ANKLE FUSION
Ross Hauser, M.D.
 

It is common for Prolotherapists to see people with continued pain complaints after surgery. This is a very common occurrence in our office in Oak Park, Illinois. Often overlooked causes of this post-surgery pain are that the surgery itself may cause ligament injury or the surgery may not repair the ligament injury. When performing surgery, the ligaments are stretched and pulled in order to gain access to the joint. In 1992, Dr. J. Albert and associates looked at what actually occurred in the ankle when the joint was opened or distracted for ankle surgery. What they found was that when the joint was opened in the clinically recommended range "complications of pin bending, excessive ligament strain, and bony destruction did occur." Anyone with post-surgery pain should be checked for ligament injury. Prolotherapy to the injured ligaments will eliminate the pain in such a case.
 

Ankle fusion may provide some temporary pain relief, at least for a while. Imagine how much motion your ankle normally has. What is going to happen when all of that motion is lost? Other joints around that fused joint must move more in order to compensate for the fused joint. This will cause excessive strain to these joints or the joints around them. The long-term outlook for fusion patients, no matter which joint, is long-term pain and disability. The reason why people succumb to these operations is that they feel they have no other options. There is an alternative to ankle fusion—Prolotherapy. For that matter, there is an alternative to almost any orthopedic surgery for pain. That option is Prolotherapy.
 

Ankle fusions typically have high rates of nonunion. This means that up to 30 percent of fusions fail, meaning that the bones do not hold together. In one study of 42 patients, the overall complication rate was 55 percent, including nonunion, fractures, pin-site infections, and hardware problems. Yet surprisingly, 85 percent of the people were satisfied with the results. People, we are setting our standards way too low! An operation has a 55 percent complication rate, yet we are satisfied? The most common long-term consequence of ankle fusion is arthritis in the joint below the ankle, called the subtalar joint. Guess how long it takes to become arthritic? It does not take long. The average time is about four to five years. Most studies show that after arthrodesis (ankle fusion) the subtalar joint is significantly arthritic in 50 percent of the cases. All that an ankle fusion does is cause arthritis to travel from one joint to the other. On top of that, the fused joint can no longer be moved at all.
 

One study with a follow-up time of 12.3 years showed that 67 percent of people had pain in this subtalar joint and that 75 percent of patients had to wear special footwear after ankle fusion. The author (Ahberg, A. Late results of ankle fusion. Acta. Orthop. Scand. 1981; 52:103-105.) noted, "In conclusion, patients with ankle fusion often have persistent trouble; therefore technical and clinical development of total ankle joint replacements seems to be indicated." Can you believe this one? The orthopedist's solution to the ankle fusion failure is "let's come up with another operation" so the sequence of events will continue: ligament sprain, RICE treatment, mild NSAIDS (nonsteroidal anti-inflammatory drugs), then stronger and stronger NSAIDs, leading to cortisone shots, then arthroscopy, ankle fusion, and, finally, ankle replacement. We think not! How about just doing Prolotherapy after the initial injury? It is much simpler. Anyone starting out with the RICE treatment is most likely going to end up later in life with several masked people around them with sharp blades. If this is what you want, follow the standard sports medicine protocols. If not, run to a Prolotherapist, if you are still able. Your joints depend on it.
 

The above scenario does not even take into account the dramatic gait abnormalities that occur with ankle fusion. Remember, fusion of the knee, back, or ankle means that the joint can never be moved normally again. At minimum, most of the motion in the subtalar joint will be lost. In regards to ankle fusion, the velocity of the gait will be much slower and the length of the stride will decrease.Other joints around the fused area, as already noted, will have to contract a lot more. This causes the energy expenditure of walking to increase dramatically.