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Ankle 13 month TAR Surgeon's Appointment

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!
 
@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.
 
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 said:
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
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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
 
Thanks! Did she have it done arthroscopically or open? And her length of recovery?
 
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
 
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!
 
hackberry said:
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?
Click to expand...
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
 
Iski said:
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!
Click to expand...
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?
 
benne68 said:
hackberry said:
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?
Click to expand...
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
Click to expand...
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.
 
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.
 
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
 
Ok, sorry, what a long gap, huh? A 360 degree weight-bearing CT showed rubbing between tibia and implant that x-rays alone could only hint at: the rubbing was on the backside. The plan was the clean-out (or debridement) that one of you had suggested. When I saw my “second opinion” very experienced TAR surgeon (who had taught my surgeon at the Mayo but couldn’t do it himself due to the complications of working with my mild hemophilia at another hospital) he and I had a wonderful talk. He said this impingement was the most common problem with TAR’s and spoke of size choice and placement, as well as suggesting screws to reinforce the tibia which would be shaved. My surgeon read his report, called me on the phone, everyone was in agreement.

The surgery just happened 3 weeks ago. Not much pain at all, really you could call it something between a tickle, an itch, and a burn - right at the medial malleolus where the incision was. 2 weeks in a weight-bearing cast, and now in a boot, soon to get back into my ASO Sport brace, and hopefully I can ride and hike and swim enough to build up the energy I need for the Colorado high country come September.

Here are x-rays. Bill

ps: it‘s a hollow cannelated screw.
 

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Bill, thank you for updating us!

I'm glad the diagnosis was sound and the path forward was really clear.

I hope for an interim follow up as you increase your activity, and to see photos of you in Colorado this fall!!!
 
Sorry you had to deal with another surgery, @hackberry, but glad that you found an answer to the pain. Here's hoping you have a quick and uneventful recovery so you can get back to doing what you love soon.
 
@hackberry Glad to hear it! Hopefully, this is what you need to get back at it.
 
Hackberry,
I’ve had two TARs on the right side first was 2011 when I was 51 yo. Revision in 2021 when I was 61. I too am hiker, biker, fisherman, outdoors a lot.
First device was wright infinity. It really took two years for full recovery.
Then in about 2019 started to have lots of pain.
New inBone device in 2021. Within six months I could hike 10 miles.
For me the Wright inBone was a much improved device. Also, much more expensive as it is a custom printed device specific to the patient.
I believe the infinity comes in small, medium and large.
During the second surgery my Achilles was lengthened. I think the lengthened tendon gave me more range of motion. It is certainly better ROM than I had in previous ten years. For me the revision left me in much better condition than the first surgery. During revision, they also managed a large bone cyst that I had on my tallus. I think that cyst was the source of much of my pain.
I would bet at the two year point you will be very satisfied.
 
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