Ankle Fusion Surgery

What is an Ankle Fusion?

This operation is designed to glue (fuse) the ankle joint. Once the fusion occurs, there will be no movement at the ankle joint and thereby the pain is eliminated in this area. The arthritic joint is cleaned out by shaving off the worn out cartilage and the fusion is carried out with either a  plate and screws or screws alone.

This type of surgery can be performed in two ways:

• Arthroscopic (key hole) – which involves about 4 small incision in total

          OR

• Open surgery – where an incision will be present over the outer side of the ankle joint.

The screws typically stays in forever, unless you are able to feel it, when it can be removed if uncomfortable.

This type of surgery does affect the up and down movement of the ankle.  You will however not lose all of the up and down movement, but about 75% of it. This depends of course on how much movement in the ankle you have already lost. Frequently after ankle injury or arthritis, there is very little movement in the ankle, so that you will not notice the loss of the up and down movement of the foot.   The side to side movement (inversion and eversion) of the back of the foot is not affected by an ankle arthrodesis.

Type of procedure

This is an inpatient procedure and you will most likely be discharged in two days time.

Type of anaesthesia

The operation will be undertaken under a general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes about 2 hours.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with risk of:

Infection

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is rare. Overall risk is 1%.

Pins & needles or patch of numbness:Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar or the top of the foot. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.

Nonunion

The fusion is generally successful.It is rare for the joint to not fuse together. It may not fuse and remain painless in which case no intervention will be required. If there is ongoing pain, then a redo operation may be required rarely. It may take unto 12 months to be certain if the fusion has not been successful. Overall risk is 5-10%.

Clots – Deep vein thrombosis

Extremely rare in foot and ankle surgery (<5%). However you will be given blood thinning injections after surgery for 4 weeks to minimise this risk.

Recovery from surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot and a below knee back slab (which is half a plaster) applied. You will not be allowed to walk on the operated foot for atleast 6 weeks. The physiotherapists will make sure that you are safe on your feet before discharge and you will be provided crutches. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol

Day 1 – 7

Ensure that you keep your foot elevated on pillows to help reduce swelling.

Foot wrapped in bulky bandage and below knee backslab

Not allowed to put any weight through operated leg.
Elevate leg and take pain medication

Expect numbness in foot 12-24 hours then moderate pain
Bloody drainage through bandage expected.
Do not change bandage.

Day 14

You will have a follow up visit in clinic.

You will have an Xray on arrival prior to seeing Mr Shariff

Your wound will be inspected. You will have sutures so they will need to be removed.

You will be put into a removable boot at this stage.

6 weeks

Cast/boot removed

X-rays taken

Use the boot for about  4 more weeks

You will be gradually allowed to walk on the operated leg at this stage, but only in the boot/cast.

The boot can be removed at night, and for gentle movement exercises.

Swimming is permitted, but with limited pressure on the foot

12 weeks

The boot will be removed at this stage.

You can expect swelling to last for about 6 months, but you will notice that it gradually starts to settle.

You will have started to wear normal foot wear from this time onwards.

Post operative clinic visit schedule

2 weeks after surgery – wound check and advice regarding basic hygiene

6 weeks after surgery – final follow up clinical exam and discharge

When can I begin to walk

This varies depending on the type of operation performed. You can discuss this with your surgeon in clinic prior to the surgery.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is within 2 weeks after surgery.

What advantages does arthroscopic surgery offer?

The main advantage is that it is performed through very small incisions. Therefore the amount of tissue damage is minimal and the recovery period can be expected to be quicker compared to traditional open surgery.

Return to work and rehabilitation can be expected to be faster.

However a note of caution, certain procedures may require the same amount of time non weight bearing particularly a fusion of the ankle whether it is done open or arthroscopically.

What are the disadvantages of arthroscopic surgery?

In some instances it may be impossible to access parts of the ankle joint arthroscopically. In these circumstances your surgeon may have to opt to revert to open surgery.