Our Regenexx® Alternatives to Ankle Fusion Surgery
Very little can feel more debilitating to your normal way of life than severe ankle pain. When you aren’t able to get around on foot without moderate to excruciating pain, there is a whole world out there that can feel inaccessible or off-limits. Many times, when patients are encumbered with severe or unbearable ankle pain, physicians are quick to recommend ankle fusion surgery as a remedy.
Before you consider ankle fusion surgery for your acute ankle pain, it is important that you understand the critical questions you should ask before undergoing surgery, and whether or not an alternative treatment option is right for you. Here are seven things you should know about ankle fusion surgery before scheduling with your physician.
Is ankle fusion surgery considered “major surgery”?
Since ankle fusion involves placing multiple screws in the ankle, all in different directions in order to hold parts in place, the short answer to this question is, yes, ankle fusion surgery should be considered “major surgery.” Whether a surgical procedure is considered “big” or “small” is often defined by how common it is for patients to experience complications post-surgery. In one early study of ankle fusions, there was a staggering 48% complication rate in patients who had undergone the surgery (3), and another later study reported:
*6% infection rate,
*10% of patients requiring a second surgery to fix unforeseen problems with the first procedure, and
*A failure of the bones to grow together 14% of the time (4).
With complication rates like these, which are several times higher than routine orthopedic surgeries with a complication rate of only 1%, ankle fusion surgery should, in fact, be considered “major surgery.”
What does ankle fusion surgery mean? What does it mean to “fuse the ankle”?
Since ankle fusion surgeries are typically done on patients with moderate to severe ankle arthritis (1), a joint fusion is performed in the hopes that the joint surfaces grow together, thereby making the joint fixed and immovable. With this particular kind of surgery, several joints can be involved, to include the tibio-talar, the sub-talar, and talo-navicular joints. It is commonplace in these types of procedures for several different screws to be placed in several different directions; the primary point of the ankle fusion surgery is that the main ankle joints will no longer move.
Is ankle fusion surgery really painful?
In short, yes. Given that this is, indeed, major surgery, and that there are several screws placed in the ankle joints, patients can expect post-surgical pain that requires a narcotic pain medication prescription. On average, patients take narcotic pain medications for a few weeks following ankle fusion surgery (6). After that, Tylenol or an over-the-counter equivalent, is recommended. Over-the-counter NSAID medications should be avoided; these medications have been shown to reduce bone healing (9), which is critical to proper surgical healing.
How long should I expect to be in recovery after ankle fusion surgery?
Most patients can expect to be on crutches for at least two to three months post-surgery, while the ankle fusion sites heal. After this, one to three months will be spent in a walking boot. According to one review, 62% of younger patients were able to return to work within two years of their ankle fusion surgery, although many were not working prior to the surgery (7).
At an average of eight years post-surgery, reported results included:
*73% of patients could hike for an average of 40 minutes at a time,
*40% of patients were able to kneel,
*25% of patients could jump down from steps,
*17% of patients could run a short distance of less than 100 yards (5).
It is important to understand not only the recovery time, but the limited mobility that often is the reality for patients after they have undergone ankle fusion surgery, especially when weighing the risks and value of the surgery itself.
Can I drive a car with a fused ankle?
Yes, you should be able to drive a car after ankle fusion. However, research indicates that, with patients who have undergone such a surgery, braking reaction time is shown to be slower than normal (8), though still within safe norms as defined by the United States Highway Administration.
Instead of ankle fusion surgery, is a replacement procedure a better option for me?
Per a recent study comparing ankle fusion surgery to ankle joint replacement, complication rates meant that the routine use of ankle fusion cannot yet be recommended to treat arthritis (4). Surprisingly, that same research found that ankle replacement complications were more than double the rate experienced by those who only had ankle fusion surgery. Because of this, it is difficult to recommend either surgery, based on these high rates of complication. Other expert research published on ankle replacement reports a 15% complication rate, still very high compared to other orthopedic surgeries such as knee replacement, where the complication rate is nearly half that at 8% (10,11).
Ankle fusion surgery doesn’t sound like something I want. Are there alternative options available to me?
Ankle fusion surgery is a big surgery that may cause you to think twice. Fortunately for our patients, Centeno-Schultz offers an alternative treatment option to ankle fusion surgery that is a much less invasive process.
A percutaneous ankle arthroplasty, or PAA procedure, is a new type of procedure that allows the physician to use x-ray guidance to inject the damaged joint and weak areas of the bone. Since loose ankle ligaments usually also pose a problem for patients, causing undue stress and pain on the joints, they are often treated through this procedure as well. The PAA procedure is minimally invasive, especially as compared to ankle fusion surgery, and comes with a fraction of the recovery time of a surgical procedure.
The PAA procedure can only be performed by physician sub-specialists using x-ray and ultrasound guidance. Fortunately, at Centeno-Schultz, our alternatives to ankle fusion surgery are backed by extensive research and published patient outcome data, and our procedures are performed exclusively by doctors who are musculoskeletal specialists possessing advanced training in their field. Our precise, image-guided injections ensure our patients the best possible results, allowing them to forego the pain, invasiveness, and complication rates of ankle fusion surgery, and get them feeling normal again in a fraction of the recovery time.
Ready to find relief?
Life is too short to live in pain. If you’ve been recommended ankle surgery, we want to provide you an alternative that minimizes complications and ensures optimal and lasting results. Take advantage of our innovative treatments that help people just like you avoid ankle fusion and other invasive surgeries, allowing them to get back to doing the activities they love, faster and without surgery.
(1) Yasui Y, Hannon CP, Seow D, Kennedy JG. Ankle arthrodesis: A systematic approach and review of the literature. World J Orthop. 2016;7(11):700–708. Published 2016 Nov 18. doi: 10.5312/wjo.v7.i11.700
(2) Friberger Pajalic K, Turkiewicz A, Englund M. Update on the risks of complications after knee arthroscopy. BMC Musculoskelet Disord. 2018;19(1):179. Published 2018 Jun 1. doi: 10.1186/s12891-018-2102-y
(3) Morrey BF, Wiedeman GP Jr. Complications and long-term results of ankle arthrodeses following trauma. J Bone Joint Surg Am. 1980 Jul;62(5):777-84. https://www.ncbi.nlm.nih.gov/pubmed/7391101
(4) Maffulli N1, Longo UG, Locher J, Romeo G, Salvatore G, Denaro V. Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Br Med Bull. 2017 Dec 1;124(1):91-112. doi: 10.1093/bmb/ldx042.
(5) Kerkhoff YRA, Keijsers NLW, Louwerens JWK. Sports Participation, Functional Outcome, and Complications After Ankle Arthrodesis: Midterm Follow-up. Foot Ankle Int. 2017 Oct;38(10):1085-1091. doi: 10.1177/1071100717717221.
(6) Merrill HM, Dean DM, Mottla JL, Neufeld SK, Cuttica DJ, Buchanan MM. Opioid Consumption Following Foot and Ankle Surgery. Foot Ankle Int. 2018 Jun;39(6):649-656. doi: 10.1177/1071100718757527.
(7) Gagné OJ, Veljkovic A, Glazebrook M, Daniels TR, Penner MJ, Wing KJ, Younger ASE. Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery. Foot Ankle Int. 2018 Jun;39(6):657-663. doi: 10.1177/1071100718757722.
(8) Jeng CL, Lin JS, Amoyal K, Campbell J, Myerson MS. Driving brake reaction time following right ankle arthrodesis. Foot Ankle Int. 2011 Sep;32(9):896-9. https://www.ncbi.nlm.nih.gov/pubmed/22097166
(9) Harder AT, An YH. The mechanisms of the inhibitory effects of nonsteroidal anti-inflammatory drugs on bone healing: a concise review. J Clin Pharmacol. 2003 Aug;43(8):807-15. https://www.ncbi.nlm.nih.gov/pubmed/12953337
(10) Borenstein TR, Anand K, Li Q, Charlton TP, Thordarson DB. A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty. Foot Ankle Int. 2018 Feb;39(2):143-148. doi: 10.1177/1071100717738748
(11) Mulcahy H, Chew F. Current Concepts in Knee Replacement: Complications. American Journal of Roentgenology 2014 202:1, W76-W86. https://www.ajronline.org/doi/10.2214/AJR.13.11308