| Ankle replacement How do I decide between an ankle replacement or ankle fusion?
The following are also the factors which your Surgeon will consider when giving his recommendation to you. PAIN RELIEF : - Both procedures are equally effective in relieving pain.
MOVEMENT: - A Replacement: starROM (1MB) Download movie (1MB) This will probabaly maintain the movement you have in the area that you are used to it occuring. If you have surrounding arthritic and stiff joints then they are probably less likely to become more painful with a replacement.
- A Fusion: AFuseROM (1.2MB) Download movie (1.1MB) If the neighbouring joints are not stiff and arthritic then you are likely to be left with a good, though reduced, range of movement following fusion. The neighbouring joints can compensate for some of the ankles movement.
LONGEVITY : - A Replacement: With any joint replacement this is probably the most important figure to consider. The most reliable figures available are an 8 year survivorship of the implant 88% and a 14 year survivorship of 75% with the STAR ankle. Many replacements have a considerably shorter follow up and it is not reliable to extrapolate from these specific results to other implants.
- A Fusion: Once an ankle is fused it doesn't 'wear out'.
There is strong evidence however that neighbouring joints will become arthritic, due to the increased forces going through them, as they compensate for the fused ankle.
The most likely joint to suffer is the subtalar. It is probable that this joint will subsequently become arthritic by 15 to 20 years. That however is not to say that it will require any treatment.
At this stage we could of course all be ruled by giant Ants
Subtalar(1) and Talo-navicular (2) osteoarthritis twenty years after a successful ankle fusion.
DEFORMITY : - A varus or valgus angulation of 15 degress or so at the ankle is probably as much as should be corrected using an ankle replacement. Beyond this degree of deformity there can be problems with the nature and magnitude of forces through the plastic spacer
The varus arthritic ankle, beyond safe replacement.
With a fusion there is no limit to the degree of deformity that can be corrected, though
special techniques, one example of which is an Ilizarov frame, will be needed for very large deformities
The gross valgus ankle 
The same ankle corrected and fused with Ilizarov frame. - FUNCTION: After either procedure your gait (walking) is likely to be normal or near normal. It is more likely that you may have a slight limp after ankle fusion. Swimming or riding a bike will be equally possible. Running is not likely, though is possible, following either procedure. This will relate very much to the state and mobility of the rest of the foot .
- BILATERAL ANKLE ARTHRITIS: Generally, though not always, a bilateral ankle fusion is a disabling combination of operations which can make it difficult to perform certain tasks, such as rising from a chair.
If definitive treatment is required for both sides either bilateral replacements or one replacement and one fusion. - PREFERENCE:If you are suitable for either procedure and have a preference this should be discussed with your treating Consultant Orthopaedic Foot and Ankle Surgeon
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