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Old 04-15-2011, 08:39 PM   #1
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Ankle Replacement- 24- questions...

Hey,
Three years ago I had a traumatic injury to my right ankle- compound convoluted fracture. I've been in progressing pain for the last three years and now it keeps me from hiking, running- at all, wearing heels, playing softball, and now even walking to class. I decided to pursue surgery and was against doing the replacement because I don't want that restriction of mobility so young. I have a friend who did that and given the choice- I would rather take my chances and deal with the mobility issue later. Especially since ankle fusions can be irreversible. Anyway, I am scheduled for June. My insurance approved!!!!!!! (A truly wonderful day) and now I just have questions. How long is the surgery, what is the post-life like? Any advice?


thanks

 
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Old 04-16-2011, 04:35 AM   #2
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Re: Ankle Replacement- 24- questions...

I can't answer your questions, but I"m interested in the answers. Right now I've been given 2 choices, ankle replacement or amputation with amputation given the better overall outlook per my OS. But, it is pretty final, so I would like to hear more about replacement as well.

What type are you getting? Did you do any research on the types?
How old are you? My age (early 40's) has been a bit of an issue, but was still told it could be an option.

 
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Old 04-16-2011, 04:39 AM   #3
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Re: Ankle Replacement- 24- questions...

I had a mid-foot fusion back in Oct. I thought that a fusion is very different to a replacement? I can help if you have any questions about fusion tho.

 
Old 04-16-2011, 10:44 AM   #4
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Re: Ankle Replacement- 24- questions...

KLana- I'm 24. Did they not give you the option of a fusion surgery? It seems strange to me to offer a replacement and amputation over a fusion. But at the same time I don't really understand why the fusion is recommended for younger people like myself unless you don't have another option. Given the choice of mobility now or later-- I would rather have mobility and no pain now rather than later and fuse my leg later on. I foresee the potential for amputation way down the road but I really try not to think about it too much. I have a very good surgeon here in NC. He uses the INBONE, Saltotalaris, and STAR parts. I'm very scared as to whether or not I've made the right decision but I've thought about it a lot and I fee like this is rightfor me. I want to play softball again and go hiking and walk without pain and I feel like these things would be more limited with the fusion. What do you think CLOUD?

 
Old 04-16-2011, 10:56 AM   #5
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Re: Ankle Replacement- 24- questions...

Well I was given the option of triple arthrodesis, (mid foot fusion) or be totally incapacitated within 10 years. I'm quite a bit older than you I think (51), and was born with bi-lateral talipes (club feet). I don't remember a time when I didn't have pain in both feet but in the year running up to October last year, my arthritis got a million times worse and caused havoc with all the surgeries that I'd had before the age of 12. Although I've had a few problems with wound healing since the surgery in October, the pain in my foot has gone. My ROM is still very limited, due I think to the wound and dressings on it. I'm nervous on uneven ground and downward steps but I'd rather be where I am now with it than have the amount of pain I had prior to surgery. So much so that I'm going to go through it all again to have my left foot done.
My wound problem means that I soon have to go and have the metal work removed as it's causing the infection. This wasn't part of the plan, I was going to keep the metal work forever, but my foot doesn't want it or need it anymore.
The recovery is long and hard to bear sometimes, but with good planning it passes, and, in my opinion is worth it in the end.
Good luck with your decision and keep us informed.

 
Old 04-16-2011, 11:00 AM   #6
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Re: Ankle Replacement- 24- questions...

Oh and my initial surgery was approx 2 hours I think. I was in hospital for 2 nights due to the nerve blocks, (femoral and sciatic) not wearing off till then. I had to have a knee scooter and wasn't allowed to use it with a numb leg so they had to keep me in.

 
Old 04-16-2011, 11:12 AM   #7
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Re: Ankle Replacement- 24- questions...

Quote:
Originally Posted by swalt View Post
KLana- I'm 24. Did they not give you the option of a fusion surgery? It seems strange to me to offer a replacement and amputation over a fusion. But at the same time I don't really understand why the fusion is recommended for younger people like myself unless you don't have another option. Given the choice of mobility now or later-- I would rather have mobility and no pain now rather than later and fuse my leg later on. I foresee the potential for amputation way down the road but I really try not to think about it too much. I have a very good surgeon here in NC. He uses the INBONE, Saltotalaris, and STAR parts. I'm very scared as to whether or not I've made the right decision but I've thought about it a lot and I fee like this is rightfor me. I want to play softball again and go hiking and walk without pain and I feel like these things would be more limited with the fusion. What do you think CLOUD?
They did give me an option of fusion. Well, my dr. in Baltimore gave me that as an option, not replacement because replacements "don't last" were his words. My OS here is talking replacement because like you mentioned, so it may get me 10+ years now of mobility and then we can always fuse later.
I'm 42 and so not as young as you, but still where a fusion will cause me much trouble and loss of mobility. My dr. down here, who knows my history better said I would not be happy with a fusion. He believes amputation will give me the best chance of having my life back followed by replacement.
WHich replacement are you having? Mine does InBone and STAR. I've thought about going to NC to see the drs up there, but I did the travel to see a dr. thing and I like mine down here just fine.
What did they say they would do when/if it wears out? Will they do a revision? Are you only allowed one revision? THese are all questions I need to ask at my next appt. I'm very curious as to the differences in the two types of replacements. I know what they look like, seen videos on how they are put in, but as for function and ease of revision followed by fusion, I don't know what would be best.

 
Old 04-16-2011, 03:18 PM   #8
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Re: Ankle Replacement- 24- questions...

I don't have to make a decision like yours. My thought process is that fusion and amputation are so final. Even if the replacement only lasts 7 or 8 years, who knows what kind of advances there will be in 8 years. There may be new options that will allow you to have continued mobility. When faced with such a life changing decision, I guess that I would travel to see what another surgeon says. I had my flat foot reconstruction done at HSS in NYC. I can't say enough positive things about the hospital. I am 9 months post op and am thrilled with the outcome of my surgery. I know that HSS is doing a lot of work with artificial ankles. It may be worth the trip to see what they say.

Good luck

 
Old 04-16-2011, 08:19 PM   #9
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Re: Ankle Replacement- 24- questions...

Quote:
Originally Posted by swalt View Post
Hey,
Three years ago I had a traumatic injury to my right ankle- compound convoluted fracture. I've been in progressing pain for the last three years and now it keeps me from hiking, running- at all, wearing heels, playing softball, and now even walking to class. I decided to pursue surgery and was against doing the replacement because I don't want that restriction of mobility so young. I have a friend who did that and given the choice- I would rather take my chances and deal with the mobility issue later. Especially since ankle fusions can be irreversible. Anyway, I am scheduled for June. My insurance approved!!!!!!! (A truly wonderful day) and now I just have questions. How long is the surgery, what is the post-life like? Any advice?


thanks
I'm going to give you my opinion. I had a bad injury to my ankle 2.5 years ago. Have not been able to walk on it normal since then. Have never had a pain free day. I know you have this surgery scheduled but this is a big decision. I'll tell you 2 stories...1. A doctor i work with did one on a patient and she is doing wonderful. 2. another doctor had to do an amputation because of a failed one (patient begged him to do it and after 10 years he finally agreed). This patient had hers done by one of the best surgeons in the world in this dr's opinion. So you have to make sure you are a good candidate.
I'm not going to bore you with my story. But I will say a joint replacement will last you up to 10 years if you are lucky THEN re-do ing it may be difficult so it may end in a fusion anyways.
With a fusion it is permanent but 20 years down the road your forefoot may break down and you will have issues.
Hard decision either way....
I was given an option of fusion or replacement. My dr said to go with fusion. sent me to another dr to do the fusion. Thats where he reccomended the ankle distraction. Because of my age it is the BEST option because I'm only 28. It is a long process but if I can avoid a fusion it will all be worth it. Just something to look into and think about. If you have any questions let me know.
If we were older this decision would be a lot easier but we arent so we have to be careful.
Also, a replacement would put you out about 6 months depending on your work. And as long as you are determined, you will do fine.

 
Old 04-16-2011, 08:37 PM   #10
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Re: Ankle Replacement- 24- questions...

Also I dont know if this will help but in my experience (I'm in the medical field and work with ortho doctors majority of the time and have asked all of them their opinions because of my own problems). And also, I ask the patients their opinions on the follow up visits and I see how their outcome is. And this is just my opinion (and I guess my ortho guys opinions too)

All but one of my ortho guys are against the ankle replacement:
Because they dont have good outcomes. Create more problems. usually end in a fusion. But if you do fuse it after you replace it is a mess because in a replacement (i've been in on one in surgery) you basically obliterate the bone between the malleoli. So if you think about it you have to graft bone from another part of your body to fill that space for a fusion. Or you can use cadaver bone(which is not a good idea because it may not fuse properly). But I know of 2 patients who have had success with them. I also know several that have bad experiences and that are worse off now.

With a fusion...it is a better option in most of my ortho guys opinions....because if it is your joint it is a permanent fix....and has a good outcome. One dr in particular has done 40 to 50 fusions and he said they are all pleased with the results. But, 20 years or so down the road your forefoot will break down because of your ankle being fused. So that creates more problems. This is why they dont reccomend fusions for anyone under 40 or 50 years old. But they will do them.

Ankle distraction: Will not burn any bridges. So if it doesnt work you can still go on with a replacement or fusion.

I hope this helps. I wish you all on here luck!!

Last edited by DeidraL; 04-17-2011 at 01:59 PM.

 
Old 04-17-2011, 03:10 AM   #11
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Re: Ankle Replacement- 24- questions...

Quote:
Originally Posted by DeidraL View Post
I'm going to give you my opinion. I had a bad injury to my ankle 2.5 years ago. Have not been able to walk on it normal since then. Have never had a pain free day. I know you have this surgery scheduled but this is a big decision. I'll tell you 2 stories...1. A doctor i work with did one on a patient and she is doing wonderful. 2. another doctor had to do an amputation because of a failed one (patient begged him to do it and after 10 years he finally agreed). This patient had hers done by one of the best surgeons in the world in this dr's opinion. So you have to make sure you are a good candidate.
I'm not going to bore you with my story. But I will say a joint replacement will last you up to 10 years if you are lucky THEN re-do ing it may be difficult so it may end in a fusion anyways.
With a fusion it is permanent but 20 years down the road your forefoot may break down and you will have issues.
Hard decision either way....
I was given an option of fusion or replacement. My dr said to go with fusion. sent me to another dr to do the fusion. Thats where he reccomended the ankle distraction. Because of my age it is the BEST option because I'm only 28. It is a long process but if I can avoid a fusion it will all be worth it. Just something to look into and think about. If you have any questions let me know.
If we were older this decision would be a lot easier but we arent so we have to be careful.
Also, a replacement would put you out about 6 months depending on your work. And as long as you are determined, you will do fine.
Deidtra and others.... I HAD the distraction. I had it last year. I did not work and instead left me with osteomyelitis and RSD. I did it as a last resort over fusion, replacement...because I was too young... and amputation. My dr. has done an amputation on another failed distraction arthroplasty procedure. I could be his second. So while distraction is an option for someone with basic arthritis in the ankle joint only, I don't think the odds are great for someone with arthritis in multiple joints in foot or with other issues like alignement, tendons or ligaments issues along with it all. The distraction tore my ATFL, my deltoids, and my peroneal tendons. I hope yours works out well for you, but for some young people, this still may not be an option, or in people like me, we've already been there done that.

 
Old 04-17-2011, 03:17 AM   #12
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Re: Ankle Replacement- 24- questions...

Quote:
Originally Posted by DeidraL View Post
Also I dont know if this will help but in my experience (I'm in the medical field and work with ortho doctors majority of the time and have asked all of them their opinions because of my own problems). And also, I ask the patients their opinions on the follow up visits and I see how their outcome is. And this is just my opinion (and I guess my ortho guys opinions too)

All but one of my ortho guys are against the ankle replacement:
Because they dont have good outcomes. Create more problems. usually end in a fusion. But if you do fuse it after you replace it is a mess because in a replacement (i've been in on one in surgery) you basically obliterate the bone between the malleoli. So if you think about it you have to graft bone from another part of your body to fill that space for a fusion. Or you can use cadaver bone(which is not a good idea because it may not fuse properly). But I know of 2 patients who have had success with them. I also know several that have bad experiences and that are worse off now.

With a fusion...it is a better option in most of my ortho guys opinions....because if it is your joint it is a permanent fix....and has a good outcome. One dr in particular has done 40 to 50 fusions and he said they are all pleased with the results. But, 20 years or so down the road your forefoot will break down because of your ankle being fused. So that creates more problems. This is why they dont reccomend fusions for anyone under 40 or 50 years old. But they will do them.

Ankle distraction: Will not burn any bridges. So if it doesnt work you can still go on with a replacement or fusion.

I hope this helps. I'm not an expert by any means as you can tell....haha. I wish you all on here luck!!
I believe with many fusions, if not all, you stillhave to have a bone graft. Of the 2 people I know who have had fusions, both had to have bone taken from leg or hip to help with the fusion. And depending on the type of replacement you get, the amount of bone taken out is less. I believe the STAR takes much less bone than some of the others.

And you are right, ankle distraction doesn't burn too many bridges, although I may not have the replacement option thanks to the ankle distraction... I think the poster was asking for advice, she has made up her mind about replacement. She saw her dr. and if he didn;t mention distraction then I'm sure it was not an option for her. Not too many OS, will do a replacement on someone that young, so she is probably beyond what a distraction can do.

 
Old 04-17-2011, 04:19 AM   #13
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Re: Ankle Replacement- 24- questions...

I didn't have any bone grafts.

 
Old 04-17-2011, 06:02 AM   #14
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Re: Ankle Replacement- 24- questions...

That is good to know. The two that I know of were subtalar fusions and they both had a bone graft and screws.

Fusion definitely has been proven that it lasts. It's just with hopefully more than half my life left, It is too limiting for me right now, and I'm asuming the OP feels the same way, she is only 24....

 
Old 04-17-2011, 10:46 AM   #15
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Re: Ankle Replacement- 24- questions...

I'm just giving my opinion. I did not have a simple injury, it was severe and it turned into severe osteoarthritis. Different patients react different to different procedures just like different dr's can do the same procedure and do follow up differently. Some dr's have success some dont. Mine has had a lot of success with this procedure. And I was offered a replacement but with my age my dr said to try this first.

Last edited by DeidraL; 04-17-2011 at 02:16 PM.

 
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