Ankle TAR vs microfracture vs graft (cadaver or DeNovo)

[half]

That's what this site is all about and we could use more information about ankle replacements, they are are becoming more frequent and we would like to have as much information for future candidates as we can @half. Your contributions are greatly appreciated!

Most definitely. Happy that my experiences can help others get through this process.

 

[half]

Meh. Got the cast off today. Some good things, but the main problem is still happening. You can actually see the difference from the (non-load bearing) X-rays taken after surgery and today (post surgery pic on the left, today on the right). Ankle is bowing out again slightly after doing nothing but healing for 6 weeks.

All is not lost, doc says that it may align itself properly when loaded because the bone alignment is good, more X-rays in 6 weeks will tell the tale. My ankle history makes me kinda pessimistic about that though. If it stays messed up, there's actually more that can be done - cadaver ligaments to further reinforce the loose side and also a muscle transfer to strengthen the muscle that pulls the foot that way (the one I initially injured).

On the plus side, everything is healed and I could immediately walk unassisted in the air boot without the pain I had after the last surgery, so the arthritis pain that was there is definitely gone. It'll be interesting to see how much range of motion I can get back without pain.

Overall, with the exception of 4th surgery last June, this feels exactly like all my other recoveries where I was able to get back to normal activities relatively quickly. We’ll see if the recovery keeps tracking the same going forward.

The alignment though is the main issue, it’s been an issue after every surgery. Damn ankle just doesn’t want to stay aligned and now that could cause uneven wear on the TAR.

 

[FCBayern]

Fingers crossed that loading that ankle will help the alignment @half. Having the arthritis pain being gone is huge. I personally lived for too long in a custom brace to prevent ankle movement while also taking pain meds just to get by, so for me that pain being gone was huge.

 

[Jamie]

Sorry you're still dealing with some challenges, but it does sound like you have a surgeon who knows his stuff and is cautiously taking things one day at a time. That is certainly advisable in situations like this. It is great to have lost the arthritis pain, though. I hope things will improve for you with a little time.

 

[half]

It’s been a little over a week since the cast came off and I’m weight bearing, and it’s now clear that the recovery will be slower than from my other ankle surgeries. Nothing alarming, but the ankle gets really sore very quickly if I have full weight on it. I was hoping for better of course, but considering how much was done this time around, it’s not much of a surprise.

Walking with crutches at 50% weight mitigates this pretty well (even in an ankle brace instead of the boot). It’ll still get sore, but not to the same degree. PT work is mostly just mobility and isometric strengthening right now.

 

[half]

About 2.5 weeks weight bearing, and a lot of the soreness seems to have dissipated. it happened pretty suddenly too. About 4-5 days ago it still hurt like crazy. Now I’m actually walking around unassisted with just an ankle brace as the boot is more uncomfortable.

I’m still being cautious when walking because I don’t want to stretch out those repaired ligaments any further, but honestly if I wasn’t worried about them it feels like I could walk around pretty normally. As far as I can tell, I’m able to keep my weight neutral or towards the medial side of my foot unlike before when it was always heavy to the lateral side. Walking up stairs alternating steps isn’t any more difficult either. I can go down alternating also, but have to cheat a bit by having my bad foot on only half the step.

I added a foot peddler to my exercise routine about a week ago. First couple of times my peroneal (the original muscle/tendon injury) would become fatigued within a minute or two, but after that it’s been pretty normal all the way out to 25min.

Overall things seem to be looking up, fingers crossed.

 

[Jaycey]

@half Great update! Sounds like you turned the corner on this recovery. Well done for being persistent.

 

[half]

Now 12 weeks out from surgery and I saw the doc today. Pleased to say things are looking pretty good. X-rays show that the ankle replacement is properly aligned when loaded:



It gets to about a 4 in soreness when I’m on it for a decent amount of time (I’ve walked a little over a half mile a few times) but there’s no sharp pain or anything else alarming. The ankle is still quite tight and I have to be semi-cautious regarding the ligaments for another couple of months by wearing an ankle brace and heel wedge outside the home, but otherwise I’m feeling relatively optimistic at this point.

 

[Chanie]

wishing you lots of luck with your hopefully last surgery. What a journey! I am now 3.5 months since my TAR Jan 8 and thank G-d walking in hi top mens basketball sneakers with a cane on bad days and without it on good ones. I've returned to work as a music teacher albeit slowly... being off your feet for so long not only affects hour foot but all other joints , and of course your stamina! PT is 2x a week now and I am bushed afterwards. Take it slow and easy and keep posting!

 

[half]

wishing you lots of luck with your hopefully last surgery. What a journey! I am now 3.5 months since my TAR Jan 8 and thank G-d walking in hi top mens basketball sneakers with a cane on bad days and without it on good ones. I've returned to work as a music teacher albeit slowly... being off your feet for so long not only affects hour foot but all other joints , and of course your stamina! PT is 2x a week now and I am bushed afterwards. Take it slow and easy and keep posting!

Thanks for the well wishes. I'm dealing with more muscle atrophy than usual because I could barely walk between the summer surgery up until I got the cast off after the January TAR. Will be interesting to see how quickly it builds back up now that I've been cleared for weight bearing strengthening exercises.

Best of luck to you also, hopefully you don't need a cane for much longer.

 

[half]

Update: saw the doc at the beginning of the month and everything still seems fine. I'm cleared to do lower impact activities like hiking, which I've been doing to help get back into shape. I've been walking around 2 miles with a lot of elevation change daily on dirt trails with no ankle support. Also played a round of disc golf. That was probably about 4 miles of relatively flat, soft dirt and pine needles and staying in one spot when throwing (no running throws). The ankle was pretty fatigued towards the end of the round.

The one negative thing is that I'll have to remove the lateral bracket hardware that can be seen in my x-rays eventually. It irritates the nerves around the lateral malleolus when I'm wearing a boot, which is a problem considering my job requires my foot to be in a boot. Doc wants to leave it in place for at least a year though, so the beginning of work next season could get interesting pain tolerance-wise.

Not much else really going on except for regular PT. Ankle dorsiflexion is still relatively stiff - mostly caused by scar tissue towards the front. Calf strength is also still pretty weak (can't do a single calf raise yet). Those are the two primary things that need to be worked on, but will continue to improve over time.

 

[Pumpkin]

Glad to hear you are doing well with your recovery, ask about padding or stretching your work boot to protect your ankle.

 

[half]

Glad to hear you are doing well with your recovery, ask about padding or stretching your work boot to protect your ankle.

Thanks, but that likely won't work. It's a very nerve-centric kind of pain that gets set off with any kind of repeated touch, even if it's super light. I had this problem before when the ankle was unstable and would rub against the side of a form fitted boot. It just gets irritated and inflamed. The only way it could be avoided was if it was possible to hollow out that area of the boot so that it doesn't touch the skin at all, but that's not really doable in a snowboard boot.

 

[LauraC]

Update: saw the doc at the beginning of the month and everything still seems fine. I'm cleared to do lower impact activities like hiking, which I've been doing to help get back into shape. I've been walking around 2 miles with a lot of elevation change daily on dirt trails with no ankle support. Also played a round of disc golf. That was probably about 4 miles of relatively flat, soft dirt and pine needles and staying in one spot when throwing (no running throws). The ankle was pretty fatigued towards the end of the round.

The one negative thing is that I'll have to remove the lateral bracket hardware that can be seen in my x-rays eventually. It irritates the nerves around the lateral malleolus when I'm wearing a boot, which is a problem considering my job requires my foot to be in a boot. Doc wants to leave it in place for at least a year though, so the beginning of work next season could get interesting pain tolerance-wise.

Not much else really going on except for regular PT. Ankle dorsiflexion is still relatively stiff - mostly caused by scar tissue towards the front. Calf strength is also still pretty weak (can't do a single calf raise yet). Those are the two primary things that need to be worked on, but will continue to improve over time.

I am really impressed with your progress. I am getting closer to 2 miles in a walk, and swimming is my savior exercise. I had TAR last Dec. and had to have an arthroscopic procedure (clean up and debride) in March because of my intense fibrosis. I have been doing better since then, but we found that loading the joint was a problem. Am now at 2 x 20-30 minute walks in a day (and best not every day). I can feel the scar tissue coming back, and am hoping that the movement has pushed it out of range of interference. My ROM is close to the level as before TAR. Amazing how out of shape I am, and swimming I hope is really helping that. I am using the chair to get in an out of the pool, because climbing the ladder seems to torque the ankle too much, and although I CAN, it is probably best not to. As I approach the 4 month mark post scope (the point at which it went south and had to get scoped), my fear that it will happen again is less.

 

[half]

I am really impressed with your progress. I am getting closer to 2 miles in a walk, and swimming is my savior exercise. I had TAR last Dec. and had to have an arthroscopic procedure (clean up and debride) in March because of my intense fibrosis. I have been doing better since then, but we found that loading the joint was a problem. Am now at 2 x 20-30 minute walks in a day (and best not every day). I can feel the scar tissue coming back, and am hoping that the movement has pushed it out of range of interference. My ROM is close to the level as before TAR. Amazing how out of shape I am, and swimming I hope is really helping that. I am using the chair to get in an out of the pool, because climbing the ladder seems to torque the ankle too much, and although I CAN, it is probably best not to. As I approach the 4 month mark post scope (the point at which it went south and had to get scoped), my fear that it will happen again is less.

Thanks. Just fortunate that it’s seemingly going well for me.

I think you are on the right track. Exercise as much as you can to keep the ankle moving but not so much that it gets super swollen and gets worse. I will say that some of the mobility exercises I do hurt quite a bit (I also have fibrosis at the front of the ankle), but as long as it doesn’t swell a whole lot after, I find it better to power through and keep breaking up that scar tissue. I’ve over done it a couple of times, but it’s not that big a deal as I just back off a bit after the swelling goes down. It’s good to get as close to the limit as you can IMO.

Wishing you continued luck and progress going forward.

 

[Sass]

@half .. how are you? It's been a year now since your op. Are you ok? Is it ok for me to ask how your snowboarding work is?

 

[Elf1]

@Sass unfortunately it looks like Half hasn't been on the forum since August of 2021 so probably won't see your post. A lot of folks tend to leave the forum after the surgery and recovery is complete for the most part.

 

[Sass]

Yeah.. I was hoping that he would get an email alert. If he has that switched on.

I don't get alerts though, so, perhaps the default on the forum is not email alerts.

Wonder how he went.