Lessons learned with three total ankle replacements!

I thought I share some of my experiences over the past 6 years as they apply to my surgery and recovery.  I enjoy seeing some of your post and I am really amazed how tough some of you are facing long term pain and disability.

I am 70-year-old male (USA) who had basically damaged his ankles through repeated injuries during active sport years.  When I was about 59 I began to encounter serious pain after running or playing tennis.  Since I am retired military and I had damaged my ankles during my years of service I sought help at the Veteran’s hospital.  I thought they would have some excellent orthopedic doctors. Well after about two years of repeated visits with different doctors all they could offer was ankle fusion.  A neighbor, who is a surgical nurse, recommended and excellent local surgeon she with whom she worked. My first appointment he felt there were other options than fusion.  Fusion will help the pain but tends to bring on further joint problems in the ankle because of the gate.  He told me of total ankle arthroplasty using Wright Medical Inbone. He directed me to the web site and to consider it as an option. He said I should think about it for a while.  (Sign of a good doctor) When I returned he interviewed me as a candidate. His criteria included age (preferred over 55), non-smoker, not over weight, and a positive attitude about recovery.  After research I elected to have the surgery on the right in January 2010.  The Inbone is a unique product as it uses a stem implant in the Tibia that reduces early loosening  ( check the web site for the animated video)  The surgery is a bit more demanding and requires an experienced team to perform the surgery . Recovery went well, about six weeks in a cast, then walking boot and Physical therapy.  If I recall, I was fully recovered in four to five months. There were limitations on high impact sports like, running, football, tennis I resumed tennis doubles and walking.  Actually about two years after the surgery I completed the Camino Frances walk in Spain. Over 525 miles in 37 days!  In June 2013 I elected to have the same surgery on the left ankle. Recovery was even faster. Since the last surgery they improved the imaging process to produce a better fit.   In May of 2014 I walked the Francesco Camino Pilgrimage from Assisi to Rome (about 150 miles) However during the walk (which was quite hilly) I began to have more pain in my right ankle.  In 2015, after attempts through orthotics to adjust my right ankle it was decided to do a revision on the right ankle.  The taluar component had begun to fail and was shifting in the talus.  The doctor felt that my right ankle had always a slight Cavovarus deformity (opposite of flat foot) which was causing the component to shift.  He recommended to perform a Calcaneus Osteotomy on the right heal first. This took place 28 October 2015. Three weeks later after incision healed he performed a revision surgery on the right ankle.  That surgery required to remove the component that had earlier been placed. The surgery was a bit more aggressive since he had to de-impact the tibia stem component ( basically, hammer it out!) The surgery went well. However, my surgeon had been recruited to be the Chief or Orthopedics at an hospital in another state so he left about six weeks after the surgery. I located another surgeon who was trained in the same ankle replacement company (Wright Medical) Recovery on this last surgery has been far more challenging. As I write it has been 8 months since the revision. I am walking without a can for most part and pain level are rarely over 4.  However there still is swelling and redness that appears as the day goes on.  My doctor feels I am doing very well considering the complexity of revision surgery, scar tissue and having multiple surgeries.  Oh yes, he had “for my age”. So I press on accepting it will be a slow road.

So after that here are some of my lessons learned:

Be realistic on what you can expect after the replacement. You will not be that athlete you were in your thirties. Take your doctor’s advice. I probably overdid it with the right ankle. I have now quit tennis and bike more for exercise.

The ankle and foot are very complex and repair is not always easy.  Talk to your doctor what you can expect as options.

Research your options, products and doctors. I read one comment where the replacement was the doctors first! I live in the USA where are the best (and probably the most expensive) medical treatment in the world.  Yet you still need to do your homework. My doctor was considered the best in the region.

Prepare for the surgery by keeping your weight low and getting fit,  Especially upper body for using crutches.  Eat well and stay healthy.

Prepare your home and family for your recovery. Think about the house.  I used a knee scooter most of the time in the house and while out.  I also used the fore arm crutches rather than the under armpit ones. Think about furniture, carpets and the bathroom. Oh yes the reading list! A good partner can really be of service

Take the pain meds. I never had greater than a 7 pain level for a short time.  During most of the recovery, the pain was around 3 at most.  I was lucky since my daughter( a nurse, taught me) don’t let the pain get ahead of you. Don’t been a stoic, take the meds.

Everyone is different in recovery and results. Your success may just be reduction or loss of pain.  Hope for the best, keep a positive attitude.

Be aware of age.  I know my recovery this time is because of my age. Keep that in mind.

To all of you I wish you your better health and reduction of pain in your journey!  Cheers, Ken

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