Arthroscopic Ankle Fusion

⚙️What This Procedure Involves

Two to three small arthroscopic portals are made around the ankle. The remaining articular cartilage is removed from the tibial plafond and talar dome using arthroscopic shavers and curettes. The joint surfaces are prepared to bleeding bone. The ankle is compressed and fixed in the optimal position (neutral dorsiflexion, 5 degrees external rotation, slight valgus) with two or three large cannulated screws inserted percutaneously under fluoroscopic guidance. The operation takes one to one and a half hours.

💡Why It May Be Recommended

Arthroscopic fusion is preferred for straightforward ankle arthritis without significant deformity (less than 15 degrees of varus/valgus). It preserves the soft tissue envelope, has lower wound complication rates than open fusion, and may achieve faster union.

⚖️Non-Operative Alternatives

Ankle brace, rocker-bottom shoes, injection, physiotherapy, activity modification. Ankle replacement (motion-preserving) and open ankle fusion are surgical alternatives.

📋Preparing for Surgery

Weight-bearing X-rays and CT. Assessment of deformity — significant malalignment may require open fusion to correct alignment. Assessment of subtalar joint (if also arthritic, a hindfoot nail may be more appropriate).

✅Expected Benefits

Union rates of approximately 90–95% — comparable to or better than open fusion. Lower wound complication rates. Potentially faster time to union (average ten to twelve weeks vs twelve to sixteen weeks for open). Less post-operative pain.

⚠️Common Risks

• Loss of ankle motionExpected

  Expected — the ankle is permanently fused.

• Altered gaitExpected

  Shorter stride, reduced push-off.

• Subtalar arthritisLong-term

  Increased stress on the adjacent joint.

🔴Less Common but Serious Risks

• Non-unionUncommon

  5–10%. Higher in smokers.

• MalpositionUncommon

  The ankle may fuse in a suboptimal position.

• Nerve injuryUncommon

  Superficial peroneal nerve near the portals.

• Screw prominenceCommon

  Screws may require removal.

• Conversion to openUncommon

  If the joint cannot be adequately prepared arthroscopically.

💉Anaesthetic Considerations

General or spinal anaesthesia with ankle block.

🏃Recovery and Rehabilitation

Non-weight-bearing cast for six to eight weeks. Boot with progressive weight-bearing from eight to twelve weeks. Rocker-bottom shoes long-term. Full recovery six to twelve months.

📅Follow-Up

X-rays at six weeks and three months. CT if non-union suspected.

❓Frequently Asked Questions