Ankle 13 month TAR Surgeon's Appointment

[hackberry]

Just read half of her thread, learned some, also that our situations are different. Have to admit, though, some of it scared me to death. Hope a few others might have related experiences.

Thank you!

 

[benne68]

Hope a few others might have related experiences.

Unfortunately, we don't have too many active members with TARs on the forum right now.

But you might want to read through some of the older threads -- HERE -- to see if they provide any helpful insights.

 

[Iski]

@hackberry . Sorry to hear about the latest in your journey. Hopefully, it's an easy fix but at least you know what the problem is. Wishing you luck, and keep us posted as you learn more.

 

[hackberry]

Thank you! I keep learning (and wondering/worrying) more through various searches. I hope my surgeon has experience with arthroscopy. If not, there’s a surgeon in town who’s done hundreds of TAR’s, worked with my surgeon at the Mayo for some time. I needed to keep everything in the Mayo ball park because of my mild hemophilia.

 

[hackberry]

My thanks above goes to you too.

 

[El Oso]

It was looking to my physical therapist and me that we’d hit the end. The unpredictable sharp pain and sometimes spike of pain centered on the knob (malleolus I think) on the left side of my right ankle wouldn’t completely go away. I finally made an appt with the Mayo surgeon who’d done about 100 TARs.

Based on the xray and my descriptions he thought there might be some interference between the lower implant and the tibia. I’d wondered about that from the start actually, but assumed the tibia must be clearing the Wright Infinity ok. But now they were concerned and promptly did a 360 degree weight bearing CT that took 450 images and looks like from some image series, so at some times, like a bone on implant situation, that the radiologist is describing as potential impingement of the medial malleolus.

The surgeon and I meet Monday to figure out what to do. I’m hoping that a few of you, administrators as well, might have some experience and/or knowledge about this that could help me. What might they do? Saw off some tibia? Saw off some implant? Just “clean up” the arthritis that’s emerged between the tibia and implant? Wish that they’d put a smaller implant in? Do nothing?

I don’t think I can attach images.

Thanks, everyone!
Bill

It sounds like you need a gutter clean out. Impingements can happen if there’s a lot of scar tissue. I have a friend who has a TAR two years ago and had a gutter clean out 6 months later. That procedure did the trick and she’s all better

 

[hackberry]

Thanks! Did she have it done arthroscopically or open? And her length of recovery?

 

[hackberry]

2/3 of the tibia, posterior, is rubbing against the talar implant and the surgeon would go in from the front, shave off a significant amount of tibia, then cast without weight bearing for 2 weeks, then gradually transitioning to full weight bearing in a boot before getting back to the approach shoes, total time 4-6 weeks.

I asked about whether the Wright Infinity CT program determined implant size and positioning and he said yes, and all was spaced out fine at the surgery but through recovery and settling the contact developed.

But the post op x-rays every 2 weeks for the first 2 months after surgery, and the xray just taken last week look the same: almost if not complete contact. And the on and off pain at the medial malleolus became the “theme” of recovery very early in the recovery process.
Surgeon says hindsight is 20/20.

What is the “etiquette” on getting a second opinion in this situation? Would another surgeon agree to look at the weight bearing CT or maybe respect the right of the initial surgeon to finish his work?

Bill

 

[Iski]

That's too bad @hackberry. I'm not sure about "etiquette", but I'd 100% get a second opinion. Particularly, when the proposed remedy consists of shaving the tibia. Considering everything else involved in a TAR, that sounds "relatively" minor, but I'd want to be darn sure that's the appropriate remedy!

 

[benne68]

What is the “etiquette” on getting a second opinion in this situation? Would another surgeon agree to look at the weight bearing CT or maybe respect the right of the initial surgeon to finish his work?

Many surgeons will decline to see patients seeking a second opinion until they are at least a year post-op. Since you have passed that one-year mark, that shouldn't be a problem.

Those who give second opinions are aware that they won't always be doing the second surgery, so you really don't need to worry about that.

However, if it concerns you, consider this: Hospital for Special Surgery ( the leading orthopedic hospital in the world) offers a great Remote Second Opinion program. They will review your medical records and provide a telehealth consult. There is a fee so there is no expectation that they will be doing your surgery. Here's a link, in case you are interested in pursuing this: https://www.hss.edu/remote-second-opinion.asp

 

[hackberry]

That's too bad @hackberry. I'm not sure about "etiquette", but I'd 100% get a second opinion. Particularly, when the proposed remedy consists of shaving the tibia. Considering everything else involved in a TAR, that sounds "relatively" minor, but I'd want to be darn sure that's the appropriate remedy!

When I asked the surgeon to describe a “gutter cleanout” after he had described shaving the tibia he said “that is the gutter clean out.” Does that match your experience or not?

 

[hackberry]

What is the “etiquette” on getting a second opinion in this situation? Would another surgeon agree to look at the weight bearing CT or maybe respect the right of the initial surgeon to finish his work?

Many surgeons will decline to see patients seeking a second opinion until they are at least a year post-op. Since you have passed that one-year mark, that shouldn't be a problem.

Those who give second opinions are aware that they won't always be doing the second surgery, so you really don't need to worry about that.

However, if it concerns you, consider this: Hospital for Special Surgery ( the leading orthopedic hospital in the world) offers a great Remote Second Opinion program. They will review your medical records and provide a telehealth consult. There is a fee so there is no expectation that they will be doing your surgery. Here's a link, in case you are interested in pursuing this: https://www.hss.edu/remote-second-opinion.asp

Thanks! How much do they charge, roughly? Plus I think a lot of time and red tape.

I’ve already had one appointment (prior to the surgery) with the noted surgeon here who’s done hundreds of TAR’s but needed to stay within the Mayo Clinic mainly for location, simplicity, and management of my mild hemophilia. I’ll call and ask him for a second opinion, with confidence, based on your first 2 paragraphs.

 

[Iski]

@hackberry . I haven't any experience with "tibia shaving" or "gutter clean out". I have one link in a TAR file I keep that you might find interesting: See https://www.healio.com/news/orthopedics/20220711/ankle-replacement-a-new-gold-standard-for-arthritis for a bit more information about fixing a gutter impingement, which I understand is a somewhat common procedure for TARs that aren't working perfectly as designed.

 

[hackberry]

Thank you, that was helpful. I hope I can have a good open talk with the second opinion surgeon in 2 weeks. He will have all the images and plans he needs.

 

[dingo dad]

Hackberry. sorry to hear about you're pain brother. I'm interested in what you find out. I remember your recovery post often. you were very positive and that glad me some hope during early days. my 2nd opinion doc just offered that.. his opinion about where I was at in my recovery seemed "typical" if there is such a thing. and then come back in 3 months for another update. then... the same again. that I had a case of CRPS to go along with my surgery/recovery. mainly the nerve pain/numbness and hyper sensitivity.
jery