Total Ankle Replacement
What is total ankle replacement?
Total ankle replacement (or arthroplasty) is a treatment option for painful ankle arthritis, where the surfaces of the ankle joint are replaced by a prosthetic device consisting of metal and specialized orthopedic plastic (known as polyethylene). It is a similar procedure to joint replacements of the hip and knee, which have been helping to relieve pain and suffering in patients for over 50 years. Dr. Jeffrey Mann has been performing the Scandinavian Total Ankle Replacement or STAR prosthesis for 20 years. He and his father, Dr. Roger Mann, helped to pioneer the use of ankle replacements in the United States.
An ankle joint replacement cures the problem of arthritis in the ankle but does not sacrifice motion. Prior to successful ankle replacements, most advance ankle arthritis was treated with an ankle fusion, where the 2 bones of the ankle joint are attached together with metal screws. Although ankle fusion is very good at relieving painful arthritis, it does sacrifice all of the motion at the ankle joint. Maintaining ankle motion with replacement surgery allows a more normal walking pattern, and also prevents the wearing out of other joints in the foot that can occur after an ankle joint fusion.
Additional information on ankle replacement surgery is available at the following places:
Our national organization’s website: www.aofas.org, click the “FootCareMD” section, then type in “ankle replacement”
You are receiving this sheet if Dr. Mann has recommended a total ankle replacement for your ankle arthritis, and you are scheduled, or are considering surgery in the near future.
Depending on your insurance coverage, the procedure will be done either:
- As an outpatient at the Surgery Center of Alta Bates Summit Medical Center, or
- As an inpatient with a 1-2 day hospital stay at Alta Bates Summit Medical Center
Once you have a set surgery date, you will receive a surgery packet in the mail from Dr. Mann’s Surgery Scheduler. Included in this packet will be a prescription for any pre-operative labwork you may need for your surgery. If you have significant medical problems, you may be asked to obtain a medical clearance letter from your primary treating physician. Also enclosed in the surgery packet will be details about the time and location of your surgery, with directions to the designated facility.
If you are scheduled as an outpatient:
Approximately 2 days before surgery, you will receive a phone call from the surgery facility nurse. The nurse will be the one to give you the time when you should arrive on your surgery day. S/he will also go over your daily medications and will let you know what’s appropriate and not appropriate to take on the morning of your surgery.
If you are scheduled as an inpatient:
If you live in the area, you will be asked to make an appointment at the surgical preoperative clinic at Summit Medical Center approximately 1-2 weeks before surgery. If you live out of the area, you will be contacted by the clinic and undergo a thorough phone consultation.
**Please Note, that you must stop any or all of the following medications 1 week prior to your surgery date, as they can increase the risk of bleeding during and after your surgery:
- Any Ibuprofen products, including Advil and Motrin; Aleve and its generics, Naproxen, and Naprosyn; and all Aspirin products, regular strength or baby.
- If you are on Plavix, Coumadin, or any other brand of blood thinner, please consult with the physician who prescribed the medicine to see if you are able to stop it. We can discuss these medicines with you on an individual basis.
You will meet the anesthesiologist and nursing staff shortly before your surgery begins. Under sedation, the anesthesiologist will place a popliteal nerve catheter (a very small tube behind your knee) that will be attached to a pump device. This catheter will drip a numbing medicine next to the popliteal nerve, keeping most, or all of your ankle numb during and after the surgery. You will go home with this catheter and pump, and will be shown how to use it by the anesthesiologist. The catheter is a great advance in surgical medicine and reduces your post-operative pain significantly.
Your surgery itself will take approximately 2.5 hours. It will be preformed by Dr. Mann and an assistant. In addition to the nerve catheter, the anesthesiologist will use general anesthesia (you will be completely asleep) for the procedure. You will be transported to the recovery room after your surgery, where you will slowly wake up in a carefully monitored environment. If your surgery is outpatient, you will be discharged home after about an hour or so in the recovery room, once you are medically stable and comfortable. If your surgery is inpatient, you will be transported to the orthopedic floor from the recovery room once you are stable.
You will also go home with a prescription for a narcotic pain medicine (usually Percocet) for the pain that is not controlled by the catheter. Many of our patients have been able to stop using their pain pills only a few days after surgery because of this portable pain pump and catheter.
Because there is a slightly higher risk of a blood clot after joint replacement surgery, you will be asked to take 325 mg of aspirin twice a day following surgery for 14 days, beginning the evening of the day after your surgery or the following morning. Some people are already on blood thinners for another medical condition, or are at increased risk for developing a blood clot for another reason, and they will require a different anti-coagulation medication.
If you aren’t seen by Dr. Mann for a preoperative visit at the office, your post-operative prescriptions can be mailed to you ahead of time. Please give us 2 weeks notice if you choose this option.
You will have a large bandage / cast on your leg after surgery. You will need to remain non weight-bearing (absolutely no weight on your surgical leg) after surgery. Most people use crutches or a walker during this period. There is also a “knee scooter” device that can be rented and is a great way to get around for longer distances. Sometimes your insurance company will cover part of the rental costs. Ask Dr. Mann’s office staff for a pamphlet about the scooter.
Your first visit with Dr. Mann in the office will be approximately 14 days after surgery. At that time the bandage / cast will be removed. The sutures will also be removed. A set of ankle x-rays will be taken. Then, you will be placed in a removable cast boot. You will still remain non weight-bearing in this boot for approximately one more week, and possibly longer, if additional procedures were performed than just the ankle replacement. However, Dr. Mann will give you specific instructions on weight-bearing after he views the x-rays during this visit. The advantage of the cast boot is that it can be taken off for showering.
Your next Post-Operative visit will be in another 2-3 weeks after your first follow-up. Usually, by that time, you will have begun full weight-bearing in your cast boot (always in your cast boot). Dr. Mann will instruct you on when you can wean out of the cam boot, and into a regular shoe. Usually, this takes place at about 6 weeks after your surgery. After your first few post-op visits, Dr. Mann will determine when your further follow-up visits will be, usually on a monthly or bi-monthly basis.
If you have any further questions, please contact us at the general office phone number; (510)422-5150. We look forward to assisting you in the care of your ankle.
Please note: After having your total ankle replacement you will require pre-medication before any dental procedures are done. That medication is usually 2 grams of Amoxicillin 1 hour prior to procedure. Please contact our office 7 days before your dental procedure if you are unable to take this standard medication and an alternate script can be called in for you.
We are trying to make sure that all total ankle replacement patients receive identifications cards showing that they have a metal implant in their ankle. This is especially helpful for you when going through airport security. Please remind us if we have not given you one of these cards at your 1st or 2nd post op appointment.
Post-op non-weight bearing Arrangements
Following your ankle/foot surgery, it is essential that you stay off of your foot completely until you are evaluated by Dr. Mann. Please make all necessary accommodations at least a few weeks prior to your surgery to ensure that you will remain non-weight bearing during this time.
- Crutches: Are you able to effectively and comfortably use crutches? If you have not previously used crutches, obtain a set of crutches a couple of weeks prior to your surgery as a test. If you have any difficulty with crutch use, including ascending and descending stairs, you may benefit from physical therapy for crutch fitting and training. Please contact the office for a prescription for crutches and physical therapy if you feel this may be necessary two weeks prior to your surgery.
- Difficulty with crutches: If you cannot use crutches, consider obtaining a wheelchair or roll-a-bout (knee scooter). Ensure that you are familiarized with either device prior to the surgery. If you think you may benefit from a wheelchair or roll-a-bout, please contact Terry or April at least two weeks prior to your surgery and appropriate arrangements will be made.
- Stairs: Are there stairs leading into your home? Can you use crutches safely up and down stairs? If you have difficulty with stairs, please obtain a prescription for physical therapy crutch use training as mentioned above, specifically with ascending and descending stairs. If you continue to feel uncomfortable with crutches, ensure that there is someone of appropriate strength to help you into your home.
- Multi-level home: Do you live on more than one level? It is important that you set up your living space on one level prior to your surgery. Plan to stay on one level until at least your first post-op appointment. Clear space of potential obstacles that may lead to injury (unstable items, power cords, etc).