Ankle scope procedure: Ankle Arthroscopy | FootCareMD
Ankle Arthroscopy | FootCareMD
What Is Ankle Arthroscopy
Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint. Ankle arthroscopy uses a thin fiber-optic camera (arthroscope) that can magnify and transmit images of the ankle to a video
screen. Ankle arthroscopies can reduce ankle pain and improve overall function.
Arthroscopy can be used to diagnose and treat different disorders of the ankle joint. The list of problems that can sometimes be treated with this technology is constantly evolving and includes:
Ankle arthritis: Ankle fusion is a treatment option for many patients with end-stage ankle arthritis. Ankle arthroscopy offers a minimally invasive way to perform ankle fusion. Results can be equal to or better than open techniques.
Ankle fractures: Ankle arthroscopy may be
used along with open techniques of fracture repair. This can help to ensure normal alignment of bone and cartilage. It also may be used during ankle fracture repair to look for cartilage injuries inside the ankle.
Ankle instability: Ligaments
of the ankle can become stretched out, which can lead to a feeling that the ankle gives way. These ligaments can be tightened with surgery. Arthroscopic techniques may be an option for treating moderate instability.
Loose bodies: Cartilage, bone, and scar tissue can become free floating in the joint and form what is referred to as loose bodies. Loose bodies can be painful and can cause problems such as clicking and catching. Locking of the ankle
joint may occur. Ankle arthroscopy can be used to find and remove the loose bodies.
Osteochondral defect (OCD): These are areas of damaged cartilage and bone in the ankle joint. OCDs usually are caused by injuries to the ankle such as fractures and sprains. Common symptoms include ankle pain and swelling. Patients may
complain of catching or clicking in the ankle. The diagnosis is made with a combination of a physical exam and imaging studies. Imaging may include X-rays, MRI, or CT scan. The treatment is based on the size, location, and stability of the OCD. The
patient’s symptoms and activities also are considered. Surgery often consists of scraping away the damaged cartilage and drilling small holes in the bone to promote healing. Bone grafting and cartilage transplant procedures also can be performed.
Posterior ankle impingement: This occurs when the soft tissue at the back of the ankle becomes inflamed. Pointing the foot down can be painful. This overuse syndrome occurs commonly in dancers. It can be associated with an extra bone
called an os trigonum. The problem tissue can be
removed with arthroscopy.
Synovitis: The soft tissue lining of the ankle joint (synovial tissue) can become inflamed. This causes pain and swelling. It can be caused by injury and overuse. Inflammatory arthritis (rheumatoid arthritis) and osteoarthritis also can
cause synovitis. Ankle arthroscopy can be used to surgically remove inflamed tissue that does not respond to nonsurgical treatment.
Unexplained ankle symptoms: Occasionally patients develop symptoms that cannot be explained by other diagnostic techniques. Arthroscopy provides the opportunity to look directly into the joint. The surgeon can then identify problems
that may be treated with surgery.
Elective arthroscopy is not appropriate for some patients. Patients with severe ankle arthritis may not benefit from arthroscopic surgery. Patients with active infections or other medical problems may not be appropriate surgical candidates.
Your foot and ankle orthopaedic surgeon will mark the operative leg prior to surgery. You will be transported to the operating room and given anesthesia. A tourniquet is commonly applied to the leg. The leg is thoroughly cleaned. The surgeon will sometimes
use a device to stretch the ankle joint and make it easier to see inside.
At least two small incisions are made in the front and/or back of the ankle. These portals become the entry sites into the ankle for the arthroscopic camera and instruments. Sterile fluid flows into the joint to expand it and allow for better visualization.
The camera and instruments can be exchanged between portals to perform the surgery. Both motorized shavers and hand operated instruments are used. After the surgery is complete, sutures are placed to close the portals. A sterile dressing is placed
over the sutures. A splint or boot is often used.
You can expect some pain and swelling following surgery. The leg may need to be kept elevated. You may need to take oral pain medication for several days. You may be able to walk on the leg immediately, or you may need to wait several months before putting
weight on the leg. This will depend on the type of surgery performed and the recommendations of your surgeon. If needed, sutures are removed one to two weeks after surgery. Your surgeon will determine when activities such as range-of-motion and ankle
exercises are allowed. Physical therapy may also be used.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Potential complications specific to ankle arthroscopy include injury to nerves and blood vessels around the ankle. Numbness or tingling at the top of the foot can occur approximately 10 percent of the time. This typically resolves over time.
When can I safely return to driving?
You will likely be cleared for driving when you are able to bear weight without limitation and are no longer taking narcotic pain medication.
When can I expect to return to work and sports?
You may be able to return work several days after surgery if you can safely complete your job duties. Most patients can expect to be out of work for at least 1-2 weeks. It is possible to return to high-level sports following ankle arthroscopy, but
expect at least 4-6 weeks of recovery before getting back to such activities.
What are the outcomes of ankle arthroscopy?
Seventy to 90 percent of patients undergoing ankle arthroscopy for the most common problems
achieve good or excellent results.
Originally written by Sarang Desai, DO
Last reviewed by Robert Leland, MD, 2018
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute
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Ankle Arthroscopy | Tri-County Orthopedics
Ankle arthroscopy is a minimally invasive surgical technique that utilizes the technology of fiberoptics, magnifying lenses, and digital video monitors to allow the surgeon to directly visualize the inside of an ankle through small incisions. Several incisions, approximately half a centimeter in length, are fashioned about the ankle to allow for the insertion of an arthroscope, or small fiberoptic video camera, and/or special arthroscopic instruments. Sterile fluid is also circulated through the ankle to distend the joint, creating more space for the arthroscope and instruments. This also allows for better visibility within the ankle, space to maneuver instruments, and clearance of debris.
How is Ankle Arthroscopy Performed?
Ankle arthroscopy is generally performed as an outpatient surgery under general anesthesia with or without a regional pain block or epidural anesthetic with sedation. After adequate anesthesia is established, a tourniquet is applied to the leg, and the leg is prepped and draped in a sterile fashion. Mechanical distraction devices are sometimes used to help surgeons temporarily enlarge the potential space of the ankle. After the foot and ankle are appropriately positioned, at least two approximately 0.5mm incisions are made in the ankle. These incisions become the entry sites into the ankle, or portals, for the arthroscopic camera and instruments. These portals are placed strategically in an effort to avoid vessels and nerves. The incisions are made in the front or back of the ankle, or a combination of these. Sterile fluid is then allowed to flow through the ankle to further open the joint. The camera and instruments can then be exchanged between portals to perform the surgery. At the conclusion of the procedure, small sutures are placed in the skin to close the portals. A sterile compressive dressing, and sometimes a splint or boot, are then applied. The patient is brought to the recovery area and is usually discharged home the same day with specific weightbearing and dressing care instructions.
What conditions is ankle arthroscopy used to treat?
Ankle arthroscopy can sometimes be used as an alternative to open ankle surgery, which is a surgical approach utilizing larger incisions to access the inside of the ankle. It can be used to diagnose and treat different disorders of the ankle joint.
The list of problems that this technology can be used for is constantly evolving, but includes:
1. Osteochondral defect of the talus (also referred to as osteochondritis dessicans, OCDs, osteochondral fractures)
This includes acute ankle sprains and repetitive ankle injuries caused by chronic instability. Atraumatic causes of OCDs include vascular insults, genetic predisposition, degeneration, and metabolic abnormalities. Patients will often present with complaints of persistent and progressive ankle pain and swelling. This can be associated with mechanical symptoms of catching, clicking, or popping, and decreased range of motion. The diagnosis is made with the combination of physical exam and diagnostic imaging, including X-rays, MRI, and/or CT scan. The treatment will be based on the size and location of the OCD, associated symptoms, patient demographics, and activity demands of the patient. After the diagnosis is made arthroscopically, treatment options include microfracture, subchondral drilling, abrasion arthroplasty, fragment fixation, and bone grafting procedures. Thorough discussion with your surgeon is necessary to determine which option is most appropriate for you.
2. Anterior Ankle Impingement (also referred to as “athlete’s ankle” or “footballer’s ankle”) and Anterolateral Ankle Impingement
These occur when either bone and soft tissue of the anterior (the “front”) ankle joint becomes inflamed due to repetitive stress or irritation. This will cause pain in the ankle joint, swelling, and can limit motion of the ankle, especially dorsiflexion (loss of the ability to bend your “toes towards your nose”). Walking uphill is often painful. This is common in soccer players and any athlete with recurrent ankle sprains. The diagnosis of anterior ankle impingement can be made by identifying osteophytes, or “bone spurs,” on standard X-rays of the ankle. Sometimes, a MRI is necessary if bone spurs are not present. MRI can identify redundant and inflamed soft tissue in the anterolateral gutter of the ankle not seen with standard X-rays. This is considered anterolateral ankle impingement. If nonoperative measures fail to relieve symptoms of either of these conditions, ankle arthroscopy can be used to shave away redundant soft tissues and/or bone spurs.
3. Posterior Ankle Impingement
This occurs when the bone and soft tissue of the hindfoot (the “back” of the ankle) becomes inflamed due to repetitive stress. This will cause pain in the ankle joint, swelling, and often times limited motion of the ankle, especially plantarflexion (loss of the ability to “press on the gas”). This overuse syndrome occurs most commonly in ballet dancers, but can also be seen in other athletes. Like anterior ankle impingement, it is usually associated with bone issues in the posterior part of the ankle (the “back” of the ankle). It can also be associated with an accessory bone, which is not found in all patients that is referred to as an os trigonum. Surgical treatment involves placing arthroscopic incisions in the back of the ankle to access the painful area. Bone spurs, inflamed soft tissue, and if present, the os trigonum, can then be removed arthroscopically.
Synovitis is inflammation of the soft tissue lining of the ankle joint (synovium) that will often manifest as pain, swelling, and loss of motion. This can occur due to an acute trauma, inflammatory arthritis (i.e. rheumatoid arthritis), overuse, and degenerative joint disease (osteoarthritis). If nonsurgical treatment options fail to provide relief, ankle arthroscopy can be used to surgically remove inflamed synovium.
5. Loose Bodies
Articular cartilage and/or scar tissue following trauma to the ankle can become free floating in the joint and form what is referred to as a “loose body”. These can also occur within the setting of a condition called synovial chondromatosis, where the lining of the joint becomes redundant for unexplained reasons. These loose bodies can cause problems such as clicking, catching, and frank locking that often lead to pain, swelling, and loss of motion. Occasionally loose bodies can be identified with standard X-rays or a CT scan, but frequently require an MRI to visualize the culprit. Ankle arthroscopy can be used to find and remove the loose body.
Sometimes, previous trauma, prior ankle surgery, infections of the ankle joint, and inflammatory arthritides, such as rheumatoid arthritis, predispose patients to the development of scar tissue, or arthrofibrosis. Ankle arthroscopy can be used to identify this scar tissue and remove it.
Septic arthritis, or infection of the joint space, cannot be treated effectively with antibiotics alone. It often necessitates an urgent surgery to wash out the joint. This can be done as an open procedure or with an arthroscopy. Although infections of the skin and soft tissue around the ankle joint preclude ankle arthroscopy in most settings, septic arthritis can be an indication for ankle arthroscopy. The decision of whether or not an infection is amenable to arthroscopic surgery is determined by many factors. Only you and your surgeon can determine whether or not it is appropriate for you.
8. Ankle Fractures
Ankle arthroscopy can also be used along with conventional techniques of fracture repair to ensure that normal anatomic alignment of cartilage within the ankle is restored. This is done to help minimize the risk of future posttraumatic arthritis.
9. Unexplained Ankle Symptoms
Occasionally patients develop symptoms, such as pain, swelling, locking, catching, grinding, or popping, that cannot be explained with diagnostic techniques such as X-rays, CT scans, MRIs, or bone scans. When nonoperative measures have been exhausted, ankle arthroscopy can be used to diagnose lesions within the ankle joint. It provides the opportunity to look directly into the joint, identify potential problems, and definitively treat many of them.
10. Tibiotalar Arthritis
Ankle fractures, infection, osteonecrosis, and arthritis may eventually lead to chronic pain and stiffness that can not be controlled with nonoperative measures. Ankle fusion is a treatment option appropriate for many patients in this situation. When performed by an experienced surgeon, ankle arthroscopy offers a minimally invasive way to perform ankle fusion that may yield results that are equal to or better than conventional open techniques. This procedure has its limitations. Your surgeon can determine if this procedure is an appropriate option for you.
Recovery: How Do I Care for My Ankle After Surgery?
This will ultimately depend on the type of problem and nature of the arthroscopic procedure used to treat the problem. Patients can expect pain and swelling following surgery that necessitates elevation of the leg and oral pain medication for at least several days. The type of procedure performed will determine whether or not your ability to bear weight on the affected leg will be restricted after surgery. This can range from progressive immediate weightbearing with crutches, to a period of strict nonweightbearing for one to two months. If ankle arthroscopy is used as an adjunct to conventional fracture fixation, this period of nonweightbearing may be longer depending on your body’s ability to heal the fracture. Your dressing will be left in place until follow-up with your surgeon, and sutures will be removed one to two weeks after surgery. Active range of motion is generally allowed immediately. After the swelling and soft tissue reaction subsides, a progressive strengthening routine may be implemented. It will be up to your surgeon when each of these activities is allowed and whether or not a formal physical therapy referral is necessary.
Many factors will contribute to the outcome of your ankle arthroscopy procedure. These include, but are not limited to your expectations, the severity of your condition, complexity of the procedure performed, as well as postoperative compliance, rehabilitation, and motivation. The literature shows that an average of greater than 70-90% of patients undergoing ankle arthroscopy for the most common indications achieve good or excellent results.
What Are the Advantages of Ankle Arthroscopy?
Ankle arthroscopy makes possible direct visualization of the inside of the ankle without large cosmetically unsightly scars. It minimizes other problems encountered with large incisions around the ankle, such as pain, bleeding, wound breakdown, and infection. The procedure can be performed as an outpatient because of its minimally invasive nature. Patients may be able to begin rehabilitation sooner, rehabilitate more functionally, and return to high level activities, such as sports.
Who Is Not Eligible for Ankle Arthroscopy?
Elective arthroscopy is contraindicated in patients with soft tissue infections of the ankle such as cellulitis, acute and chronic open wounds, and dermatitis overlying the ankle. Patients with severe arthritic changes with loss of the joint space are not good candidates for arthroscopic debridement procedures. Patients with severe peripheral vascular disease, peripheral neuropathy, reflex sympathetic dystrophy/complex regional pain syndrome, and edema may not be eligible for ankle arthroscopy. It is important to thoroughly discuss your individual risks, potential benefits, and the alternatives to ankle arthroscopy with your surgeon.
Potential complications of ankle arthroscopy include, but are not limited to injury to nerves, vessels, tendons, ligaments or cartilage about the ankle, deep and superficial infections, scarring, reflex sympathetic dystrophy/complex regional pain syndrome, missed diagnoses, broken instruments, and anesthetic complications. It is important to attend follow-up appointments with your surgeon following surgery as recommended.
The following symptoms should be urgently reported to your surgeon, as they may be an indication of a complication:
- Pain not controlled by pain medication
- Constitutional symptoms including nausea, vomiting, fevers, or chills
- Wound redness, swelling, warmth or drainage
- New numbness, weakness, or tingling.
Frequently Asked Questions:
When Can I Safely Return to Driving?
This will be determined by the type of procedure you undergo and your surgeon’s evaluation of your progress. When you are able to bear weight without limitation and are no longer taking narcotic pain medication, you will likely be cleared to return to driving. This can be as soon as several days after surgery or may take one to two months.
When Can I Expect to Return to Work/Sports?
This will be determined by the type of procedure you undergo and your surgeon’s evaluation of your progress. If your mobility allows you to safely complete your job duties, there is the possibility of returning to work several days after surgery. Most patients can expect to be out of work for at least one to two weeks while they recover. It is possible to return to high level sports following ankle arthroscopy. This will depend on your ability to protect yourself effectively and perform during your particular sporting activity. Athletes could be cleared to return to play at as early as one to two weeks, but in all likelihood can expect an excess of four to six weeks.
*Source: American Orthopaedic Foot & Ankle Society® http://www.aofas.org
Conditions Arthroscopic Ankle Surgery Can Treat
Arthroscopic ankle surgery may be a treatment option for certain types of ankle pain. In arthroscopic surgery, a small camera is inserted inside the joint. Through other small incisions, instruments can be inserted to repair or remove damaged structures. Arthroscopic ankle surgery is often called “scoping the ankle” or arthroscopy.
John P Kelly / Getty Images
4 Reasons for Surgery
Not all causes of ankle pain can be effectively treated with an arthroscopic procedure. Some of the reasons to perform an arthroscopic ankle surgery include:
1. Restoring Ankle Cartilage Damage
Small, isolated areas of cartilage damage (not widespread ankle arthritis) are commonly found in people who have sustained injuries to the ankle joint. Left untreated, these cartilage areas may lead to the development of generalized arthritis of the joint.
Ankle arthroscopy is often used to assess these areas of cartilage damage and to try to restore the normal cartilage surface to the joint. Restoring a cartilage surface can be accomplished by either repairing the damaged cartilage, or by trying to stimulate new cartilage growth with a microfracture, cartilage transfer, or chondrocyte implantation procedure.
2. Removing Bone Spurs in the Ankle Joint
Bone spurs can form in the front of the ankle joint, causing the ankle to pinch when the foot is pushed all the way up towards the shin. This condition, properly termed anterior ankle impingement syndrome, has also been called athlete’s ankle or footballer’s ankle. Ankle arthroscopy can be used to shave down the bone spur on the front of the joint, to allow for improved motion of the ankle joint.
3. Removing Loose Debris/Scar Tissue
Ankle arthroscopy can be helpful whenever there is a condition causing the accumulation of loose debris or scar tissue within the ankle joint. Removing debris or scar tissue may be helpful in restoring motion and decreasing swelling and pain inside the joint.
4. Treatment of Posterior Ankle Pain
Pain in the back of the ankle can sometimes be treated arthroscopically. While there is limited space to perform an arthroscopic procedure in the back of the ankle, there are some conditions that can be helped when people have posterior ankle pain. Certain types of tendonitis and some bone spurs in the back of the ankle may be treated arthroscopically.
Ankle arthroscopy can be done under general or regional anesthesia. After adequate anesthesia, your surgeon will create ‘portals’ to gain access to the ankle joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem.
The length of the ankle arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, your ankle will be wrapped in a soft bandage or splint. Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.
The most concerning complication of arthroscopic ankle surgery is an injury to one of the nerves or tendons that surround the ankle joint. Other complications include infection and damage to joint cartilage from the arthroscopy instruments.
Ankle Arthroscopy – Procedure Details
Knowing what to expect can help make your road to recovery after ankle arthroscopy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will go home the same day of your surgery. You may have physical therapy to help you recover. This will improve ankle strength, function, and range of motion. Many people can return to moderate daily activities, such as work or school, within a few days. You surgeon will tell you when it is safe to return to all your normal activities, sports, and exercise programs.
Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Full recovery can take a few weeks depending on your ankle condition.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and physical therapy appointments after ankle arthroscopy. Contact your doctor for questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor’s specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might ankle arthroscopy affect my everyday life?
In most cases, ankle arthroscopy improves joint function and reduces symptoms so you can lead the most active life possible.
Ankle Arthroscopy | Foot HealthCare Associates
Technology and unique instrumentation have led to the development of surgical techniques for the diagnosis and repair of joint disorders. Knee arthroscopy was developed in the late 1960’s. Small joint arthroscopy was developed in the early 1980’s by orthopedic and podiatric surgeons and adapted to foot and ankle joints. Your podiatric surgeon may identify a potential problem with a foot or ankle joint after examining the lower extremity. Ankle Arthroscopy may be recommended to confirm a diagnosis or perform a surgical procedure within a joint using an arthroscopic instrument.
For example, needle-like probes enter the joint through a small opening of the skin. The podiatric surgeon introduces a tiny camera to inspect the joint. The podiatric surgeon may also insert surgical instruments through another small incision to perform additional procedures within the joint. Unlike traditional joint surgery that requires large incisions to expose the joint, arthroscopy uses small openings to examine the joint. By eliminating the need for large incisions, arthroscopy reduces the risk of infection and swelling. Podiatric surgeons may perform arthroscopic surgery in hospitals, outpatient surgery centers and in their offices. Arthroscopy is often a “same day” procedure allowing the patient to return home after surgery. Your podiatric surgeon will discuss all aspects of surgery with you.
Podiatric surgeons use delicate instruments and miniature video cameras to perform arthroscopic surgery. These instruments include cutting tools, burrs, graspers, shavers, fastening tools, sutures, laser and electrocautery to control bleeding. Arthoscopic techniques allow for a variety of procedures that are performed on foot and ankle joints. The following table reflects conditions for which the arthoscope can be used to diagnose and perform reconstructive procedures.
CONDITION ARTHROSCOPIC TREATMENT
Chronic Ankle Pain Diagnosis, biopsy
Arthritis Biopsy, arthroplasty, fusion
Loose bodies Excision
Ankle instability (the feeling of giving way) Ligament repair
Cartilage fractures, chrondromalacia Cartilage repair or removal
Meniscoid body (scar tissue) Excision, biopsy
Advantages of arthroscopic surgery include reduced trauma due to the small instruments used. Small instruments cause less damage to surrounding skin, ligaments, tendons and bony structures. Movement of the joint reduces swelling, stiffness, and postoperative discomfort. Your podiatric surgeon may recommend exercising the joint to hasten your recovery to bathing, walking, and sports activity.
Your podiatric surgeon may recommend rest, ice, compression, and elevation (“RICE”) to help speed healing.
REST: Ask your podiatric surgeon how long you should rest or restrict activity.
ICE: Ice reduces swelling, bleeding and pain following surgery.
COMPRESSION: Dressings help reduce swelling and stabilize the joint, preventing unnecessary motion. Dressings should be snug but should not interfere with proper circulation.
ELEVATION: Keep the foot at or above the level of your heart to drain excess fluids away from your foot. This helps to reduce swelling and discomfort.
Arthroscopy allows your podiatric surgeon to look directly into your ankle and reach a more accurate diagnosis. Additional benefits of arthroscopy include a shortened postoperative course and rapid recovery.
Post-Operative Instructions: Ankle Arthroscopy
Medications: (Prescription given to patient)
- Oxycodone/acetaminophen –10 mg/325 (Percocet®)
Take as directed for pain (with food)
- Hydrocodone/acetaminophen – 5 mg/325 (Norco®)
Take as directed for pain (with food)
- Oxycodone Hydrochloride –10 mg (OxyContin®)
Take as directed for pain (with food)
- Oxycodone – 5mg
Take as directed for pain (with food)
- Promethazine (Phenergan®)
Take as directed for nausea
- Zolpidem (Ambien®)
Take as directed for sleep
- Ondansetron (Zofran®)
Take as directed for nausea
Diet: Advance diet as tolerated.
Constipated is common with the use of pain medication. You can ward off constipation by increasing both dietary fiber and water intake. One tablespoon of milk of magnesia is effective and can be taken once or twice daily.
Activity: Rest with ankle elevated above the heart.
Use crutches – weight bearing as tolerated when ambulating.
Dressings: Keep dressing clean and dry for 3 days after surgery. You may then remove the dressing, apply waterproof bandages, and shower. After showering, replace the waterproof bandages with dry ones. No soaking or scrubbing, no bath, no swimming, no hot tubs, etc.
Apply an ice pack to the ankle to minimize pain and swelling.
Use Cryo/Cuff® as directed (see attached instruction sheet).
Office Appointment: If you do not already have a post-op appointment with your doctor, please call our office to make one.
Call your surgeon if
You develop a fever above 101 degrees.
The pain is severe and unrelieved with medication.
You have any questions or problems.
The subtle effects of general anesthesia or sedation with regional/local anesthesia can last more than 24 hours. Rest on the day of surgery. Although you may feel normal, your reflexes and mental ability may be impaired. You may feel dizzy, lightheaded, or sleepy for 24 hours or longer. Do not consume alcohol, drive, operate machinery, or make important personal or business decisions for 24 hours. After a general anesthetic, it is normal to feel generalized aching and sore muscles for 24 hours. A sore throat may occur.
Ankle Arthroscopy Post-Surgery FAQ
How much weight should I put on my leg?
All of it. One of the greatest advantages of ankle arthroscopy is that you may start walking on the operated ankle right away.
Do I need to use crutches? For how long?
Many surgeons give their patients crutches after surgery while many do not. It is hard to predict who may or may not need them. Use the crutches as needed. Some patients need crutches for a few days after surgery to help support them while walking while others never use them at all.
If you need then, use them.
How much ice and for how long?
There is no right or wrong answer to this question.
Ice simply helps with the swelling and can help to decrease pain after surgery. For the first few days after the surgery, our advice is “the more, the better.” We recommend icing for approximately 30 minutes 3–5 times per day. The first night and first day following surgery, use ice as much as possible.
Will the ice penetrate through the dressing?
Yes, it will. It might not feel like it, but it does.
Will the moisture from the ice get my incision wet?
No. There are many layers under the tape.
My dressing fell off; what should I do?
Don’t worry; due to the shape of our legs, this does happen. You may want to try to pull it back into place. You may want to unwrap the ace wrap bandage and reapply it. You may want to remove the dressing, place large band-aids over the incisions, and reapply the ace wraps. Prior to this, please wash your hands, and don’t mess with the incisions.
My appointment is not for a week; do I need to keep the dressing on?
We would like the operative dressing to be left in place for the first 3 days. After that, you may follow the above instructions. We recommend removing the dressing, placing large band-aids over the incisions, and then reapplying the ace wrap.
When can I shower?
You will need to cover the dressing and brace to keep it dry while in the shower. There are a variety of ways to do this. We suggest wrapping the leg with plastic wrap (e. g., – Handi-Wrap, etc.) above and below the dressing. You may also use a plastic bag with tape or a rubber band.
Can I bend my ankle?
Yes. This will cause no harm to your ankle.
The pain medicine doesn’t last long enough, but the bottle says “take every 3–4 hours”. Can I take it more often?
People vary in how much and how often they need to take pain medicine. Pain pills take a good 30–45 minutes to be absorbed and start giving relief. Try to anticipate and stay ahead of the pain the first several days after surgery.
Don’t be a clock-watcher. If the pain medicine only lasts 2.5 hours instead of 3–4 hours like the bottle says, simply take it a little more often. If you are in pain, take medicine. Don’t suffer. Some people never take a pain pill after surgery and other patients take them for a week or so. We are all different. If you have a history of drug or alcohol use, you will probably find that you will require more medications.
Can I take Tylenol® or ibuprofen (Advil®/Motrin®)?
The pain medicine is mixed with Tylenol® so do not take any additional Tylenol®. You may take ibuprofen along with your prescribed pain medications.
When do I need to see my doctor in the office?
Your doctor usually makes your first one or two appointments in advance. Simply call the office to make or find out. The appointment might not be for a week or so. We have an open-door policy; that is, if you have any concerns or problems before your first appointment, just call the office, and your doctor will see you.
When can I start physical therapy?
You may start the following week. If you have already seen a therapist before surgery or know where we plan to start therapy after surgery, we suggest setting up your appointments in advance. Most of the therapy places are very busy, so setting up your appointments in advance will allow you more choice of time to attend.
Can I drive? When?
While you are on pain medication, do not drive. We believe that you may drive when you feel it’s safe. Consider this analogy: if you were driving and got into a car accident with yourself and saw yourself get out of the other car (follow that?) . . . How would you react if you were that other driver, and to whom would your first phone call be? If that first call is to a lawyer, then don’t drive!
When can I return to work?
It depends on the type of job you have. If you do mainly desk work or sedentary work, you may return when you feel up to it. Most people return within 3–5 days. If you have a physical/labor-intensive job, then expect to take at least a couple of weeks off. We will discuss it as you progress postoperatively. Most people return to regular activities/sports anywhere between 4–8 weeks after surgery. This usually sport-dependent and depends on your level of activity (e.g., high school, recreational, college, professional).
Remember that you will have little aches and pains in different parts of your body after surgery.
If you have questions or concerns, please call our office. If it is after hours or on the weekend, follow the instructions on your doctor’s answering service to leave a message. He or she will call you back as soon as possible.
If you have a history of serious medical problems and start having difficulty breathing, chest pain, etc., please call your doctor here and/or your primary care doctor, present to a local emergency room, or call 9-1-1.
Ankle Arthroscopy & Recovery – Milwaukee, WI
Southeast Wisconsin’s Arthroscopic Ankle Surgery Experts
Arthroscopic ankle surgery is a minimally invasive surgical procedure used to treat conditions that affect the ankle joints. While each arthroscopic ankle surgery varies, the procedure generally involves creating a few small incisions, of approximately one centimeter in width, to access the ankle joint. An arthroscope, a small tube with a camera and light for viewing is inserted into one of the incisions, and small instruments to perform the operation are inserted through the other incisions.
If you’re considering arthroscopic surgery, it’s a good idea to speak with an orthopedic surgeon for an expert opinion. At one of our conveniently located affiliated physician offices in Milwaukee or Southeast Wisconsin, an ankle specialist can answer all of your questions and discuss next steps.
Benefits of an Ankle Arthroscopy Procedure
Ankle arthroscopic surgeries have become more common as the indications for such surgery have increased. Compared to traditional open surgical procedures, arthroscopic surgery is much less invasive, using smaller incisions and resulting in minimal soft tissue disruption and trauma. Arthroscopic surgical procedures of the ankle are generally associated with:
- Faster healing
- Significantly lower pain levels
- Lower infection rates
- Earlier return to sports and activities of daily living
- Little scarring
When is an Ankle Arthroscopy Procedure Used?
Arthroscopic ankle surgery may not be a suitable treatment for all ankle conditions. In some cases, open ankle surgery is the best or only alternative to treat problems in the ankle. Ankle arthroscopy is typically useful in treating:
- Inflammation in the ankle
- Cartilage damage, such as tears, injury or wear
- Tendon damage
- Loose bone or cartilage
- Undiagnosed ankle pain
Recovery from Ankle Arthroscopy Surgery
The wounds created by the incisions during surgery generally take several days to heal following ankle arthroscopic surgery. Ankle arthroscopy recovery time is dependent on the extent of the surgery and the individual patient. Surgery is done on an outpatient basis; meaning patients are able to leave the hospital several hours following the surgery.
Patients typically return to normal daily activity within a few days, and are back to more strenuous activities and sports within a few weeks after the procedure is performed.
Possible Complications from Ankle Arthroscopy Surgery
While complications from ankle arthroscopy are rare, the procedure does pose a few risks to be aware of. The largest risk is injuring other tissues and structures near the ankle joint. Since the area is rich in nerves, it is possible that the nerves could be affected during the procedure. Infection is also a risk of ankle arthroscopic surgery. Lastly, once the patient heals, it is possible that pain is not entirely relieved.
90,000 Arthrodesis of the ankle joint – the essence of the operation, price, rehabilitation – Clinic No. 1 in Moscow
In situations where the ankle joint gives a person severe pain, but at the same time cannot be treated and cannot be endoprosthetised, arthrodesis remains the only option. This is an operation to completely immobilize the joint, in which the pain syndrome goes away, since there is no movement and friction. It is important to understand that this is an extreme method, the results of the operation are irreversible, and it is necessary to make a reasoned decision to perform arthrodesis of the ankle joint.
Classification of protocols
Like most surgical operations, arthrodesis can be performed according to various protocols, depending on the characteristics of the clinical picture. The decision on the choice of the technique is made by the doctor.
The bursa cannot be opened, the joint is fixed in one position using a bone graft, after which, over time, the immobilized cartilage tissue gradually hardens, turning into bone.
The joint is opened and the cartilaginous and synovial tissue is removed. The doctor exposes the tibia and fibula in a predetermined position and fixes it with metal elements.
A type of extra-articular or intra-articular protocol in which the joint is fixed using special compression devices – the Ilizarov apparatus, Gudushauri, etc. d.
When it is impossible to choose the optimal variant of arthrodesis due to the complexity of the clinical picture, doctors combine elements of different protocols in the operation of ankle arthrodesis.
When should you have arthrodesis?
The irreversibility of the results of the procedure determines the highest responsibility for the appointment of arthrodesis. The most justified reasons for immobilizing a joint:
- Severe inflammation of the joint that does not respond to treatment.
- The third stage of arthrosis, manifested by deformation of the support area of the affected ankle joint and a significant reduction in motor activity.
- Deforming arthritis.
- Articular complications of poliomyelitis.
- Constant joint pain even with light exertion.
- Incorrect bone fusion after fracture.
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- Young age (as a rule, doctors do not perform surgery on patients under 12-13).
- Over 60 years of age.
- Tendency to thrombosis, severe varicose veins.
- Serious diseases of the cardiovascular system.
- Inflammatory process in the ankle joint, including suppuration.
- The presence of fistulas in the joint.
- Inability to use general anesthesia due to allergic reaction.
Before the operation, the patient is given general anesthesia, and the whole process will take about 2-2.5 hours.If general anesthesia cannot be used, ankle arthrodesis can be performed under epidural (spinal) anesthesia as an option. During the operation, surgeons implement a pre-selected protocol, immobilizing the ankle joint, fixing it in a certain position.
A specific feature of the arthrodesis operation is the need for long-term recovery. It is important to understand that it takes time for cartilage to ossify. So, if we are talking about ankle surgery, it is at least a year.In order to ensure complete rest for the cartilage tissue, plastering may be prescribed to the patient during the rehabilitation period. This will speed up the ossification process. After arthrodesis of the ankle, the bandage should be worn for 3-5 months.
Physiotherapy is an obligatory component of rehabilitation after arthrodesis. Various technologies are used to maintain muscle tone, from magnetotherapy to electrophoresis. Also, the patient is engaged in exercise therapy under the supervision of a rehabilitation physician.
Where to do ankle arthrodesis in Moscow?
In the multidisciplinary medical center “CLINIC №1” (Lyublino), experienced trauma surgeons return patients to life without pain.If there is no other way to relieve pain, it makes sense to consider arthrodesis. Sign up for a consultation and make a decision that will return you to a normal quality of life.
Cost of consultation and surgery
|Free consultation of a traumatologist on joints||0.00|
|Consultation of a professor, Doctor of Medical Sciences||2400.00|
|Consultation of a professor, Doctor of Medical Sciences (Bagirov)||3000.00|
|Repeated consultation D.M.N.||1200.00|
Ankle Replacement Surgery | ortoped-klinik.com
Information: Ankle arthroplasty
- Duration of hospital stay: 5 days
- Outpatient rehabilitation: 4 weeks
- Earliest departure time home: 10 days after surgery
- Recommended time to fly home: 21 days after surgery
- Showering possible: after 12 days
- Duration of incapacity for work: 6 weeks (depending on the type of activity)
- Removal of stitches: after 12 days
- Driving possible: 6 weeks
Ankle joint endoprosthesis implantation procedure
Fig.1. An ankle prosthesis consists of three components, one of which covers the tibia. The parts of the prosthesis are not connected to each other and overlap the affected areas of the joint. The implants grow together with the bone tissue of the joint. The components are held in place by muscles and ligaments. Also, the durability of the prosthesis is dictated by the straight axis of the legs and strong ligaments. © Gelenk-Klinik.de
Ankle joint replacement is used for advanced arthrosis, which is often caused by an accident or injury.Over time, the disease progresses and results in a neglected form.
The ankle joint (Talus), the tibia (Tibia) and the fibula (Fibula) form the upper ankle joint and it is this joint that is most often susceptible to arthrosis. This joint is responsible for the vertical mobility of the foot in relation to the lower leg, which is important when walking.
Who will benefit from ankle replacement?
Joint replacement with innovative prostheses is primarily intended for patients suffering from wear (arthrosis) of the upper ankle joint.
What to expect from an ankle replacement?
- Relief of joint pain – severe pain predisposes to surgery.
- Preservation or normalization of gait after joint replacement.
- Full ankle mobility cannot be restored, but it is sufficient for normal walking.
- 10 ° dorsiflexion and 20 ° plantar flexion of the prosthesis are sufficient for all daily tasks.
- 90% of patients are satisfied with the performed prosthetics operation.
These patients suffer from chronic pain and limited range of motion. Conservative therapeutic attempts to treat ankle arthrosis are often used: ankle school and physiotherapy.
Forms of ankle arthrosis
- Concentric arthrosis – the talus is centered in the joint.
- Eccentric arthrosis – the talus is displaced.
- Valgus arthrosis
- Varus arthrosis
- Back centering
- Front centering
The shape of ankle arthrosis plays an essential role in the prosthetics process.The method of prosthetics directly depends on the specificity and location of ankle arthrosis. To do this, you need to consult a doctor and undergo a series of examinations. Arthrosis, the cause of which is unknown, as well as arising from trauma and in rheumatic diseases, is treatable. In case of necrosis of the talus, implantation of a prosthesis is possible only in the initial stage; unfortunately, advanced cases cannot be prosthetically replaced.
A complete picture of the ankle joint is necessary for making a decision on prosthetics
The following is an explanation why ankle replacement is possible only after evaluating all aspects – ligaments, position of the hindfoot and arch of the foot.An isolated examination of the ankle joint is not sufficient to provide a long-lasting and successful prosthetics.
If we manage to reveal the complete picture of the individual structure of the ankle joint, then the prosthesis increases comfort, allows the resumption of sports activities and preserves the patient’s gait.
Fig. 2: The ankle joint consists of three bones. The talus forms the lower part of the ankle by connecting to the greater and fibula (fork).From below, the talus is connected to the calcaneus, and in front – to the scaphoid. Through these joints, the talus transfers body weight to the entire foot. Calcaneus deformities increase the risk of arthrosis. Each of these bones, along with ligaments and tendons, are directly involved in walking and stabilizing the ankle. © Viewmedica
Fig. 3: The latest Hintegra ankle prosthesis with three components. There is a movable element between the articular surfaces – a stable synthetic polyethylene core.Thus, the prosthesis is both stable and mobile at the same time, which preserves the natural gait. © Gelenk-Klinik.de
If we manage to reveal the complete picture of the individual structure of the ankle joint, then the prosthesis increases comfort, allows you to resume sports activities and preserves the patient’s gait.
Surgical concepts for ankle and ankle surgery complement the performance of the ankle prosthesis. We will cover this topic in the next article.
Not everything that we talk about will necessarily affect every patient, but we hope to highlight as much as possible all the factors of this complex operation in the presence of arthrosis of the ankle joint.
What are the causes of ankle arthrosis?
- Bone cartilage injury.
- Ligament sprain.
- Curved position of the leg axis.
- Asymmetry of the supporting leg in the ankle fork.
- Valgus flat feet
- Blood clotting disorders (hemophilia).
- Metabolic disorders (diabetes, gout).
- Unstable fork after tibia fracture.
- Tears of the ankle syndesmosis.
Injuries as a cause of wear of the ankle joint
A common cause of developing arthrosis of the ankle joint is valgus flat feet or deformity due to trauma.
What treatment options are there for ankle arthrosis?
- Ankle prosthesis: The prosthesis is made of titanium with a movable polyethylene core and retains the mobility of the ankle joint for a long time, even if the articular cartilage is completely worn out.
- Ankle arthrodesis: Therapeutic immobilization of the joint promotes painless stress on the ankle.
- Osteotomy with preservation of joints to improve atypical distribution of loads: due to changes in the talus and calcaneus, healthy cartilage is moved to the area of the main load, the joint is preserved.
If it is not possible to save the joint even after correcting the axis, its implementation was still not in vain. Axis correction is a prerequisite for a stable ankle prosthesis.
Is it possible to play sports with an ankle prosthesis?
The following sports are shown
Initially, with an ankle prosthesis, all sports are possible, but the patient’s condition and previous physical activity must be taken into account.
The likelihood of pain-free sports in the long term is not always predictable, but golfing, swimming or skiing remain within the range.
Return to tangential impact physical activities such as ski speed slalom, football, tennis, etc. succeeds quite rarely. The prognosis of further loads is purely individual.
Adverse sports activity in case of arthrosis of the ankle joint
- Martial arts
- Ski speed slalom
Much depends on the correct operation and postoperative care (rehabilitation) in the best conditions.
In general, patients are significantly more likely to return to sports than before the intervention.
What restrictions await you after prosthetics?
As a rule, there are no contraindications to the usual activities if ankle joint replacement is performed.
The only limitation is lifting weights over 20 kg, therefore, for patients employed in construction or those who do heavy work every day, we still advise you to choose immobilization of the joint.
Arthrodesis of the ankle joint (therapeutic immobilization)
With advanced arthrosis of the ankle joint, many orthopedic surgeons in the first place still advise immobilization surgery (arthrodesis).
Arthrodesis is always associated with a significant loss of mobility of the ankle joint, and the natural gait after immobilization cannot be maintained.
This gait disturbance is one of the main disadvantages of this intervention, but it still has a reputation as the “gold standard” (treatment of the highest grade) for arthrosis of the ankle joint.
Changing the sequence of movements causes excessive stress on adjacent joints such as the hips and the upper and lower ankles. Therefore, before immobilizing, it is necessary to weigh all the options, including the ankle prosthesis.
Arthrodesis (immobilization) can provoke additional arthrosis
After immobilization surgery, the patient often faces consequences affecting adjacent joints.They also begin to develop a disease associated with too much load caused by its unnatural distribution. The closer the adjacent joints are to the ankle, the more consequences arise as a result of arthrodesis, therefore, it is the ankle joints that most often suffer.
Disadvantages of arthrodesis:
- Rehabilitation lasts at least 4 months.
- Pseudoarthrosis due to insufficient consolidation of bone tissue.
- Occurrence of additional arthrosis in adjacent joints.
Immobilization of the upper ankle joint is still considered the “gold standard” among orthopedic surgeons, because the consequences and chances of recovery after arthrodesis have long been known to everyone.
Arthrodesis (immobilization) can provoke additional arthrosis
Fig. 4: Alternative to an ankle prosthesis: Ankle arthrodesis immobilizes the joint. The remaining cartilage is surgically removed (cartilage removal). For immobilization by means of screws, intraosseous nails, etc.the bone grows together and the pain subsides. Such an operation is reversible; it remains possible to replace the screws with a joint prosthesis. © Dr. Thomas Schneider
Despite multiple disadvantages in comparison with prosthetics, in most cases arthrodesis was the choice for arthrosis of the ankle joint.
While knee and hip replacements have been around for 40 years and have long become a routine, the results of ankle replacement 15 years ago were unsatisfactory.Prosthetics failed to displace immobility in ankle arthrosis.
In fact, there are still contraindications for ankle prosthetics. If they are, then arthrodesis is a reasonable way to get rid of pain.
The necessary medical prerequisites under which the prosthesis remains stably fixed are largely clearly identified, but experts have not reached a general consensus. Experienced ankle prosthetists see a great future in joint replacement.
In many cases, arthrodesis is recommended even when, in our opinion, there is still a possibility of prosthetics. In any case, it is very important to seek the advice of several experienced therapists prior to ankle surgery.
In what situations is arthrodesis only necessary?
Minimally invasive immobilization
We mainly perform arthroscopic immobilization. Thus, the least amount of soft tissue damage is achieved and the possibility of reversing immobilization for further prosthetics remains.Removal of cartilage from the joint space is performed arthroscopically, and the screwing of intraosseous nails is performed through the skin. Since damage to the soft tissues around the joint is one of the main obstacles to further freedom of movement of the prosthesis, we give the patient the opportunity to choose an arthroscopic form of arthrodesis.
Due to the fact that the prosthesis wears out after a while, we advise young people to immobilize the joint.
Choosing arthrodesis, a young patient gains time, because at a more mature age it is still possible to replace a joint with a prosthesis.It is possible to resort to ankle prosthetics when the discomfort increases due to the occurrence of additional arthrosis in the adjacent joints.
In these situations, young patients are given a real chance to continue stressing the ankle. If a decision is made to carry out arthrodesis, then with an eye on the future prosthetics, we take into account the even axis of the ankle joint, if necessary.
Surgical progress in the field of ankle arthroplasty
Over the past decade, the possibilities of creating prostheses have expanded significantly, and the operating methods have become more sophisticated, which means a qualitatively improved prosthetics.
We now know what provides the long service life of the ankle prosthesis and the accompanying measures by which the ankle prosthesis is fixed were designed to maximize the effect of the surgery.
Accompanying stabilization measures in effect significantly improve the result of prosthetics
Correction of deformities and injuries of the ligaments becomes decisive for good fixation of the prosthesis in the ankle joint.The main goal is to achieve stability in a standing posture with a horizontal load on the implant, because this is how the weight of the weight is evenly distributed on the ankle prosthesis.
Fig. 5: Calcaneus hallux valgus (x-position or inward bending) – malposition of the ankle joint. Such a deformation can cause arthrosis of the ankle. © Dr. Thomas Schneider
With the help of accompanying measures, a high stability of the ankle prosthesis can be achieved.In order to recognize all the existing deformities, it is necessary to take a series of X-rays under load, after which the doctor will accurately analyze the mobility and strength of the ankle joint.
The first step towards successful prosthetics will be accompanying measures in the form of offset operations. Such operations are carried out several months before the direct prosthetics and do not imply removal. Thus, the prosthesis lasts much longer.
Recently, there are more and more examples of the fact that the load, correctly and evenly distributed on the damaged joint, has a positive effect even without prosthetics.In addition, the patient does not have to expose himself to all the risks of surgery.
Improving the stability of the ankle prosthesis by ligament grafting
Supporting interventions on the ankle ligaments
- Ligament plasty (transplantation)
- Ligament refixation
- Ligament tightening
Strong internal and external ligaments are a prerequisite for maximum functionality of the prosthesis. The prosthesis, consisting of three components, is not attached to the joint surfaces and is limited only by a movable polyethylene core, which means that the level of stability is determined precisely by the ligaments.An artificial joint, like its own, needs the support of ligaments.
Excessive mobility of the stretched ligaments must be stabilized before or during prosthetics. If the tibial collateral ligament is too stretched, then correction is not possible, in addition, such stretching is a contraindication for ankle prosthetics.
Correction of the axis: the straight axis of the ankle is necessary for a stable prosthesis
Its changes are due to…
- X-shaped position of the back of the foot (valgus arthrosis).
- O-shaped position of the back of the foot (varus arthrosis).
- Valgus flat feet.
- Rotational deformation.
- Deformation of the talus.
In order for the prosthesis to be held as long and stable as possible, it is necessary to eliminate all deformations, most of which were acquired as a result of accidents or injuries.
In the same way as its own ankle joint, an artificial one needs a natural load.Deformities, sprains, or hallux valgus prevent the ankle prosthesis from fully engrafting. The greater the deviation of the axis from the norm, the less time you can expect to use the prosthesis.
The task of the surgeon is to achieve the most successful result, which means to correctly expose the posterior part of the foot, heel bone and pay attention to deformities.
If correction of the leg axis is not possible, then we also consider arthrodesis as a treatment option.
Preliminary examination and prerequisites for ankle prosthetics
Favorable conditions for ankle prosthetics:
- Medium level of physical activity and gentle mode of the ankle joint.
- Sufficient volume of joint bone tissue.
- Satisfactory condition of the vessels of the legs – the blood supply must be excellent so that there are no complications with wound healing.
- High mobility of the upper ankle.
- Good joint stabilization due to ligaments.
Unfavorable conditions for ankle prosthetics:
- High BMI.
- High physical activity, hard work.
- Long-standing ankle infections.
- Nicotine abuse (smoking)
- Other axial loads, instability in the upper region of the ankle joint (deformations and sprains) must be eliminated prior to prosthetics.
Resilience and firmness of your bones
Only a small part of the bone is removed for ankle replacement. Bone tissue grows together with the surface of the endoprosthesis. If too much bone tissue from the tibia and fibula is removed during bone resectomy, this greatly reduces the elasticity of the joints. And since the most elastic part of the bone is located immediately under the layer of articular cartilage (the so-called subchondral bone plate), and then the bone becomes softer, save bone tissue is required.The surface is removed only on the talus, so that the spongy bone tissue grows together with the prosthesis and it is fixed.
This elastic surface of the bone is called the bony cortex. Its integrity must be maintained for stable ankle prosthesis placement. With ankle arthroplasty, as with any other prosthetics, bone density is very important for the prosthesis to hold well. The density of a bone is an indicator of its elasticity. This will help the surgeon evaluate the success of the prosthetics.The denser the bone, the more stable the prosthesis will hold.
This is called osseointegration of the ankle prosthesis (osteo means bone or bone). If the bone is not dense, this can lead to loosening of the prosthesis and its displacement after surgery.
It is especially important to pay attention to the tightness of the tibia in the inner part of the ankle “fork” that forms the ankle.
Damage to the bone tissue, if necessary, is repaired with the help of parallel surgical interventions.When implanting an ankle prosthesis, special efforts should be made to preserve the tibia.
Computed tomography (a three-dimensional image of a bone using X-ray) is often used as an examination in order to accurately determine the shape and possible deformations of the bones.
The role of weight in ankle arthroplasty
Heavy weight always has a negative effect on the durability and stability of the prosthesis. This also applies to the ankle prosthesis.
Soft tissue injuries affect upper ankle prosthetics
Joint prosthetics are difficult to perform if the patient has had any injuries. Soft tissue injuries in the lower leg area are a common consequence of any kind of injury. They can adversely affect the mobility of the ankle prosthesis. In such cases, before starting prosthetics, it is necessary to conduct a thorough examination of the patient in order to find out whether it is worth installing a prosthesis at all.
Treatment of accompanying arthritic diseases in arthrosis of the ankle joint
Often, due to accompanying arthritic diseases of adjacent joints, it is difficult to assess the success of arthroplasty. Rarely when arthrosis of one joint is present. Very often arthrosis progresses and also spreads to the lower part of the ankle joint.
With arthrodesis of the upper part of the ankle joint, most of the load is transferred to its lower part. The joints compensate for the mobility in the part where it disappeared.Thanks to arthroplasty, which improves gait, arthritic diseases in other joints can be eliminated.
There are cases when during the prosthetics of the upper part of the ankle joint the mobility in the lower part was lost. The implantation of the prosthesis depends on how much arthrosis affects the mobility of the patient’s lower ankle.
How is the new generation ankle endoprosthesis arranged?
Fig. 9: For ankle prosthetics, only third-generation prostheses are implanted, which after the operation are completely fused with the bone and are therefore held in place.
Modern ankle prostheses have been redesigned to improve stability and mobility.
Denture implantation began in 1969. At the same time, many problems arose, which, for example, did not exist with prosthetics of the knee or hip joint.
Especially metal endoprostheses, which are fixed to the bone with the help of special cement, turned out to be unstable and impractical. Over the past 15-20 years, new, more durable third-generation endoprostheses have been developed.
These state-of-the-art prostheses are fused with natural bone tissue, thereby providing greater stability of the prosthesis. To do this, it is also not necessary to completely remove the bone tissue, but only a small part on the bone surface.
History of development of ankle joint endoprosthesis
The previous model of endoprostheses had a different structure. It was attached to the bone using special cement, which often led to instability and loosening of the prosthesis. Modern models of prostheses are installed in such a way that natural fusion with the bone occurs.For this, only a very small part of the bone tissue is removed. Such prostheses are much less likely to loosen, as they are firmly held on the bone. Three-piece prostheses, due to their unique mobility, also contribute to the natural biomechanics of the ankle joint.
Design and mobility of a modern ankle endoprosthesis
For ankle arthroplasty, a special metal cover is put on the talus. The surface of the tibia is covered with a metal plate.The third component of the endoprosthesis is a freely moving polyethylene core, which transmits movement between the two joints. Free movement of the core reduces the likelihood of bone overload.
Arthrodesis of the upper part of the ankle is no longer used as a standard procedure in the treatment of arthrosis of the ankle. It is resorted to only as a last resort.
How is ankle replacement performed
Installation of an ankle joint endoprosthesis is performed under general or local anesthesia.
During the operation, the patient lies on his back. Taking into account the approximate duration of the operation, the patient’s leg is tied with a special cuff to prevent the flow of blood into the leg.
If the operation does not take a long time, the operation takes place without a cuff.
Observance of special sterility in ankle arthroplasty
Maintaining sterility and hygiene are two urgent components of ankle arthroplasty.Therefore, during the operation, the surgeon wears a special closed helmet.
Operating rooms are equipped with Laminar Flow hoods and air conditioners, which are responsible for maintaining only a certain size of microparticles in the air. They minimize the appearance of infectious microorganisms and remove them.
Fig. 10: X-ray after front and side ankle prosthetics © Dr.Thomas Schneider
Additional measures for the prevention of infectious diseases in ankle prosthetics:
The surgeon operates in a helmet without consuming the air from the operating room.The patient takes a dose of antibiotics in front of the cuff that stops the blood flow.
The operation takes place in a sterile clean room with the Laminar Flow system, which controls cleanliness and air intake.
The surgeon tries not to use hooks (retractors) during the operation, so as not to introduce an infection.
In addition, during the operation, a mobile X-ray machine under a sterile cover is used for instant imaging.
This allows you to control the operation as well as the placement of the prosthesis.
How is an ankle endoprosthesis inserted?
Fig. 11: Site determination and implantation of the ankle endoprosthesis. On the left, there is a special tool that determines the axis on which the prosthesis will be installed. The installation is regulated by a movable X-ray unit. The position of the prosthesis is also determined using X-ray images even before the start of the operation. © Dr. Thomas Schneider
At the beginning of the operation, an incision is made along the front of the ankle and is made down to the dorsum of the foot.
Above the ankle, the lying tendons move to the side. Sometimes, during the operation, it is also necessary to partially displace the cutaneous nerves.
The joint capsule is opened and the joint is prepared for the placement of the prosthesis. For this, a small part of the bone tissue is usually removed in order to achieve a good view of the joint.
With the help of special instruments, as well as a mobile X-ray machine, the axis and position of the hindfoot, where the prosthesis will be implanted, are determined.Several incisions are also made with a special surgical saw for optimal placement of the prosthesis. The goal of economical bone removal is to restore elasticity to the soft tissues of the ankle. During surgery, a trial prosthesis can be used to test the mobility, strength and stability of the ankle.
When the surgeon is positioned, he checks the position of the hindfoot and the length of the Achilles tendon.
If it is difficult to determine the optimal position, in order for the joint to be fixed, further accompanying interventions are necessary.
An ankle joint prosthesis shall replace the natural joint in its function; it must have optimal mobility and withstand the load. Incorrect placement of the prosthesis can shorten its life, therefore it is very important to optimally position the prosthesis.
Cementless fixation is increasingly used for ankle prosthetics
Genuine ankle components are increasingly being implanted using cementless fixation.
The talus is covered with a metal cap, on the inside of which there are metal pins that allow movement.
The surface of the tibial joint is covered with a protective metal plate. Both components of the ankle joint endoprosthesis are coated with a special layer on the side that is adjacent to the bone in order to achieve a reliable fusion of the bone tissue.
The third component of a modern ankle prosthesis is a movable sliding core, which consists of artificial materials, in particular polyethylene, and serves to provide the necessary movement between both parts of the artificial joint.
General questions about ankle arthroplasty
How long does it take to stay in hospital after prosthetic surgery?
The length of hospital stay is approximately 5-7 days. The first phase of the stay serves to ensure the success of the early phase of wound healing and targeted pain therapy. Lymphatic drainage, elevated leg position and pain therapy are essential components of inpatient therapy.
How is follow-up care after ankle replacement without accompanying bone surgery?
The ankle joint prosthesis must grow together with the bone, for this purpose it is necessary not only to prevent increased loads, but also to avoid them.Until the wound heals, after 14 days after the intervention, it is recommended to proceed with careful mobilization using special shoes (ROM Walker) and with minimal stress, leaning on crutches on the arm. Then a full load of the whole body is possible, but in a sparing physical and general mode.
Specially designed footwear provides stability when walking for the first time after ankle replacement. After 6-8 weeks, a second X-ray is taken and a plan for further increasing the load is drawn up – physiotherapy and lymphatic drainage are an important and integral part of the recovery process.After prosthetics, regular examination of the wound is important, because it heals slowly, even after careful and gentle surgery.
When can I drive again?
It is allowed to drive only if you can again fully load the ankle joint and rely on a trouble-free response in dangerous situations. Usually, this does not happen earlier than after an 8-week recovery period.
How is rehabilitation after ankle arthroplasty and is it necessary?
After the operation, you will be hospitalized for a week.Since at this time it is not yet possible to apply rehabilitation measures, we recommend gradual rehabilitation on an outpatient basis or in a hospital. Patients return home with a shin brace.
What are the risks of ankle replacement surgery?
Results of ankle replacement are the subject of ongoing scientific research. In 90% of cases, the prosthesis is more than 8 years old. The percentage of reoperation does not exceed 6-8%.
What complications can occur after ankle replacement surgery?
- Problems with wound healing over a new prosthesis.
- Shin edema
- Infection or suppuration of ankle prosthesis
- Formation of blood clots, thrombosis
- Fracture of the ankle fork
What complications may arise later after the implantation of an ankle endoprosthesis (artificial joint)?
- Ankle immobilization / loss of mobility.
- Loose fixation of the prosthesis without previous infection.
- Subsidence of the ankle prosthesis.
- Wear of the prosthesis.
Magnetic resonance imaging (MRI) of the ankle
We will select a clinic or diagnostic center for free.
Magnetic resonance imaging (MRI) of the ankle joint provides high quality visualization of the structures of the ankle, which helps doctors diagnose a wide range of diseases and conditions. Patients who have pain in the ankle may be referred for an MRI scan. Most often, an ankle MRI scan is prescribed to diagnose injuries to the bones, tendons, ligaments and cartilage of the ankle.Imaging with MRI can also diagnose tumors, arthritis, and joint infections.
Various tendons and ligaments in the ankle, including the Achilles tendon, provide flexibility and range of motion. Forcing the ankle in an uncomfortable position outside of the typical range of motion can damage the tendons and ligaments of the ankle.
MRI of the ankle can detect both tears and complete tears of ligaments and tendons.For most injuries of the ankle tendons and ligaments, MRI is the most informative and reliable diagnostic method. Thinning and changes in the structure of the cartilage tissue of the ankle joint of an involutionary degenerative nature are also well visualized using MRI of the ankle. The bones of the ankle (including the talus and calcaneus), the bones of the foot are well visualized with MRI of the ankle and allow determining the presence of fractures. MRI of the ankle can also determine the presence of bruises, dislocations, or manifestations of ostearthritis.In addition, MRI of the ankle gives good information about the presence of tumors, accumulation of blood in the soft tissues around or inside the ankle. MRI of the ankle can also assess the condition of the distal tibial or peroneal tissue, as well as the muscles of the foot. The introduction of contrast allows a more detailed visualization of the structures of the ankle and the identification of small morphological changes.
Main MRI indications of the ankle:
- Tendon injuries
- Ligament injuries
- Cartilage injuries
- Tumors (soft tissues and bones)
- Aseptic necrosis
- False joints or unconsolidated fractures
- Arthritis, arthrosis
- Tendinitis, tendinosis
- Presence of a tumor in the joint area
- Presence of pathology on radiography
- Congenital anomalies
- Pain, swelling, redness in the ankle area
- Decreased range of motion in the joint
- Unclear genesis of ankle pain
- Preparation for surgical treatment
Preparation for ankle MRI procedure
The patient can use special disposable clothing or be in his own clothing during the procedure if it is loose and does not have metal fittings.
Food intake during MRI of the ankle joint is not regulated, but it is better to refrain from eating a few hours before the study if a study with contrast is planned. If contrast is planned, the MRI technician needs information about the presence of an allergy to the contrast agent or bronchial asthma.
The contrast agent most commonly used for MRI examinations contains a metallic substance (gadolinium). And although gadolinium very rarely leads to complications, unlike the contrast with iodine content (which is used in CT studies), nevertheless, its administration is undesirable in the presence of serious somatic diseases, especially chronic kidney disease.If MRI of the spine is performed for women, then information about the presence of pregnancy is needed. Although long-term studies have not shown a harmful effect on the fetus, it is nevertheless not recommended to undergo MRI for pregnant women, especially in the first trimester. Conducting MRI with contrast is possible only in exceptional cases, according to clinical indications. In the presence of claustrophobia, MRI is recommended to be performed on open-type devices. Sedation is imperative for young children on an MRI scan so that the child can lie still during the exam.Sedation is performed by an anesthesiologist.
All objects containing metal must be removed prior to MRI. These are items such as:
- Jewelry, watches, credit cards and hearing aids that may be damaged
- Pins, hairpins, metal zippers and similar metal objects that can distort the image MRI
- Removable dentures with the presence of metal
- Pens, pocket knives and glasses
- Body Piercing
MRI is contraindicated if the patient has implants or implanted electronic devices:
- Cochlear Implants
- Some types of clips used on cerebral aneurysms
- Certain types of metal coils placed within blood vessels (stents)
- Artificial heart valves
- Implanted infusion pumps
- Implanted electronic devices, including defibrillator, pacemaker
- Endoprostheses of joints (with metal content)
- Implanted nerve stimulators
- Metal pins, screws, plates, stents or surgical staples
- Metal parts in the human body (e.g. bullets or shrapnel), as the strong magnetic field can displace metal objects and damage tissue.And therefore, in such cases, it is necessary to conduct an X-ray before the MRI examination.
Parents accompanying children must also remove all metal objects and report the presence of objects containing metal in the body.
Ankle MRI procedure
A traditional MRI machine (closed type) is a large cylindrical tube surrounded by a magnet. During the examination, the patient lies on a movable table that moves to the center of the magnet.There are also open-type MRI machines, where the magnet does not completely surround the patient, but is open at the sides.
Investigations on devices of open type (and they are mostly low-field) are useful for examining patients with claustrophobia or overweight. Recently, devices of the open type with a high field (1 or more Tesla) have appeared, which allow obtaining a high-quality image, in contrast to the main models of open MRI, where the magnetic field is low and the image is of lower quality.
When performing MRI of the ankle joint, the coil is installed on the ankle joint. During the procedure, the patient must lie motionless for a certain time (on average 30-40 minutes). When examining with contrast, the exam duration will be longer.
The MRI procedure is completely painless and, nevertheless, some patients may feel warmth in the area where the examination is being carried out, which is a normal tissue reaction to the magnetic field.As a rule, the patient is alone in the MRI machine during the examination, but there is two-way audio communication between the radiologist and the patient, and the doctor sees the patient. After undergoing the MRI procedure, the patient does not need time to adapt.
Recently, it has become possible to conduct MRI of the ankle joint on small devices, in which only the joint is examined and the whole body is not in a magnetic field, especially in such devices the magnetic field is powerful enough and allows you to obtain high quality images.
Benefits and risks
- MRI is a non-invasive imaging technique without the use of ionizing radiation.
- MRI is a very valuable method for diagnosing a wide range of conditions, including diseases and injuries of tendons, ligaments, muscles, cartilage and bone pathology.
- MRI can help determine which patients with ankle injury require surgical treatment.
- MRI can help diagnose a bone fracture when X-rays and other imaging techniques prevent the diagnosis from being verified.
- MRI detects abnormalities that may not be visible with other imaging techniques.
- MRI presents little or no danger to the average patient when appropriate safety precautions are followed.
- If sedation is used, there are risks of over sedation.
- Although a strong magnetic field is not harmful in and of itself, implanted medical devices that contain metal may deteriorate or malfunction during an MRI procedure.
- There is a very small risk of an allergic reaction if a contrast agent is injected. These reactions are usually mild and can be easily controlled with medication.
- Nephrogenic systemic fibrosis is now a recognized, but rare, complication of MRI with contrast and is believed to result from injections of high doses of gadolinium, which is the basis of contrast medium, in patients with very poor renal function. Careful assessment of renal function prior to contrast administration minimizes the risk of this very serious complication.
- Manufacturers of intravenous contrast agents recommend that breastfeeding mothers do not latch their baby to the breast for 24-48 hours after an MRI scan with contrast.
Restrictions for MRI of the ankle
High image quality can only be obtained if the patient lies still during the examination.
If the patient is large, then the study is best performed on an open-type MRI.
MRI examination of the ankle joint is best performed on a high-field (closed type) device, since the image quality is better than on low-field devices, especially if visualization of ligaments and tendons is required.
In some cases, when it is necessary to obtain a detailed image of bone tissue, MSCT can be performed, which is better than MRI at visualizing bone tissue.
Department of urology with lithotripsy room at the Central Clinical Hospital of the Russian Academy of Sciences
The department, equipped at the most modern European level, allows the treatment of urological pathology at the most modern level, taking into account world and European standards of medical care.The department is the clinical base of the Department of Urology of the Medical Institute of the Russian University of Peoples ‘Friendship and the Department of Urology, Oncology and Radiology of the FPK Medical Institute of the Russian University of Peoples’ Friendship.
Advantages of the urological department of the Central Clinical Hospital of the Russian Academy of Sciences.
In our own endoscopic X-ray operating room , a full range of endourological interventions is performed, including operations using medical laser devices – laser vaporization and enucleation of the prostate gland, transurethral resection of the prostate gland and bladder, contact laser uretero-, preelo-, cystolithotripsy, percutaneous nephrolithotripsy.Photodynamic equipment from Storz makes it possible to diagnose and treat bladder tumors at the earliest stage of their development. More than 500 surgical interventions are performed annually in the endoscopic operating room.
Remote shock wave lithotripsy (ESWL) – has been used at the Central Clinical Hospital of the Russian Academy of Sciences since 1982. It is a non-invasive, one of the safest treatment for urolithiasis, suitable for the treatment of kidney stones and all parts of the ureter.It is based on the formation of shock waves using a special generator and focusing these waves on the stone, which leads to its destruction. ESWL breaks the stone down to small particles, which then pass on their own in the urine. Since the procedure is performed without incisions, intravenous potentiation is sufficient.
For equipment on which aiming at a stone is performed not only with the help of X-rays, but also with ultrasound, neither the composition of the stone nor its location matters.Our clinic uses lithotripters: Dornier Gemini Premium class and Dornier Compact Delta.
Both devices are equipped with both X-ray and ultrasonic positioning systems.
We use the latest equipment for the treatment procedure. Dornier Gemini is a multifunctional urological complex that provides the technical capabilities for any urological, transdermal and endoscopic procedures.
The Dornier Gemini urological complex combines the following equipment and components:
- Dornier lithotripter – device for percutaneous shock wave therapy;
- equipment for X-ray and ultrasound imaging;
- C-post – arc;
- endoscopic equipment rack;
- multifunctional motorized patient table;
- UIMS computer control center.
Below you can see a photo of the Dornier Gemini lithotripter and its technical characteristics.
The Dornier lithotripter is used for the percutaneous therapy of urolithiasis. The generator of electromagnetic shock waves EMSE, with a wave penetration depth of up to 170 mm, is located on a special movable therapy head, which provides a three-dimensional effect of waves on the calculus.It is a patented technology with proven benefits:
- shortens the time of lithotripsy;
- has a minimal level of side effects;
- minimizes the chance of re-treatment.
In the urology office of the Central Clinical Hospital of the Russian Academy of Sciences, you can also sign up for:
Indications for lithotripsy in the Department of Urology.
Among the main parameters that were previously taken into account as indications for lithotripsy is the size of the stone.In the early 1980s, stones up to 1.5 cm in size were the main indication for lithotripsy; however, modern ESWL devices allow stones of 0.5 to 2 cm in size to be crushed.
After destruction, the fragments of the stone leave on their own along the urinary tract, therefore, with a large stone (usually more than 1.5–2 cm) or structural features of the renal cavity system, a long or incomplete passage of fragments is possible and several lithotripsy procedures may be required for destruction.
Contraindications to lithotripsy in the Department of Urology.
- Among the absolute contraindications to lithotripsy are bleeding disorders, menstruation.
- Lithotripsy is contraindicated in any purulent and inflammatory kidney processes.
- In addition, lithotripsy is contraindicated in cardiac abnormalities (atrial fibrillation).
- 7 days before the operation, you must stop taking the following drugs: aspirin, Thrombo Ass, Plavix, warfarin, in agreement with the cardiologist, it is possible to switch to short-acting anticoagulants.
Hospitalization of patients with urolithiasis is possible on the day of treatment !!!
Laparoscopic methods of surgery are widely used in the department, which are gradually becoming the standard of treatment for many diseases, where open surgery was previously required. The advantages of laparoscopic surgeries over open ones are obvious: this is a lower incidence of complications both during and after surgery, less blood loss, fewer infectious complications, less aggressiveness and tissue trauma.Moreover, the results of such operations are in no way inferior to open operations.