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LabGimp 06-04-2012 04:54 PM

Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Hi. This is my first post, so Iíll give a brief account of my story and my current dilemma.

I am a 55 yo female with a bad right ankle. I was in a car accident at age 19 and broke my right ankle and right femur. I was put in traction for my femur for 6 weeks and had an ankle cast. No pins or internal hardware of any kind. Seems a bit barbaric now. I was then put into a hip spica cast for 6 more weeks. Ten years after the accident, I was diagnosed with traumatic osteoarthritis and bone spurs. I had ankle surgery to remove the spurs & thickened fascia and shave down the rough cartilage.

Skip ahead to now, 36 years after my car accident and 26 years after my last ankle surgery. I still have traumatic osteoarthritis and the bone spurs have grown back. I now also have a peroneal tendon that is out of place. It is too far forward and too loose. This causes quite a bit of pain on the outside of my right leg. The bone spurs are mostly located at the base of the tibia and they dig into my ankle and also cause pain. There is a spur on the inside ankle bone, too, but that one doesnít hurt very much.

Here is my dilemma. I am currently having quite a bit of pain just walking and need to do something. My choices are:

1) Do nothing and keep feeling pain.
2) Ankle fusion
3) Debridement, bone spur removal and peroneal tendon reconstruction
4) Total ankle replacement (STAR system)

I have eliminated number 1 & 2 because I have to do something and ankle fusion does not appeal to me at all.

I am going back and forth between doing the debridement route or getting a total ankle replacement. The doc told me if go with the debridement/bone spurs removal/peroneal tendon reconstruction, it would not be my last surgery. In other words, I would probably need an ankle replacement in 10 or so years. Iím concerned that the STAR system has not been around that long. Itís been done in Europe and Canada for 20 or so years, but only 3 or so years in the U.S. He also said there is more risk of developing osteoarthritis in the small bones around the ankle with the replacement system.

Iím looking to get one of these procedures done in the next couple of months, if I can last that long. This puppy hurts. I have a follow up appointment in 3 weeks and have lots more questions. One is ďHow many STAR replacements have you done?Ē

So what do you think? I thank you for any and all input!

K_Lana 06-07-2012 05:23 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
I would go with the least invasive first. There is no turning back after an ankle replacement. I just found out my STAR failed on Tuesday. The options are not that great once you have a failed replacement.

You can always do the replacement if the other doesn't work.

LabGimp 06-08-2012 11:11 AM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Thank you for your response K_Lana. That is terrible that your STAR replacement failed! How long have you had it? How did you know it failed? What kind of options do you have now? I'm so sorry you are going through this.

I appreciate your advice. I am definitely leaning toward the simpler surgery, although it's not really that simple. No matter what, I will need to have the peroneal tendon fixed. He said they would carve a groove into my fibula and detach the tendon, then reattach it. That is the part the has me the most scared. I'm not even sure how they reattach it or what kind of incision it will be. I had the spurs taken out once before, so at least I know how that feels (not great!). That recovery took awhile and I was only 30 years old back then!

I have an appt with my doc on June 28, and I have a big list of questions, both medical and practical. Like, when can I drive? Unfortunately, it's my right ankle and I have a stick shift. Time to get an automatic, I guess!

K_Lana 06-10-2012 12:37 AM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
[QUOTE=LabGimp;4995340]Thank you for your response K_Lana. That is terrible that your STAR replacement failed! How long have you had it? How did you know it failed? What kind of options do you have now? I'm so sorry you are going through this.

I appreciate your advice. I am definitely leaning toward the simpler surgery, although it's not really that simple. No matter what, I will need to have the peroneal tendon fixed. He said they would carve a groove into my fibula and detach the tendon, then reattach it. That is the part the has me the most scared. I'm not even sure how they reattach it or what kind of incision it will be. I had the spurs taken out once before, so at least I know how that feels (not great!). That recovery took awhile and I was only 30 years old back then!

I have an appt with my doc on June 28, and I have a big list of questions, both medical and practical. Like, when can I drive? Unfortunately, it's my right ankle and I have a stick shift. Time to get an automatic, I guess![/QUOTE]

Hey there,
I got my STAR in Dec of last year, so about 6 mos. I knew the first second I put my foot on the ground that something was not right. But a month ago the pain was so severe I had to go back on crutches. My options are limited. I can convert to a fusion, which would not be easy given I have had bone removed for the replacement. I already have my subtalar joint fused, so I would not be happy with a fusion. I could amputate, and we have discussed this. I have rsd in my entire leg though so amputation might aggregate it so I can not wear a prosthesis. There is a hope that I may be able to convert to another type of replacement. That is what I am holding out hope for.

I have had peroneal tendon repairs and a subluxation repair before. It cut down on the pain significantly. The scar is good size. It goes from mid outside of the foot to up to the top oh the lateral malleolus ( outside ankle bone), you really can't see it that much. Of all my scars, it is one of the biggest, but least noticeable, probably because of location. I am lucky that mine is my left ankle so I never had to worry about driving. But recovery was much like my other surgeries, 6-8 weeks on crutches.
Good luck!

Fredel 09-05-2012 05:33 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Hi, I am new to this whole ankle thing as well, just lived with the pain for ten years.
I am doing extensive traveling next May and trying to figure out my options. All the surgical ones are definitely making me thing twice. Maybe I need to become better friends with my Tylenol bottle.

Hollywood48 09-05-2012 08:17 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Hi! I'm so sorry you are having to go through this. I do not have the experience to tell you what to do on the 2 options you are considering. I can say that I have had a peroneal tendon repair back on 2/22/12. I'm 6 months out. My peroneal tendon was torn and both tendons were subluxing. I had some other stuff repaired too, but anyway, for the tendon repair, he fixed it and then drilled/broke the fibula (called an osteotomy) to deepen the groove so that the 2 tendons will no longer pop out of place. I was on crutches and in a cast for 6 weeks. There was definitely pain and he warned me that the bone part would cause more pain and it did (had the same surgery minus the tendon repair and groove deepening 11 years ago and it wasn't as painful), but he controlled it well with meds and so far I think it has fixed my issues. Good luck with your decision!

LabGimp 09-07-2012 01:28 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Thanks for the replies. I have made a decision to NOT get an ankle replacement at this time. It is too invasive and they would need to remove bone to do it. I will opt for the "simpler" surgery of getting the spurs removed and the peroneal tendon moved back into place. I can always do a replacement a few years from now.

For the repair work, I found out that they do NOT detach the tendon. He will deepen the fibular groove so the tendon has a deeper place to lay. Then he will tighten up the ligament that holds the tendon in place. This ligament lays on the outside of my right foot. He will essentially fold it over on itself and secure it to the bone (like a face lift). "How do you secure it?, I ask. He says, "I will drill holes into the bone and suture the ligament into place". This will tighten the ligament and keep the tendon from popping forward. This is all assuming my tendon is in good shape. If the tendon is shredded and in bad shape, they will take a tendon from my big toe to use as a replacement. Now we're having fun.

I don't have the actual surgery date scheduled, but I will get it done either the end of September or October. I don't want to be on crutches in the snow. I better get good drugs.

iredrose 10-29-2012 04:26 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Hello. I am 37 with Rheumatoid Arthritis. I have had a total of 11 Surgeries on my Left Ankle. Pain, I was beyond pain. I would black out walking for 5-10 minutes in Walmart. Me and My Surgeon decided to amputate or Total Ankle Replacement (STAR). I am living a "normal" life now. I still have my up's and down's, but I am greatfull for my surgeon. Best of luck, and keep us posted!

LabGimp 10-29-2012 05:35 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Hi iredrose & thanks to all who replied.

I had surgery 11 days ago on 10-18-2012. I decided against the total ankle replacement. They debrided my ankle to remove the osteophytes (bone spurs), deepened the fibular groove and moved my peroneal tendon back to where it should be. They reconstructed the ligaments as well to hold the peroneal tendon in place. My tendon was in good shape, so there was no need to harvest one from my big toe (big relief). So far, so good. I get my initial splint/cast off in 3 days and they will put me into a fracture boot. At that time, I will get to see my incisions for the first time and he will remove the sutures.

I am having quite a bit of throbbing, but it feels like it is from normal healing. Each day is a bit better. I am still NWB (2 weeks) and once I get the fracture boot, I will be PWB as tolerated with crutches.

I'm glad I went with the decision to wait on the STAR replacement. For me, that would have been an overkill measure at this time. I feel like I have bought myself a few years, and I can always have a total ankle replacement 5 or 10 years in the future (assuming this surgery heals the way I want it to).

iredrose - Did you get the STAR replacement vs amputation? When was your surgery? It sounds like your RA was crippling and incredibly painful. I'm so sorry you had so much pain. I'm glad you are living a more normal life now. Isn't that all any of us want?

I will continue to post on my progress. :)

LabGimp 11-01-2012 12:35 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
UPDATE: Day 14 Post Op

Today is 14 days from the date of my surgery. Today I went to the doc and got my sutures out and went into a CAM walker boot. CAM means Controlled Ankle Motion. It is one of the big black boots with velcro closings.

My incisions were pretty impressive. I have 3 of them. One on the inside ankle bone that is about 1.5" long, one in the front that is also 1.5" long (both for removal of spurs), and the one on the outside ankle bone that is maybe 4-5" long where they did the peroneal tendon work.

Getting the stitches out HURT! Holy moly! The doc was impressed with my scooter. He thought it was one of the better constructed ones that he has seen. I am SOOO glad I have that scooter. Trying to do what I did today on crutches would be unthinkable. It was a breeze with the scooter.

I took my camera and had my husband take lots of pictures of the cutting off of the old cast and the removal of the sutures. The med team was totally cool with that, except the doc didn't want his face in the pic. lol.

I am going to have my husband take pictures of the CAM boot, too, since it has quite a few velcro straps, and I'd like to be able to put it back on correctly after I take it off for a shower (looking forward to that). This CAM boot also has an air bladder that can be pumped up to allow for additional support.

I went to the DMV yesterday to get my temporary handicapped parking placard (good for 90 days) and then my husband didn't even park in a HC spot! I was a little annoyed at that. Again, thank goodness for my scooter.

The doc told me I could go FWB as tolerated, but I haven't gone there yet. I need to recover a bit from a busy morning. I will be in the CAM boot for 4 weeks.

I guess that's about all for update right now. I'm currently in my recliner with my foot elevated eating leftover Halloween candy. mmmmm. candy.

Mr Blotto 11-01-2012 12:41 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Glad to hear that things are coming along. I think that in addition to pain meds, they should perscribe candy just after surgery - it makes everything better!

LabGimp 11-01-2012 12:52 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
Thanks Mr Blotto, and totally agree on the candy! ;)

trudove 05-31-2013 04:33 PM

Re: Ankle replacement vs debridement, spur removal & peroneal tendon surgery
 
LabGimp,
Boy your story sounds a lot like mine, except I broke my left femur and both feet were twisted and broke and they didn't do anything with them. I was in traction for my femur and I kept telling them my feet were killing me. They finally x rayed them and put a cast on the right one and I had a full leg cast on the left leg. I didn't get out of bed for several weeks but when they got me up they took the cast off the right ankle and it healed turning out from putting weight on it, the ankle bone sticks out too.
Fast forward to 5/24/11, I was having arthritis pain in both ankles so they went in and scoped both ankles and found the left one had way more arthritis. After that it hurt worse and was like bone on bone. So my Dr told me about this great STAR ankle replacement and I decided to have it done 8/24/11. He had only done 35 so wasn't all that experienced. He was assisted by another Dr that had done the same amount. The lower component was tilted to the back from the start and I had pain when I put weight on it. I had a lot of complications and have had 5 surgeries. I had a debridgement on 11/23/11 to clean out what they missed and take a screw out, still had pain and swelling so they did a revision and put a smaller lower component in on 5/24/12. Then I had pain around my heal and they said my sub talar joint was collapsing so I had to get that fused. I still couldn't walk right and the lower component was tilted way back. I finally went to Chicago on 4/2/13 and they took out the STAR and put the InBone II ankle in and did a calcaneal osteotomy on my heal. I am still in the CAM boot and my plantar flexion is very limited yet from going in the same incision 4 times. The Dr tried to cut out scar tissue, but didn't want to take to much for fear my incision would not heal properly. There was no comparison to the Dr experience and care. If you ever do need a replacement make sure it is a reputable Dr that has done several hundred and has successful outcomes.
Trudove


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