Ankle Replacement Surgery
Hamilton resident Nancy is the goal-setting type.
A few years ago, at a weight of 300 pounds, Nancy set a goal to lose weight, and achieved it with the help of bariatric surgery and exercise.
Nancy’s next goal was to visit Walt Disney World with her grandson without pain in her knee. So she had knee replacement surgery and, once recovered, she was Florida-bound.
Next up, Nancy wanted to wear a set of matching shoes. Now, this goal may seem a bit unusual, but Nancy had been wearing an orthopedic boot on her right leg for three years because of degenerative joint disease in her right ankle.
Reaching the Limit
“I work in a medical practice. I’m on my feet most of the day. I couldn’t be in that boot forever, and the pain was just awful,” explains Nancy.
The orthopedic physician who performed Nancy’s knee replacement, Thomas Bills, MD, worked with Nancy to help reduce the pain with conservative treatments, including the boot and injections to start. When the pain became too much to bear, Dr. Bills recommended Nancy speak with one of his colleagues, foot and ankle specialist Rudolf Zak, DPM.
“Nancy developed advanced degenerative joint disease in her right ankle which led to a painful bone-on-bone joint,” says Dr. Zak.
"Degenerative joint disease, or osteoarthritis, is the wear and tear of the cartilage in the joint. This occurs with age, but lifestyle factors, like obesity and injury, can accelerate the development of this disease," he explains. "In Nancy's case, we determined she was a candidate for total ankle replacement surgery."
Ankle arthroplasty, or replacement surgery, is not something you hear about as regularly as hip and knee replacement. Though it came onto the scene in the 1970s, its rise has been a slower one because of high complication rates early on. More recently, ankle arthroplasty has become a viable option for those living with pain.
“It has come a long way in recent years with the advancement of the technology of the implant and the technique,” explains Dr. Zak.
Ankle Replacement Journey
Dr. Zak’s criteria for consideration of ankle replacement surgery includes:
- Exhausted non-surgical pain management
- Age 35 to 65
- No evidence of osteoporosis or bone infection
Prior to surgery, Dr. Zak prescribes a CT scan of the ankle joint to ensure there are no abnormalities which could lead to complications. If the patient's ankle joint is cleared, Dr. Zak works directly with the implant company to ensure selection of the proper implant for the individual patient.
Unlike other joint replacement surgeries, the ankle recovery requires a much longer rest period for the new joint. For example, in knee replacement surgery the typical patient is out of bed within a day to begin rehabilitation.
Full ankle arthroplasty recovery looks more like this:
- 6-8 weeks non-weight bearing
- 2-4 weeks weight bearing in a walking boot
- 4-8 weeks of physical therapy
“The reason for this longer recovery is the inherent instability of the ankle. The talus bone structure, which is the foot bone that connects to the implant, is ‘softer’ than the tibia or femur (in knee replacement). Thus, we have to make sure it sets right before the patient can begin to put weight on it,” Dr. Zak explains.
After the non-weight bearing period of recovery, Nancy started physical therapy at home.
“I was very nervous to put weight on my foot. I was more scared than I was with knee surgery,” says Nancy.
Once she did, though, Nancy was able to begin in-home physical therapy exercises to strengthen her leg and ankle. Since her surgery, Nancy’s pain has decreased significantly. She is happy to report she has said ‘bye-bye’ to the boot.
“My ankle is so much better than it was. And I’m excited just to be wearing matching shoes again,” says Nancy.
Nancy’s new goal: a return trip to Walt Disney World on her new ankle, with her new granddaughter.