# ankle fusion surgery



## mactweek (Oct 3, 2011)

I've had a very arthritic ankle for over 20 years. There is a bone spur that rubs across the ligaments when I flex my ankle and bone on bone jointpain when the ankle is rolled to the outside due to ruptured tendons that were not repaired many years ago.
I usually ride with a hinged brace to keep the ankle "in plane". I also wear it most of the time , and always when hiking, which I don't do often. 
I have been to 3 orthopedic surgeons and they claim that my only options are ankle replacement or fusion. Replacements are getting better but don't last more than 10 years. With a fusion your foot and knee must take up the motion that your ankle can't.
Has anyone had an ankle fusion? How is it to live with?How is riding?


----------



## mikesee (Aug 25, 2003)

subscribed. i'm more or less in the same place -- with both ankles.

i have hinged braces that i have to wear when riding or hiking, otherwise i end up on the ground a few times per hour.

i've been told that sub talar fusion is imminent. and that it's not the same (not as bad) as full fusion.


----------



## Radium (Jan 11, 2019)

Just curious, but what effect, if any, do your ankle arthralgias have on balance?


----------



## mactweek (Oct 3, 2011)

On the bike balance is fine, I use spd pedals and can "body english" the bike around enough without getting into the painful range of motion. However, I cannot support myself standing on only my right foot for any length of time.


----------



## honkinunit (Aug 6, 2004)

I went to lunch just yesterday with someone whose husband just had an ankle replacement, and she said the projected lifespan for his was forever. He is 60 and active but not an "athlete", so maybe they project different service from an ankle replacement depending on that? 

She did say there was some kind of nylon/teflon bearing surface that might need to be replaced sooner. Maybe that is the ten year lifespan?


----------



## sturge (Feb 22, 2009)

Seems like knee, hip replacements are very common but I do not know one person who has had an ankle replacement.

4 years ago I had cartilage 'graft' surgery on one ankle (Denovo). I damaged it ski racing in my 30's. No surgery required from initial injury but it progressively began to get worse over 10-15 years. I stopped running and playing hoops in my 40's and eventually decided to try this procedure at about 55. It helped but still bothers me with chronic dull pain about 50% of the time. 

I've learned to manage it and at 60 I'm more active by far than most guys 10-15 years younger so I just continue to power through it. But it sucks to get up every morning and gimp around until it loosens up and as time goes on it's not going to get better.

I'm thinking fusion or ankle replacement are my two options to consider at some point.


----------



## chiva (Oct 13, 2010)

Ankle fusion is the gold standard for end-stage ankle arthritis. I do ankle fusions on a regular basis. If I had end stage ankle arthritis, I would definitely have an ankle fusion and not a replacement. I won’t go into all the advantages and disadvantages as I am “off the clock” and don’t want to talk about work when I’m not at work. It is easily researchable.


----------



## ScaldedDogCO (Sep 22, 2016)

Like Sturge, I also had a Denovo implant just before I turned 55, after two microfractures, and have had 2 follow up surgeries since. The surgeries work for a year, or year and a half, but the pain returns. I'm 61 now, and manage the pain with daily PT after my gym workout, and a Naproxen twice a week.

My doc doesn't want to do a replacement till I'm 65, presumably because he figures I'll be less active by then. He does not want to do a fusion, at all, again because of my activity level. My takeaway from that is to avoid fusion if you take your active lifestyle seriously. 

Mark

Sent from my SM-G935V using Tapatalk


----------



## Stevebiker (Feb 17, 2004)

I had this done (Triple Arthrodesis) on both ankles when I was in high school due to weak joints and minor deformity. Before surgery, walking and standing to long was getting progressively more painful. Orthopedic shoes worked for a while but it was determined that surgery was the best option. I had one done each summer. The surgeon that did the first (left) one retired so another surgeon did the second. The second (right) one ended up aligned a little off. Walking more on the arch (inside) of the foot. Also, probably due to alignment issues and over compensation, that foot ended up turned out roughly 15 degrees. 

I have little to no movement in my ankles. This was roughly 1979-80. I couldn’t run quite as fast or jump quite as high. This didn’t stop me from playing in volleyball and softball leagues where I was an average player. after a particularly tough Vball match, my ankles would ache. I have prescription arches and wear high tops or hiking boots the majority of the time for added support. 

By 2012, the pain in the right foot was becoming an issue. After seeing several specialist, had the fused joints broken open and reset. There was improvement, but the adjustment went a little far which will likely be an issue in the future and has thrown my balance off a little. I was doing easy rides on my rd bike in 4 months after surgery. 

The only real issues with biking is clipless peddles because you pretty much have to twist your leg to get unclipped. XTR with zero float cleats works best for me.

Of the half dozen or so specialists I’ve seen over the last decade, most say they wouldn’t have performed the surgery in this day and age for MY particular issue. I’m not going to go into details, but the surgeon that did the work in 2012 had to go back in. If you decide to get this done, be comfortable with the Dr. If he seems overly enthusiastic, run. 

A little more on balance. I had the original surgery in high school and don't remember much as far as before and after. Only that I wasn't as fast and couldn't jump as high. After the 2012 surgery, my balance on that side is a little worse and isn't improving. I still climb around in rocks and stuff, but am cautiously slower.

Steve


----------



## mikesee (Aug 25, 2003)

chiva said:


> Ankle fusion is the gold standard for end-stage ankle arthritis. I do ankle fusions on a regular basis. If I had end stage ankle arthritis, I would definitely have an ankle fusion and not a replacement. I won't go into all the advantages and disadvantages as I am "off the clock" and don't want to talk about work when I'm not at work. It is easily researchable.


Care to point us toward few articles or resources that you think are worth reading?


----------



## chiva (Oct 13, 2010)

mikesee said:


> Care to point us toward few articles or resources that you think are worth reading?


I can't think of any journal articles off the top of my head to cite. The easiest thing to do would be to do an Internet search for total ankle arthroplasty long term results. Also, TAA versus ankle fusion for end stage ankle arthritis. Those two searches should give you plenty of info. The main thing I don't like about an ankle replacement for younger and/or active people is something called subsidence of the talus. You can look that up too. That is the main reason these implants fail. The ankle is just not a good anatomic construct to replace generally speaking. The hip and knee are different than the ankle significantly.


----------



## mikesee (Aug 25, 2003)

chiva said:


> I can't think of any journal articles off the top of my head to cite. The easiest thing to do would be to do an Internet search for total ankle arthroplasty long term results. Also, TAA versus ankle fusion for end stage ankle arthritis. Those two searches should give you plenty of info. The main thing I don't like about an ankle replacement for younger and/or active people is something called subsidence of the talus. You can look that up too. That is the main reason these implants fail. The ankle is just not a good anatomic construct to replace generally speaking. The hip and knee are different than the ankle significantly.


Thanks -- I'll do that.

A good friend whom I used to ride with a lot recently crossed paths with some old friends. He just sent me this, and I'd love to know if you know anything about what he's describing:

"She had recently had to have an entire ankle reconstruction/replacement at the Steadman Hawkins Clinic in Vail, and they had used some new replacement joint from Australia and she is doing amazing with the new ankle."


----------



## Radium (Jan 11, 2019)

mikesee said:


> Thanks -- I'll do that.
> 
> A good friend whom I used to ride with a lot recently crossed paths with some old friends. He just sent me this, and I'd love to know if you know anything about what he's describing:
> 
> "She had recently had to have an entire ankle reconstruction/replacement at the Steadman Hawkins Clinic in Vail, and they had used some new replacement joint from Australia and she is doing amazing with the new ankle."


I think technologies are improving surgical outcomes all the time as Science Marches On. But with any human system, there are always mysterious variables that make nothing a sure bet.


----------



## mactweek (Oct 3, 2011)

WELL... I have scheduled an ankle fusion for Dec. 3.
I talked to 2 more orthopedic surgeons that specialize in ankles, And a friend who had an ankle replacement in June. She is really pleased with her progress, and expects to be able to nordic ski this winter. She had just come back from a 4 mile hike when I talked to her.
After discussing the pros and cons of both with the surgeon I decided that the fusion is the better choice for me. Once it is healed it will be very robust, the replacement can be somewhat fragile. It is not uncommon for a replacement to require a revision after a few years. Biking should not be a problem after the fusion, though I may want to use flat pedals. My surgeon is also an avid Mtn biker who races endurance events, so he 
understands needing to ride.I will re-visit this forum later when I am recovering with an update on my results. Thanks to all who have responded. Bob


----------



## Radium (Jan 11, 2019)

Good luck to you, Bob!


----------



## sturge (Feb 22, 2009)

Good luck Bob...thanks for sharing this.


----------



## mactweek (Oct 3, 2011)

Well! I would say that I am about 75-80 percent back.
The surgery went very well, the recovery was tough. It was a lot harder than my knee replacement 8 years ago. The doc says that is because the joint is small and all of your weight is concentrated on a smaller area. Basically 3 months non weight bearing. I am now almost 4 months and am finally starting to sense what my future will be like. I am starting to walk more normally now, but if I overdo it I have to put on my ankle boot to give the foot some rest. I can pedal a bit,mostly on a trainer, but I have done a little bit outside on really gentle terrain. It feels good, I wear the boot for protection still and place my foot further back on the pedal to lessen the leverage on the (former) joint. There is still some swelling and the foot feels a lot like plantar faciaitas. I feel better daily though and expect that I will be walking and riding better than I have in years by this summer. I will update again later Bob.


----------



## mikesee (Aug 25, 2003)

mactweek said:


> Well!


Congrats on the success so far. Hope that improvement continues and you can soon find your new normal.


----------



## ddoh (Jan 11, 2017)

ScaldedDogCO said:


> Like Sturge, I also had a Denovo implant just before I turned 55, after two microfractures, and have had 2 follow up surgeries since. The surgeries work for a year, or year and a half, but the pain returns. I'm 61 now, and manage the pain with daily PT after my gym workout, and a Naproxen twice a week.
> 
> My doc doesn't want to do a replacement till I'm 65, presumably because he figures I'll be less active by then. He does not want to do a fusion, at all, again because of my activity level. My takeaway from that is to avoid fusion if you take your active lifestyle seriously.
> 
> ...


My doctor wanted to hold off on my shoulder replacement as long as possible because they don't last forever. No one wants to have to make the replacement decision at 85. Thats a tough one.


----------



## sturge (Feb 22, 2009)

mactweek said:


> Well! I would say that I am about 75-80 percent back.
> The surgery went very well, the recovery was tough.


Great to hear you are doing well. Congrats on making the decision and going through with it. Sounds like the hard part is over for you!


----------



## chiva (Oct 13, 2010)

mactweek said:


> Well! I would say that I am about 75-80 percent back.
> The surgery went very well, the recovery was tough. It was a lot harder than my knee replacement 8 years ago. The doc says that is because the joint is small and all of your weight is concentrated on a smaller area. Basically 3 months non weight bearing. I am now almost 4 months and am finally starting to sense what my future will be like. I am starting to walk more normally now, but if I overdo it I have to put on my ankle boot to give the foot some rest. I can pedal a bit,mostly on a trainer, but I have done a little bit outside on really gentle terrain. It feels good, I wear the boot for protection still and place my foot further back on the pedal to lessen the leverage on the (former) joint. There is still some swelling and the foot feels a lot like plantar faciaitas. I feel better daily though and expect that I will be walking and riding better than I have in years by this summer. I will update again later Bob.


I think long term that you will be very happy with a successful ankle fusion surgery. You probably will never need to have surgery on that ankle again. It should be a lifelong solution to a bad problem. The famous basketball player Bill Walton, has a bilateral ankle fusion and is an avid road biker. Again, as a surgeon who does these procedures, it would be the procedure I would choose for myself if I was in your position. I wish you all the best.


----------

