for a full evaluation.

Again, if you are unsure put off the fusion, because once it is done, it's done. You cannot convert an arthrodesis to a replacement.

You might be able to get a list of surgeons in your area who do total ankle arthroplasty (TAA) from the AAOS or the AOFAS (Am Acad of Orthopedic Surgeons and Am Orthopedic Foot and Ankle Society).

Good luck. Hope you get your problem taken care of.
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