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The Ankle Total Ankle Replacement Before your Surgery The Surgery

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The Ankle Total Ankle Replacement Before your Surgery The Surgery Powered By Docstoc
					The Ankle
The ankle is a ball and socket joint witch it is covered by a very smooth surface (like glitter) called cartilage,
its function is to allow gliding and cushioning of the joint as it moves during weight bearing. Due to a number
of medical conditions and injuries arthritis or alteration of the normal anatomy can take place resulting in
damaged joint leading into “wear and tear” destroying the cartilage this is felt as pain stiffness with swelling
and loss of motion in the joint.


Total Ankle Replacement
Ankle replacement surgery has become more and more popular in the last 5-10 years .There are a number
of different prosthesis with varying shapes each developed to increase the mobility and durability of the
implant.

These pieces are implanted after the bones are cut into shape and held in place by press-fit 80% of patients
with ankle replacement present satisfactory results for 5 years or more long term results (more than 10 years)
are scarce but encouraging.


Before your Surgery
The preparation for surgery begins before of the date of the surgery. We recommend certain activities that will
increase your strength this enabling the use of crutches after surgery. Undetected problems such as urinary
infection or small ulcers and any similar conditions could affect the new joint therefore a pre-assessment is
generally held prior to surgery to ensure that your are fit for the operation. Total ankle replacement surgery
requires anaesthesia. There are various types of anaesthesia available (general anaesthetic and/or spinal
anaesthetic) this will be explained before surgery.


The Surgery
Surgery will last 1 to 1/2 hours. After this you will be transferred to the Recovery Area, where you will be
care for of by trained nursing staff. You will have had a plaster applied to your leg. We will ensure that you
are comfortable and treat any undue pain or sickness. After returning to the ward further monitoring will take
place until you are discharged usually after 2 or 3 days.


After Surgery
After returning to the ward further monitoring will take place until you are discharged. While in the ward you
will receive pain medication and commence with physiotherapy. It is likely that you will be out of bed and
walking with crutches or a walker within 24 hours of your surgery but you will not be allowed to weight bear on
your ankle you will also notice that you have some antiembolic stocking in the opposite leg in order to promote
circulation and prevent blood clots. 48 hours after surgery as the swelling will have subsided significantly you
will be given another more secure plaster, this time you will be allow to partially weight bear.

You will be shown how to climb and descend stairs safely and how to get in and out of a seated position.
Your physiotherapist and will show you a variety of exercises designed to help you regain mobility and
strengthening your leg muscles. You should be able to perform these exercises at home.

Before you leave the hospital (after approximately 3 to 4 days), your occupational therapist will advise you on
mobility and other matters such as assistance at home and managing activities of daily living.


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Complications
Whilst uncommon, complications can occur during and after surgery. A total hip replacement is a fairly big
operation. Approximately one patient in ten will develop one or more minor complications these complications
may require a longer stay in hospital.

More commonly the complications are not directly related to the actual operation and should not affect the
results of the operation. These complications may include; chest infection, urinary retention Urinary Tract
Infection (water infection) Blood clots in the leg, (DVT) and more seriously blood clots in the lungs (PE). We
will take several measures and precautions in order to minimize any potential problems.

Other complications, which affect the ankle directly, are less common. In these cases the operation may not
be as successful as initially thought. These complications include: some ankle pain, fracture of the bone,
wound problems with skin necrosis, loosening of the prosthesis, stiffness of the joint Infection of the ankle,
numbness and pins and needles.

These complications and a few such as infection (approximately 1%) and loosening of the prosthesis (20%
at after 5 years) and stiffness may require re-operation. Infected artificial ankles sometimes have to be
removed. After a course of antibiotics the surgery can often be done and this is known as a revision, your will
usually be reasonably comfortable, and you will be able to walk with the aid of a crutch or stick and a special
shoe.

Loosening of the prosthesis is in part related to body weight and activity. A loose, painful, artificial ankle can
usually but not always is replaced again. The results of the second operation are generally not as good as
the first, and the risks and complications are usually higher. Generally most failed ankles will required another
operation for Fusion (Arthrodesis) where bone graft and a metal screws or rods are inserted to supports the
ankle. After this operation there will be NO further movement of the ankle joint.


What can I expect after this surgical procedure?
Discharge from the hospital is likely to be two to three days after surgery. A patient can often be in Plaster for
the best part of six weeks until the wounds have healed properly.

You should have just had your stitches removed two weeks after surgery and had your joint examined a new
plaster applied (one that you can put some weight on) and will be in place for another 6 weeks, X-Rays will
be taken and all being well your ankle will by them protected by a plastic boot for up to 3 months. You should
increase the distance you walk daily. You are encouraged to continue with the exercises recommended by
the physiotherapist for as long as indicated.




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