Looking for opinion about ankle fusion / replacement

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Hi everybody 

needing advice on weather to fouse my ankle totally so there will be no movement at all or a ankle replacment my specialist is thinking of a fousion then when I'm older he would give me a replacment but it still in the talking stage for now so just wanted to here from anyone who has had a replacment to know how long u took to recover ect and a if anyone has had a total fousion to know about the recovery etc so please help if u can ???????? 

Cheers 

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  • Posted

    Hi Nadine

    I had a similar discussion with my surgeon before opting for TAR, but  I understood that it was either fusion, or TAR followed by fusion if and when the TAR finally wears out after 10 or15 years. i.e., that you cannot have fusion and then a TAR further down the road.

    I guess this is because once the ankle has been fused  it is not possible to install a TAR due to tissue damage.

    Surgeons prefer to offer TAR to younger patients (under 65) due to the limited life of the TAR prothesis and the fact that it cannot be replaced once it has worn out - only fused.

    However, at any age I would opt for the TAR  to enjoy the movement and freedom from pain I how have (mine was installed in Dec 2014) even if only for another 10 or 15 years.Moreover, Fusion has a much longer recovery process (6 months in cast and boot instead of 3 months with TAR) and my surgeon agrees with me that later implants are much better and should last longer than the historical average.

    So far, whilst I am still getting my movement back (it takes a year) I am very pleased at the result and the difference it has already made to my life.

    I am 66.

    My only advice is that you pick a surgeon who has done a lot of TARs because it is a fairly demanding piece of surgery (2.5 hours as compared with 1 hour for a hip replacement) and it goes wrong it cannot be revised.

    My surgeon had done 70, but I spoke with one guy whose surgeon had only done one TAR before - rather him than me! 

    Good luck

    Best

    John

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    • Posted

      Nadine 

      Whoops, I should have said 

      Surgeons prefer to offer TAR to OLDER patients (over 65) due to the limited life of the TAR prothesis and the fact that it cannot be replaced once it has worn out - only fused.

      Phoenix is quite right - the decision depends on personal and medical circumstances and you must rely on the experience and advice of your surgeon.

      John

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    • Posted

      Hi john 

      thanks very much for replying to my question I have a hell of a lot of thinking to do , also because they don't really like doing TAR on a younger person I'm only 38 and I spoke to my specialist today and had a very long chat with him to try and work out what to do and he has told me he can fouse my ankle to a way of then going back to a total ankle replacment so my brain is going crazy with all the information but thanks so much for giving me some insight into what u have been though 

      cheers 

      Nadine 

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  • Posted

    Hello,

    You should make sure you speak with your specialist to get things clear in order to make the right decision and take the option that suits you better.

    You can not go from ankle fusion to replacement, but you can go from replacement to fusion.

    Recovery time will take depending on the person (everyone is different), but full recovery is usually within a year.

    I personally would recommend replacement, but again; you should talk to your doctor about it, in order to get an idea of which procedure is better for you. It all comes down to mobility requirements. Usually Fusion is done on those patients whose mobility will not be an issue (50 + years old). Replacement does have a life spam, since it wears out while fusion is a onetime thing.

    Again: you should sit and discuss the pros and cons, with your specialist; in order to educate yourself on which procedure would fit you best. 

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    • Posted

      Hi Phoenix omen 

      thanks for your input with my question about my ankle an TAR and yes there will be a lot of thinking and talking in the next few weeks I've spoken to my specialist today and had a long chat so he is saying do to my age.   ( 38 ) a fousion is maybe the best way to go and it can be turned back in years down the track to a TAR so there is another 3 weeks until I see him again so I've lots to think about and thanks very much for replying to me. Cheers 

      Nadine 

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    • Posted

      I think you are misunderstanding your specialist

       

      ​Fusion can not be “turned back” into TAR, but TAR can always be “turned back” to a fusion.

      In the case that your specialist is actually telling you what you just explained here, I would start looking for a new specialist if I were you.

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  • Posted

    Hi Nadine,

    I agree with John to an extent but it is actually possible to have a TAR revised, ie replaced when it wears out or becomes loose. Fusion is the end of the road as he said.

    I'm currently waiting to have mine replaced due to loosening .

    I had mine done December '13 age 59

    Best wishes 

    Gill 

     

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    • Posted

      Hi gill08601

      i have spoken to me specialist today and he has said that it's possible to have my ankle foused for now and in years to come then I will have a TAR and because of my age ( 38 ) they don't really like doing a TAR unless your an older person but thanks very much for your reply 

      cheers 

      Nadine 

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  • Posted

    Hi Nadine

    i had my TAR done 2 and a half years ago at the age of 52.  My first surgeon would only do a fusion, I didn't want this so I looked around for another one and for a second opinion and found one. I wanted to have movement in my ankle and a fusion doesn’t give you that. At the moment you cannot go from a fusion to a TAR ( so my Doctor told me) Find another surgeon you have nothing to lose. Also make sure he has done over 30 Tar’s so he knows what he’s doing. If you look on the internet people as young as 25 have had TAR’s. They are becoming more popular than fusions. In my mind a fusion is a last resort. I’m so happy with mine and in 10 to 15 years time when mine wears out I’ll go for another TAR, if that can’t happen then it’s a fusion. I can walk (on sand, rocks up steep hills) ride my bike and most important to me is SKI on it. Only thing I can’t do is run.

    Good luck fishersid

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    • Posted

      Hi fishersid 

      thanks very much for letting me know what has happened to you and I'm still doing a lot of resurch before doing anything which ever way I have to go so a second opinion is a great idea too thanks again 

      cheers 

      Nadine 

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  • Posted

    Nadine

    I agree with Fisher Sid in that I'd opt for a TAR whatever my age. However, I guess that if you are relying on the NHS they only want to pay to do the job once. So in view of the limited life of a TAR  their consultants head for fusion as a one hit solution and  discourage TARs for younger patients. 

    Certainly, at the age of 60 my NHS consultant strongly recommended fusion after just 1 XRay and a 5-minute consultation without even mentioning TAR as an alternative. This was despite that during my alloted 5 minutes I'd emphasised my wish to carry on sailing, which, as he told me, is pretty much impossible with a rigid ankle.

    So I elected to suffer the pain for several more years and finally went to the private sector where I selected a surgeon only after satisfying myself that he'd done enough of these demanding procedures to deserve my confidence (70).

    Just 6 months into my 12 month recovery period I am already delighted with the results and am sure that in 10 years or so TAR will be so well established that we'll look back on fusion as something they did in the dark ages.

    Finally, on the question of revisions, my surgeon tells me that replacement of a prosthesis is not generally feasible due to tissue damage.

    I guess this might be another problem the techies will solve in coming years. However, in the meantime my surgeon agrees with me that it's quite possible to monitor the condition of the prosthesis by periodic XRay and merely replace the polyethylene bearing when this becomes thin, rather than allow metal-to-metal contact and attendant  damage to the polished titaneum bearing surfaces, in turn requiring replacement of the two implants.

    However, I am also pretty sure that such monitoring is only possible if I pay for it myself.

    John  

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    • Posted

      Sorry but your statement against the NHS is just not fair, untrue and it has nothing to do with NHS. NHS, just like in the private sector, has bad and good providers.

      Using the same assumption you just did on NHS I could say: "Private providers want you to "do" a TAR in order to keep giving them cash on a continuous manner".

      It is actually thanks to the NHS that TAR products use in EU are better than those use in US. In US the "private sector" forced a push back on new TAR products in order to sell the overstock they had on old TAR products. It was not till the old TAR were gone (and they got the winnings) when they decided to push forward the new sets.

       

      ​Anyhow, not every patient can have a TAR done on him/her; health and physical condition takes a huge factor on such decision.

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    • Posted

      Phoenix

      I acknowledge your view but must say that NHS did not mention TAR to me and I only found I had the choice when I went to the private sector after learning of my options from surgeon friends .

      This is no surprise and disappointment to me as I appreciate that TAR is an expensive and time limited procedure and NHS has famously limited resources.

      At my age they surely have greater opportunity cost elsewhere.

      So I take a pragmatic view. NOT a statement against the NHS

      John

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    • Posted

      I understand, but generalizing a whole sector, because and based on your case, it is just wrong. I had a friend that was “Checked out” by a private provider on his right ankle and consequently told that there was nothing to worry about (With MRI’). A week after, and because of continuous pain, he visited a Public care provider; this provider using same MRI’ stated he was in need of a Lateral Ankle Ligament Reconstruction.

      I could give you thousands of examples on which private providers have committed same mistakes as public providers; yet I don’t go around generalizing. Anyhow this is off topic, I just hope Nadine gets the best outcome.

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    • Posted

      I can actually give you personal examples of failures by private sector providers - and of excellent service by the NHS. My intention was not to condemn the NHS, but rather attempt to explain what to me is otherwise an illogical reluctance to offer TAR to younger patients, or in my case to older patients. This is inarguably an expensive procedure of finite life ultimately requiring a second procedure, and the NHS has extremely limited resources. Both sectors are served by the same practitioners and equally well, and the only obvious difference between them is sovereignty of expenditure.

      As a further general example, I cited my wish for my prosthesis to be periodically monitored by XRay in order to maximise the possibility of future revision, but could not, and would not, expect the NHS to fund this monitoring considering its current financial pressures.

      John

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    • Posted

      "and the only obvious difference between them is sovereignty of expenditure."

      The only diference between them is: the Private sector procedures is worth how ever much cash the patient can afford. So only a minority is able to reach it. While NHS offers the procedure to every single person regardless of social and economical status. Private sector will only provide such services to those that can afford it, NHS will allow every one to be on the list; taken in mind priorities.

      You keep using your own failure experience as a way to generalize, and you are wrong by doing such thing. 

      Private sector does not have the best equipment nor procedures is just not as weared off as the one used by NHS. You only need to use comon sense:

       Not every one can afford a private provider, there for the waiting list are shorter and their "machines" are not as weared off. But with NHS every one has the right to be in the list.

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