Ankle Replacement Surgery

Ten weeks post op, week two of therapy and I have nothing but positive feelings regarding operation. Should have done sooner.

That said, I must talk to the only real pain I have had and from the response of others I am not the norm, but believe anyone contemplating this op should be aware of. From what I understand nerves are not cut, but do get moved around, handled, etc. and in my case are have been slow to return to what might be considered correct function. I have since the stitches were removed experienced shocks, burning, and other random pulse type pain that I don't remember anyone else mentioning. It has/is improving, but this pain responds to nothing and I have pretty much just endured. No prescription antidepressant, no over the counter pain reliever, etc. have all been of noand inturn sleeping has been poor at best. Just as I start to sleep a zing of pain shoots through my foot and brings me back fully awake.

Please don't let this turn you off especially if you have had the issues that make replacement your next or only option. I am amazed at the results and would do again (probably the other one as it is just as bad). Don't no if this is of any interest, but best of luck and if you have any questions please feel free to write.

 I had a right TAR and subtalar fusion  15 months ago, and a left TAR 4 months ago.    I was absolutely crippled from the arthritis prior to each surgery.    I could not walk.

The recovery period is difficult, with my surgeon requiring six weeks of no weight-bearing.   This leads to a tremendous amount of atrophy and weakness of the legs.  It helps to exercise your legs  multiple times per day when you’re not weight-bearing and the push yourself one weight bearing is allowed. 

Now I am quite functional with relatively minor pain requiring Tylenol as needed. 

 My right subtalar fusion 15 months ago has probably posed the most difficult recovery.  However, the more I exercise and walk, the stronger my ankles and legs are getting.  My wife and I are currently on a cross-country road trip, having traveled about 7000 miles before my left TAR in the fall, and another 4000 miles past six weeks. The second leg of the trip began 5 werks  after being allowed to bear weight.  I was able to walk about 11 miles over two days in Las Vegas a month ago, and  many miles along the south rim of the Grand Canyon, and just finished playing 18 holes of golf today. 

For me the surgery has been nothing but a miracle.   

 I have not experienced any of the shooting pains that Kenneth describes. That does sounds difficult. 

 I’ve been involved in this blog for quite a few months, and the most recurrent theme that I have seen is the advice to be sure you hire a surgeon who has performed a lot of these.    I agree with this whole heartedly. There are many prostheses being used, but I think which prosthesis to use is secondary to which surgeon to use.   The foot and ankle are much more intricate than hips and knees, and therefore the most important ingredient for success is a surgeon with a lot of experience in the procedure. 

Dear David

I put a lengthy reply together many hours ago and just as I was about to press send I had to plug it into the phone charger and it vanished, lost forever! So here goes again.

Total ankle replacement surgery is very critical in many ways because we know the ankle joint is amazing in so many ways quite apart from being such a small joint when compared to the hip joint yet taking the same weight plus the weight of the leg. It is a universal joint, a shock absorber and a propulsion unit all rolled into one!

As a result it is critical that the load of one's body is carried straight through the prosthesis from the tibia. It is also critical that all the angles are correctly planned out before the surgery so that there is no flying by the seat of their pants by the surgeon.

My TAR done in 2012 seemed to have been a great success with certain concerns on the part of the surgeon though he failed to bring a major fault to my attention at any of our follow up appointments. It was only when I moved to another part of the country into a different heath authority and obtained my x rays and notes that the problems became obvious to me.

My original surgeon had spotted something at about six months that made us both very concerned indeed and it was what is called Osteolysis. This is basically the bone becoming destroyed by tiny holes that become steadily larger and known as cysts. This situation was carefully watched and at the three year point was considered to be not getting any worse thankfully and we both relaxed.

At my four year annual consultation my surgeon shattered my world completly by telling me that the osteolysis had returned with a vengence and that cyst filling was all that he could offer me and did not hold out much hope that this was any more than a temporary band aid fix. It was then obviously to me at that point that this surgeon who I had put so much trust in was not capable of dealing with the problem in a way that would give me my independence for the future back and that I would have to find a surgeon with the necessary experience who could.

Finding the right surgeon was complicated because a few months earlier I had moved a couple of hundred miles into a different health authority area. For speed I had to pay for copies of my x rays, CT scans and notes so that I had the necessary when visiting possible surgeon's to discuss possibilities

This was the first time that I could have a careful look at what had gone on and I was firstly surprised to read a mention of cysts or a cyst in the area of the surgery site but nothing to say what corrective action had need taken. The second and just as worrying revelation was realizing that the prosthesis had been inserted so far out of a central position in my tibia that to get it it in he had had to choo out a section of my tibia! This made a nonsense of putti g my body weight loading straight through the prosthesis of course.

I need to say that it is thought that osteolysis is thought to be caused by the wear debris from the poly spacer that is between the upper and bottom metal parts that make up the prosthesis interacting with one's body causing a rejection and resulting in the bone destroying cysts called osteolysis. The greater the friction the greater the amount of debris created. It is quite obvious that the more out of position that the prosthesis js the greater and faster will be the creation of this wear debris sludge.

It took me months of researching to find the right surgeon to do my revision then to transfer to his NHS list and then just when the surgery was weeks away my twenty year old hip replacement on the other side failed so back to square one to find a great hip revision surgeon. This all took many months before I could have the surgery and by the time I had recovered I had to start at the beginning of my ankle surgeon's list

OK this is all getting far too long and to a avoid loosing it all I'm going to hit send.

Cheers, Richard

Just a suggestion, but you might speak to your physician about trying Gabapentin for the nerve related pain.  I have neurological issues and Gabapentin seems to be a benign drug that definitely helps with nerve related pain (and it really helps with sleep too).  I anticipate having a total ankle replacement in August; my surgeon uses the Zimmer TAR.  A second surgeon prefers the STAR TAR which seems to result in more nerve related issues (more tissue cutting).  The surgeon comes in from the side of the ankle when using the Zimmer TAR.  Anyone familiar with or have experience with the Zimmer TAR?

Glad you have been able to have such mobility.  Which TAR did your surgeon use?

 

To add to my long posting the revision involved a considerable number of visits to the surgeon and due to his location each took a day. The planning that went into the planning by the surgeon and his team was very considerable and must have cost a huge amount.

The actual surgery was carried out out on February 26th and took six hours and generally went well and I'm not just started very limited but progressive weight bearing but will be in a hard cast for about ten weeks. Ugh! There was a lot of filling to clean out the large cysts and repair the damage caused by the badly positioned hole where the earlier prosthesis had been.

Guys please, please only let a very experienced ankle surgeon carry out a TAR. In the UK there are quite a number of surgeons prepared to carry out this surgery but most are doing perhaps only five a year which means it is very experimental most of the time and it is people like my revision surgeon who has to put the mess right at huge expense if indeed it is possible. YOU HAVE BEEN WARNED!

I'm 76 so having to deal with all that has been involved in this revision has been very tough but the really hard work starts in five or more weeks time assuming all is well!

Guys, the recovery from a good primary TAR is very demanding and is far worse usually than a hip replacement so ankle joint (TAR) surgery should be given the respect it deserves. I'm happy to try to answer any questions you might have, Cheers Richard

Thank you for input and suggestions. My Infinity was a front of the ankle unit and as I said, best outcome to date that I could have expected. Currently I am using Gabapentine for nerve issue to no avail, but it seems to be lessening so I will give it the benefit of the doubt. If this is nerve pain I never want to experience shingles or diabetic issues. Operation pain was handled well and in reality very bearable. I'm still amazed on how much I can do already and no longer have so many odd pains (used to bring tears to my eyes if I slipped my shoe on too quickly). Best wishes for your surgery and hopefully no new nerve issues.

Darn, I was hoping the Gabapentin would give you some relief.  300mg is a starting dose.  I've been told you can take up to six 300 mg tablets daily.

Glad you brought up the surgical pain issue.  Did you have a nerve block for the surgery?  If so, 12 hour or 24 hour block?  Just want to gear myself up for whatever lies ahead.  I'm pretty flexible, 70 years old, pretty adaptable.  Compared to bone on bone deterioration of joint, I'm looking forward to doing this surgery. 

 

Richard:  consider in the future typing your post in Word or some other word processing program, editing it, then copy and paste it to the discussion group once you are sure it is as you want it. That way you don’t risk losing it, and can polish it

STAR

My nerve block did not work the first time with my right TAR, but worked like a charm the second time when I had my left done. It lasted 36 hours. 

I love my STAR!! I am 6 years out and it is holding up excellent!!

67 years old w/ bone on bone in both ankles. Nerve block if anything was over kill. Took three plus days till I could feel someone touching my toes and while I took pain killer for ten days I never felt the pain I expected. Operation and recovery were great. You just don’t want nerve issue afterward, but as it seems I’m not the norm...best of wishes and Yes it’s worth it. 

Six months ago I had my right ankle done with a TAR. The surgeon was fabulous. However, I experienced horrific nerve pain, I was perscribed gabapentin, it relieved the some of the discomfort. Currently I’m free of the nerve pain, I’m walking, playing golf, not well, but playing. I’m not in chronic pain any longer. However, my body is recovering from being sedentary.

I feel as if I’ve been given a new life, I’m so grateful for science.

Wish yiu the best.

 

Jeanette, Currently I'm taking 300mg gabapentine daily and really not sure it's helping or if it is I fear for the day script runs out. How long did you use it and any side affects or issues when you stopped? At the moment I can almost deal with discomfort during the day, but sleeping is a joke at best (2-3 hrs, wake up for no apparent reason, hour to two to get back to sleep, up again in a couple hours). 

Any info would be appreciated and congratulations on your success.

Dear James

Good suggestion, thanks. You know how it is, you start writing a posting and it goes on much longer than you had expected and in my case very much longer!

Cheers Richard

For several months the nerve pain was horrific, especially at night. Once I started walking in boot, nerve pain began to reduce slowly. I still have tingling in foot, but not like after surgery.  Be patient, they moved many nerves in that foot, they are angry.  Wish you the best.