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Ankle My TAR adventure

Noki

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I had a total ankle replacement done 1 week ago at Hospital for Special Surgery in NYC. Here's my story.

I am a very active person. My passions include hiking, Disc Golf and skiing. I used to run but I stopped that a few years ago. Hiking continued and 2020 COVID lockdown made a lot of time available for 4-5 long hikes a week. For a number of years now I've noticed pain in my left ankle when running or hiking but it was never much worse than the regular pain I have in my hips, knees and other ankle. I have psoriatic arthritis so I'm pretty accustomed to mild to sometimes flaring moderate pain in various places. I've never let it slow me down. Advil was my friend and then graduating to Celebrex in the last few years.

Fairly out of the blue last December the pain in my left ankle became severe. It had me hobbling around the house, using a railing on stairs, and it made hiking, skiing, etc impossible. Whenever I dorsiflexed it felt like a knife was being jabbed into my ankle. I saw my rheumatologist and eventually two orthopedic surgeons and all agreed that the x-rays and CT scans showed clearly that I had end-stage severe arthritis. This was all extremely stunning and depressing for me. I went from hiking 20 or more miles a week and playing Disc Golf on other days to having trouble walking around my house in a pretty short period of time..

One early intervention I tried was a hard plastic custom molded brace (AFO). It did not eliminate pain but at least it prevented me from aggravating the ankle by bending it too much. It allowed me to go for 45 minute street walks and to play Disc Golf but it was not a long term solution. In April I decided to get the TAR in July (I am a teacher and that timing would minimize missed work). At the time I got a cortisone shot to get me through the 3 months. Wow the shot temporarily restored my old life. For those months i could once again move up and down stairs with ease, do light hikes without the brace, play disc golf without pain etc. It actually made me frequently question (my poor wife had to hear about it all every day) whether I should get the surgery. But, discussions with a couple of different doctors helped me realize that the cortisone boost was temporary and the underlying structure of my ankle remained horrendous. I might have been able to get through another year on the current shot and then a second but the best timing for me to do this and get it done is now.

So, in a 2.5 hour surgery on July 23 I had a Wright Infinity device implanted via the Prophecy 3-D guiding system that uses images from a standing CT scan to optimally align the new ankle parts. Currently I am in a heavily wrapped splint/cast. I go into HSS in another week to have that removed. I am looking forward to that! I will be non-weight bearing until week 6. Hoping to be back on the trails next spring.
 
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half

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You might be able to hike sooner than that. My TAR surgery was back at the end of Jan and I’ve already hiked up to 11mi with a 2000’ elevation change. Gonna try for a 12mi 3000’ hike in a week or so and will see how a short talus field goes. Anyway, if your recovery goes well, you should be pretty happy around the start of next year.

Amusing side note, my main activities are hiking, disc golf, and snowboarding (I can ski also).
 

Sara61

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:welome: to BoneSmart can you please give us your exact details and which ankle was operated on so that your signature can be created for you.
 
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Noki

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@Sara61 - it was left ankle. What other details do you need?
 

Jaycey

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@Noki Thanks for posting your experience. We are quickly building up this ankle forum and appreciate any input. I look forward to following your journey.
 
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Noki

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@half - that is EXACTLY the kind of hopeful news I need to hear right now. Thanks for sharing. And congrats on your success. Assuming you'll be back on the snowboard next winter?
 
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half

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[Assuming you'll be back on the snowboard next winter?
In theory. My job requires it so I certainly hope so. Biggest possible issues are that I still have a decent amount of scar tissue in the front of the ankle and dorsiflexion is just ok so far, and the other issue is that I have a metal bracket (related to the lateral style TAR I had put in, a frontal TAR won’t have one AFAIK) running down the outside of my lower leg which makes wearing a boot uncomfortable. I can get the bracket removed eventually but my surgeon wanted to leave it in for a year.

Anyway I’ll give it a shot in November and see how it goes.
 
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Noki

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About 10 days post-op. I had a fever that peaked nightly at around 101 for the first 5 days. Thankfully thats dropped. Its normal during the day and climbs to the low/mid 99s at night. Most likely just inflammatory response. I see the surgeon in 3 days and they'll listen to lungs etc.

Also will have the splint/cast removed in 3 days and I am VERY much looking forward to that. Periods of unreachable itchies and tightness when swelling happens have been very annoying.

Otherwise things are as expected. Pain is close to zero when the leg is elevated. When its down there is pain, sometimes intense jolts. I'm not always sure the exact source - the incision? Nerve damage? Another reason it will be good to get the cast off.
 

FCBayern

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Welcome to BoneSmart @Noki, and thanks for sharing you ankle recovery journey with us. I'm now on my 10th year with my STAR ankle replacement and going strong, hopefully you will be as happy with yours as I am with mine. I scuba dive, golf, hike, etc. TAR gave me my active life back.
 
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Noki

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@FCBayern - thats great to hear. I also SCUBA dive. Roatan is high on my list so maybe I'll see you there one day.
 
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Noki

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Update: its been 3 weeks since my surgery. The cast/splint came off last week and they removed three of the four suture spots. They left the anterior ankle ones in so that I could start doing dorsiflex stretches with a towel. Those sutures will be removed next week. I am now in a plastic removable boot. Non-weight bearing for 3 more weeks because he also saw the need to do some ligament tightening.

As mentioned I am doing dorsiflex stretch exercises 3 times a day and icing 3 times a day. The stretching has led to lots of improvement in range of motion and that can't be a bad thing. My one big complaint is what seems to be nerve pain. The anterior third of the top of my foot is mostly numb but also frequently tingly and very sensitive to touch and periodically very painful. It's the main impediment to getting a good night's sleep. I'm hoping it starts trending better soon?

. Ankle.jpg
 

Jaycey

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Early days for you @Noki ! Sounds like patience is going to be your biggest challenge. Have you asked your surgeon about this nerve pain?
 

FCBayern

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As Jaycey said, you are still very early days. Nerve pain is pretty common after TKR and you should definitely talk to your surgeon, there are things that can help. If you ever get to Roatan I can definitely point you towards the best dive operations on the island.
 

Larryr

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Hi Noki,
I read your posts today and it appears you are on schedule in your recovery. Don’t rush your rehab as I did because I will never know for sure if it caused me to undergo my second ankle surgery.
No pain no gain is not the way to recover from a TAR; just go about it smartly. I too experienced nerve numbness across the top of my foot for several months as well as the tingling of nerve endings all the way to my toes.
I was prescribed Gabapentin to help with the nerve pain, but being a person who resists prescription drugs I had them reduce it from 300 mg to 100. It has helped a lot so I was able to sleep.
Best of luck in your recovery.
 

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