Ankle Replacement Surgery

Hi,

As a 7 month post op TAR I was wondering how your wife is progressing. I guess she is a couple of months ahead of me. I have good mobility most days but I'm not without pain. I am able to walk my dogs again for about 2 hours, three times a week and this is over fairly rough terrain. I get no significant swelling but the pain is sometimes debilitating. Am I expecting too much too soon? 

Most doctors say it takes a year for any surgery to be really classified as fully healed... So give it some more time... If time doesn't help talk to the doctor, they are the experts in what's going on

Thanks for posting 😊 Hearing the experiences of of others in the same situation is very encouraging. Are you still mostly pain free and mobile?

Thank you for this.  I am alomost a year of my ankle surgery,which was a redo.  I am still have so much pain.  I awm curious as to what ankle boots was ordered.  I am not doing another surgery and would love any help that may be offered. i know it is a better surgery than the first, but just need to have reduced pain.

 

Kathy, I had my TAR 4/3  on my left foot in CA. I am 64 yrs old. I too have pain but not where I had pain originally. From reading these posts, it seems like it takes time, more time for some,  I have heard that even up to 18 months.  My dr has ordered orthotics for my shoes, you might want to ask you Dr. about them.

I had an Wright Infinity ankle replacement in California. I'm 19 months post op and very happy. I can say I have my life back! It takes a full two years to completely recover.

Hi Tara!  I am so glad to hear this. I am actually having a TAR using the infinity on the 23rd of this month. I am an active 37 year old woman. I had a severe injury and this will be my 3rd surgery on my right leg/ankle. I had a fusion done in 2014 and it was unsuccessful.  

I understand that this will be a long and painful journey, but is there any advice that you can share with me that helped you?  

Hi Shanda.  I'm jumping in univited.  I crushed my ankle in 1991 and lived with moderate pain for 26 years while researching ankle replacements and waiting for the right one to come along.  Earlier this year I decided to have my ankle replaced with the Infinity Inbone/Prophecy system.  My surgery was June 9, 2017.  I was given nerve blocks for pain which wore off after 24 hours.  My surgeon prescribed 60 Oxycodne pills but informed me that only 2 of his many patients ever needed to use all of the pills.  I began taking the pain medication on the morning following my surgery to "stay on top of the pain".  I took 4 pills that day and night.  The next morning I woke to discover that my pain wasn't any worse than prior to the surgey.  I took 3 pills that day and each of the next 2 days.  After that I took 1 pill prior to bedtime to help me sleep for about another 10 days.  My ankle was basically pain free.  I'm now about 10 weeks post surgery and the only pain I've had has been related to stretching and strengthening my muscles and tendons. I took 1 more pain pill after a day in which I broke up some scar tissue on the right side of my ankle. I'm in an aircast now and will be for another 2 weeks at which time I visit my surgeon with the expectation that I will be placed into my regular shoes.  I'm currently able to walk with or without shoes with no pain, just stiffness which should go away over time, but I do stay in the aircast as most of the time per my surgeon's advice.  I know each operation is unique as are each patient and each doctor.  I just figured I'd let you know that for me the pain was a huge non-issue, especially after reading all of the horror stories.  I hope you see the same results with the Infinity that I have..   

Dear Bruce

I had a TAR five years ago and am waiting to have it revised due to osteolysis. It seems that there was some evidence of it at the time of surgery but it was not dealt with and it spread.

This is just to warn everyone to be aware that osteolysis can effect all joint replacements but it seems that it is potentially a bigger hidden danger for ankles. Please confirm with your surgeon at each check up that there is no evidence of it.

The surgery transformed my life but the future looks bleak but hopefully you will be fine.

Cheers Richard

Hi Richard,

Thanks for the notice.  My research prior to my surgery did not pick up any instance of this condition.

I did some searching online last night and today and the only instances of this occurring that I was able to find were with the AES and HINTEGRA ankle replacements and these seemed to have taken place at least several years ago.  I have not found any reports of this condition with the Inbone ankle but I will ask my surgeon about this when I see him in three weeks.

Regards,

Bruce

Dear Bruce

There is a lot of stuff about it out there especially in various research papers. surgeons are very reluctant to say anything about it...its as if it's a dirty secret.

Please be fully aware of it's danger and make sure others are aware of it and directly ask at every check up to avoid being in the same situation as I'm now in.

You can see how well I was doing at twenty weeks by googling Yogesh total ankle replacement. Let me know if that fails to bring it up please.

Cheers Richard

Hi Tara. I'm also in CA and looking for a doctor for a TAR. It sounds like yours is successful. I saw one doc that wants to do the Infinity, and it sounds good, but it's hard to know where to research doctors. I feel like I need more information and a second opinion before taking the leap. It would be great to know where you are located or who your doctor is. I'm on the central coast of CA but would travel. 

Dear Cawalker

Here in the UK there were about 800 TAR surgeries done last year by a large number of surgeons and I understand most surgeons only do less than five a year so are getting very little experience.   This I gather leads to poorer results than should be the case and I bear witness to this and face a very uncertain outcome to try to find a solution to my failing prosthesis.

This is a very technical, tricky and exacting surgery and I urge anyone going in for a TAR to be fully ware of this situation.    It may be different in the US but I somehow doubt it!

Good luck.  Richard

Hi, I had a STAR replacement on April 6th of this year by Dr. Thordarson at Cedars Sinai. No real pain, easy recovery. Non weight bearing for a month, followed by a month in a walking boot, and then... Walking, hiking, surfing, riding a bike... pretty much pain free. Amazing! Before the surgery I hadn't taken a pain free step in 7 years... it's not 100% but it's 90+% at this point, and I'll take that any day of the week. Good luck.

I think he's probably the best ankle surgeon in the western U.S. What I did before surgery was ask a lot of Physical Therapist and other Docs who they'd recommend for a TAR and Thordarson seemed to be the one they all liked. Once again, good luck!

Hope this will help.

I had TAR last week with Shannon Rush MD PAMF, El Camino Hospital in Mountain View. At 9 days out, things seem good: no blood, little pain, minimal antibiotics.

I found Dr. Rush this way:

Went to a non surgical DO and got his opinion. I have had good experience with this DO in the past. He said Dr Rush was by far his first choice.

I spent a lot of time on line and confirmed that Dr. Rush might be the best.

My primary doc talked with Rush and said he seemed like the right guy.

I talked with a guy in my golf club who had had TAR and he said Dr. Rush was great, and performed a successful surgery with him a year ago.

I talked with my physical therapist and she said that she had worked with Dr. Rush's patients, and they were all positive about him.

He is a pretty straightforward guy. Not chatty, but pleasant.

I was in El Camino hospital for a night. Rush said that this is often done as an outpatient procedure.

I have never used this forum before so I don't know if I will get notified if you ask another question. I may check back in a week or so.

Mike

I'm now 3 months removed from surgery.  As of last week I'm out of the boot and in sneakers and hiking boots.  I've had no pain other than that associated with using muscles and tendons that haven't been used in 26 years.  I'm now able to walk or slowly jog on a treadmill, hike, do squats and lunges with weights, etc.  I should have full range of motion within the next 9 months.  I'm ecstatic with the results so far. 

This is good news; share with us: where the surgery was done, who did it, and what device was used.

The surgery took place in Hendersonville TN USA.  The device was the Infinity Inbone/Prophecy system.  I had researched this for many years before deciding on the Inbone, Other patients reported very good results.   The doc is Marc Tressler.  He's performed more than 700 total ankle replacements over the years, I believe there are only 3 docs in the US who have performed more.  There is more detail in my reply to shanda1980 from 25 days ago.  Let me know if you have any questions.

Dear Bruce

So glad that all went well for you. I'm interested to know if you were told about osteolysis before you had this surgery.

I had a TAR in the UK five years and am having to have a revision next month due to osteolysis destroying the bones were the prosthesis is.

The galling thing is that I had full mobility following the surgery and only minor discomfort in the following years and it was a year ago at my annual check up that it was found that I had a huge problem and it has taken all this time to get to a revision due to the complexity if the situation.

There is a Youtube video showing me walking, and running up and down stairs at twenty weeks. If anyone is interested Google Yogesh total ankle replacement Kenward to get to it.

My new surgeon who is very experienced would like to use the Infinity but since my bone quality has been badly compromised he is doubtful about how successful the revision will be.

Osteolysis is something that can effect all artificial joints but it seems that TAR are much more likely to be effected.

Cheers. Richard

Dear Bruce,

Thank you so much for joining in and responding!  I am so glad to hear of someone with a good outcome!  I believe I had no other choice but to have an ankle replacement. I did not go with the inbone, although I did choose the infinity TAR.   The surgeon was very pleased with the outcome and believes I will make a full recovery. 

My surgery was on the 23rd of August and I spent 3 days in the hospital for pain management and I developed a low grade fever. 

They wanted me to take 2--5mg  OxyContin pills every 6 hours.  There were times when I did need them but most of the time I only took 1 pill every 6 hours.   Since addiction runs in my family, I was scared to keep taking them so I called and expressed this to my dr so he changed my pain meds to 1 Percocet 5 every 6 hours and I am doing fine with that, if I even need to take meds at all. 

My follow up is sept 14th and I will be getting out of the cast and getting stitches out. Hopefully I will be starting PT 3-4 days a week. 

At this point, I am very pleased. Barely any pain at all so far!  I am very glad for your recovery as well!  Many thoughts and prayers headed your way!  

Bruce,

This is great news!!!!  I am so happy for you,  most people who never have had their ability to walk normally or live in pain, won't understand what a relief it is when you are finally able to be pain free!!!  

I am 17 days out of surgery and the pain relief I feel is outstanding.  I do have good and bad days, but the good days outweigh the bad by 90%!  Although I have a long way before I can consider myself 100% again, I am very optimistic for my recovery so far!  I go back on September 14th for my first follow up, they will take me out of the cast, remove my sutures, and hopefully place me in a boot, then set me up for Physical Therapy. 

I only need to take 1 Percocet 5mg when I wake up. The rest of the day, I am fine!  

I am able to do housework, while sitting on my walker (which has a set and wheels). When I go outside to visit with my horses and pig, I'm in my wheelchair and I have no pain other than the occasional nerve pain in my toes, which I was told that is normal and will subside eventually, seeing the nerves, tendons, and muscles are healing. 

I wish there was a way to post pictures on this site.  I would love to share with you what my ankle looked like after my initial injury back in 2013. 

If you would like to see it, you can email me and I can send it to you through email.

I look forward to keeping up with your progression!!!  Hearing your updates....make me feel very hopeful about my future progress!!!  

Thank you & congrats on your progress thus far!!!!

Shanda

Moderator comment: I have removed the email address as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

Hi Shanda, I'm 38 and planning to have a TAR in the next few months, due to a 24 year old severe fracture that has resulted in end stage artheritis. The news that I had reached this stage was a shock, I'm obviously in a lot of pain and mobility has reduced steadily but still a shock to find how limited my options would be, especially still being relatively young and a single working mum, my life has changed dramatically and I know I have a lot to come. Reading your comments has filled me out th hope after being tearful for the last few weeks. So happy you seem to be recovering well!

Claire x

Hi Shanda, I'm 38 and planning to have a TAR in the next few months, due to a 24 year old severe fracture that has resulted in end stage artheritis. The news that I had reached this stage was a shock, I'm obviously in a lot of pain and mobility has reduced steadily but still a shock to find how limited my options would be, especially still being relatively young and a single working mum, my life has changed dramatically and I know I have a lot to come. Reading your comments has filled me out th hope after being tearful for the last few weeks. So happy you seem to be recovering well!

Claire x

Hi Claire!  I am truly sorry that it's come to the point where you have to have a TAR.   Do you know which prosthetic they will be using?  

Believe me, having a TAR, isn't necessarily a bad thing.  I can tell you that deciding to have a TAR was the best decision of my life.   My surgery was on August 23, 2017 and I honestly tell you that I am about 95-96% pain free!  The first few days after the surgery was pretty rough, I won't lie to you. But as of today, this is the first time since my accident that I can say I'm almost pain free. 

I am starting physical therapy soon. Hopefully in 2 weeks, I will be able to start walking. 

If I may give you a little advice for a successful recovery...

1. Do exactly what your Dr says. 

2. DO NOT put any weight on it at all for at least 6 -8 weeks. 

3. When they take the cast off and put you into a boot....when you take the boot off, start rotating it slowly, don't force any movement. 

4. When your discharged from the hospital, continue elevating it. (I still keep mine elevated)

5. No matter what, do physical therapy for as long as you can. (It will hurt like hell, but the pain is only temporary but the outcome will be worth it!

Before my TAR, I was in constant severe pain to the point where it was debilitating. For me to be almost pain free.....I can't tell you how good it feels knowing I will have a better quality of life now!  My dr even said that once I am completely 100% healed, I may even be able to jog (I was a runner), I will be able to ride and train horses again.  I even know of a man who is able to snowboard after he healed from his TAR.  

I hope you have a successful surgery and recovery!  This forum has helped me so much mentally and emotionally, going through this process. These people are amazing!!!  If you have any questions or advice, we are here for you!  If you want to keep in contact, you can send me your email through the private message feature on here!  

Good luck!!  

Shanda

Shanda, thank you so much for the advice and the kind words, I will take every bit of advice, I feel a million times better just hearing other people going through the same as me, I've been feeling so alone, it as if all the memories of my original accident at age 14 came back, struggling with constant pain and struggling to fit in and play down my disability. Yours and the others on this thread have given me courage and hope. I'm not sure what implant they will be using I see the surgeon on the 9th October so will post regular updates, all also PM you my email.

Thank you ????

This forum and people really helped me as well. That's one thing your not, is alone!  Not in here!  

My surgeon used the infinity prosthetic on me. I did a lot of research on different ones. It may help you to do some research on different TAR prosthetics.  Google TAR prosthetic. One that is popular and has a good success rate is the inbone. You can look up star, infinity, inbone, invision, and prophecy.  Hope that helps a little bit to get you started!  

It always pays to do your research before you see your surgeon. 

The success of a total hip replacement is choosing a really experienced surgeon who has done a lot of ankle replacement surgeries.

Here in the UK a large number of surgeons do very few each year which is very bad for many patients because they are likely to have a much worse outcome than they expect. Happened to me.

Cheers, Richard

Claire, I couldn’t agree more with Shanda.  I researched this with a number of surgeons over many years and my experience was that each one worked with a particular brand or model of TAR.  I don’t know that for a fact but that was what I came to believe.  You really owe it to yourself to research the different TAR’s available and pick one you’re comfortable with.  Shanda and I both went with the Inbone.  I have several posts earlier in the forum you can look at if you wish.  I’m now about 17 weeks post surgery and I can’t believe I feel this good.  I had no pain except for the first few days after surgery other than from using muscles and tendons that hadn’t been used for years.  It was supposed to take one year to fully recover but I honestly don’t think it will take that long for me.  Good luck and keep us posted!

Thanks so much for your information. I called the office of Dr. Rush and was told that they don't keep track of how many TARS they have done or the success rate. That seemed a little odd to me. I thought that was a standard question from someone considering that type of surgery. I'm still looking for a doctor in the Bay Area in California or someplace within driving distance. I'm in the Santa Cruz area and saw Dr. Abidi but I'm not feeling very optimistic about proceeding with that office. 

HI Mike,

I'm strongly considering a STAR ankle replacement with Dr Rush, as well.  I'm just checking in with you to see how it is progressing now that you're a few months out of surgery. Any information on your progress and if you feel it was the right decision would be very helpful. Thanks.

--dan

Jog???!!! Really I thought high impact was out?? I don’t even try to run. I look ridiculous. I recently sprained my ankle.  I got a new look at the ankle and the STAR is perfect! No bone spurs   The sprain in impacting the  the Tarsel nerve. Pins and needles all the time ugh!! I am in NJ and Dr Scott Miller takes care of my ankle. I adore him and my ankle thanks hims

Dear Bruce

Sounds very odd and not very professional. I would avoid any surgeon who did not keep a record of his/her surgeries. Here in the a UK I think it is a requirement of all surgeons which makes it an easier job when choosing a surgeon.

Cheers Richard

Dear Lynda

Choosing to run after a TAR or similar surgery seems to me to be a very bad idea unless the aim is to have it fail early! Same goes for hips.

Cheers Richard

Hi Richard, you have me confused with another participant in this forum.  My surgeon did advise me of his experience prior to my surgery.  That is one question I asked of all the surgeons(8) I visited prior to my surgery.

Regards,

Bruce

My apologies Bruce, not sure how that happened as I thought that I was responding to catwalker!

Cheers Richard

Maybe I exaggerated a little bit.  My "jog" was very, very slow.  Just slightly faster than a fast walk.  I did that for a few sessions at the gym but it wasn't comfortable.  So now I just use an elliptical machine where I don't need to concern myself with my balance or my stride.

Regards,

Bruce

I am in the same similar situation but Drs. I've seen aren't helpful. What Dr. Did your TAR?

Hi I’m scheduled for my right TAR on March 20 2018. I too am in Ca where are you ? I am near Sacramento and my Dr will be using an Infinity. I’m a little apprehensive as I just hat TKR in August but my ankle is so bad rehab is very difficult. Any positive advice you can give me would really be appreciated. I guess throw in anything negative too. It’s better to see the whole picture. Thx

Dear Jan

Please check out their experience with that prosthesis and their level of successful outcomes.

My TAR five years ago by a surgeon with limited experience needs to be revised now and because he set it badly off centre it will be a messy job . Probably due to this the bone has developed osteolysis which increases the difficulties.

Ankle replacement surgery is a very exacting difficult surgery and it needs to be got right first time or the implications are likely to be devastating .

Good luck, Richard

Jan,

I would like to echo what Richard wrote.  Ankle replacement is much different than knee or hip.  Compared to hip or knee, the foot is more complex structure consisting of many joints, TAR is a much more recently developed procedure, TAR is a much more complex procedure to perform, and surgeons in general have much less experience performing them.  I had my right done 11/1/16 and my left done 12/1/17.   It took me 2 years to make the final decision to have the first one done, and consulted several ankle surgeons in several major referral centers in the NE until I made my decision.  I waited each time until I simply could not walk due to the pain, and I lead a very active lifestyle as a golfer and sailor. I am very satisfied with the results, and hope to get back this spring to walking the golf course and sailing my boat on Lake Ontario.

The local surgeon here in Syracuse planned to use the Inbone prosthesis, which other surgeons seem to feel is better reserved for re-do's.  The local surgeon in my opinion had not done enough of them to make me comfortable.  A surgeon in Mass General in Boston I saw was clearly very experienced and capable, but I did not want to travel 6 hours for each appointment.  I found a highly regarded surgeon in Rochester, 1.5 hours away who was well published and past president of the American Society of Foot and Ankle surgeons and she referred me to a colleague who was in his 40's and doing quite a few TAR's over several years.  Driving 1.5 hours each way for post op apts is not easy, but is doable, especially considering we can have lake effect blizzards daily, and has not been a major problem, but I would not want to have to go back and forth to Buffalo, Boston, or NYC for the post op visits.

In addition to the ankle pain, before my right TAR in 2016, I was also experiencing a lot of heel pain.  The local surgeon felt my heel pain represented plantar fasciitis, but I was not convinced.  He kept giving me steroid injections into the ankle and wanted to inject the plantar fascia as well, which I did not agree to.  The surgeon who eventually did my TAR, more carefully examined me and suggested that my heel pain was actually secondary to subtalar joint arthritis, not plantar fasciitis, and suggested a right subtalar joint fusion in addition to TAR.   It turned out he was right on target.  The subtalar fusion takes a long time to heal (a full year) compared to the TAR, but I would have continued with crippling pain from the subtalar arthritis had I not had the subtalar fusion. 

I would also like to state that it is my opinion that the steroid injections destroyed my ankle joint over the year that I had 3-4 of them.  It is my understanding that steroid injections can hasten the process of degenerative arthritis, and my current surgeon states that it is the general consensus nationally that no ankle injects should be given to anyone.

Each surgeon has his/her own preference for prosthesis, and I think the key is how much experience each has doing the procedure.  I suggest asking straightforwardly, "how many have your done, and how many with this prosthesis, how many complications have you seen and what kind of complications?"  Get a recommendation from a local general orthopedist if you have such a relationship.  Ask your PCP help in finding someone.  Get as many opinions from various foot and ankle surgeons or podiatrists that you can until you are comfortable with your decision.  Bring a friend, spouse or significant other with you to each apt for a second set of eyes and ears.

If one correctly by an experienced ankle surgeon or podiatrist, one has a good chance of success with TAR.  Having it done by an inexperienced surgeon may potentially increase your risk of complications.

Dear James

You are 100% correct. Here in the UK where I live many surgeons are doing very few ankle replacements which leads to many poor outcomes. It is almost as if they feel that it is important to be able to list it on their CV. This is IMO very unfair and costs our National Health Service a huge amount in revision surgery.

I would like to make people aware of a big danger surgeons usually fail to talk about when setting out the risks attached to this surgery!

It is Osteolysis. This is bone degeneration caused by cysts in the bone and is thought to be caused by the interaction of the wear debris generated by the new joint causing a reaction that ones body cannot cope with.

The body can usually deal with a small amount of this debris but if the joint is badly set the amount of wear debris is potentially going to be very much higher as in my case and being very active too simply increases the risk!

I've been trying to get my TAR revised for over a year and am now happy with the surgeon I've selected and his proposed plan of action. This just should not have happened.

Members may be be interested in seeing a short video of me walking up and down a slope and trotting up and down a flight of stairs at twenty weeks post op. You will understand why I feel so gutted at the subsequent failure of my prosthesis! For anyone interested just Google yogesh total ankle replacement kenward.

Please do not be put off having this amazing surgery but do go into it with both eyes open and find a really experienced surgeon. Dies not matter a jot if you like or dislike them as you are the one who will ha e to live with the consequences of the surgery for the rest of your life.

Cheers Richard

Who was your surgeon in Rochester NY?  Two prominent surgeons have recommended a TAR; one suggest Infinity; one prefers STAR. 

Dr. Sam Flemister did the surgery.  I first saw in Rochester Dr Judy Baumhauer, who is past president of the American Society for Foot and Ankle surgery, and very highly thought of nationally, and she said she was mostly doing research now and not doing as many TAR's, and suggested I see Dr Flemister.  I have been very happy with Dr. Flemister.  I also consulted Dr DiGiovanni at Mass General, who has done a ton of TAR's, who recommended Dr Flemister as well, since I did not want to wait 8-10 months to get on Dr DiGiovanni's schedule and also did not want to have to drive 5-6 hours to appointments.  I saw a local Syracuse surgeon a few times and decided for several reasons to not have him do the surgery.  I didn't think he had done enough of them, he was going to use the Inbone prosthesis, which seems huge to me, and he did not correctly diagnose the heel pain I was having (he thought it was secondary plantar fasciitis, when it turned out to be secondary to subtalar joint arthritis).  The local doctor also gave me a series of steroid injections which I feel hastened the destruction of the joint.  

Many thanks for your prompt response.  I met with Sam Flemister this week and he concurs with another orthopaedic surgeon - TAR is my only option.  May I ask, and please be direct, what is the pain level after surgery.  I'll hop, roll, jump do whatever is needed to recover but would like to 'program' myself for post surgical pain.  Flemister seems to be the surgeon who has the most experience in this area.

I had an TAR with an Infinity device on June 9 of 2017.  Everyone's pain tolerance is unique, each surgeon is unique, and each ankle is unique.  Having said that I can tell you that I had virtually no pain after surgery.  They did a spinal block on Friday the day of surgery which was to last 24 hours.  I had some discomfort at 9 AM the next day so I took an Oxycodon-Acetaminoohen 7.5 - 325 to "stay on top of the pain".  I took 3 pills that day and 1 at 2:00 AM the next morning.  When I woke up later that morning I realized I had only mild pain which was no worse than what I had lived with for 26 years while trying to decide what TAR and surgeon to choose.  I took 2 pills during the day and 1 just prior to going to bed.  After that I took 1 pill each night for about a week just to help me sleep.  I'm now 7 months out and I couldn't be happier.  Maybe my story is unusual but I firmly believe the surgeon and TAR model you choose make a huge difference.  I've been all over the east coast over the years getting opinions from John Hopkins in Baltimore, the Hospital for Special Surgery in NY, etc. The surgeon I used just outside of Nashville has performed over 800 of these operations. 

Best of luck and keep us posted.  

800 surgeries is remarkable!  I investigated going out of area to have the surgery, but so many expenses would not be covered by my insurance if I did so.  I have a pretty high tolerance with pain, and like you said, compared to the grinding we've lived with, a few uncomfortable days is well worth it.  Thank you for responding.  I'm leaning towards going with the most experience surgeon in Rochester NY.

I have also been looking for a doctor in the middle Tennessee area. Is your doctors name Tresssler? How have you been doing since your TAR?

thanks, Mike

Yes.  Dr. Marc Tressler.  It's been awesome, a life changing experience.  No more pain and after 7 months I don't even think about my ankle.  

Yes, there are only a few surgeons in the US who have performed more of these surgeries.  I would definitely recommend checking the experience level of your surgeon.  I chose the Infinity because with that TAR the placement of the new ankle is for the most part taken out of the surgeons hands with a device they call the Prophecy.  I've read so many horror stories in this blog regarding improper placement of the TARs.  Good luck to you!

Dear Bruce

I very much support the premise that it is far too critical a surgery  to be done by anyone than by a really experienced surgeon with lots of successful ankle replacement surgeries under their belts.  As a result of a poor ankle replacement surgery some years ago I am waiting for what is likely to be a difficult revision so I'm speaking from bitter experience.

Cheers, Richard

Dr Flemister is moderately experienced.   There are doctors who have done more, but I think he has done enough to do a reliably good job.  There is a doctor in Buffalo who has done several hundred, but I never consulted him.  Dr Flemister is very down to earth and caring.  He communicated directly with me via their portal messaging system when I needed.  His office staff were very responsive to my needs as well.  When I had a difference of opinion or questions about a direction we were going, he was very willing to discuss the issues openly, and review medical literature I sent him.  I have no qualms about his care.

Regarding post op pain:  I had two divergent experiences. At my 2016 surgery, I had both a right TAR and a right subtalar fusion.  I was given a nerve block and was told I would awaken from anesthesia without pain, and that the block would last about 24 hours.  Unfortunately, I woke up in agony because the nerve block did not take.  The pain was major for over 2 weeks, and it continued until almost a year after the surgery.  However, I was able to enjoy sailing Lake Ontario and golf over the spring and summer (had to take a cart, could not hoof it), and took tylenol for the pain.  I believe my abnormal gait from my other (left) ankle made my recovery from the right more prolonged.

When I had the left TAR done in 12/17, my experience was the opposite.  The nerve block was fabulous and lasted 36 hours.  It was still in effect when I left the hospital.  I didn't take my first pain med until I was home, and then only needed it for less than 2 weeks.  The first week was the worst.  I did not need the subtalar fusion for the left, and I think that played a role in having an easier time a year later with the left TAR.  I do not regret having the right subtalar fusion, because the right subtalar joint was severely arthritic and was a major component of my right ankle pain prior to surgery.

I had some minor delayed wound healing with both procedures, but it eventually worked out.

The most difficult part of the recovery for me was not the pain, but the 6 weeks of non weight bearing.  TAR's are different from total knee and hip because they do not use cement.  The bone has to grow into the prosthesis, which takes 6+ weeks.  Because they cement the knees and hips, one can walk immediately post-op knee and hip as soon as the anesthesia wears off, but not so with ankles.

My words of advice are to take the nerve block (usually they work), keep your leg strictly elevated post op for the 6 weeks (reduces swelling and therefore reduces pain and promotes wound healing), do as much upper body exercise as you can to keep yourself sane (dumbbells, weight machine, stretch bands, etc), take the pain meds liberally as needed the first couple of weeks then switch to tylenol (barring any personal contraindications), ice pack the ankle for at least the first week or so15 minutes every 4 hours, (I suggest a Chattenooga cold pack 

https://www.amazon.com/Chattanooga-Reusable-Shoulder-Swelling-Inflammation/dp/B000EAPNCQ/ref=sr_1_2_sspa?ie=UTF8&qid=1516555584&sr=8-2-spons&keywords=chattanooga+colpac&psc=1&smid=AU7J3LKP4F2O4

and be patient, and be patient, and be more patient.  You will get frustrated, but be kind to your care givers.  The 6 weeks seems like forever when you are going through it, but it passes.  I found a knee walker to be great.  I actually used it to go to basketball games at the Carrier Dome.

Both times I was walking at 6 weeks with minimal discomfort.  Dr Flemister preferred I continue using the post op boot for a month after starting weight bearing, but I could not because walking with the boot aggravated other joint problems (knees and hips).

Overall, I have no regrets for having had these procedures, and I am very grateful for the excellent medical care I received from Dr Flemister and his team.  I would be in a wheelchair had it not been for his magical hands.

 

Hi Richard,

I've read what you've gone through in the past and I can only imagine the difficulties you've encountered.  Good luck with the revision and please keep us posted.

Regards,

Bruce 

Dear Bruce

Many thanks.   Hope your ankle is doing well.

All the best, Richard

I had the Wright In Bone TAR a little over 11 months ago.  I can honestly say I have no pain, but I still have a lot of numbness.  My two big toes and the bottom of my foot are numb.  I am 66 years old and live in Eugene, Oregon.  Nicholas Strasser was my surgeon and I believe he did a fine job,  If the bottom of my foot gets bumped I will experience discomfort.  It's like the nerve is there but just out of whack.  The surgeon had to move the nerve in order to clean out the arthritis and he has told me that it could take a year or more for feeling to come back.  Does anyone else have experience with numbness?   I really don't have much of the prickly pin cushion sensations but I will feel little jolts of sensation every once in a while.  I'd be interested in knowing if others have experiences this and if their feeling came back.  Thanks!

John

 

Hi John.  I never had numbness but I did have what felt like little jolts of electricity on the left side of my ankle.  I had a large amount of scar tissue in that spot from my original accident.  I believe the tingling was a result of the scar tissue breaking up as I regained movement in that area.  It happened occasionally for about 4 months.  I'm now 7 months in and have not had any recent occurrences.

Possibly your jolts of sensation is just part of the healing process.  Good luck.

Bruce

I did not experience this with either of my TAR's

Wish I would have found this blog a few years ago, but that is moot at this point. I am about 7 weeks PO of what I so far feel is excellent procedure, but I've been looking to see if anyone else has had the following.

Operation (TAR) went well with everyone involved pleased. Nerve block seemed to have lasted far longer than I expected. Stopped Percocet a day or two before prescription ran out as there really and still isn't any pain. Uncomfortable but no pain till day stitches removed. I've had stitches many times in my 67 years, but the last three (closest to top of foot) brought me to tears and looking for that stick to clench in my teeth like some old western movie. Since then I have had random shocks, burning sensations, and aches that are just enough to wake me up just as I fall asleep. I was hoping to find more references to this, but you seem to come the closest. No mess seem to effect this what so ever (Percocet, Flavil, over the counter anything, etc.). I think surgeon, post op nurse, and everyone else believes this is temporary and I'm hoping. Just wondering if you've heard or experienced anything similar.

Thanks for any consideration. I still think the operation is todate a success and I'm pleased with surgeon et all, just wondering why my symptoms aren't mentioned.

Kenneth, I am 11 weeks out.  I have at time experienced a burning pain at the top of my incision.  It lasts a few minutes and goes away.  I attributed it to reaction to the suture material (don't know if this is correct or not).  The burning is not as severe as what you describe, and has lessened in intensity as time goes on.  Hope this is helpful

Which TAR (brand, STAR, Zimmer, etc.) did your surgeon use.  I have read numerous reports of nerve pain, after a TAR, particularly with a front entry surgery.  Zimmer is installed from the side.  Good luck.  Encouraging to chat with people who have actually had the surgery; not that common. 

John I had mine done almost 4 months ago and my foot, toes, top of foot and lower leg still feel asleep! I did not have a nerve block. I am being told this is normal and may take up to a year. My swelling is pretty bad as well and that is the hardest part adding to my toes being numb, it is like going to the dentist and getting Novocain and feeling like your tongue and lips are swollen but really aren't, where in this case they are! My heal has been awake since almost the beginning and about a month ago I started feeling like I was stepping on tacks just in the middle of my foot that has not stopped or changed in anyway! I do have pain and discomfort everywhere in the area of the surgery. I have gotten more stiff lately and my range of motion and gone backwards too. So you are not alone!

Good Luck to you! My best suggestion would be to make sure you are mentally prepared for this! It may turn out to be more than a few uncomfortable days for you! I did not have the nerve block and the pain really wasn't too bad once I was home. As long as I didn't let my leg hang down! Always keep it propped way above your heart when sitting or laying!  Listen to your surgeon when it comes to your incision! If not prescribed get some 15-20 compression socks when you can start wearing them to help with the swelling. Ice as much as you can! That being said, I'm 4 months out and I am regretting doing this each and every day now! I still cannot feel my foot/toes/lower leg, my swelling is horrible and my PT just cut me off after only 2 months because I'm not getting any better. My range of motion is not where it needs to be either. Yesterday I went to get a second opinion and the Dr. said "I can see you were not prepared for this nor given all the information upfront" and I guess I wasn't. Everybody is different but the dangers are the same for us all! Oh and don't let me forget this, my insurance company didn't pay my surgeon, they said it was not medically necessary because I did not meet the criteria. So that is another thing to make sure of. Just because it may be a covered benefit does not mean that they will pay for it!

Shelly, it has been 13 months since my surgery.  I came out of the surgery with numbness in my two big toes the top of the foot and the bottom of my foot.  I had tingly sensations for the first month or two.  I really have not had pain since the first 10 days or so.  I just have a foot that feels like a half a block of cement.  Still have some swelling but I'm able to play golf 3 days a week and have no pain.  The biggest thing is that I'm aware all the time that the ankle and foot do not feel normal.  I just had a complete nuerological workup and the neurologist told me not to expect getting feeling back at this point.  He said it was possible but not likely. So this is my new normal.  I don't have the pain I used to have which is great but I'm always flexing my foot to see if the numbness is still there.  I do have feeling but it's out of whack.  If I were to bump the bottom of my foot it would hurt or if I have flushed my toe up against a baseboard I wouldn't know it till after a lengthy period of time and then I would feel it.  All in All, I would do the operation again.  I walk much better than I used to.  Hang in there and hopefully you will progress in all areas.

Sounds like your insurance carrier got it right, either you should not have had the procedure, by reasonable risk/benefit analysis, or the surgeon was horribly incompetent.  So many times we have been told it is very important to have a very experienced surgeon.  What is the name of your surgeon, so others may avoid him/her?

A short update. The surgery was carried out six weeks ago and appears to have gone well. The surgery took six hours and for protection I was on an antibiotic drip for ten days.

Very little pain but totally shattered looking after myself at home. Now at six week feeling much stronger and capable.

Been allowed partial and increasing partial weight bearing in the last few days but think that I may have set my recovery back because I'm now getting a little bit of pain and twinges.

Another follow up visit to hospital next week so hopefully nothing horrible will be found!

Cheers Richard

Tara

​I am headed for the Infinity replacement and worried. I have a bunion on the same foot and bad feet to start with broke my ankle 2 years ago and arthritis now there and getting worse. How bad were the first few weeks and months after he TAR ? I see so  much bad news from so many that I fear I may be worse of if I do this Infinity TAR and searching for anyone for advice to see if it is even worth doing ?

 

Hi Richard,

I have been reading your comments and the last one was 6 months ago. I do hope that by now your ankle is much better and you have not had to go through any revision surgery. I have just had an ankle arthroscopy at the RJAH Hospital near Oswestry with Mr. Andrew Bing. They were going to also do a foot correction due to no arches left, but abandoned this as they found I have no cartilage left, and therefore have final stage post traumatic arthritis. Mr. Bing has already done around 80 replacements and I found him via a previous patients whose replacement was very successful. My two options now are a fusion or a replacement. Can't have a fusion as my other ankle is not good either and I had CRPS very badly following a break. So, my only choice is a  replacement. After the arthroscopy op, Mr. Bing said that I might not feel too much pain walking and this could last for 3 days, 3 weeks or even 3 years. Not sure at this stage how I will fare, as I am only in my 2nd weeks of recovery. I would really like to have the op soon and get on his waiting list, but having read all the comments above, I am not so sure.

I am doing a lot of research and will ask him all the questions you suggested. Could you please let me know where and who did your replacement and have you heard of this hospital? I can only say good things about the care and this surgeon. 

Thank you very much for your response.

Update for anyone who may be interested.

OK, the revision surgery was on February 26th and I've made a fantastic recovery in the opinion of the surgeon. I have tried to be sensible and I started back to swimming as soon as my incision had fully healed about three months ago and go five days a week and swim for about ninety minutes.

I was asked not to use my legs so as to avoid the danger of pumping fluid into where the surgeon had to repair a large cyst resulting from the original TAR which caused the trouble.

I've started using my legs now for swimming but not all of the time as I was told to increase the use. Of course I overdid it and had to rest my ankle for several days but t did not prevent me from moving about.

I've been back to full exercising for a couple of weeks and have walked up to four miles in one day with no ill effects, just slight tiredness in the ankle. Sometimes it feels a bit tender alost the feeling one gets from a bruise but it does not feel sensitive when squeezed.

My gait is excellent and nobody would be able to tell that I have had a TAR. My stride length, and speed of walking is very good and I can keep up with guys half my age so I'm pretty happy.

If anyone would like to talk on the phone about it then please message me. I am not prepared to try to do it by email as firstly I'm not fast on the keyboard and secondly you will get much more benefit from having a discussion. Just send me a message.

Cheers Richard

Please check out the update that I have just posted to this thread. Cheers Richard

Would love to have a quick chat, but how?? Inge

I've just sent you my phone number. Cheers Richard

Dear all

Please call. If I don't pick up can you please leave me a voice mail and I will call you back

I need to talk to anyone who has either done a TAR or will be

Thanks.....David

Moderator comment: I have removed the phone number as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

please can you tell me which surgeon you are now seeing many thanks

Hi Ellie,

to date, I have had an ankle arthroscopy 6 weeks ago at the RJAH Orthopaedic Hospital in Oswestry under Mr. Andrew Bing. Once they had done the debridement, it was found that I had no cartilage at all left, so will need a TAR. I researched very carefully for a surgeon who had already done a number of TAR's and Mr. Bing , I believe, has done some 70 TAR operations to date. I think he is brilliant and I would not go anywhere else, even though I live 2 1/2 hours away from this specialist hospital. I can't really comment on any other hospitals or surgeons, but you can research on the following website for specialists in ankle replacements.

Good luck with your research and ask your doctor to refer you to the surgeon of your choice on the NHS.

Let me know how you get on. Inge

thank you so muchi live in central london , mr BINGS SECRETARY RECOMMENDED mr andrew goldberg in london . that just confirmed what i had been told . has anybody ever had surgery under mr andrew goldberg ??

Dear David

I also need a TAR and just deciding which surgeon to use < very tricky ?

Mr Bing recommended Mr Andrew Goldberg in london .

I see this post is 5 years old. How are you doing, these days. I am end stage on my ankle, but I can walk in 1 1/2" wedge shoes most days.

I only get about 30 minutes to an hour on my feet with rests inbetween.

Was your doctor very experienced with TAR? I have seen 4 surgeon DPMs, young and not too experienced. One is 45 and more experienced, but I just don't believe the amount he says he has performed. 'Trust, but verify'.

I am 69 and pretty fit, considering I shattered my ankle 47 years ago.

I hope you see this and respond with good news.

If I wait much longer, it may result in amputation as there are MANY subchondral defects (sacs filled with fluid)...

Thank you, in advance.

Warm Regards,

Viki

Hi Viki

Thank you for the message.

How am I doing these days... well it's been 5 years that I have had the TAR and if I compare to what I had before the TAR, I must say it was a worthwhile 5 years because I have had much less pain and more mobility than what I had before the TAR. Was my doctor experienced?. One must look at that in terms of how experienced the doctor was with the specific prosthesis and the procedure attached to that specific prostheses. In that regard, I heard after the operation that I was number two in Africa to receive that specific prosthesis so I guess he was not experienced enough but he still did a pretty good job. I was unlucky with the after-care and the healing process took longer than I anticipated so it could have been a much better outcome, was I aware of it.

That said, at the moment I am struggling with a stress fracture of my Fibula close to the TAR and I have to wear a Moon boot for 6 weeks. The prothesis moved and the alignment is putting stress on my Fibula, to such an extend that it caused a stress fracture now. Apart from that also, I was told that the prosthesis is pretty loose and will eventually work it's way up the bone and that can cause huge damage to the bone...possibly split it etc. I can still walk on it with relatively low pain and movement of my foot and when I lie down, it is totally painless....very normal movement etc.

In my case I really have two busted ankles and also very worn out shoulders...at 57 ...not a joke. So I have to be very careful what my next move have to be becasue I can not walk too far on crouches either. I currently have appointments with two surgeons. The one who did my TAR 5 years ago and the other is to my knowledge the most experienced and specialized ankle surgeon in my country. I have been to both in the past also. I need to find out what has perhaps happened in the last 5 years in terms of TAR revision etc. so that I can plot a way forward for my replaced ankle. Maybe there is also for me a bit of good news?. The other one will have to be fused, but not a complete fusion, only one of the three joints. Depending on what I come back with after my visit, I will have to make calls and plot my course of action going forward. I am very sick and tired of not being able to do things I want to do as a normal person and also of cutting back on my quality of life all the time. One has to get yourself up-and-running - figuratively speaking, as soon as possible.

I am not against TAR at all. If a revision can be done with maybe a prosthesis that has a more sturdy method of fixation etc. I will have to consider it because I already have a hollowed out hole with a loose prosthesis in it currently. Taking it out and filling that gap is another longtime uncomfortable process, unless it can be filled with another prosthesis and that is why I have to consider revision surgery for that ankle.

I have just spoken to a friend of mine who had both his ankles fused after they were crushed in a parachuting accident in 1986. Now, 30+ years later only things he complains about is the occasional cold winter pains and a bit of arthritis. If I knew him 5 years ago, I might have gone the fusion route instead because I was under the impression that walking with two "stiff" ankles will be very hard, which is in fact not the case.

I have learned that each ankle case is unique because there are other factors e.g cysts and like in your case other sub-cordial defects etc.. Each one has to be judged on it's own merits and age does also play a role, as does levels of activity. I am actually much in the same boat as you in that regard, but I have two of them little buggers to worry about😒. If I were you, I would seriously consider ankle arthrodesis and not TAR. Chances of complications with TAR is just too high and once you have a TAR, ankle arthrodesis afterwards becomes much riskier and hard to perform due to loss of bone tissue. Don't let them tell you that ankle arthrodesis is still an option if TAR fails....it is not that simple. To have that fixed can literally take a year or more. Age and healing of bones etc. is also in your case perhaps more of a factor than in mine, but you will have to talk to an experienced medical practitioner about the options. Also lots of information on the internet. Just remember whatever you decide, after-care and complete healing is the number one factor for success. To accomplish that, you have to be manic about letting your ankle heal 100% completely before you put weight on it. I am serious, you can sort out any stiffness etc. afterwards but just let that thing heal completely. To give your body the best chance of healing, you have to abide by the rules of good healthy living by eating healthy food and to absolutely NOT smoke any tobacco. (Smoking retards bone growth up to 2.7 fold)

I will report back when I have more clarity on my position end of this month and I wish you all the best Viki. Please let me know what is happening on your side also. One has to prevent amputation at all cost, I believe, but when it comes to a certain point in ones life, it may be the best option to regain the joy of life you may have had to give up due to the condition of your ankle. I will however explore all possible options before I settle for amputation though.

Regards

LDT:

Thank you for your in-depth reply. Fortunately, I've eaten organic for forty years. Though I smoke loose organic roll your own cigarettes, I have to stop. I use systemic enzymes and understand horsetail herb promotes bone healing. It us the time of healing that gets me, but am so glad you do not regret yours.

Take care.

I look forward to your rrply. God Speed.

Viki

Was your TAR an inbone? I don't qualify for the Star or any regular TARs.

Warm Regards,

Viki

Hi

I had the Zimmer Trabecular TAR done in 2014.

In the past I have taken a look at the in-bone system and I guess it may well be the only possible option for me, as far as a "revision" of my TAR is concerned. Not sure if it is done in my country but I will certainly ask the question end of this month. It seems to me like the only TAR that has the strength and agility to hold up to the forces at play in an ankle.

Regards

Hello, may I ask how you are doing now and which TAR you went with? Are you pleased with the result?

Thank you

I am at week 5 with an infinity TAR....It seems to be great...no pain...my surgeon thinks it is the best...good luck

David from Northern California

I am in week 5 post op with an infinity..

All is good so far and next week I get my cast off and finally a walking boot...my surgeon from Sacramento was Dr. Russell from Kaiser who is amazing...he says infinity is the best and would never use a star....like to stay in touch..

David

hi David, how are you doing now? I'm working with Dr. Russell now and thinking about the ankle replacement and doing some research. I had a bad fall that resulted in a compound fracture of my ankle. I have been in pain ever since. Dr. says I have no cartilage left in the joint and a TAR or fusion are my only options. Was wondering how your TAR is holding up.

Thanks for any insight you can provide,

Byron