Ankle Replacement Surgery

Dan,

No issues with random nerve pain? I'm about 38 days behind you and while I believe it is improving the random nerve pain has been a bit unexpected. I believe it is not the Norma's I've only found one or two mentions in this forum. As I will most likely need to have left ankle done sometime in the future I would like more info on nerve response. If you have any insight I would appreciate same.

Thanks and best wishes.

not the norm....but you probably got that.

Fortunately, I do not have any random nerve pain. I've got pain in the ligament or tendon bundles on the outside of my ankle, but I'm hoping that will work itself out over time as I get stronger and the joint loosens up. Regardless, that pain is far less than the old bone-on-bone pain. So, I can't really complain.

Excellent. I'm glad it is going well for you. I believe that the feeling of electric shocks, burning sensation, random itching, etc. are becoming less frequent and as I work ankle through therapy and use expected and warranted muscle pain is more often observed. Not sleeping is by far the worst result of my operation and I attribute the coming wide awake to random pain. Still believe operation and replacement was the best choice and like you stated it is way better than bone on bone pain. Be well and enjoy the return of painless movement.

Dan

?I am being set to do the replacement. I am very anxious and saw your positive comments and see you had yours done recently. I have bothersome arthritis in my ankle and painful to the point I can't think right in winter so feel I can't live like this any more. They are offering the Infinity TAR by Wright. Have you heard of it and know if it is as good as the STAR ? I worry I will be worse off with a replacement and very hessitant

Dear David

IMO the Wright Infinity prosthesis is the more advanced option . I had their Invision as a revision seven weeks ago and it seems to have been successful though it will be a couple of months before I know.

I hope that you have chosen a surgeon who is experienced in using this particular prosthesis and has done a lot of successful TARs. This is REALLY essential.

Good luck, Richard

 David:  I can’t agree more with Richard. The most essential ingredient  is not which processes is being used, but the experience of the surgeon, and the experience of the surgeon with that particular prosthesis.    With the symptoms as you described, I can’t blame you for proceeding with the operation.  Understand going in that the recovery from this operation is for longer then with hips and knees, but work through it. Keep exercising before your surgery, immediately after the surgery, and once you are weight-bearing.  Never let up for a day. The entire process takes a good year, although in a couple of months you should see a lot of results. 

David,

I had an Infinity replacement on June 9, 2017.  It was the best decision I've ever made.  I came out with no more pain than I had going in and after 3 days stopped my pain medication with the exception of 1 pill each night at bedtime for about a week more.  I'm 10 months out now and I don't even think about my ankle.  I experienced some discomfort on occasion for a month or 2 as I began to walk without crutches as my muscles and tendons began to work again. I strongly encourage you to chose a surgeon with a lot of experience in TARs.  My surgeon had performed over 750 ankle replacements prior to doing mine last year.  Good luck.  

Richard

?I am not good with using the computer or internet . I'm in with Dr. Erroll Bailey with Resurgens Orthopedics in Atlanta who is "supposed" to be about the best surgeon at this but I have no evedince that he has done many of them of the Infinity besides what his staff says and who knows how accurate that is. Have you heard of him and Resurgens Ortho ? Do you know how to find out on the internet is he has done a lot of them ?  I need a friend who can help me check ? Can you by any chance ? If not I understand

?David 

 

Bruce

?You are one of the few positive ones I see on line or on this chat room. I am set to go with Dr. Erroll Bailey at Resurgens Ortho in Atlanta  and he stresses the Infinity TAR. Have you heard of him or do you know how to find out if he has done a lot of the Infinity's ?  I have no way to really know how many TAR's he has done. Have you heard of him ? So you did the Infinity and after 10  months you don't even feel like you even had a TAR and are like new ?....David

David, it will never be like my original ankle prior to my accident but pain free and able to walk at a quick pace on a treadmill with no pain.  I'm in the Nashville TN area.  My surgeon is Dr. Marc Tressler in Hendersonville TN.  There are only 3 surgeons in the US who have performed more TARs than him.  That said I did some internet searches on Dr. Bailey in Atlanta and he sounds like someone I would trust.  One of the most difficult steps in a TAR is removal of the original ankle and placement of the new one.  The Infinity system takes that decision away from the surgeon via their Prophecy guide.  That leaves much less chance for human error.  As my doctor says you have humans operating on humans, there are never any guarantees.  My opinion is if you go with the Infinity and Dr. Bailey you have a good chance of getting the best possible outcome.

 

David:  I have had both ankles done in Rochester, NY, using the STAR, right one 12/16, and the left 11/17 and am doing well with them both.   

"Supposed to be the best at this"  There is no such rating system for doctors, therefore such statements are meaningless.  You have to find the right doctor for you.  Do not be shy. Ask him/her, not staff, how many he/she has done, how long he /she has been performing TAR's, with what prostheses, and why, how many complications he/she has had, and what kind. Visit with several surgeons, even if that requires travel, and ask each one how the same questions.  Bring with you a written list of such questions to each visit.   In my opinion, you want someone who has done a minimum of 40-50, but preferably over 100. 

Ask your PCP, general orthopedist, or physical therapist to help you identify several ankle/foot surgeons who are known to do TAR's.   Physical therapists know which surgeons are good and which are not, because they see the results postoperative.  If you don't know any PT's, ask a friend or your PCP if they do. Keep in mind that you are the purchaser of the service, they are the vendors.  Stay in the driver's seat on this.  Too many patients see themselves as beholden to their doctors.  Turn this dynamic around.  The doctor should be beholden to the patient.  If not, find another doctor.  No good doctor is afraid of such a dynamic.

Dear David

I see that you have had some good advice already. I will take this opportunity to remind everyone who has had a TAR to ask their surgeon to check for any evidence of OSTEOLYSIS when they have periodic x rays. Osteolysis which is the development of cysts in the bone will lead to the failure of your prosthesis if not attended to.

Cheers Richard

Hi David,

Yes, I've heard of the Infinity by Wright. Biggest difference I understand is that the STAR has a mobile bearing plate while the Infinity (and Inbone) have fixed bearing plates. In fact, I believe (or was told) that the STAR is the only implant that has a mobile bearing plate. What this mean is that the bearing surface, which is more or less a super high-tech grade of a plastic cutting board material, is not physically attached to either the tibia plate or the talas plate. As such, the purported advantage is that the bearing plate will not put undue strain (e.g. pull against) the metal plates that attach to the tibia and talas bones. This also allows for varus and valgus movement (twisting toward and away from your body's centerline).

I'd suggest Googling "pros and cons of TAR ankle STAR vs Inbone vs Infinity," and also spending time on the manufacturers websites. Most device manufactures have animated videos of the surgical procedures and how the device functions. And, in the case of Stryker, who makes the STAR device, you can even watch a cadaver video of the surgery, if you have the stomach for it. 

Caveat, while I did discuss the Infinity and Inbone with my surgeon(s), I'll note that most of the surgeons who advised me were big fans of the STAR (very comfortable with installing it and have had great success with their patients). In short, they were much more familiar with Stryker's STAR versus Wright Medical's Inbone or Infinity device. And, adding to Bruce34866's comment about the Infinity device having a guide for the surgeon's, the STAR device also had a very advanced guide. I have no doubt all the manufacturers do at this point in time. 

Also, I agree with two other important points raised so far -- get in decent shape before your surgery, to the best of your ability, and focus on the recover. Do exactly what the surgeon says regarding recovery, do lots physical therapy and other forms for recovery (pilates, yoga, walking, biking, etc).

And, the most important aspect of this entire endeavor is finding a really, really experienced surgeon.   Best of luck!

Bruce

?Your comments are encouraging. Did you do the Wright Infinity brand or what brand ? Have you heard of Resurgens Ortho in Atlanta Dr. Erroll Bailey ?  I chose him off the internet and don't have any way of knowing how many he has done besides what his staff tells me which is hundreds. I have  bunions on both feet and worried about how it will all turn out. I am 57. How old are you if you don't mind me asking and what was your pain level that made you  do the TAR ?.... thank you....David

I had a TAR in July 2017. Mine was complicated because I had 2 surgeries prior to remove bone tumors and this third surgery needed a bone tumor removed as well. I had a custom ankle made and needed cadaver bone as well. I had recovery times on the passed two surgeries of like 4-6 mths but this one was a lot longer. Im 10 months in and still not walking at 100% but Im getting there now!!! I had the pain at night a lot waking me up, stiffness etc. That is getting a lot better finally! My surgeon told me right away after surgery that my Achilles may be too tight but we would work on that and sure enough that was a huge problem. He could have fixed that in the surgery but he wanted all the rest of the areas of the ankle to heal properly and not add another area to heal all at once! Ive been walking with a huge limp and the leg would not bend properly. I could have had another surgery to fix it but didn't want to do that, so we are working on the stretching with a custom made brace that I wear only when Im sitting down with leg up and it slowly stretches the tendon! I get measured when I go back to doc and it is definitely working but it is a slow process! I also still have episodes where it sort of feels like it locks up so i have to let it sort of adjust before taking too many steps at once. This happens after sitting for awhile or when I wake up in the morning and the first few steps. Stairs are also not good especially going down still but getting there! Making progress, was one hell of a long ride for me! But I'm praying that this will be it as far as recurrences and surgeries and I will be on my way back to a more normal life soon! I have lost jobs and fell into depression, and Im slowly trying to crawl my way back!! I work out and go for slow walks to also help with the stretching. At one point I did the PT but it was so excruciating all due to this tendon I guess. In my case I believe this was the only choice either that or the fusion, but this option gives me more mobility ! Good luck to all and keep the faith! 

Hello frankle

It sounds as if you are having a tough time with your recovery if your TAR. I'm into week eleven having had a five year old badly installed prosthesis removed and a special revision put back in it's place and cyst filling with a bone mixture.

The surgery took six hours and was done here in the UK by an experienced ankle revision surgeon and was complicated as the damage done by the badly positioned first one had to be worked around!

I've been walking in normal shoes with a simple ankle brace for protection for a week and driving for that time. If I plan on walking for longer than ten minutes at a stretch my surgeon had asked me to put on the Aircast boot.

My walking in normal shoes without crutches is excellent with hardly any sign of a limp so I think I'm very lucky. Oh I'm 76 BTW. Cheers Richard