Ankle Arthrodesis / Ankle Fusion

Anesthesia Implications

Position: Supine
Time: 1-2 hours (average)
Post-op Pain: Moderate (3-6)
Tourniquet Use: Yes
Blocks: Ankle, Popliteal

Approach – General anesthesia with an ankle block is the preferred method.

Antibiotics – Ancef is the typical antibiotic.

Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2)

This procedure is performed for severe pain due to arthritis of the ankle.  The ankle joint, aka the tibiotalar joint, is where the tibia rests on the talus of the foot. Arthritis can affect the subtler joint (where the talus and calcaneus meet) or the tibiotalar joint. The three main types of ankle arthritis are osteoarthritis, RA, and arthritis due to a prior injury. The arthritis will result in pain, inflammation, and swelling of the joint.

An alternative to ankle fusion surgery is a total ankle replacement.

Typically the surgery is performed using an anterior approach. Alternatively the surgeon may approach through the medial malleolus. First, the ankle joint is exposed and the joint surfaces are debrided. The spongy bone is exposed on the distal tibia and the joint is clamped together with an external fixation device or with bone screws. Then the wound is closed with a drain, and a splint is applied.