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Should I get an Ankle Fusion or Ankle Replacement?

Ankle arthritis can be debilitating, and the effects of chronic pain has been well established. Whether it is from previous trauma (injury) or wear and tear (arthritis) the aim of treatment is to cure the pain and allow return to activities.

During an ankle fusion the ankle joint is removed so that the 2 bones (talus and tibia) can become one bone (fuse). This can be done using key-hole surgery as a day case. This procedure has a predictable long-term outcome and works well for younger and active patients. Research have shown good outcomes 20 – 30 years after the surgery. The downside of ankle fusions is a longer recovery (up to 3 months in a cast/boot) and loss of movement. The joint under the ankle (subtalar joint) and midfoot will still allow movement.

Ankle replacements involve removing the arthritic joint through open surgery with an incision in the front of the ankle. This procedure works well for older patients, that are less active and would like to keep ankle movement. Recovery is faster with walking starting from 2 weeks after the surgery. Ankle replacements have more potential risks such as infection, wear of the implant or loosening. Currently more than 90% are doing well at 10 years. Due to the movement preservation the joints around the ankle are less likely to become arthritic.

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