The Decision: Total Ankle Replacement Surgery vs Ankle Fusion. Arthroplasty vs Arthrodesis


This blog is not meant to convey scientific information. It is only my understanding of some of the things I learned as I researched the difference between ankle replacement surgery versus an ankle fusion and my decision for my ankle replacement. You have to apprise your condition, your desired level of activity post-surgery and especially you need to do the research and talk with your orthopedic surgeon to determine what is best for you.

Choosing a Surgeon for my Ankle Replacement Surgery

I met with Doctor Thomas Clanton the ankle specialist with The Steadman Clinic Sports and Ankle Group in Vail, Colorado and was immediately impressed with his humble kindness. His resume is very impressive and his expertise goes unquestioned; he wouldn’t be at Steadman if he wasn’t among the best in the world. His articles in the journals I found in the exam rooms provided more assurance. Though, asking me whether I understood what I read is like asking a high school science student to explain particle physics.

Once again, Dr. Clanton gave the same prognosis as the two other ankle specialists; ankle replacement surgery or ankle fusion. 

Again, I asked about alternatives and again was assured that temporary steps could be taken; SynVisc maybe, cortisone certainly and a prescription for a custom brace. Hoping to put off any surgery I asked whether he foresaw any new non-surgical treatments in the next year or so. He replied that no revolutionary non-surgical treatments were even on the horizon, nothing certainly within five years.

Trying a Brace

I took him up on the custom brace, had it fabricated because medicare and my supplement covered the $1000 it would’ve cost. I wore it off and on. It helped but wasn’t a solution. My shoe size is 10 and I had to buy a pair of size 13 shoes just to have one that fit my right foot and brace! What a waste. And because I am constantly working outside, I needed to find a pair of size 13 hiking boots as well. Fortunately, I found a next to new pair for $15 at the local Thrifty Shoppe.

View from my deck to the creek bench whose rocky nature makes work with a bad ankle difficult even with a brace.

The brace was clumsy and somewhat uncomfortable. It provided me more stability on the rocky uneven ground of my land and allowed me to hike farther with less pain but didn’t solve the basic problem. What a relief it was to remove at the end of the day. It always felt wonderful to massage in some CBD ointment. Oh, and of course I needed inserts for the left shoe because the difference in height and thickness could easily cause problems in my knees, hips or back.

My office in late fall with a bunch of curious wild Turkeys.

Dr. Clanton gave me some websites to peruse, links to articles to help me decide on the best course of treatment and finished by telling me that putting off surgery as long as possible was preferable, a conservative attitude I appreciated.

Researching Arthroplasty vs Arthrodesis

I started reading. You of course, can too. Just Google ankle replacement surgery, which you’ve already likely done if you’ve found me, and you’ll find lots of info from orthopedic surgeons, some from the device makers; STAR by Stryker and Wright Medical Group makers of the InBone, and others. You can also use Goggle Scholar to find scientific articles but they’re fairly old and provide more of a historical perspective than new science.

Google ankle replacement surgery vs ankle fusion, arthroplasty vs arthrodesis and you’ll find both sides of the argument.

Dr. Clanton had told me that if I were younger and more athletic then a fusion would be the best solution. In other words, if I were a pro basketball player or pro mogul skier like bronze medalist Toby Dawson whom Dr. Clanton treated, he’d recommend a fusion because a replacement can’t take impacts and jumping like a fusion can.

Reading the literature, there’s an issue with gait because the ankle is fused, with a very limited range of motion. Plus there’s increased possibility of developing arthritis in other parts of the foot. Recovery though, is easier and faster with an ankle fusion than with ankle replacement surgery.

I spoke with my friend who’d had the STAR put in by Dr. Clanton. She’s very happy with it. She could hardly walk before getting it and now she’s again skiing, hiking and even playing pickle-ball!

After several months with the brace I returned to The Steadman Clinic Sports and Ankle Group and Dr. Clanton. Things weren’t getting better and in all my reading and talking with doctors I determined that my ankle wasn’t going to get better and likely continue to get worse. If it got too bad, the angle of deformity to large, then I would no longer be a candidate for ankle replacement surgery. 

My Decision for Ankle Replacement Surgery

I told Dr. Clanton my decision for ankle replacement surgery, told him I’d like him to do it and asked which device he would use. He replied Wright Medical’s InBone 2. Even though he had played a prominent role in the development of the STAR ankle replacement, his experience taught him that because of certain deformities in my ankle, the InBone 2 would be the better device for me.

Next step, CAT Scan and then surgery.

Dennis Jones/Dreamcatcher Imaging