# Ankle fusion

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{{Short description|Ankle surgery}}
'''Ankle fusion''', or '''ankle arthrodesis''', is [surgery](/source/surgery) of the [ankle](/source/ankle) to [fuse](/source/arthrodesis) the [bone](/source/bone)s to treat [arthritis](/source/arthritis) and for other purposes.<ref name="pmid32940217">{{cite journal | vauthors = Manke E, Yeo Eng Meng N, Rammelt S | title = Ankle Arthrodesis - a Review of Current Techniques and Results | journal =   Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca| volume = 87 | issue = 4 | pages = 225–236 | date = 2020 | doi = 10.55095/achot2020/035 | pmid = 32940217 }}</ref> There are different types of ankle fusion surgery. The surgery involves the use of screws, plates, medical nails, and other hardware to achieve bone union.<ref name="pmid32940217" /> Ankle fusion is considered to be the gold standard for treatment of end-stage ankle arthritis.<ref name="pmid32940217" /> It trades joint mobility for relief from pain. Ankle fusion has also been used to resolve [foot drop](/source/foot_drop) in certain circumstances.<ref name="pmid36918915">{{cite journal | vauthors = Fahmy FS, Salam MA, Mahmoud HF | title = Improvement in clinical outcome and quality of life after arthroscopic ankle arthrodesis in paralytic foot drop | journal = J Orthop Surg Res | volume = 18 | issue = 1 | article-number = 202 | date = March 2023 | pmid = 36918915 | pmc = 10015676 | doi = 10.1186/s13018-023-03691-y | doi-access = free | url = }}</ref><ref name="pmid25128306">{{cite journal | vauthors = Seidel J, Mathew B, Marks J | title = Bilateral Ankle and Subtalar Joint Fusion Secondary to Guillain Barré-Induced Foot Drop | journal = J Foot Ankle Surg | volume = 55 | issue = 2 | pages = 260–2 | date = 2016 | pmid = 25128306 | doi = 10.1053/j.jfas.2014.06.020 | url = }}</ref> Complications of ankle fusion may include [infection](/source/infection), [non-union](/source/nonunion), and, rarely, [amputation](/source/amputation).<ref name="pmid32940217" />

== Outcomes ==
A randomised controlled trial comparing [ankle replacement](/source/ankle_replacement) with ankle fusion found that both led to similar improvements in walking, standing and [quality of life](/source/quality_of_life). Fixed bearing (but not mobile bearing) ankle replacements outperformed ankle fusion in a separate analysis. A cost-effectiveness analysis revealed that ankle replacement may be better value for money over the course of a person's lifetime.<ref>{{Cite journal |last1=Goldberg |first1=Andrew J. |last2=Chowdhury |first2=Kashfia |last3=Bordea |first3=Ekaterina |last4=Blackstone |first4=James |last5=Brooking |first5=Deirdre |last6=Deane |first6=Elizabeth L. |last7=Hauptmannova |first7=Iva |last8=Cooke |first8=Paul |last9=Cumbers |first9=Marion |last10=Skene |first10=Simon S. |last11=Doré |first11=Caroline J. |date=2023-03-30 |title=Total ankle replacement versus ankle arthrodesis for patients aged 50 85 years with end-stage ankle osteoarthritis: the TARVA RCT |url=https://www.journalslibrary.nihr.ac.uk/hta/ptyj1146/ |journal=Health Technology Assessment |language=EN |volume=27 |issue=5 |pages=1–80 |doi=10.3310/PTYJ1146 |issn=2046-4924 |pmc=10150410 |pmid=37022932}}</ref><ref>{{Cite journal |date=9 January 2024 |title=Severe ankle osteoarthritis: which surgery should I have? |url=https://evidence.nihr.ac.uk/alert/severe-ankle-osteoarthritis-which-surgery-should-i-have/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_61707 |s2cid=266915564 |url-access=subscription |doi-access=free }}</ref>

==Tibiotalocalcaneal arthrodesis==
Tibiotalocalcaneal (TTC) arthrodesis is a special type of ankle fusion.<ref name="pmid21338935">{{cite journal | vauthors = Shah KS, Younger AS | title = Primary tibiotalocalcaneal arthrodesis | journal = Foot Ankle Clin | volume = 16 | issue = 1 | pages = 115–36 | date = March 2011 | pmid = 21338935 | doi = 10.1016/j.fcl.2010.12.001 }}</ref><ref name="pmid28576195">{{cite journal | vauthors = Burns PR, Dunse A | title = Tibiotalocalcaneal Arthrodesis for Foot and Ankle Deformities | journal = Clin Podiatr Med Surg | volume = 34 | issue = 3 | pages = 357–380 | date = July 2017 | pmid = 28576195 | doi = 10.1016/j.cpm.2017.02.007 }}</ref><ref name="pmid26829585">{{cite journal | vauthors = Asomugha EU, Den Hartog BD, Junko JT, Alexander IJ | title = Tibiotalocalcaneal Fusion for Severe Deformity and Bone Loss | journal = J Am Acad Orthop Surg | volume = 24 | issue = 3 | pages = 125–34 | date = March 2016 | pmid = 26829585 | doi = 10.5435/JAAOS-D-14-00102 | s2cid = 42817431 }}</ref><ref name="pmid19389600">{{cite journal | vauthors = Kim C, Catanzariti AR, Mendicino RW | title = Tibiotalocalcaneal arthrodesis for salvage of severe ankle degeneration | journal = Clin Podiatr Med Surg | volume = 26 | issue = 2 | pages = 283–302 | date = April 2009 | pmid = 19389600 | doi = 10.1016/j.cpm.2008.12.009 }}</ref> It is used in select situations, for instance as a salvage therapy in severe complicated cases of ankle deformity or in other situations.<ref name="pmid21338935" /><ref>{{Cite journal |last1=Yang |first1=Chalen |last2=Spacek |first2=Ashley E. |last3=Abicht |first3=Bradly P. |date=2023 |title=Tibiotalocalcaneal arthrodesis using a posteriorly angled nail for definitive fixation augmented with fibular onlay graft and autogenous tibial bone graft within the surgical technique of retrograde-delivered locked compression nail: A case series |journal=Foot & Ankle Surgery: Techniques, Reports & Cases |volume=3 |issue=3 |article-number=100307 |doi=10.1016/j.fastrc.2023.100307 |s2cid=259256059 |issn=2667-3967|doi-access=free }}</ref> One major approach to TTC arthrodesis uses an intramedullary (IM) medical nail.<ref name="pmid21338935" /><ref name="pmid22187841">{{cite journal | vauthors = Jehan S, Shakeel M, Bing AJ, Hill SO | title = The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature | journal = Acta Orthop Belg | volume = 77 | issue = 5 | pages = 644–51 | date = October 2011 | pmid = 22187841 }}</ref><ref name="pmid25715850">{{cite journal | vauthors = Franceschi F, Franceschetti E, Torre G, Papalia R, Samuelsson K, Karlsson J, Denaro V | title = Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review | journal = Knee Surg Sports Traumatol Arthrosc | volume = 24 | issue = 4 | pages = 1316–25 | date = April 2016 | pmid = 25715850 | doi = 10.1007/s00167-015-3548-1 | s2cid = 22264469 }}</ref><ref name="pmid28576195" /><ref name="pmid26829585" /> A 2011 systematic review reported the rate of bone union to be 87%, with a range of 74 to 93% in different studies.<ref name="pmid22187841" /> The average time to union was 4.5&nbsp;months.<ref name="pmid22187841" /> Only 26% of cases of non-union required revision fusion, with the remaining cases being asymptomatic or not being severe enough to require revision.<ref name="pmid22187841" /> It was concluded that the nail can oftentimes provide structural support and relief from pain even without union.<ref name="pmid22187841" /> The complication rate was 56%, with hardware-related problems comprising a majority of complications.<ref name="pmid22187841" /> The rate of reoperation was 22%, with screw removal done in 11.4%, nail removal done in 4.2%, revision fusion done in 3.4%, and amputation in 1.5%.<ref name="pmid22187841" /> The review concluded that there is a good fusion rate with TTC arthrodesis using an IM nail but that the surgery has a high rate of complications.<ref name="pmid22187841" /> On the other hand, a 2016 review concluded that there was a low rate of complications.<ref name="pmid25715850" />

==Bilateral ankle fusion==
Ankle fusion is usually done only unilaterally, but more rarely, bilateral ankle fusions have been performed.<ref name="pmid29334782">{{cite journal | vauthors = Maenohara Y, Taniguchi A, Tomiwa K, Tsuboyama D, Kurokawa H, Kumai T, Tanaka S, Tanaka Y | title = Outcomes of Bilateral vs Unilateral Ankle Arthrodesis | journal = Foot Ankle Int | volume = 39 | issue = 5 | pages = 530–534 | date = May 2018 | pmid = 29334782 | doi = 10.1177/1071100717749505 | s2cid = 19073698 | url = }}</ref><ref name="pmid27614825">{{cite journal | vauthors = Henricson A, Kamrad I, Rosengren B, Carlsson Å | title = Bilateral Arthrodesis of the Ankle Joint: Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry | journal = J Foot Ankle Surg | volume = 55 | issue = 6 | pages = 1195–1198 | date = 2016 | pmid = 27614825 | doi = 10.1053/j.jfas.2016.07.014 | url = https://lup.lub.lu.se/record/6885b372-f45c-4903-9c97-8906b94037fb}}</ref><ref name="pmid25249317">{{cite journal | vauthors = Houdek MT, Wilke BK, Ryssman DB, Turner NS | title = Radiographic and functional outcomes following bilateral ankle fusions | journal = Foot Ankle Int | volume = 35 | issue = 12 | pages = 1250–4 | date = December 2014 | pmid = 25249317 | doi = 10.1177/1071100714551947 | s2cid = 23729084 | url = }}</ref><ref name="pmid26235853">{{cite journal | vauthors = Vaughan P, Gordon D, Goldberg A, Cullen N, Singh D | title = Patient satisfaction and function after bilateral ankle arthrodeses | journal = Foot Ankle Surg | volume = 21 | issue = 3 | pages = 160–3 | date = September 2015 | pmid = 26235853 | doi = 10.1016/j.fas.2014.11.001 | url = }}</ref>

==See also==
* [Ankle replacement](/source/Ankle_replacement)

==References==
{{Reflist}}

{{Bone, cartilage, and joint procedures}}

Category:Orthopedic surgical procedures

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Adapted from the Wikipedia article [Ankle fusion](https://en.wikipedia.org/wiki/Ankle_fusion) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Ankle_fusion?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.