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ankle Ankle Replacement'

Discussion in 'Other Joints Forum' started by Baldrick, Nov 9, 2017.

  1. Baldrick

    Baldrick new member
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    I have just become aware of this Forum via a leaflet from the National Joint Registry.

    In 1990 I suffered a fall from a ladder resulting in a comminuted pilon fracture of my left ankle. Following recovery I was able to walk well even doing some quite severe walks in the Lake District and also following a hobby of exploring old mine workings in the Lakes and North Pennines.

    My work was as a technician in woodwork, metalwork and multi-media in a university meaning I was on my feet all day, including carrying heavy objects and operating machines. After some years I started to develop arthritis in the ankle meaning eventually that I had a partial fusion of the ankle.

    I also underwent a hip replacement of my right hip, due I am convinced from me tending to stand on my right hip to reduce the pain in my left ankle. Further pain developed in my ankle and I had a series of three simple steroid injections into the ankle with a varying degree of success. I subsequently was referred to another specialist who recommended image guided steroid injections. I have had three of them but with little long lasting effect, the last hardly having any.

    When I had the fusion I was informed that if problems subsequently occurred the only course of action was full ankle fusion. However the specialist who recommended the IGS advised last year that I could either continue with the steroid injections (no point) use pain relief (not much use really) have a full fusion of the remaining joints or have an ankle replacement which can now be done for fused joints. Full fusion would inevitably lead to further complications in other joints and muscles in my leg so I have agreed to ankle replacement which is planned for next Wednesday 15th November in North Tyneside Hospital under Mr Kakwani, Mr Murty and Mr Powell (plastic surgeon)

    Apparently they have only ever done three other replacements following previous fusion surgery. I should also mention that I also had a left hip replacement just over two years ago so maybe I am a good candidate for this forum!!! I shall add comments once I have had the surgery.
     
  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Baldrick,
    Welcome to BoneSmart, glad you joined us!

    You are in the right place!

    I am going to tag our Forum Nurse @Josephine, she is located in the UK.

    Please post your exact Hip replacement surgery date, having the dates of both surgeries will help us better advise you. A moderator will add the dates to your signature.
    Thanks!
     
  3. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Baldrick, but I can't find either of those surgeons in the National Joint Registry and I would certainly never allow someone who has done so few ankles to operate on my ankle! Ankles are a lot more complex than either hips or knees and a lot can go wrong. You need to see someone who has some significant experience with them.

    If you like, I will look out some alternative surgeons for you.
     
  4. Baldrick

    Baldrick new member
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    I did say they had only done three replacements after previous fusion. They have done many replacements of non fused ankles. Replacement following fusion is relatively new.
     
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  5. Baldrick

    Baldrick new member
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    Looking at Mr Kakwanis record indicates he is above the national average for ankle replacements. Also he referred me to Mr Murty for a second opinion and then due to the possible complexities of the incision required which will use an original incision then goes across the foot then down he referred me to Mr Powell for his opinion. He will be there to make the incisions and finish off apparently so that the blood flow to the area is maintained after the operation to prevent complications. I am satisfied that all avenues are covered with three surgeons present.
     
  6. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    I don't think so! I remember scrubbing for them years ago!

    But the important thing is that you feel confident with them.
     
  7. Baldrick

    Baldrick new member
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    Quote "North Tyneside Hospital is the pits"
    CQC, North Tyneside Hospital, May 2016, Surgery = Outstanding. Overall = Outstanding.

    NJR data, Murti, Ankle primary = 35, national average = 10
    Kakwani, Ankle primary = 13, national average = 10.
    Both surgeons ARE on the NJR.

    If you don't mind me saying, advising no exercise after knee surgery unless you know something that many others don't is ill advised even if you do have medical knowledge and experience (I don't and I haven't read your article) and especially on a site like this.
     
  8. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Only that based upon several patients I've met (in real life) who had surgery there but did not have a good outcome.
    I don't recall giving you this advice!
     
  9. Baldrick

    Baldrick new member
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    Your "no exercise" comment is on your own reply page for all, including me, to see!!!!! You even recommend reading it!
     
  10. Jamie

    Jamie ADMINISTRATOR Administrator

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    Balldrick, our guidelines for knee replacement patients do suggest that patients take things easy as far as physiotherapy is concerned. Our experience is that people tend to push too much otherwise.

    Just because our members or staff indicate they do "no exercise," it does not mean they sit around and don't move. Many surgeons understand that too much activity or therapy too early in the recovery process is counterproductive for a lot of patients and they will advise them not to do formal PT in the first critical weeks of their recovery. I believe you may be misinterpreting mentions here on the forum of "no exercise" to mean nothing at all when it really means no formal exercise.

    As for your discussion with Jo regarding the hospital and doctor ratings, would you be so kind as to provide a link to the place where you've obtained the data and a screen shot from the site? It would appear that your data from the National Registry and Jo's don't match up and we'd like to get that clarified for people who come along and read your thread.
     
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  11. Baldrick

    Baldrick new member
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    The link to the NJR is http://www.njrsurgeonhospitalprofile.org.uk/
    This allows the input of surgeons name, GMC code (not required) and hospital and then a series of individual records are available for all to see.
    With regard to exercise, it specifically says "NO" in capitals thereby emphasizing it! I respectfully suggest that is a distortion, to me "No exercise" means exactly that, and if your site wants to be correct then 'no formal exercise' should be used as you state.
     
  12. sistersinhim

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    I wish you the best of luck and sent up prayers for you on your surgery on the 15th. I broke my ankle and foot in late May and am still healing. I will be following your recovery closely and will help all I can!
     
  13. Jamie

    Jamie ADMINISTRATOR Administrator

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    Thank you for the link. It helps me to have that, as I'm in the USA and not as familiar with your NHS healthcare program.

    I do see the numbers you posted for both doctors.....and agree that it shows they do more than the average number of ankle replacements. As I cannot explain the reason for a discrepancy in what @Josephine found in her search, so I'll tag her to come and take a look at your link. If she has some concerns about the hospital, perhaps she can tell you more details so that you can know specific things to look for and questions to ask when you are there.
     
  14. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Baldrick I checked the NJR registry for Murty. The number you quoted above is for 3 years. The annual number for Murty is 13.

    I do wish you all the best on your surgery and look forward to following your journey.
     
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  15. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Please don't confuse 'no exercises' with 'doing nothing'. One can get a lot of useful 'therapy' by simply walking, going up and down stairs and sitting/getting up from chairs.
     
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  16. Baldrick

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    I have had two hip replacements and on both occasions maintaining movement has been mentioned as critical by the physiotherapists and others. Walking, stairs and sitting/getting up (in a controlled way of course) was seen as part of the recovery regime and although I know you were referring to knees, still relevant.
    Thank you to those who wish me the best.
     
  17. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    @Baldrick, I agree that we must keep our joints moving, especially our new ones! We know that if a person does too much and/or aggressive exercises on a new joint, it has detrimental effect on the traumatized tissues. These new joints aren't out of shape, they are injured from the surgery! No one would exercise a broken bone, well after a replacement the tissues and bones have been cut and need to heal before expecting them to be able to exercise without swelling and pain occurring afterwards.
     
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  18. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Hi @Baldrick
    My sister in law had an ankle replacement several months back. Really sensitive ongoing recovery as she has some weight issues but is doing well.
    First, please add those hip replacements to your signature as I would've had no idea you are a multiple bionic.
    Second, I would guess the time for exercise and how much would definitely be different for all of these different joints. And I also would think more difficult due to weight distribution. Often heard hips easier than knee...up at mid torso. Knee, more weight pressure on smaller bones...ankles...at the very bottom.
    Not any kind of revelation, just seems like a common sense observation as far as how much stress to put on what and how soon
    Best of luck on your upcoming surgery.
    How are those hips now?
     
    Last edited: Nov 13, 2017
  19. Celle

    Celle FORUM ADVISOR Forum Advisor

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    HI @Baldrick

    I have had three knee replacements. For all of them, my surgeons had the philosophy of no formal PT for the first month, to allow the joint time to start healing. During that month, I didn't just lie around like a couch potato, doing nothing. I rested a lot, but I also walked around the house, to and from the bathroom and kitchen, and I gradually increased the length of time I was walking. I certainly kept the joint moving.
    After the first month, I went to PT once every two weeks. At PT, I was shown exercises to do at home.

    For my last knee replacement, I did no formal PT at all, as I already knew what to do. I did a few heel slides when I remembered but, for the most part, the activities of my daily living were my PT. As my knee healed, I naturally increased my daily activities.
    I have had three excellent recoveries.

    I wish you all the best and I hope you will let us know how you get on. As I have osteoarthritis in both my ankles and mid-feet, I will have a personal interest in your progress.
     
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  20. Baldrick

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    I went in on Wednesday at 7:30. After all the preliminaries was taken to the prep area where I had two image guided nerve blocks into my leg just above the knee at around 9:15.. Not the most pleasurable experience I have to say although I have had image guided steroids into my ankle in the past so knew something of the procedure. After that something into the canula in my hand and I knew nothing until around 3:30pm or thereabouts. All apparently went well, needing a skin graft done with a flap by the incision as they used an original scar and it was tearing when they were finishing off needing extending. The nerve block has taken a long time to recover from and i still have no feeling in the bottom of my toes but have on the top. They are not over concerned. All apparently went well and I have surprisingly been discharged the next day! Non load bearing for two weeks then the large pot is removed and should be replaced with a moon boot and then part load bearing. I am keeping the ankle raised most of the time. When I put it down I get mild pain but the pain level overall has not gone over a 4. I have paracetamol, codeine and morphine if I need it and have the blood thinning injections to do every day for 6 weeks.
    With specific reference to North Tyneside General Hospital which was commented on by someone else on here, the overall experience was superb right across the board from the initial reception to final discharge. Both surgeons and the the plastic surgeon were very pleasant and informative as were the man who did the nerve block and the anesthetist. I felt that anything of concern was dealt with in a proper manner. Apparently there was a slight concern that I took 35 minutes to come around from the anesthetic.
    I shall report again soon unless anyone wants any questions answered.
     
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