Ankle Replacement Surgery

Dear Fishersid - your comments are very reassuring, particularly for me now when my surgery approaches. I also rejected the option for ankle fusion - why would anyone do that anyway? - I'd rather live with minor stiffness and swelling than having any mobility at all.

Thank you for spreading hope among us.

Mayday - thanks for sharing this wanderful story of resilience.Old school indeed, pain plus over pain minus, one pain nulling another, I guess many bloggers here might have had a like experience one time or another. Having tolerance to pain is certainly a personal thing, depending on the level of daily activity one may have, age factor, etc. Just imagine this, last weekend I went for a 20 some miles bike ride, it was great, no pain, no swelling of the ankle, just a dream normal middle-age life. But just a month or so ago, this ride was not even a remote possibility for me, since for almost a week I could not bear touching my foot on the ground, a simple walking to the restroom was very difficult. Such cycle of pain/no pain has been a sure thing for me for the past 12 years, it comes unexpectedly, and it is due to arthritis/worn cartilage, not a broken bone. I have known people who suffered broken toes but managed their situation and some pain without surgery (I guess it depends how serious a fracture is), joint arthritis is, however, another ball game altogether.

I mean no demeanor to your friend’s case, she surely lived a long, healthy and good life, bless her soul for that.

Hi lucy53675

I'm 55 now and had my right ankle replaced 2 years ago, and it is the best decision I’ve made.  I was like you not sure what to do. I looked into the fusion first and I thought this is the last resort option, I wanted movement in my ankle as I wanted to ski and a fusion will not give you this.  The ankle replacement will give you movement, I am able to walk on uneven ground, sand, rocks and do most things I could do before my arthritis set in, the only thing I can’t do is run. I saw about 3 consultants the first said I will end up with a fusion and showed me an x ray of a fused ankle with two bolts through it, this put me off straight away. The second did keyhole surgery (Ankle Arthroscopy) to clean the ankle joint and then had Cortisone Injections and I felt both of these were a waste of time and he said he would only do a fusion. So I went to see his partner for a second opinion and he agreed to do the replacement. And I haven’t looked back! I do not have any pain just a bit stiff if I haven’t moved for a while but this frees up after a few steps, I ski on it hard and fast! No jumps or bumps. I just after it.  I kept reading you have to be old to have a replacement this is not true, I’ve read on the internet people of early 20’s having this done. 10 years is the average life time for a replacement, for me that’s 10 years of movement! But they say that about a hip and they can last for 20 years. My consultant said in 10 years time he will be able to re-place a replacement if not then you can have a fusion. Remember if you have a fusion you can’t have a replacement. Your ankle might be too far damaged to have a TAR (Total Ankle Replacement)

I was in a cast for 4 weeks then in a plastic air boot for another 6 weeks then went to physiotherapy for 10 weeks by then I was walking pretty well with hardly any pain, it took a year for me to fully recover and it’s worth the wait.

You are not too old, you need to find a consultant who is willing and has done over 50 ankle replacements.  Find out what replacement he uses as there are loads out there, I had the mobility by depuy but the best (I thought)was the hintegra system at the time. All I can say is research, read the forums ask questions look at both options, fusions are common and you will find someone with one.

Hope this helps.

 fishersid  

Hi Lucy, I had TAR on 24/11/14 I was offered a fusion at first as to which I refused, and I was offered a tar and jumped at the chance, I'm 41 yrs old. I've also been told it will last 10 yrs but I suppose if you don't go mad then maybe It will last longer. So 6 weeks post op, lots of pain swelling gone down a little now, and due to start physio this week. But all doctors and surgeon(wrightington hospital UK) are very pleased with the outcome and are very positive about the long term outcome. I wish you luck with your surgery hope all goes well. Let us know how you get on...

Hi I'm 53 - I had my TAR Nov 2015 and I'm very happy with it - I was also told by 5 surgeons I could only have fusion and I'm so glad I said NO.

I can do everything I used to - don't run but can jog - I walk 18 holes of golf and do 3 flights of stairs all day at work.

I can move the new ankle almost as much as the old 53 year old one lol

I believe a positive attitude is important and the right phyiso.

Best thing I did, do your research. I've been told ten years the same as everyone else but my surgeon also said "who Knows" there not that common here in the UK. Lets see.

Steve   

Steve saw your note with positive results.  Glad to hear a success story.  I had my STAR in May of 2015 and as you are, I am very happy I did it.  The motion is great.  Only some numbness from some nerve damage during surgury but well worth the trade off.  I am hoping for at least 10 more years but will hopefully have options to keep this one going and no fusion.  Technology keeps pressing on.  I think about it almost everyday that I do not have that pain.  I lived with pain for 8 plus years limping along and I tell you...it is awesome living with that pain gone.  I walk my normal fast pace again with my long legs....just great.  Happy you are doing well.  Sorry but no running.  Please do not run as you can mess it up with high impact.  Use exercise machines like elyptical and take up hiking.  Bycycling too.  Good Luck.

Hi - Thanks for the advice, i think that the idea of running was a little ambitious.

I've been thinking a lot this week and been reading a lot on here and an american FB ankle replacment site. 

The trade off between being classed as a fully fit officer on the front line and the health of my ankle has been a very hard choice for me, I'm very stubourn, It's not that I want to be on the streets chassing crim's, those days are long gone - but not being a fully fit officer reduces the work I can (allowed) to do, at the moment I have my old job still investigating crimes but also been told this week I can't stay in that role anymore and I'm being moved.

I DO understand some of the reasons but I also work with a few people who after the three flights of stairs have to rest before they can talk, I do them easy - just seems wrong somewhat but thats the system.

It's amazing how much just a small joint can effect your whole life but the difference in the pain from walking bone on bone for so long is fantastic.

I've had a lot of comunication this week ( I was starting to think I was the only one in the country to have a replacment ) and so refreshing to hear the recovery stories from so many on here.

All the best

Steve   

 

Hi Steve, that's great news. Would you mind telling me where you had your surgery?

What devise was used in your operation?

Hello there Lucy, I too am new to this forum...Thank you all for your very informative comments.  I have a very similar situation to yours. I can still walk for short distances but cannot stand for very long.and i have severe arthritis.. I too agree that Cortizone increased the rate of the growth of arthritis..  I am trying to make a decision of fusion or TAR. I like to swim so the TAR is definitely more appealing.. but 2 docs have said my ankle is 15-20% off so i am not a candidate of TAR. But just yesterday another Doc said i was... and he recommended the Salto Tolaris replacement. Has anyone on this site used this device and if so what is the

success rate... My family and friends also all think i'm crazy to get so many opinions but i personally need to feel comfortable with the Doc. I had a great one at Mass General, but unfortunately i am not able to go there , so i am looking for the best in Connecticut if anyone has any recommendations. please let me know. I am feeling a little desperate... and it seems the more research on Doctors i do the more confused i become... thank in advance for your advice and comments.. 

 

Hi Jean2018,

I don have this implant (yet) but living in the Netherlands this is one model available.

The success rate is very much depending on the doctors skills, my doctor told me his success rate is much better now he has experience. Still he was so honest to tell that overall he had to completely

remove 20 % of the implants within 12 years. Scary!

I spoke to only one patient he he could not be happier, back on his feet in no time no pain.

OK after long walks he experience some mild discomfort, asking what he called long walks he said FOUR HOURS and more. His implant is about 7 years old now.

Personally I am scared to go for the operation but sooner or later I have to. My first choice was the

Wright Inbone type but cannot find a hospital doing that in Europe.

I wish you all the best.

 

Dear Edmund

The key to a successful TAR is your choice of surgeon. Whether or not you actually like them should not be a factor but their PROVEN competence judged by the success long term of their TAR replacements.

I had a TAR five years ago and whilst I made a good recovery and returned to a pretty physically demanding job I'm now having to have the prosthesis removed and a replacement installed!

This is because of osteolysis and the fact that is was badly positioned which is likely to have caused the problem. Google Yogesh total ankle replacement and you will be able to watch a short video of me walking on different surfaces and running up and down stairs at twenty weeks.

The right surgeon will select the prosthesis for you based on a number of factors. Good luck. Richard

I should have added that I have now selected a new surgeon who is an expert in TAR revisions even though it has not been easy given where I live.

Cheers Richard

Jean2018:  I agree with what RichardKen said. The choice of prosthesis is not the key here.  Your choice of surgeon is the key.  Each surgeon uses the prosthesis he/she is experienced and comfortable with.  The personality of the doctor is not nearly as important as his/her skill.  Of course no one wants a surgeon with the personality of a mule.  I believe you are correct in interviewing as many doctors as you need to before making the decision.  This is your body. This is very complicated surgery, that, if not done correctly will haunt you.  However, the surgery can be very successful if done by the right set of hands.  I would have had Dr DiGiovanna at Mass General do it, but I live 6 hours away. I don't know where in Connecticut you live, but if it is only a couple hours away, go to Mass General to the surgeon you like. I am in Syracuse and traveled 2 hours to Rochester for my surgeon.  While the travel for post op visits is a pain, esp in the snow we get, I am pleased with my decision and would not have chosen a local surgeon that I was not confident of just for the sake of less travel.  

I am 71 years old.  I had a right TAR with STAR prosthesis along with subtalar fusion 11/2016.  The TAR is pain free, but the subtalar fusion has a ways to go.  I had a left TAR 12/17 and I only have occasional discomfort, essentially pain free.  In my rehab, which I am doing on my own at home, I am up to a 30 minutes vigorous workout on an elliptical and a 15 minute light workout on treadmill (at a slow pace).  I am far from walking normally, but I am happy with where I am at this stage 10 weeks out.   My biggest limitations are not the TAR's but my knees:  right knee needs replacement and left knee was replaced in 2011, but the workout helps both of those as well.  The worst part of the surgery for me was 6 weeks of no weight bearing.  I found that those 6 weeks along with the past year of less exercise due to my arthritis left my legs very weak, and it is taking a lot of time to build my leg strength back up.   And it takes a lot of focus to do that much work.  Don't expect the surgery to give you new legs.  The surgery helps the joints, but the muscles and tendons need to be built back up, and that takes many months of hard work.  The surgery is just the start of the process.  The rest is up to you.

I am doing well enough that my wife and I are leaving next week to take the second leg of our cross country trip from San Francisco to Syracuse over 2 months (we did a 6,000 mile trip east to west in our van last fall).

Good luck

Dear James

Congratulations on your progress! When I was told that I would have to go through a repeat recovery I was really p***ed off because as you know it is a long boring recovery until one is weight bearing. I hated being unable to carry food and drinks around but have been practicing with an iWalk 2.0 hands free crutch which will give me back this ability and keep some of my muscles active on the operated side

Cheers Richard

I kept a cloth bag hung over the handlebar of my knee walker.  I kept all my important belongings in that:  meds, tissues, nuts to munch on, coffee, tea, and water in a sealed thermos, stretch band, wound bandages, ipad, eyeglasses, extra contact lenses, nail clippers, toothbrush and toothpaste, and much more.  I learned to carry my bowl of cereal in the morning with one hand and navigate the knee walker with the other. The contents of that bag were as mysterious as my wife's pocketbook!  I also at times learned that at times it is easier to crawl on all 4 on the floor pushing my plate of food in front of me.  I learned the best way to navigate stairs is to sit on the step, and go up backward or down one step at a time on my butt:  very easy and very safe.  I hate to be waited upon.  We all use our imagination to improvise  

Dear James

I had to look after myself and it was hard as the house was a very old house on several levels but I managed. I well remember at times as you did crawling whilst moving a plate of food. With the iwalk it will be very different....I hope! I will see in two weeks time.

All the best Richard

Thanks James, I really appreciate all comments.  Now i am torn between a fusion or TAR....Ive gotten 2 different opinions...Enjoy your trip.

Thank you EdmundF,  I have decided i am not going to push this  decision and take my time finding the right surgeon, I am on the fence with fusion vs TAR because i now have 2 different opinions... thanks for your comments. Jean

understand that I had TAR on both sides.  I had a subtalar fusion as well as TAR on the left, and that is different than an ankle fusion.  I don't know how long it takes to recover from an ankle fusion, but it has taken over a year for me to recover from my subtalar fusion, whereas it has only taken me a couple months to recover from my TAR. Most ankle arthritis does not require a subtalar fusion.  I was very symptomatic from my subtalar arthritis as well as my ankle joint arthritis, and therefore needed the subtalar fusion and TAR on the right:  See references 

Subtalar joint fusion:

http://www.aofas.org/footcaremd/treatments/Pages/Subtalar-Fusion.aspx

Ankle joint fusion

https://eorthopod.com/ankle-fusion/

 

Hi Jean:  I've been diddling around trying to make a decision on surgeons to do a TAR.  One surgeon utilizes the STAR replacement and the other utilizes the Zimmer.  My retired orthopaedic cousin suggested going with the Zimmer.  Both surgeons enjoy great reputations.  I've decided to go with the Zimmer because several othopaedic surgeons won't use anything but Zimmer hips and knees and I believe there is less likelihood of nerve damage usinig the Zimmer (approached from the side of the ankle, repositioning the fibula); STAR surgery approach is from the front.  I am a 70 year old female, pretty active, with Lupus and my conservative Zimmer surgeon isn't in favor of my doing a fusion. 

Another thing I learned yesterday when I had my third cortisone/medol injection is one cannot have surgery within the six month period after a steroid injection.  So, my intent is to schedule TAR in August/September. 

Note 1:  I had previous ankle surgery and did find going up and down stairs on my bottom worked best.  Also helped to keep my arms toned. 

Note 2:  15 years ago I fell on ice and broke my fibula, sprained my ankle.  Both surgeons believe the osteo arthritis accelerated because of that trauma. 

Thank you. I did a comparison. and the Zimmer looks like the most anatomically correct on and the least invasive... The doctor says they last about 10 years and he uses the salto taloris unit... I'm just having a hard time of the thought of going back in after 10 years for a redo. At that time i will be 75.. 

Thank you James for the links to the websites. That is really helpful...