Ankle Replacement Surgery

Hi there,

I am jumping into this conversation after lurking on the site for a few months.   I had TAR almost 9 months ago in Boston using the STAR device.  I am beyond delighted with the results.  I have essentially no ankle pain (less than my 60-year old still-original and much-used left ankle) and have been able to return to all activities, save running. I avoid running only because of the admonition of my doctor not because it is uncomfortable in any way.   Regarding numbness, I suppose 6 weeks out from the surgery I still felt some nerve trauma from the major operation but for months now I feel that all sensation has returned to my foot.  My only concern at this point is finding a balance between living my physical life to the fullest and trying to make sure that I don't hurt this joint and require another surgery.   It seems pretty bulletproof at this point with hiking and farm work being the things that I do that stress it the most.

Glad to hear you're doing so well! I hear alot of negative stories about TAR results, it's nice to hear such a positive one.  I'm in the same boat as you, I'm an athlelte and now I need to find something to do that won't damage my ankle, especially because I'm so young I need to make this one last as long as possible before the next one! 

Hi Ultrarunner,  I'm also from Boston and about to have a TAR and wanted to hear how things are going for you.  I need to hear a "success" story after reading so many stories about complications. Please write back with any words of encouragement  or advice. Thanks again for your post

Had the operation 3 months ago and i could be a succes story?????.

Goog movement and nearly the same as my good ankle , no pain sitting or lying down BUT walking thats another story. I would say pain 6 0ut 0f 10 prior to op and 7 out of 10 now.. I am told that prior to the op my ankle would get worse over time but with the op i would get better or stay the same.

I look forward ever day to improvement and back to a full walking situation.

I must admit i have just ordered a an electric scooter just in case i dont get any better.

Regards Mr Ankle

I'm 8 weeks into my TAR. My mobility gets a little better every day and I am ceasing to use a crutch about the house but need one for any distance. Soreness and acheyness occurs at end of the day and I still keep it raised whenever I rest.

Movement of the joint itself is very limited compared to my other foot if I point my toes downward but almost the same on pulling them up towards me as far as I can. Advice from a recent physio session was useless and a waste of time. 

There is a dull ache most of the time and plenty of numbness still but I am cautiously optimistic. Most of the stories here full me with alarm and I feel very sorry for those who are struggling.

Hi Mr Ankle

Glad to her that your operation appears to be a success. I had my TAR about 4 months ago and generally I'm good. I came to terms along time ago before the final decision to have ankle replacement that I would never be able to run again, do high impact exercise or contact sport. 

But having said that I can now walk for about ten minutes straight without any pain or discomfort, longer walks I take fold-away stick with me. My surgeon said that it will take at least tweleve months to "fully heal" so I as far as I am concerned I am on the right track. I finish my course of hydro therapy which has been so helpful today and then revert back to normal PT probably for about a month maybe two depending on how `i get on.

The only real annoyance I found was the numbness and loss of sensation in my foot on my left hadn side from my big toe to the back of me foot (I'd already lost sensation in the back of my heal the last time I had my final Laparoscopy)

But I guess given the trauma that your surrounding muscles, tendons and arties and veins are put through during surgey some loss of sensation is bound to occur.

I massage my scar daily which helps a lot too and exercise as much as I can flexing my foot pointing my toes using escalators to hang my heels over the edge and stretch and using stairs as much as possible. Each person is different for me it's be the best thing though I have been warned that it is possible I may experience the same scenario in my left ankle but will cross that bridge if and when it occurs

Hi lainey58

Keep going - do the ankle foot exercises start of with a towel around the ball of the foot hold on to the ends with your hands to create resistance and push the towel away from you and downwards with

Similalry when seated gently take hold of you ankle - crtoss your leg over with your ankle on its side sole of your foot faceing away from you and gently push the ankle and foot to point your toe

I'm constantly doing "exercises" when I do stuff standing in a lift I will rise up on the balls of my feet trying to make sure that my weight ie evenly spread for a count of ten and then slowly lower to a count of ten you can do this practicly anywhere it's small things that you can do step up and off using your good leg a counter weight so if you have an exercise step at home then you can do this one but make sure you can place the step somewhere where you have support. If you have a house with a landing and a banister then do it on the landing using the banister for support. So with your operated ankle step onto the step, then swing your good leg through and touch the toe of your ankle/leg onto the floor and then swing the good leg back through.

I also found that running warm water over my ankle helps too

Best of with your continuing recovery

Lucy

Dear Lucy,

I am approaching my 9th month since my left TAR, and reading what you describe about your case I find lots of similarities with my own case. Numbness to the big toe and back of the ankle is a mostly match, but like you I have a history of operations. I also had to come to terms with the possibility of never run again, although the thought still scares me because I never quite know how I can "save myself" in an emergency situation. I recall a time that I was caught in the middle of a lightening storm in the open, unable to run for cover, all I could do was fast pace myself, keeping all my fingers crossed. Another less frightening situation, but similarly stressful to me, is when I need to rush between flights in complex (an long lines waiting) airport systems. In times like that I feel quite inadequate for not being able to run - which I forgot how to do!

I do work on my mobility though, I am currently doing PT at the hospital and have to kick myself off my office desk to do streching excercises during the day. I feel that everytime I exercise my walking becomes less cumbersome, but if I sit down for too long the swelling and stiffness exacerbate. The "cure" is to keep your movement, you already do that. As for the numbness, well, we just need to cope.

Regards,

Gilbert

Hi gilbert-grapes

I hear you. We just have to keep on going and at the moment the progress that I'm making maybe slow but the ankle situation is a dam sight better than it was prior to my ankle op.

Wishing you all the best and hoping that the numbeness lessen as each month goes by

Regards

Lucy

Hello Amanda26614,

I am unable to advise you but am interested in your situation. I had a pretty major accident almost a year ago (hit by a car whilst out running!)  - I've healed very well but have the same issue with one of my ankles. my consultant says im a good candidiate for both TAR and fusion but is trying to steer me towards fusion which i dont want. Did you face the same issue? How did you decide to go with TAR?

Having had many ops on both my ankles, i have had ongoing issues with numbness in both feet. Whilst I cannot relate to your particular op, I do find that the numbness fades eventually  - it took 11 months for one foot and my other is still numb in part following an invasive op 5 months ago...not sure if this helps!!

Hey, i see that you had a TAR over a year ago, and was interested in how its holding up over a year later. I fractured my talus in a jet ski accident 8/30/2015 and its now 2/01/2016, doc said im not dealing with post-traumatic arthritis and might have to get the joint fused. Im debating between fusion or TAR.

What's life like after TAR? Im interested in your story because you're young as am i. Would snowboarding be out of the question? Im pretty active, snowboarding, running, gym and work on my feet.

Any insight would be helpful

Thank you

Sal

Hi salg13

I had a TAR in 2014 and all went well for a year and then it started to become loose. Had a CT scan 3 days ago. The prosthesis appears to be loose, has subsided and tilted and there are bone cysts forming in the talus bone and needs to be removed. The main reason why I had a TAR was because I am relatively young and wanted to live my normal life. Only afterwards, I found out that TAR is something that only older people should consider, just the opposite of what my impression was at the time.

A fusion usually is only one of the three joints in the ankle and you can have a pretty normal life after it. My TAR was done by a top surgeon, all was great (see my posts here) but somehow it just started to push up into the bone (I am 100% in shape for my height). It's not nice to have to go for more surgery now and to be honest, it could all have been avoided if I knew what (or how small) the impact was of fusion. For me at the time it meant something which I felt I would not have been able to live with. Today, retrospect, it would have been a breeze walking with only one little stiff joint that can not break loose,  instead of now having to face a possible stiff foot plus a leg that is 3cm shorter than the other.

Also remember, once you had TAR and things do go wrong, like in my case, a fusion of the one joint becomes extremely challenging and somewhat unlikely and that is not a position you want to find yourself in. A removed TAR prosthesis leave a huge hole in the bone that needs to filled up or completely cut out.  Please do your homework, there are more TAR cases that went wrong than success stories and you can by no means judge a TAR on only a year. Mine was fine after a year and shortly after that the trouble started.

Please don’t get me wrong, I am not opposed to TAR but I am definitely of the opinion that TAR is on the long term, not suited for an active lifestyle and should only be considered for older less active people.

Regards

Leon

Dear Sal,

I reply to you after the reply you received from LDT. I must agree (with Leon) that a person with an active life style - regardless of age - should consider TAR with great caution, for the risk to have issues in the near future after the procedure will be likely higher. With that being said, it seems to me that a person like you, who appear to want to keep the same physical activities, would most likely have problems, and that is all the logic to it.

In my case, I am now 1 year 1 month after my TAR, still fairly young (60) and active, I have few things to say: 1- the procedure Works! provided you have the best surgeon available to do it technically and scientifically; 2- the patient MUST do a good follow up post-surgery, doing ONLY recommended exercises (I would rule out snowboarding, for instance) for the duration of recovery, which might take a whole year or more; and 3- patient shall not be naive to expect 100% return to what he/she considered 'normal' life activities after a TAR (I, for instance, used to practice karate, I cannot see myself kicking a punch bag, or a person, again, ever) but instead should accept the new reality and adapt to it with new activities - don't see that as loosing all but as achieving new fun things in life that you never considered before, you'd be surprised...I am now coming to terms with just 'walking normal' again, it is still a challenge, every day I do stretching exercises for my foot and leg tendons - those are the real culprits for pain and stiffness you feel after the procedure - and walk at least a mile. I do not hold any hope to run again, although I am setting a goal to be able to at least sprint in case of an emergency.

The bottom line (for me, at least) is, as I always say in this forum, every case is a case, and each will certainly have different results after the TAR intervention, some will be good and others, unfortunately, not so good. As for fusion, I cannot say much or anything at all; probably, like everybody else who considered to continue having an active (by that I mean sports) life, I ruled it out in hope that TAR = joint flexibility as opposet to fusion = permanent stiffness forever, or so I thought. I still maintain that my decision for TAR was right one for my case and  so farI am happy with the result I've got.

All the best.

Laura32963, I don't know what you decided but,I was in a car wreck in 1992. My foot was cut and laying up inside of my leg, so it was almost cut off. I had my ankle fussed in 2004. Now I am having my ankle replaced with a star ankle in June 2016. My ankle has been in so much pain since December 2015. I have not been able to do very little since the beginning of December.  I go to work but that is only because I have to and at least as little as possible. I had the choice of a new ankle or amupate my ankle. I had not hearf of the ankle replacement, I was in so much pain I was ready to amputate my lower leg. When you have a fusion your ankle does not move and it hurts you hip and your knee. My Dr. said people that have a fusion are just miserable. I agree with him.

Hi

My late father had an ankle fusion and it was the best thing he did. He walked well and WITHOUT a limp. Don't believe all what the doctor says. Ask people who have experienced this. My late father was free from pain. 🙂

How did you get the surgery approved??? I'm 23 and every doctor I've talked to about the replacement told me no because of my age

I am also fromboston and would love to know who you saw

My options are ankle fusion and ankle replacement

Leaning towards replacement

What was your recovery time

Its really refreshing to hear stories like yours, I've had the replacement a year now (Nov15) and I'm so glad I had it done - I've been told not to run, but would love to hear from people who can.

Hi Amanda,

Sorry just hopped on this site and your story stuck out. I just turned 30, and have had 6 surgeries to repair my ankle after a fall. I have had a subtalur fusion and have extremely limited range of motion. My only option right now is a replacement, but I'm nervous cause of my age. How is yours going after a year? 

Hi, I'm about to get a STAR TAR and I'm incredibly nervous about the procedure. I have no cartilage left in my ankle and every step is painful but I can still surf, ride a bike, get around... my fear is, what if the replacement is worse than what I have now. It sounds like you've had a very positive experience and I'd love to hear how you're doing at this point. I'm male, late 50's, very active, and in good shape. Thanks

I am having a TAR next Friday.  Had fusion last April as I need both surgeries due to auto accident 6 years ago and 5 surgeries since the accIdent . Pain is constant, had to quit golfing, walking, any distance requires crutches or knee walker.  Limited to stationary bike, and floor exercises such as bridge lifts(100 pr day) bicycle crunches, etc.  Ten weeks non weight bearing caused atrophy in my leg so working have hard to get it back before next surgery.  I read this blog and hope my situation works out well. I know it will be 10 weeks again, and  months  before I'm active again.  I'm late 60's and was extremly active in all sports.  Not a good candidate for couch potatoe lifestyle. my surgeon is using a Wright in bone, as I have small bones, and considered small woman.  

Good luck and keep us posted. The couch potato life isn't for me either... fingers crossed!

 

Hello Amanda, my name is Bob , I'm a 63 years old,and have severe  arthritis in both ankles. I am researching Boston Hospitals and procedures. I have been considering the STAR procedure. I used to play tennis ,hike,run etc.I have been surfing my whole life and still get out surfing  when I have the occasional "good day". I have had bone spurs removed with no results with less pain. I would be real pleased to be able to walk without bad pain and surf long board style. If you could share the hospital that treated you it would help me start my search for a seasoned physician for a TAR in Boston.

  I'm really glad and encouraged  to hear you are doing well with your TAR.

It takes about a year for the numbness to go away. In some cases it doesn't go away completely. After my replacement my toes an entire top of my foot was numb. 19 months later I have tiny bit of numbness on the top of my foot but it doesn't bother me at all. It's barely noticeable. Give it time

Research the failure rate with the Star. Do as much research as you can. I have the Wright Infinity replacement. While I know people who have Star replacements , many of them needed revisions early on and some of them failed completely. The difference between the Star and other replacement is that the Star is a mobile bearing device . That plastic piece in the middle can slip causing replacement failure and future surgeries. I encourage you to get a second and third opinion. After stating this I can also add that I've talked to people that are happy with their Star too. I just encourage you to check the recent failure rates.

I got my replacement st 48. I'm very active . I have had a subtalar fusion as well as a heel alignment with my replacement. I'm very active. The subtalar fusion often prolongs the life of the replacement , which is a good thing if you are active. I don't have the same range of motion as my left foot but I'm still really happy . I have a normal walking gait, bicycle, hike in rough terrain, and work on my feet 40 hours a week. I have met other people your age that have had replacements.At your age I would stay away from total ankle fusion .

An ankle fusion can be great for someone who is not very active. However , I have met so many people who ended up get arthritis in the rest of the foot due to the fusion . This is very common with fusions . I'm very happy with my replacement. I am now pain free. I had an extremely complicated case so that fact that I am now pain free and very active I am so happy I didn't opt for the fusion. Get a second and third opinion if you are still not sure what you want to do.....

I think that you will find that all ankle prosthesis have a poly insert these days. The poly insert is thought to be the main cause of osterlylis following replacement ankle surgery.

This is caused by the tiny wear debris leading to cysts in some patients which can then lead to the failure of the prosthesis! This is what I’m facing after having had my ankle for only four years.

Most ankle surgeons will not explain this very real danger before your surgery which I think is disgraceful. You only have to look at their web sites to confirm this.

Cheers Richard

I have always understood that ankle fusion is the recommended option rather than ankle replacement surgery for very active people. I am pretty active but choose replacement surgery because I did not like the prospect of my foot joints failing and reduced ankle movement.

Cheers Richard

Hello my name is Mike and I am 62, about 8 years ago I had a latter slip out  fell 14 feet to the ground. My right ankle was only hanging on by muscle and skin. 6 surgeries and a ton of metal and screws I walk. I have developed arthritis and live with alot of pain and I mean alot every walk is calculated if you get the drift. Once I start walking the pain subsides but alot of foot work and it is sourer and more pain than before. I have been thinking haveing it cut off, but going to Advanced Orthopedic yesterday has renewed my hope. I am thinking about gettted a TAR so I found your this post. I am hopefull and still feel that this is my best option. Pain is pain and I live with it every day. My life is limited at best no running, jumping, carrying weight and the like. Everything I do or try to do I must consider my foot. My bigest problem is how to schedule it with my life and work and an unsympathitic family. 

sounds exactly like my situation.  Where are you and Advanced Ortho located? My orthopod (Dr. Patton, Arrowhead Ortho, Redlands CA) is anxiuos to do a Wright replacement, and he has given me Orthovisc injections which provide some relief.  Scheduling & family assistance is big problem. 

Hi Mike,

My two cents.

?I’m a 66 year old male in relatively good shape. 

On September 1, 1991 I broke both right leg bones and crushed my ankle and heel.  I’ve been living with moderate pain and very limited mobility for the past 26 years.  I chose not to have a fusion.  I waited all those years searching for an ankle replacement that looked good to me.

Earlier this year I discovered the Inbone Ankle replacement.  One of the more difficult things for a surgeon to do during this type of surgery is to remove your ankle and properly align the replacement into the correct position.  The Inbone system eliminates this.  6 weeks prior to surgery a CT scan is taken of your ankle.  From this your new ankle is manufactured along with the Inbone Prophecy.  The Prophecy instructs the surgeon what to remove and how to place the new ankle, thus greatly reducing the chance for human error.

I had replacement surgery on Friday June 9, 2017 in Hendersonville TN.  On Saturday a nurse helped me out of bed and had me stand with weight on both legs.  I was able to do this with no problem.  I stayed in the hospital one night and was discharged the next afternoon with a splint on my leg and 60 Oxycodone pain pills.

I had mild pain for 4 days after the surgery and took a total 8 Oxycodones to help relieve the pain during that time.  After 4 days I had very little pain.  I did take 1 Oxycodone each night to help me sleep for 7 more days.  After that I was pain free.  I was allowed to shower with full weight on my ankle immediately providing my splint did not get wet.  I was able to buy a splint cover for $35 at a local medical supply shop.

On Wednesday June 28 the splint was removed and I was placed into a hard cast.  My next appointment is Wednesday July 19.  At that time the cast and all stitches are scheduled to be removed and I expect to be given a walking boot.

I’m ecstatic with the results so far.  I’ll post further updates as time goes by and I begin to walk.

 

I had a TAR almost 4 years ago in Boston. At that time the Baptist was the best for this procedure. At 53 they said I was too young. At 55 I did my research regarding fusion and why I didn't want one. Basically as someone else on this thread indicated you can get arthritis elsewhere from unnatural movement. I have arthritis in many joints and didn't want this. My mobility and pain is much better than before but it's not great. I dropped the ball as I was out of state. I am finally following up. Seems the ankle is fine. Swelling and pain is tendinitis. I am going to start treatment for this and I hope to have a complete recovery. I will say this my TAR has the same mobility as the other ankle. Tendon pain keeps me off my feet.

Dear Bruce

That's fantastic news. If your research did not flag up osteolysis this is something to be aware of as it can effect all man made joints due to the wear debris reacting with the body.

Not too much is known about it and it is not something surgeons warn you about before surgery but it is very real. The TAR I had four years ago has gone wrong because of this and because of the degredation to the bone a revision is not likely to be an option nor the fall back of a fusion.

Everyone owes it to themselves to be aware of the possibility and to make a point of asking their surgeons to look carefully at the X rays at each check up for any signs of this starting.

I had made an excellent recovery as you can see if you Google Yogesh TAR total ankle replacement.

Cheers

Richard

Hi Advanced Ortho is in Brighton Mi. The surgeon that put my ankle back on was Wise, no longer in Ypsilanti heath systems. 

Thanks for the response, good to know the surgeon's that do well, and the ones that don't.

Hello Richard,

Sorry to hear that you have osteolysis. Has there been any thing positive since your post 7 months ago?

I had a TAR in 2010 and although it took a few years for the ankle/foot to be happy again after the TAR - I have found it was a blessing, having reduced my pain by about 80%. Sure, I still have some pain and swelling, some cramps as well as some numbness some restrictions of movement - but I was very pleased with the outcome. i used to go up or down stairs sideways, like a crab lol lol before my TAR.

Unfortunately last week at my 7 year post op review my orthopod told me that my x-ray and CT Scan revealed one rather large cyst on the tibia and one smaller one on the fibular - possibly caused by as you said "tiny wear debris".

But on a more positive note he proceeded to tell me that he could drain the fluid out of my cysts and fill the cavities with some sort of synthetic bone transplant that should harden in there and after a few years will be like new again. 

Oh the reason we are not using my own bone from my own hip for the transplant is because the larger cyst is a fair size and he said that my hip would certainly protest after we were to take a large chunk out.

I am scheduled to have this done on the 25th of October 2017 and if you like, I will post again after the op to let you know how I went.

Regards Esther

Dear Esther

Thanks for asking.   It has bee a very trying year really.  I was all set ti have a revision of my ankle to deal with the failing TAR and the osteolysis but then my twenty year old hip on the other side decided that it was a really good time to wear the cup out and that meant a revision.  

I had to find a surgeon who I felt was good on revisions and then wait for the surgery which was in early May.  On my return home in the passenger ambulance I was thrown onto the floor as the driver had not waited for me to put my sat belt on.    As it was thought that I had suffered a cracked pelvis I was ordered to not weight bear until June 21so I was confined to my bed room as I was not to use the stairs.    A very frustrating time, however I started weight bearing on June 21sst and have made excellent progress and am fully recovered.

My pre. op for the ankle is at the end of September with the surgery set for October 22rd.   My gut feeling is that this will be delayed but I hope not.    I've been getting strange feelings of pain running up my leg for nearly a year and they are getting steadily worse.   It is just a warning to me that time is running out for my ankle.  

It is good that your osteolysis was picked up at your annual check up.    It amazes me that the dangers of osteolyssis are not made clear before surgery....it's as if it is a dirty secret.    Not that it would stop us going ahead with surgery but it is not right that we are not informed so that we have all the facts.    I suspect that many surgeons are ignorant of this risk as most ankle surgeons do so few ankle replacements that their experience of the surgery is limited.

I hope our conversation helps to bring this to the attention of those about to have the surgery and especially those who have had it to ask their surgeons to check for any signs of it at all of their check-ups.

Best wishes and please keep posting your progress.

Cheers Richard

Wow Richard - you have "been in the wars", so to speak. I'm sorry to hear.

I would like to know if your osteolysis is the same as my two bone cysts, as I live in Australia and my orthopod referred to my problem as a bone cysts filled with fluid which he will drain and then fill the cavity with a synthetic bone graft.  Is this the same as your osteolysis?

My op is scheduled on the 23rd of Oct., only one day after yours, provided they go ahead with yours.

I would really love to hear from anyone else who has had a synthetic bone graft or even an auto-graft from their own healthy bone.

Take care and all the best.  Esther

 

Dear Esther

Yes it is one and the same.   Had mine been spotted earlier this is what would be been the course of action.   My surgeon felt that the artificial paste had the advantage that it could be pumped into every part of the cavity whereas actual bone could not be packed in as completely.

I hope that is of some help.

Cheers

Richard 

Dear Ultrarunner

Glad to hear that all went well for you.   I had my TAR five years ago but due to osteolysis I'm having to have it revised in a few weeks time.    Unfortunately just when I was to have the revision my total hip replacement of twenty years ago on the other side failed and it was necessary to wait until I had recovered from that surgery.  

The delay has meant that the revision has far less chance of success.   Over the five years I had the TAR I've gone heavy building and hill sheep farming and although have had twinges from it I've not had to restrict myself apart from not running though I could have.   If you Google Yogesh total ankle replacement you wil see a short video of my walking and running up and down stairs at 20 weeks post op.

Best wishes, Richard

I was operated on by Dr. Jockel. He moves to Colorado. There is a greaT dr. he worked under who heads this area of surgery. please use The New England Baptist directory to find his information.

tara54372

who did you surgery? you seem really well informed and in a similar situation to my husband.

thank you.

molly