Ankle Fusion or ankle Replacement ?

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Hi dear friends

I am 28 yrs old male from Denmark, I injured my left ankle around 7 yrs ago, it's been so painful for the last 3 yrs and doctors told me that I have arthritis in two joints of my ankle and an ankle fusion or replacement is a necessary.

so which one would you recommend me to have ?

I would be glad to get your experience and suggestions ?

Thank you all.

1 like, 12 replies

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12 Replies

  • Posted

    Difficult decision to have to make. I had to make this decision 4.5years ago at 70 and went for a TAR mainly because of the possibility of the joints of my toes failing due to them having to work harder.

    My TAR is now to be revised due to Osterlylis a well known issue the surgeons usually fail to tell you about. In my case a good outcome has poor odds as it continues to get worse as my hip on the other side failed recently whilst waiting for the revision.

    Cheers Richard

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  • Posted

    Being so young your TAR will only last 10 yrs and most don't even last that long and you have to be very careful with them after and may limit some activities and sport. The recovery is so much faster with the TAR though and that makes it appealing. You can weight bear in a few weeks as opposed 3 months with the fusion. I had a fusion and it had been a long journey . I'm 5 months and can still only walk very short distances and I am getting my plate and screws out next week.

    I would do you research, the TAR are not done often here in Canada and my surgeons opinion is that it is really not perfected yet and has a high percent of failure.

    I wish you the best whatever you choose.

    Also fusion do last for life , but ROM can be limited.

    Margie

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  • Posted

    If I can come back and say that in the Uk the are at present only about 900 TARs done each year shared out between quite a number of surgeons with a few doing quite a number with the remainder only doing very few each year.

    This is a very tricky procedure requiring everything to be as near perfect as possible for it to be a success so experience is essential.

    Mine seemed to be good but has failed due to osteolysis which could have been because the surgeon did not deal with a cyst in the surgery area and or one half of the prosthesis not being positioned as well as possible and at the wrong angle.

    This could have created wear debris that my body was not able to deal with resulting in osteolysis.

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    • Posted

      Hi Richard and Margie

      Thank you for sharing your stories, I am really confused and can't take a decision yet, because couple of doctors that I met are telling me if fused I may walk with a limp, and I don't want that, but it looks like that I have no other option, and all surgeons are advising me the Fusion,

      Best

      Mo

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    • Posted

      My brother in law had the full fusion and he got an orthopaedic shoe with a slight rocker bottom and now does not limp at all. The rocker bottom is hardly noticeable not like some of those that have that goofey looking bottom.

      It is a tough decision, so maybe get a second opinion from another surgeon, and do your own research.

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    • Posted

      Dear Mo

      Unfortunately at the moment for a young chap like you a fusion is likely to be the safest option but it should come with the warning that as the years go past your joints in the foot are quite likely to fail.

      It's a real bummer. Sorry I cannot give you more encouraging news.

      Cheers Richard

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  • Posted

    Hey Mo,

    I'd say do some research on current rates of failure for replacement at the 5, 10 year mark, particularly among younger, more active populations ("failure" is usually defined as needing further surgical revision within that 5 or 10 year period).

    When I was considering your same two options about 9 years ago, the failure rates were abysmal (pushing 100% by year 10).  That along with my surgeon's strong advice against (he would not do them and said he didn't respect surgeons who did) convinced me to go with the fusion.  I'm fused all the way down through the heelbone.

    I "kept up with the art" for a few years, hoping a better ankle would come along, but after about 5 years gave up on it.

    As margie mentions, reduced ROM is the main issue with fusion.  With cross-trainer type shoes (having the relatively higher heel) I can walk full stride and people who don't know me don't know I'm sans one ankle.  Walking transverse across a slope can be an issue.  I can manage a sort of loping-gait run which, while awkward, can still best all of my teenage children in a short sprint.

    I also had "rocker bottom" shoes made up for my work shoes.  They slice the shoe's sole into two wafers and build in extra material that provides a bit of an arc across the bottom of the shoe.  This provides the ability to take a full stride without putting quite so much stress on the mid-foot bones and bones of the toes.  

    So the only time I have a noticeable limp or shortened stride is if barefoot.

    As Richard mentioned, I was also told I would at some point start wearing out the joints between those bones, needing further fusion.  So far so good, though, with no signs of arthritis at 9 years.

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    • Posted

      "the joints between those bones"

      Sorry, on re-read that looks confusing.  By "those bones" I meant the mid-foot bones and metatarsals.

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    • Posted

      Thank you Richard again and Yawa for the advices and sharing your experiences.

      According to your experiences, fusion is the best option for me.

      Sorry Margie your last comment is not visible to me, it says (this reply is waiting to be moderated)

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  • Posted

    Hi, I had the same choice 9 years ago. TAR was not recommended  as I was only 50 and still very active. At that time the expectant life of a TAR was 5-10 years. May be better now, but at your age, still not a long time. I had a TT fusion. It was very successful. 3 mth nwb, 12 mth to get back to previous mobility, except running, which I didn't do anyway. My post op pain was nothing, compared to what I had before.  Over the years I have been very active again. Had shoes with 'rocker' bottom (much cheaper now!) and custom orthotics to reduce impact on rest of foot. But the arthritis increased in the other joints. I am now 6 weeks post sub-talar fusion, and removal of some screws from previous surgery. Healing well.Can start to WB in 2 weeks. I am optomistic about my recovery, but also realistic about effects on other joints, as I already have moderate arthritis in most of the joints mid foot. So more may be in the future for me. I guess ihat if you have arthritis in 2 joints, and chose a fusion, get them done together. Wishing you all the best.

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    • Posted

      Hej mammalu

      Thank you for sharing your story with us, its very inspiring and I wish you all the best. I think fusion is the best choice for me. and I was doing a research for the last months so I think fusion is mostly successful.

      thank you again

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