If you've got severe arthritis in your ankle, you may be exploring surgery. But which kind of surgery is best for you: arthrodesis or arthroplasty? Arthrodesis involves fusing the existing bones of the ankle permanently, while arthroplasty is the replacement of the entire joint. While arthrodesis has been the surgery of choice for most doctors and patients for years, it's not right for everyone. 

What can arthrodesis do? "Arthrodesis is predictable, reliable, and gives pain relief," states Anand Vora, MD, an orthopedic foot and ankle surgeon in Chicago. Those are the positives of arthrodesis. But negatives do exist. "[Patients end up with] limited motion and increased stresses in adjacent parts of the foot." For older people or those who are relatively sedentary, total replacement of the ankle joint with a prosthesis could be a better option.

But for young, active folks, arthroplasty is too risky, according to Vora. His ideal candidate for arthrodesis? A 25-year-old construction worker with a broken ankle and severe arthritis, and severe pain that doesn't improve with treatment. "A laborer puts an incredible amount of stress on a prosthesis," he states. "An ankle replacement may not stand the test of time. The plastic spacer [used between the joints] can wear out. Metal implants can loosen." If an active person wears out a prosthetic ankle joint within ten or fifteen years, someone in his or her twenties could conceivably be facing five or more ankle surgeries over a lifetime. Arthrodesis, on the other hand, never needs to be redone.

What if you're a marathon runner who discovers you have severe arthritis in your ankle? Be aware that your fitness regime may need to change after arthrodesis. "You can walk on flat surfaces," Anand says, "but uneven surfaces can be hard, as can climbing stairs." As for running, that's probably out of the question. Anand stresses that patients can stay fit after arthrodesis by changing their exercise routine to include the elliptical or swimming.

Other people who are good candidates for arthrodesis are those, young or old, with severe deformities of the ankle. For those patients, a prosthetic replacement can tilt and lead to early failure. But generally, the younger and more active you are, the more likely you are to be a candidate for arthrodesis in order to avoid multiple surgeries over your lifetime.