Ankle Fusion vs. Total Ankle Replacement

FAQs with Dr. Gregg Koldenhoven

Total Ankle Replacement

Q. I am considering an ankle fusion or an ankle joint replacement; can you give me any guidance, or things to think about, as I make my decision?

An ankle fusion has been around much longer than the ankle joint replacement; therefore, an ankle fusion is the gold standard.  Nonetheless, the technology behind ankle joint replacement has been advancing, resulting in ankle replacements becoming more main stream.

Ankle Fusion: The fusion eliminates any motion of the ankle (you still have motion in the foot).  By eliminating the motion you eliminate a lot of the pain because pain is typically associated with motion.

Ankle Replacement: The technology is much improved and allows you to maintain most of your motion.


Q. If I decide to have an ankle fusion, can I later have an ankle joint replacement (and vice versa)?

Fusion to replacement: It is possible, but difficult to go from a fusion to a replacement.  Most people with a fusion function quite well so they opt not do a replacement.

Replacement to fusion:  It is possible.  It is more challenging because we have to use bone graft to fill in the space where the replacement once was, but it is very possible to have a fusion after a replacement.


Q. Will I lose height (length in leg) with an ankle fusion or ankle joint replacement?

Ankle Fusion: You may lose some height but it won’t be much, it probably won’t be that noticeable.  If you did notice it, you can use a heel lift.  You should know that you won’t lose inches.

Ankle Replacement:  You should not lose much height with a replacement


Q. If I have an ankle fusion or an ankle replacement, will I develop other joint problems over time?

You could potentially develop more arthritis in the joints of the foot because the force will be distributed to your foot … when you take the force away from the ankle it dissipates in the other joints of the foot so it can potentially cause more arthritis in the foot.


 Q. Will I have physical restrictions with an ankle fusion or an ankle joint replacement?

I would advise against high impact activities.  Regarding physical daily restrictions, there are none.  You will experience some limitations with both, especially with inclines.  Fusions and replacements are similar when it comes to making adjustments to shoe wear.  A new style of shoe may be required to help you roll through the walking motion.


Q. Can I sprain my ankle with an ankle fusion or an ankle replacement?

Ankle Fusion:  Unlikely

Ankle Replacement: It is still possible, because the ligaments are still there.


Q. How long will an ankle fusion last? How long will a total ankle replacement last?

Ankle Fusion: It should last your lifetime

Ankle Replacement: The technology is still evolving, but we are hopeful to get at least 10-20 years out of the replacement.  The more high-impact activities you do, the faster you go through the lifespan of the joint replacement.


Q. Will I be able to move my ankle from side to side after an ankle fusion or an ankle replacement?

You should be able to because the ankle joint doesn’t actually move side to side, it is the other joints in your foot that allow the side to side motion.


Q. What is rehabilitation like after an ankle fusion or an ankle replacement?

The rehab protocols are similar: You will be in a splint/cast for 6+/- weeks; a boot for 6 +/- weeks; and on crutches for 2-3 months.   Sometimes with a fusion we let you ambulate a little quicker (it varies from patient to patient).


Q. How long will I have to stay in the hospital?

Overnight or 2 nights in the hospital for both procedures, occasionally outpatient.


Q. Will my pain be eliminated?

I can’t guarantee that anyone’s pain will be completely eliminated, but I would hope that it is significantly lessened with both.


Q. What is the typical age of someone who has an ankle fusion or an ankle replacement?

If you have bad arthritis and are of a younger age we would consider a fusion because the length of a joint replacement is less predictable.  For a replacement: There is no set age group.  It depends on the individual and their situation.


Q. Do you recommend any websites for me to do additional research?

Wright Medical –

Tournier –

Biomed –

At this point I mainly do the Wright Medical Replacement, but that doesn’t mean I won’t consider using others in the future.


Q. How long will I miss work?

It depends on the type of work you do.

Desk job: 1-2 weeks

Construction worker: 3 months


Q. How does an ankle fusion work?

We remove the articulating cartilage off the joint surface.  Next we put the bone directly on bone and it fuses together … the fusion is similar to what a fracture would do if you broke a bone and it healed back together as one bone.


Would you like to discuss your options with Dr. Koldenhoven?  Call to schedule an appointment at 303-772-1600.  For more information on ankle injuries and treatments, visit our Foot & Ankle Education Page and our Total Ankle Replacement Page.