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I've seen two different orthopedic surgeons who have said I'm not a good candidate for an ankle replacement so I'm facing a fusion instead. They both gave me different reasons but I came away wondering why a surgeon wouldn't want to do surgery on me. Isn't that what they do?

Every surgeon knows that sometimes the risks of surgery outweigh the benefits. And the biggest reason for this is because of a little thing we call risk factors. By studying who has a good outcome and who has poor results after any procedure, it's possible to predict who will do well and who won't. Some of the most common risk factors that have the potential to disrupt healing or contribute to post-operative complications are known. These can include patient factors such as age, sex (male versus female), body-size ratio called body mass index, general health, and the presence of conditions such as diabetes. In other cases, surgical factors are more likely to increase the risk of problems developing. Length of time in the operating room, type of incision used, size of implant, type of surgical procedures used are examples of intra-operative risk factors. In the case of a total joint replacement for the ankle, the presence of inflammatory conditions (e.g., rheumatoid arthritis) is an important risk factor for infection. And infection is the surgeon's number one fear after joint replacements because it can destroy the joint. Given the fact that surgeons do, indeed, like to do surgery, if both surgeons declared you aren't a good candidate for an ankle joint replacement, you would probably be better off exploring other treatment options.

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