Early Weight-Bearing Following Open Ankle Arthrodesis: Radiographic and Clinical Outcomes.

Abstract

Background: Ankle arthrodesis is a standard surgical treatment for end-stage ankle arthritis. The optimal timing of postoperative weight-bearing remains controversial, as traditional protocols recommend prolonged non-weight-bearing. Early weight-bearing may improve functional recovery without compromising fusion. This study aimed to evaluate radiographic union and clinical outcomes following early weight-bearing after open ankle arthrodesis.

Material and methods: A retrospective study was conducted on 20 patients with end-stage ankle osteoarthritis who underwent open ankle arthrodesis between January 2024 and August 2025. All procedures were performed by a single surgeon using a standardized anterior approach and crossed screw fixation. Partial weight-bearing in a removable walking boot was initiated two weeks postoperatively, with progression to full weight-bearing at 12 weeks. Clinical and radiographic outcomes were assessed for up to one year. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used for clinical evaluation.

Results: Radiographic union was achieved in 19 patients (95%). Partial union was most frequently observed at three months, and complete union was commonly achieved by one year postoperatively. One patient developed nonunion, and one minor wound complication was treated conservatively. The mean AOFAS score improved from 13.55 preoperatively to 90.1 at one year in the patients with successful fusion.

Conclusions: 1. Early weight-bearing following open ankle arthrodesis demonstrated high union rates, significant clinical improvement, and a low complication rate. 2. Early mobilization appears to be a safe and effective alternative to delayed weight-bearing when stable fixation is achieved.