Desperately need help and advice, Ankle Fusion or Replacement?

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Hi, I desperately need some advice and from people who have had either an ankle replacement or ankle fusion.  Specialists have recommended fusion as I’m only 46...and I really don’t know what to do. Have read lots of research on both and seems I either damage adjacent bones due to them becoming arthritic with a fusion,

Or choose to have complicated surgery later when the ankle replacement fails (don’t know if could be 2 yrs, 5 yrs, 10 yrs). 😔 

Really looking for insight(s) from people who have had either operation and their experiences?  I would be very, very grateful for any help anyone can provide as it seems the fusion op doesn’t stop the pain? Plus how have ppl coped with recovery.

Thank you so much.

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  • Posted

    Hi  Cindy!

    I had ankle replacement surgery on November 22, 2017. It's a hard recovery, but not much different from ankle fusion surgery. And with an ankle replacement, you will be able to walk normally instead of a stiff walk from ankle fusion. I am 53 and my doctor told me this ankle part should last me my life time,  as long as I don't abuse it. 

    There are six ankle replacement patients at my rehab, and all are doing well. Most of us had a problem with incesion healing, but for the most part , we are on our way to a full recovery. But, you will need at least four months off of work and a lot of support from family and friends. There was a brief time I wished I didn't have the surgery, but I was in so much pain, I really didn't have a choice. 

    My opinion , ask your doctor what's the difference in the healing time between an ankle replacement and an ankle fusion?

    I'd much rather be able to rotate my ankle than walk like a peg leg. 

    Good luck!

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  • Posted

    Hi Cindy,

    I had an ankle fusion in January 2017 the healing time was hard, I had 6 months off work, non weight bearing for 6 weeks was the hardest part, I used a wheelchair . I wasn't able to have a replacement as I had infection in the bone which meant I was  not suitable for the replacement. I am frustrated because I can still not wear a lot of shoes, that I have my left ankle is still larger than my right. However I think I walk ok, I did do lots of physical therapy which helped a lot. I don't get much pain, mainly when its raining. 

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    • Posted

      Hi Marian, thank you for your update and sorry to hear of your experiences on this.  Pls can you let me know re your comment on shoes? You mentioned you still can’t wear a lot of shoes, can you pls let me know what type of shoes you can or can’t wear? 

      Thank you.

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  • Posted

    Hi Cindy

    I had an ankle fusion in jan 2017 but had the same dilemma as you for quite a while before.  I was offered to go on a TARVA trial which researches post op outcomes for ankle fusion and replacement.  The replacement seemed like a good option on one hand in order to keep movement in the joint, however everything I read was that the ankle replacements these days although better than 10 years ago, still don't last that lon,g and there can be complications.    Also that you have to be very careful about how much activity you do. I was only 51 at the time and therefore decided to go for fusion.  It's been a long hard recovery but I'm starting to get to the point now when I'm glad I did something as my pain before was so bad I could barely walk at all.  The recovery from fusion was far longer and harder than I was expecting, but on a good day now I walk with almost no limp. However the downside is that in the future, further arthritis may develop in surrounding joints.  It's a really difficult decision and neither option is really 100%. I think you have to consider how active you want to be, as the general opinion seems to be that ankle replacements will wear out quicker the more active you are.  Good luck with making your decision. 

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    • Posted

      Hi Tessa, Thank you so much for your reply. It seems 18 months is more of the true time scale for recovery? Also you mentioned on good days you can walk without an limp, what are the bad days like? Are you able to walk at all? 
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    • Posted

      Hi Cindy, yes for me I think it's going to be 18 months until I feel really back to 'normal'. I had my screws out after a year so that set me back a bit but I'm now trying to build up my fitness again.  As well as all the muscles and tendons in your foot having to readjust to walking with a fused ankle, you also lose a lot of muscle in the legs due to being less active for quite a while (at least I did).  I'm doing physio now to rebuild my wasted quads and calf muscles, and just trying to walk more every day and do swimming etc.  On bad days I just feel a bit weaker in general but I can still walk about. There's no pain in the ankle at all, but just residual discomfort in the heel and side of my foot, but I think that's all soft tissue stuff.. Compared to before it's much better, as I was living off painkillers and not able to walk far at all. I don't take any painkillers now and can wear normal shoes, albeit only trainers.  All in all I think it's been worth it, I couldn't have gone on as I was.  

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  • Posted

    Hi Cindy. I had ankle fusion in August 2017 age 55. I'd had osteoarthritis for around 10 years and was offered TAR or fusion. I went for the fusion and it was the best thing I ever did. I was off work for 3 months but had very little pain after the first 2 weeks. I'm now enjoying life a whole lot more pain free abd can walk miles. I also do powerlifting and am now squatting and deadlifting heavy weights with no issues. I'll never run again but that's no problem. I didn't want the TAR because I'm very active and wanted a long term fix.

    All the best,

    Andy.

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    • Posted

      Hi Andy

      Thank you for your update.  That’s encouraging to hear. Were you able to go back to ‘life / work’ after 3 months? Or did it take longer?  Do you currently get any pain at all? Also, how long did it take before you could do squats and go back into the gym? 

      You mentioned it has has been the best decision made and can walk miles, do you get any residual joint pain at all? Sorry for the 101 questions. 

      Thank you!

       

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    • Posted

      Hi Cindy,

      I had the op 24th August and started work again 11th December.  I was still on crutches for the first week back but only used them for confidence really.  I started physio as soon as the cast came off and that was mostly to get as much mobility as I could out of the remaining joints.  I really had no pain at all after the first 2 - 3 weeks and was getting into the gym using the static bike at 12 weeks.  As for the weights, I started some prehab work in December but held off full training until 6 months (Feb).  Everything else was pretty much back to normal around Xmas.  I don't have any pain in the foot or ankle but I did get a bit in the Achilles whist the area was adjusting to the new alignment - over the years my foot had become misaligned due to the arthritis.  

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    • Posted

      Hi Andy, really appreciate your update and thank you for providing more info.

      Really good to hear you have recovered so well - a success story for your ankle fusion offers the potential of hope for the future.

      Best of luck.

       

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  • Posted

    Dear Cindy

    Always a difficult decision. At age 71 I could have had either but chose the TAR but because of the lack of experience of the surgeon it needed to be replaced six years later. I had the replacement done by one of the most experienced ankle surgeon's in the UK six weeks ago.

    There is no way any doctor should be saying that with care that it should last a lifetime unless the duration of a lifetime is stated!

    I had an excellent recovery but it was very tough. I made a short YouTube video showing my walking on different surfaces out doors and running up and down stairs. Google Yogesh total ankle replacement.

    The key to TAR success is a very experienced specialist ankle surgeon who has many successful TARs behind them. DO NIT TOUCH SOMEONE WHO DOES NOT MEET THAT CRITERIA. Forget bedside manner or if you like or don't like them as that really is totally irrelevant!

    Cheers, Richard

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    • Posted

      Follow up. I should have made it clear that the video is of the surgery that subsequently had to be revised six weeks ago by a totally different surgeon and the surgery took six hours a d was very difficult. I have my fingers crossed that it will turn out well but I will have this cast on for a further five or six weeks.

      Cheers Richard

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    • Posted

      Richard, thank you for your considered responses.  I’ve watched your video and it’s great.   So sorry to hear the TAR didn’t work the first time and definitely hope this time around works.  Do you mind letting me know what happened? Was it subsidence or loosening of implant? Yes I have heard the TAR is absolutely dependent upon skill of the surgeon. 

      Do you know which prosthetic was used? I’ve read reports on 2 vs 3 components and different models make a difference I.e Hintegra or Star. 

      Any further advice or thoughts at all, most gratefully received and will be very helpful, thank you. 

       

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    • Posted

      Dear Cindy

      Glad that you found the video useful After it was made I was doing a lot of building work including very demanding roofing work and looking after a flock of sheep. Apart from not running there basically was nothing that I could not do.

      As stated in the video the first prosthesis used was a Zenith which like most modern ones is a three part. The revision used the Wright Invision and is based on their Infinity prosthesis.

      I cannot stress strongly enough how important the skill and experience is of the surgeon. Anyone not observing this warning is setting themselves up for problems sooner or later. Please remember that the problems with mine only really showed up after four years.

      If you want to know how my recovery goes please send me a message and I will be happy to let you have my email address.

      Cheers Richard

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  • Posted

    Hi Cindy!

    I forgot to mention the name of my part in case you wanted to look it up. 

    It's the Infinity Inbone Ankle Replacement. 

    It's more advanced than all the other replacements mentioned on this forum. 

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    • Posted

      Many thanks Gigi, will definitely look it up and check out the details for this implant. Thank you also for your original response, it’s really helpful to hear first hand experiences in order to make decisions- much appreciated. 

       

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