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Ankle Fusion or Replacement... Either way, I'm not looking forward to what comes next...

zjrog

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Many of you know me, or know of me for my left TKR 10 years ago. I'm having my right TKR soon, next month I hope... But now some background on my left ankle issues...

Nearly 4 years ago, right after healing and being cleared for everything from my RIGHT ankle surgery, a heel spur removal that had cut my Achilles tendon, which needed repair, I twisted my left ankle and fell. Short story, that strain/sprain/twist never fully healed. And created muscle/tendon/ligament damages. Last year I couldn't tolerate the pain any longer and sought help. I've been in an AFO brace since December. The surgeon had the following to say, and this is right out of my chart...


1.Severe tibiotalar and 1st through 3rd tarsometatarsal osteoarthritis with multifocal mild-to-moderate osteoarthritis throughout the remainder of the foot.
2.Medial talar tilt with hindfoot valgus, pes planus, and close apposition of the distal fibula and lateral calcaneus consistent with subfibular impingement. Possible anterior tibiotalar impingement as well.

Assessment:

Initial encounter, Left valgus ankle, end stage ankle OA, 2nd TMT OA

Plan:
I reviewed the CT scan with Roger and all questions were answered. With the type of deformity he has, the surgical intervention has a long recovery. He will need an ankle fusion. He understands he will have functional ROM but will not be able to run again. He would need to be NWB for at least 8 week and understands it will take a year to know his new normal. Because he has a lot going on right now, he will continue to use the brace. He will need new foot and ankle film at least 2 months prior to surgery.

The surgery would be an ankle fusion, distal tib/fib, plantarflexion 2nd TMT fusion with iliac bone graft and possible gastroc lengthening


I had asked at that time about TAR. And his first answer was that I might not be a good candidate. I see him next Wednesday, and I'm not sure I want to take NO for an absolute answer. I spoke with him over the phone during a consult last week. And we discussed my need for a right TKR as well, and he won't do my ankle until I am healed from the TKR. His reasoning was I need a solid platform in that knee to support my 8 weeks NWB... At present, that knee will not. It has given out more than a few times. And I am more than ready to get SOMETHING taken care of once and for all...

I have more questions, but will ask after I read a lot more in here. I'm SO GLAD to see ankles represented in here. I discovered Bone Smart a few months after my Left TKR, and I stuck around and kept coming back to see how others were faring. Now, instead of answering others, I seek answers.
 

Pumpkln

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@zjrog
Welcome Back, sorry to hear you are facing a couple more joint replacements.

If you are questioning TAR vs fusion, suggest you seek a second opinion before making your decision.
Since you are doing a TKR first you have time to make your decision about your ankle.
 
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zjrog

zjrog

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@zjrog
Welcome Back, sorry to hear you are facing a couple more joint replacements.

If you are questioning TAR vs fusion, suggest you seek a second opinion before making your decision.
Since you are doing a TKR first you have time to make your decision about your ankle.
Thanks. yes I have time. But no idea how much. I'll have a better idea after the CT of my ankle next week, and surgeon's visit...
 

Jaycey

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@zjrog Welcome to the ankle forum. This area is not as active yet but certainly growing. Please keep us updated on your situation.
 
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zjrog

zjrog

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Had my CT scan today, followed by the visit with the surgeon. After he covered what he felt was his best solution, I started asking more pointed questions, which took me to ask about replacement. So, he scheduled me with a TAR surgeon. After that visit, we will have another phone visit to discuss all further options.

My next issue is to talk with my insurance about TAR vs fusion for my future needs. Considering that will be fresh on the heels my my right TKR, this might get interesting...
 

Pumpkln

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Yeah! Glad you are set up with a TAR surgeon so you can explore all your options.
My neighbor had a TAR about 2 years ago, she was given the choice of fusion. She is very happy with her TAR ankle.
I agree it will be interesting.
 
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zjrog

zjrog

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@pumpkin I am glad to have made at least one move forward. I am a bit concerned in the post visit notes, the doc I saw the other day still says I'm not a good candidate. I really hope that doesn't bias the TAR doc against that path. Again, I'm not certain my insurance covers TAR when fusion is the primary choice. But that will be a discussion I will have on my own.
 

Larryr

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Hi,
I am now 12 months post TAR and am glad I made the choice of TAR vs fusion. My surgeon does both but when he told me i ' would have a permanent limp I chose TAR. It has not been easy and I still have slight pain when I walk, which I am doing a mile and a half. I have total flexibility in all directions which is great.
I totally understand your frustration as to which way to go, so good luck to you .
 

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