Looking for opinion about ankle fusion / replacement

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

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. 

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 

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

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