Ankle TAR UPDATE

@Chanie
Great to hear your progress, sounds like you are doing great. I hope that I will be moving around more soon, am taking a rest but most of the time my body says to get moving, so it is difficult to stay in bed, especially with our incredible weather right now. I am really having trouble with this disconnect between what my body says and what my ankle says. I am interested in what the Dr. says tomorrow about how to understand my ankle a bit better. Wishing you all the best in your recovery, one step at a time. Keep us posted.
 
@LauraC All the best on Monday. Please update when you can.
Well, I went to the Dr. about the change in the way my ankle was feeling. She recommended a CT. I got the CT results that same afternoon, and my interpretation of the results were that I am headed for a revision. Impingement, both the device and most probably some scarring impingement are causing this sharp, bone pain in my malleolus. I waited for the Dr. to see if my interpretation was anywhere close to what she thinks. After one week of silence (I believe that this normally very responsive Dr. was conferring with her colleagues), I received a message tonight. They are recommending a revision to replace the talar component with a smaller one. I am really devastated. Although I know this happens, and really went into the surgery with eyes wide open, now that it is here, I am having a stronger emotional reaction than I expected. 19 wks today, and now .... I have a lot of questions, and hope to be getting a video meeting with the Dr. this week. Will keep you posted.
 
@LauraC Bummer about the revision! But at least they have identified the problem and there is a solution. I hope you can get this done quickly and get back to recovery. Fingers crossed! :fingersx:
 
Sorry to hear about the revision. Best of luck going forward.
 
So sorry you are looking at more surgery @LauraC. We will be here for you! If more surgery solves your problem it will be well worth it.
 
Well, I met with my surgeon, and she had indicated that the revision would require implanting a smaller talar component because of the current 4mm (sounds huge! how come?) overhang which is rubbing on my medial malleolus which is causing the pain. She had also suggested a gutter clean out instead of the revision. We reviewed the CT together, and it does look pretty good other than the impingement. Initially, I did not want to do the scope procedure because I felt that I would have to go for the big revision anyway, but she checked with Wright and they do not have a smaller talar component, it would have to be custom made, making that a long road on top of the long road to recovery. The scoping sound like my best alternative at this time because the recovery would be short, no NWB phase, and basically in parallel to my current replacement rather than starting all over again. My strength and ROM are just coming back and I am walking well, jut not far mostly for fear that the pain indicated damage, not something to "work through". I want to keep up that progress if I can. I am scheduled for the procedure on Tuesday, March 23rd. I am vigorously entertaining the thought that this may solve the problem and that I will not need a revision. Think positive thoughts.
 
Fingers crossed the scope procedure works for you @LauraC. :fingersx:
 
Update: Had the scope procedure on the 23rd. Much more painful than I expected, but I think the pain is diminishing. What they found is excessive fibroid tissue, a difficult and extensive procedure. The fibrotic tissue had moved in between the poly and was all removed. Today, the Dr. went picture by picture and explained the process and what she was seeing and doing at each stage. She really could not visualize an excessive overhang on the talar component, and was able to see about 3mm space with a probe in the gutter. Cartilage was all worn off on the media malleolus, she said it could have happened from the fibroid tissue which was so thick. So, the good news is that it is all cleaned out, and I am cleared to start back to PT as tolerated next week. I agree with the Dr. that this was the best thing to do at this time. The revision is off the table for the time being. Please keep your fingers crossed that I can now proceed where I left off with this recovery!
 
Glad to hear things went well @LauraC. Make sure you don't press too hard and :ice::ice::ice:
 
I am reclined and icing as I read this. I have such a history of fibrotic interference, that I have to make every effort to keep the swelling to a minimum (which I have so far), and HOPEFULLY minimize the scar tissue that forms from interfering with my joint, and causing the pain that happened. I will gladly leave some ROM behind for the ability to walk without pain.
THANKS FOR THE SUPPORT!
 
LauraC,
Glad your surgery is behind you. Our TKR's with fibrosis, after surgery to remove it, have done well by focusing on keeping the knee calm and avoiding swelling and inflammation for the first 3-4 weeks.
All the best in your recovery.
 
I am still trying to keep my ankle calm, have tried swimming (but can't get in the pool often due to limited pandemic spaces and a popular activity) got a couple of slots at pool at PT, but that too is limited by pandemic. So the ankle is quite painful when walking. I need to alternate between a walker and a cane and am walking very little. My surgeon is looking into the options for revision. I am hoping that I will start getting some relief from the pain, and don't have to go to revision.

Are there any threads from people who have had revisions in the forum?
 
I am 40 wks out from TAR and still having trouble walking/pain. I am active, and had hoped that by this time I could take hikes of 3 - 5 miles without this much pain/difficulty. Yesterday I had a full leg length Xray which appears to show that I have a varus deformity that is possibly causing my problems. This same Xray appears to indicate that the TAR is in good shape and is in alignment with the knee etc, it is when you look at the full leg that this issue can be visualized in one leg (TAR leg) but not in the other... So they are recommending an osteotomy rather than any kind of revision. In my reading, I do see studies about this and staged surgeries, TAR then osteotomy, due to the complexity of each of the surgeries. This is really scary. Anyone have any experience with TAR and osteotomy?
 
@LauraC
Sorry it took so long for some one to respond. Osteotomy is a complex surgery, as is a revision. My best guess is they would rather leave a well placed and healed TAR in place, and avoid the risks revision surgery would bring.
How are you getting along now?
Chris
 
I am doing OK. I am still not able to walk as much as I would like. Yes, you are correct, they don't want to touch the implant because it is well aligned to the knee and solidly placed.

I am in a holding pattern until the 1 year mark, and just trying to really define my limits so that I can determine if the limitations are acceptable. I really did this so that I could do some hiking, and stay somewhat fit and active (not over the top, just see the sights etc) and am pretty disappointed that I haven't been able to do that. I am swimming, but the indoor pools are not open, and I am not very hearty so I don't know what I will do in the winter. Some days are great, and I appreciate them when they come.

Laura
 
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@LauraC
Glad you are doing OK, hoping your ankle continues to improve over the next year. Many of our hip and knee replacement members report improvements into the 2nd and 3rd year after replacement. Hoping that will be true of your ankle.
Keep staying within your limits, nudging at the edges from time to time to see if your ankle is ready for more activity.
Keep us posted on how you are doing,
Chris
 
Keep staying within your limits, nudging at the edges from time to time to see if your ankle is ready for more activity.
This is perfect advice @LauraC, basically what I did in my recovery. It wasn't near as fast as I wanted but I eventually got there.
 
I just hit the 1 year mark and thought I would post an update.

I just want to state that due to this forum and other forums, I was able to research the risks of moving forward with my surgery, and it is what it is. I can swim, but I cannot walk or hike more than 1 mile without significant pain (I do however wince through a few miles...)

My surgery overall went very well, good healing, no infection, looks very well aligned to the knee, and the Wright Infinity device is nicely attached to the bone. I am pretty comfortable most of the time, when I am not doing anything. I went forward with the surgery to be able to hike, and be more active. Not a big ask, no court sport or running desires.

From about the 3 - 4 month point I began having a lot of trouble with weight bearing activities. I had a scope clean out and there was lots of scar tissue in the joint but there was space and no apparent bone impingement. THIS IS NON WEIGHT BEARING VIEW.

I had an evaluation at 9 months, and a full leg weight bearing xray which showed that from the ankle to the knee was nicely aligned but from the ankle to the knee showed a curve. So, do to the limitations of the methodology of the infinity process where the CT is a non weight bearing imaging, it was not picked up before the surgery, or the surgery may not have been recommended (according to some clinical trial data to correct varus deformity using osteotomy that I have found from 2009). I understand that if this varus deformity had been found, there is nothing that the surgeons could have done during the TAR surgery because they have to stick with the Wright protocol to place the device in alignment to the knee.

So, since the offer that the Dr. gave me at 9 months was an osteotomy to shim my leg and straighten it. To say the least, I am not eager to do that. Yes, I am making a pitch for an overall body evaluation (full length leg xray) before recommending this surgery.

My plan at this time is to get fitted for an orthotic/prosthetic AOF to take the load off my ankle so that I can do what I would like to do. (Unfortunately, I think this solution could have been implemented before the surgery, and the TAR may not have been indicated if the full exam had been done) I see this as a very exciting solution to my dilemma, although it will be very expensive. I am looking at the ExoSym device, and will start that process at the end of December.

I am truly excited, and fully accept my condition which is clearly worse than before the surgery unless I do nothing...

Wish me luck on my non surgical journey to getting back to walking!
 
I'm sorry to hear you are still having issues and maybe shouldn't have had a TAR at all @LauraC, that has to be very frustrating. Please continue to let us know how you progress. Hopefully the AOF will help.
 

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