Severe pain from osteoarthritis in the ankle can be truly debilitating, making everyday tasks seem nearly impossible. When arthritis pain no longer responds to other treatments, your doctor may recommend a surgical intervention to get you back to living a pain-free life. They may suggest getting a total ankle replacement or a fusion, but there are a lot of things to consider before taking the plunge and scheduling an appointment for surgery. That’s why we sat down with one of our surgeons, Dr. Adam Lukasiewicz, a fellowship-trained orthopedic surgeon who specializes in foot and ankle surgery, to discuss the differences between an ankle fusion and a total ankle replacement so that you can better understand these treatment plans.
What is a Total Ankle Replacement?
Ankle replacement, or total ankle arthroplasty, is a procedure that restores a damaged ankle joint by removing arthritic cartilage and bone and replacing them with artificial components. The surgeon fits metal prostheses onto the shinbone and ankle bone, separated by a plastic spacer that acts like new cartilage, allowing the joint surfaces to glide smoothly and preserving a natural walking pattern. This is a crucial benefit, as maintaining ankle mobility prevents compensatory stress on other joints like the foot and knee.
Modern implants are highly reliable, with many still functioning well after 10 to 20 years. Dr. Lukasiewicz notes that “implant designs have come a long way in the last 20 or so years, and not everyone has realized how much better they are now.” He explains that improvements in metal alloys, manufacturing processes, and designs have made the devices more durable and better at securing the metal to the bone.
When it comes to choosing between ankle replacement and ankle fusion, Dr. Lukasiewicz shares that patient preference often leans toward replacements. “Even though the literature suggests that patients with both procedures do well, anecdotally, patients with total ankle replacements are usually happier. Some small studies show that patients who have a fusion on one side and a replacement on the other tend to prefer the replacement. Most of my patients with replacements seem a little bit happier with the surgery overall.”
What is Ankle Fusion Surgery?
Ankle fusion, or arthrodesis, is a surgical procedure for severe ankle arthritis that permanently stops joint movement to relieve pain. The surgeon removes the damaged joint surfaces and connects the tibia (shinbone) and talus (ankle bone) using hardware like screws and plates. Over time, these bones grow together into a single solid bone.
The main benefit of fusion is its long-term durability and the predictable relief of motion-related pain. The tradeoff is a permanent loss of ankle flexibility, which can place extra stress on foot and knee joints, potentially causing new issues. Dr. Lukasiewicz explains, “These surgeries are best for younger patients doing manual labor who expect to be working for another 20 to 30 years. They are more durable, and that is one of the main reasons people choose ankle fusion surgery.”
Which Surgery is Right for Me?
The choice between replacement and fusion depends on age, activity level, bone quality, and the condition of other joints. An ankle replacement works best for older or less-active patients who want to maintain natural walking motion and have strong bones to support the artificial joint. It is particularly beneficial if arthritis affects the foot or knee, since preserving ankle movement helps those joints.
Ankle fusion is often recommended for younger, highly active patients whose joints will be under high stress, or for those with weaker bones or severely damaged ankles that would make a replacement unstable. Dr. Lukasiewicz emphasizes that “patients who undergo either of these surgeries do very well,” highlighting that both procedures can successfully relieve pain.
What Can I Expect After Surgery?
Recovery differs significantly between the two procedures. After ankle fusion, patients typically spend 6 to 12 weeks non-weight-bearing in a cast or boot, followed by several months of rehabilitation. This initial period is more restrictive, though it leads to long-term stability.
Ankle replacement recovery allows for earlier motion through physical therapy. Patients can often start partial or full walking by 6 to 8 weeks and reach their maximum improvement in gait and function within 6 to 12 months. As Dr. Lukasiewicz notes, replacements often allow patients to maintain a more natural stride and participate in low-impact activities more easily. Ultimately, fusion offers absolute stability and reliable pain relief at the cost of motion, while replacement provides pain relief while preserving essential ankle movement.
Southlake’s Role in Advanced Ankle Care
Southlake Orthopaedics is recognized as a regional center of excellence for foot and ankle surgery, particularly for advanced procedures like total ankle replacement and ankle fusion. Dr. Lukasiewicz points out, “Southlake is special in the Birmingham area. We have three experienced subspecialist foot and ankle surgeons and are a center of excellence for foot and ankle surgery, with several surgeons who have put in hundreds of these prostheses.”
The practice employs the latest generation of durable implants, advanced plastic bearing components, and sophisticated fixation designs to promote bone growth, reduce wear, and preserve mobility—contributing to a higher long-term quality of life for patients with severe ankle arthritis. Dr. Lukasiewicz adds, “It’s important to note that there are other options to consider before surgery. With an on-site osteoporosis clinic, orthotics lab, and in-house physical therapy, our board-certified foot and ankle orthopedic doctors provide comprehensive care, treating a wide range of foot and ankle conditions, including arthritis, sometimes without the need for surgery.”
Visit Southlake Orthopaedics Today
If you’re struggling with ankle arthritis, there are solutions. Southlake Orthopaedics can help you regain mobility and find relief so that you can get back to living the life you love. Schedule a consultation with Southlake Orthopaedics to discuss your ankle care options with an expert today!
