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Ankle Fusion

Posted , 20 users are following.

jim86105
jim86105

i am told I require a fusion of my right ankle, the damage was caused by a fall from a ladder. I have had a peroneal tendon and liagment reconstruction, the deltoid liagment is detached from the bone also but this will be fixed when the fusion is being done 

my question is how long will it be before  I can use the ankle. Can anyone let me have an opinion on having a fusion and your experience

0 likes, 25 replies

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  • john09838
    john09838 jim86105

    Posted

    Jim.

    ​Have you investigated the viability in your case of total ankle replacement ?Fusion will leave you with a limp, some remaining mobility restritions and a longer recovery process than TAR.

    Surgeons maintain that ankle replacement is only for older people on the basis that the implant has limited life of say 10 years and cannot be revised, so when it is finished you can only have a fusion.

    ​However, 10 years is a rolling average spanning several generations of implant, which have improved substantially.

    I had an ankle replacement only 3 months ago, so far with very positive progress and results.and feel I made the right decision by effectively putting fusion off for at least 10 years.

    Good luck.

    John 

    • jim86105
      jim86105 john09838

      Posted

      John,

      many thanks for that 

      The surgeon has told me that I would only get 2/3 years from a TAR I am a farmer and I am walking for almost 10hours a day 365.  I think your point of putting off fusion is a very valid reason for having a TAR   How long after your operation were you walking 

      Jim 

    • john09838
      john09838 jim86105

      Posted

      Jim,

      I am now walking unaided after 3 months, albeit slowly and with short duration, but am getting more mobile every day. Indeed, I went shopping with my wife in the local mall for a couple of hours on Saturday which seems to me good progress after a 3 hour op on 3rd December.

      My biggest problem is the muscle wasteage from disuse before the op and immobility during early recovery. No pain from the new joint, only from overstressed wasted muscles and tendons.

      Note that the recovery period for fusion is much longer than for TAR requiring at least 6 weeks in a cast. However, muscles waste very quickly, so the extra time is a real issue and restoring them takes a disproportionately long time.

      2/3 years sounds very short and I feel its worth getting a second opinion.

      A number of my neighbours are surgeons and advised me strongly that as this is still a new and developing procedure I should find the specialist with the greatest experience. The man I plumped for only does feet and ankles and had perfomed 70 previous TARs. He warned me of its limited life, but I am a very active 17 stone yachtsman maintaining a 13 acre garden and he is still talking of at least 10 years.

      Post op I expect to make some concessions to prolong the life of the implant as much as possible. Maybe you should try to spend more of your 10 hours per day on a quad bike rather than your feet.

      John

       

  • claire214
    claire214 jim86105

    Posted

    Sorry to jump in Jim but John if I may ask - how old are you ?  I have asked if i can have a TAR but my surgeon refuses point blank to do one because of my age (46 in June) so I have been told to have a double fusion sad
    • john09838
      john09838 claire214

      Posted

      Hi Claire,

      I am 66 but, as I say, very active with no plans to let up (Indeed I have just bought a new bluewater yacht!)

      I am aware that there is reluctance to prescribe a TAR to younger people because they tend to be more active and the statistics say the TAR has a limited life of 10 years. However, the implants are still being developed and I have the latest BOX prosthesis so, as an engineer I put two key questions to my surgeon:

      1. is the 10 year life currently quoted a long term rolling average that is likely to be improved for more recent implants? His answer yes

      2. As the polethylene insert is the wearing component in a three part prosthesis, is it possible to replace this if wear is monitored to catch it before failure from metal to metal contact? His answer, yes.

      This encouraged me to believe that the 10 year rule is possibly already out of date and there is some possibility of revision rather than automatic fusion when the implant wears out.

      Of course there are other reasons for premature failure, such as subsidence of the implant into surronding bone tissue, but there are risks in everything - including fusions!

      When I first went to see an NHS specialist he promoted fusion with no mention of TAR, which emerged only in discussion with my surgeon neighbours, and I eventually had it done privately so I could pick the time and surgeon. ​

      Fusion is by far the cheaper option (my TAR hardware alone cost £4000) and many surgeons are new to TAR. So it might be also for these reasons that Fusion remains the gold standard.

      However, I suspect that in the future TAR will be as routine as hips and knees, and fusion will be looked upon as 'dark ages' stuff.

      Hope this helps

      John

       

       

  • daniel46902
    daniel46902 jim86105

    Posted

    If you don't have an avascular necrosis of the talus, you must consider a TAR
    • jtjones
      jtjones daniel46902

      Posted

      Hi, I don't know if you're still following this, but if you are, if you have AVN does that disqualify you for TAR?  Thanks.

  • john09838
    john09838 jim86105

    Posted

    Jim

    my objective in joining this blog was to encourage people to look at TAR in view of my own very positive experience just 3 months in. 

    There are so many negative blog reports of TAR, I guess partly because it is  an improving  procedure with many recipients of earlier solutions, and partly because people are more inclined to report negative experience.

    I was presented by my first consultant with only one option, fusion, and told that I would thereafter have to give up sailing as I would be unable to stand on a heeled deck.

    So, very depressed, I rejected fusion and limped on for a couple of years until finally driven by increasing pain to fully investigate alternates.

    The many negative  blogs nearly put me off TAR but faced with giving up my only hobby I eventually took the plunge.

    Undoubtedly the right decision in my case and after just 3 months I am beginning again to do my own gardening and so optimistic of a full recovery that I have upgraded my elderly boat.

    The surgeon who performed the TAR emphasised its likely 10 year lifespan, but 10 years is a long time and if I need fusion in my late 70's, so be it.

    He also mentioned that for this reason it is only recommended for older people, but if I was only 30, I would still be glad to put fusion off for 10 years, albeit I recognise that NHS practice must reflect their budgetary constraints.

    So, like you I would encourage people to look beyond the blogs and recognise that there is a viable alternative to fusion.

    john

    • jim86105
      jim86105 john09838

      Posted

      Hi John,

      thank you you for you help and sound advise  I am on my third consultant and he is just an ankle specialist, he recently reconstructed a peroneal subflexion. I have to have my deltoid ligament reattached and some work done on damaged tendons along with sorting the joint its self   The damage to the joint was caused by concussion and various options have been discussed example putting a piece of steel in place of the damaged cartlidge and various other options but he rules out a TAR as not suitable for me. I am 62 and like yourself very active and I hate the thought of having the ankle fused. I have a MRI scan early next month and an appointment a few weeks after that at which time I will discuss the TAR in more depth. I will let you know how I get on and I hear clearly what you are saying and will pursue it.  

      Many Thanks

      jim

  • john09838
    john09838 jim86105

    Posted

    if your consultant definitely rules out TAR, then if he is an ankle specialist I guess you must take his advice. My first specialist who enthusiastically promoted fusion was an general orthopaedic surgeon, and I feel it is generalists that should be avoided. Anyway, I wish you the very best of luck and look forward to hearing how you get on.
  • jamie95127
    jamie95127 jim86105

    Posted

    hello jim,i had my left ankle fused two years ago and its the best thing i ever did,im 37 and came off a ladder too,after 3 lots of surgery and a very painfull cortizone injection i was at my wits end,the initiall thought of a fusion is that your foot will be stuck in one place but thats not true,the rest of the bones in your foot allow plenty of movement,i was in plaster for 3 months and had physio for two,5 months after the fusion i was back plastering and playing golf,my advice to you is to check out the doctors history,if hes not that experienced then ask for someone who is,my doctor was a brilliant bloke by the name of andrew skyrme,he works at the horder centre in crowborough,east sussex,he was amazing and very proffesional,you can look him up online easily and hes nhs as well as private,so the choice is yours.honestly mate i understand what your going through and people dont understand how awful this injury is.its going to worry you of course but trust me apart from a bit of soreness now and then im so much happier now,its not as longer treatment as you think.good luck and contact me if you need any more help,will check in each day to see how your going
    • andrew52113
      andrew52113 jamie95127

      Posted

      Hi Jamie,

      I'm still living with my painful ankle, at the moment.

      My surgeon advised me to stick it out a long as possible.

      I too have been advised that joint replacement is inappropriate for me..

      I have spoken to a trusted physio

      about fusion, he said in his experience the outcome for the ankle is good, but, other joints suffer and fail because of the unavoidable change in gait.

      Does anyone have experience with this?

      Regards

      Andrew.D

    • StuartSt
      StuartSt jamie95127

      Posted

      Hi Jamie, are you still around on this site? I just wondered how you are getting on with the fusion?
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