Ankle Replacement Surgery

Hi, did you have to do physical theory. They. Also had to stretch my tendons because nothing had been used for years. I think when I go back in two weeks they might put me in. A walking boot and send me to theory. I have read so many bad reviews and I don't want mine to be a bad surgery. I prayed about this for years before I agreed to have it done. The pain was so bad it was affecting my right side of my body. They it they used on me was the infinity. Not sure how many they have available. They say recover averages 1 to 2 years. I just kind of. Want my life bad. Before my accident I played softball, volleyball, roller skating hiking all kinds of stuff and then I couldn't do anything. I gained all kinds of weight because it was a challenge for me to just get up and get to work. When I come home I just wanted off my feet. You talk about a life change.

Hi robin, I had a cast on for two weeks and then they put on a boot and I had to stay off it for two more weeks then the had me walk on that just slightly about 40lbs of weight on it for two more weeks and then in my sneakers with an air cast ankle sturip brace for one month. I have been walking full weight Bering in my sneakers at 6 weeks. I know how much pain you had me to. When the opened me up and seen that I was grounding a hole wit bone against bone they culd not believe that I was walking and that I never took any pain medicine. If you go on wright medical under inbone ankle replacement they have videos showing the whole procedure,really cool. Your right about gaining weight when you can't walk you can't loose weight. I hope you will recover and walk again without pain. I have no pain in my ankle anymore just a little discomfort when walking and I think it is the brace I'm wearing for a month. I was in a wheel chair for a log time as a child and I won't go back in one as long as I can help it. Ha ha. I have a Millwork shop and work every day and I will start to build a 48 ft boat soon a project I have put off for years because of my ankle.

Hi Jpsotan

I have taken a look at the inbone type of TAR you had it seems like very well designed system. It also seems that Tornier is now the owners of the Wright company. I will keep the Wright inbone and Infinity type implant as a possibility or probably as a last resort for my failing TAR, however I am not sure if it is available in South Africa. Having to seriously look at the alternatives after I found out my TAR is failing, I am forced to weigh all the possibilities and to be honest, they paint a grim picture…completely fixed foot or amputation. One thing one must realize about your implant is that it has a huge effect on your bones and there is not much to be done if something goes wrong with that prosthesis and it has to be removed, on the other hand, I like the stem in the bone on both sides. The sponge type tantalum metal let’s the bone penetrate the metal and completely “grows” to be part of your body. Much the same as my hip replacement.

 I sincerely hope your implant lasts all the way. If one looks at the fact that one’s  ankle's actually have an enormous amount of concentrated weight on them, one must be very careful not to over tress them. I have also had swelling during the day and after a good night sleep it all was gone. I am not saying it's a sign of trouble though, but just be very careful of not damaging your replacement by being too active on it too soon. I am a living example of a person who had no hip and it was replaced 8 months after it was destroyed in an accident and the doctor who replaced it did an excellent job, but instead of having me walk on the hip too soon, he opted to restrain the movement of the hip to only 30 degrees with a body suit and I had to keep it on for 6 weeks and stayed off the foot all the time. It was hard and frustrating but now, 8 years later that hip is still 100% and I can use it normally. I am saying this to demonstrate the value of looking after a replaced joint the right way. As far as my ankle is concerned, I am up and about but I am walking on a time bomb and in retrospect, I could have taken better care of the TAR and I could have rather kept it protected for one day more instead of perhaps one day to few. TAR is not to be compared to hip or knee replacement ever. It’s way more complicated and the forces at play are really very strong.  Never think it is 'ok'  if you have pain in it and believe me, nothing lasts forever unless you make it last. One tend to become oblivious to the fact that there is a bit more pain on a day-to-day basis and you ignore it because you are busy and you write it off as just small discomfort that will go away. Listen very carefully to your body. I am 1000 km away from my surgeon and it complicated things enormously for me I ignored the little spike here and there in my ankle, I ignored it being more stiff in the morning than a few before etc., but don’t take any abnormality lightly.  Just a few wise words from a person who owns the TAR T-shirt, the hip replacement one and is busy (reluctantly) putting on the failing TAR T-shirt, amongst many others. 

Regards

Leon

Leon, seems you had the Zimmer TAR, correct?  I had a Zimmer about 14 months ago at the age of 41.  Recovery was rocky, and at times I almost felt my ankle was normal.  But those moments never lasted long and was always followed by periods of pain and discomfort.   From a recent CT scan, there is concern my tibial component has loosened.  It is not definite.   Not going to do anything drastic at the moment, but I have decided to have a small scope procedure to determine if it is indeed loose, and my surgeon will also be taking out my fibular plate.   Procedure in about 10 days.  If it is loose, he said he might be able to get some bone cement in there and/or do some small bone drilling to promote further in-growth.    Probably should have had the fusion, but I also have mild arthritis in the subtalar joint, so it was a tough decision.   Anyway, saw some of your posts and our situations appear similar, so thought I would respond.  Would be interested to hear about your future course of action.  Take care, Scott.

Hi

Glad to make your acquaintance Scott. Makes me feel a lot better knowing I am not alone.

I had the Zimmer Trabecular implant with the plate/screws on the Fibula. I also had a CT scan and it is clear looking at the "dark" lines around the prosthesis that there is loosening. I am amazed that your CT scan can’t determine the status of the prosthesis as that is supposed to be the ultimate method of determining the status

I also had great movement (still have) and at times it all felt 100% normal and at times I had a bit of pain and discomfort. It went so well that my physiotherapist said they can’t do anything more because of the great movement, painlessness etc. Slowly I started limping more and more and eventually I realized that there must be something wrong. My left leg shrunk with 1 cm (hence the increased limping) and then when we took X-rays the damage became evident.   

In my case the Fibula never really healed and eventually it collapsed. I am not sure what happened first, the collapse or the screw that broke in half. So far I am still able to "walk" wearing a Moon Boot. No doubt here about the status of the prosthesis and it is definitely loose. What is in interesting is the fact that the prosthesis subsided and tilted. It really makes me wonder about the long term prospects of any TAR due to the amount of weight placed on the small prosthesis. I am not sure if the bone behind the prosthesis can endure and absorb the pressure put on it by the metal prosthesis. Maybe the Infinity in bone TAR is an exception as it will spread the pressure with the pin inside the bone. One tends to forget about what is going on in your ankle when you walk normally and in most cases the very reason fora TAR, is directly related to bone decay etc. because of the forces at play. That's how I see it. For all practical reasons, I am in deep trouble and I am not sure what can be done. I am obtaining a few opinions from surgeons. One thing is for sure and that is the fact that no matter what will be done, it is not going to be an easy operation, no guarantees offered and a lengthy recovery period to follow plus possibly a shorter (3.2cm) leg. Looking at your age you probably are same as me, an active member of the work force.   The prospects of not being at work for up to 6-8 weeks is not what I anticipated at all. I also have a shoulder that is bone-on-bone and my other ankle is also in an advanced state of osteo arthrosis so walking on that ankle with crouches will also put tremendous pressure on those two joints. I guess I will have to take them one-by-one.  

I really hope in your case they can get the cement in and promote bone growth thereby saving the prosthesis.  I think one should also consider the effect of the cement in (the hopefully unlikely) case the tibial component need's to be removed at a later stage?. Speaking from experience, I would suggest you stay off the ankle right away as walking on it for the next ten days may only aggravate the loosening of the prosthesis, if it has indeed started to become loose. 

I have an appointment next week with one of the very best surgeons in the field of reconstructive ankle surgery. I will post his findings and I will definitely consider what he can offer me and probably go for it. He is not in my city and although I am going for a consultation only, it may be the case that he want’s to operate right away, in which case I may be out of contention for a while, but I will report back.

Look well after that ankle Scott, it's worth it.

Leon

Thanks for the reply Leon.  In case you are interested, maybe do some research on the Exosym/IDEO device.   It was invented several years ago for wounded warriors here in the U.S.  In recent years it has become available to the civilian population.   It has helped many folks with lower leg problems and has prevented amputations for many.   The only problem, there is only one place to get it, the Hanger Clinic in Gig Harbor, Washington (near Seattle).   Seems you might be out of country, so would be quite the commitment.   I traveled there a couple months ago to get the device, and plan on wearing this for as long as possible before having another radical surgery.   I met others there with failed fusions and failed TARs and it has helped all the folks get back on their feet.   In hindsight, I wish I would have gotten this device as opposed to this TAR.   All the best at your consultation, will look forward to your report.

Thank you for the information about the Exosym/IDEO devise. I have had a look on the internet  and it seems like a real option to me. My most nagging worry at this stage is the fact that my bones do not grow very well and going for a fusion, what if the required growth is not there?. My other ankle is also on it's way towards losing all the cartilage and I will have to either look at surgery or maybe the Exosym/IDEO devise will be a better option there also. As it is now, I guess you can imagine what it's going to feel like to walk on crouches with a left ankle that is fused and the right weight bearing one also in an advanced state of decay. Not easy at all.

I am not from the US unfortunately (South Africa) but that is an issue that can be overcome. I am really glad you gave me this information now because I am seeing a surgeon next week and I also want to bounce this option off from him. Maybe I can get such a device for my other ankle and stretch his lifespan a bit longer.

Seeing that you went to Washington for the devise, can you give me just a rough estimate of the cost involved?. We are struggling with an ever weakening ZAR /US$ exchange rate but at least to have an idea will give me the opportunity to make a few calculation’s. I was actually supposed to be in Seattle on 4 March for a conference but I was not sure if I can make it with the condition my ankle is in. If I knew this earlier, I could have made sure to be there and afterwards went for the devise. 

Regards

Leon

Leon, the cost of the device is $9000.   Some here in the U.S. were fortunate  enough to have insurance cover it.  Others like me were not so fortunate.   I had to pay out of pocket, but am going to appeal with my insurance company.   I am very glad I made the travel to Washington to get the device. Are you on Facebook?  If so, there is a Facebook page devoted to the device.    You can search on Exosym/IDEO.   I would encourage you to reach to the Hanger Clinic in Gig Harbor, Washington to get further information.  They are very helpful.   When I went to get my final product I trained in the device with some Israeli soldiers who also got the device as they all had terrible lower leg injuries/wounds.   Let me know if you need anything further.  Scott

Hi Scott

Thank you for the information.

$9k is expensive in any denomination but that can be overcome. I have good medical cover and I will talk to them at some stage. I have noticed the Facebook page but I personally do not have any connections with Facebook, though I am an IT professional. Just a matter of principal.

I have already contacted the Hanger Clinic and they have also replied. For now I want to get all the information I need and discuss it with the surgeon I am visiting next week. For me it's much about saving my other ankle plus whatever can be done for my current failed TAR ankle. From what I have seen, I am extremely impressed and I feel this is a definite option for me. I have friends in Vancouver ...not sure it it's a bit too far out of the way though. How long did you stay at the clinic?. That will obviously also contribute to costs for me.

At least I have another option if nothing else comes to light. I really appreciate the fact that you mentioned this device to me. I will definitely let you know what comments I get from the surgeon next week. Should be interesting to see what he says. 

Leon

Leon, I believe Vancouver is approximately a 3.5 hour drive to Gig Harbor.   For those here in the U.S. , many of us had to make 2 trips to the clinic.  The first trip is to get fitted/molded with a test device.   From this mold, your own personal device is then manufactured.   My first trip at the clinic for the test device was 2 days.  I returned 2 weeks later to get my final device.   On the 2nd trip they have you stay 4-5 days to go thru a training regimen with the device.   Since you would be coming from out of country, I am sure they could work with you to make sure you only have to make one trip.  You may want to give some thought getting a device for each leg.  There are several folks that have done that.   In regards to our failed TARs, do you get like a "tingling" sensation in your failed TAR ankle?  I have this feeling almost constantly.  Thanks, Scott.

Hi Scott

 

Thanks for the information, must be pretty late at night in the US by now?. Very sunny and hot 32C day here.

This is very helpful and if I do go for this option, then I will certainly have to stay in either the US or Canada (Vancouver) for the 2 week period in-between visits and then fly back to SA. I will work thru all this when I am back next week and who knows, could very well be that the surgeon himself wants to check it out etc. Pity it's not available locally but in time it should become available here also, probably only in a few year's time. An Exosym/IDEO device for both legs will be the ultimate but it will also be a financial nightmare. I do have the same problem in both ankles so it makes sense to go for both.

In all the time I have had the TAR, I have never had any different sensation in any part of my foot. I had a bit of swelling in the beginning after the operation and had to put a lot of ice on it. That went away after about 2 months. Later I had a build-up of water in my left leg which gave me a very “heavy” feeling  when I walked. It was noticeable with a ring pressed into my leg by my socks. It literally felt like I had two bricks tied to each foot when I got home from work. Was gone in the morning after I slept and elevated my leg for a few hours.  I later found out it had something to do with a high blood pressure pill I was drinking. I seldom have that sensation now, obviously not taking that particular pill anymore. I currently walk with the boot and it’s becoming easier by the day. Very little pain and discomfort at this stage when I walk with the boot. I still have 90+% gate, also mostly painless. Kind of weird to think it’s actually loose while it feels not that bad. I can also walk barefoot, usually more pain after I sat for a while but when it’s “warmed up” I walk rather effortless.  Maybe you have either a nerve that is being pressed upon by a bone or another object or it could be new nerves growing. They can grow for around 18 months and that gives off a tinkling sensation. I had some “dead” sensation on the back of my left hand after being in an auto accident in 2007. Later the feeling came back but it had a "tingling “ sensation for a while then. Gone now.

Regards

Leon

Mary, I will offer another option.  Go to the Hanger Clinic in Gig Harbor, Washington and get fitted with IDEO brace.   I recently discovered my TAR has likely come loose.   My doc gave me similar grim options.   I said nope, heading to Gig Harbor to get the IDEO.  Maybe research it and consider it.