Four months ago, I had surgery to reconstruct my ankle. I had a worn and arthritic ankle joint on one side. I was trying to avoid having a fusion. But I'm no better off than before the surgery. Pain and loss of motion affect the way I walk. Even my balance is off. How long do I have to wait before going ahead with the fusion after all?

It sounds like you might have had realignment surgery to correct an asymmetrical (uneven) deformity. Sometimes realignment surgery works very well to restore the normal ankle position. Decreased pain and increased motion often result in improved function.

But when the procedure fails, then a second operation may be needed. The surgeon may be able to revise the original surgery. Two treatment options include total ankle replacement and ankle fusion.

The treatment decision is based on the position of the ankle bones. The surgeon will also look at the width of the joint space across the joint. It may be possible to measure the load placed on each side of the joint. A minor revision may be all that's needed to unload the diseased (worn) joint area.

See your surgeon again before assuming a fusion is the next step. It's possible that you might benefit from a rehab program. If not, a second revision operation may be possible.

The surgeon will do whatever is possible to postpone or avoid an ankle fusion or TAR. With reconstruction revision, fusion or TAR are still possible if needed later.

Geert I. Pagenstert, MD, et al. Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis. In Clinical Orthopaedics and Related Research. September 2007. Vol. 462. Pp. 156-168.