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Total Ankle Replacement - Recovery issues & ongoing struggles
I had a TAR in July 2024. I am a female in mid 60's in very good health. I was told I would be an excellent candidate. I wanted the ankle replaced because of repeated traumatic injury over the years causing severe arthritis and restricting my activities including horseback riding and hiking and actually just plain walking.
I had problems with the anesthesia in the first surgery which landed me in rehab for a couple of weeks. The wound then got infected and they eventually determined that my body was rejecting the internal stitches so I had surgery again to correct that. Then, the wound would not heal and I was in a cast for eight weeks. Two weeks after cast removal I was in the walking boot and it twisted causing me to fall and break my tibia on the same side as the TAR, and my wrist on the opposite side. I was then in a cast for another eight weeks while the bone healed, I then began therapy and have been doing well, but six weeeks ago my surgeon commented that the bone density in my leg with the TAR was not great. He attributed it to lack of use and said it woud get better. Therapy has been extensive as they have tried to increase the mobility in my stiff ankle. I returned for a follow up visit to the surgeon after the six week period. He now believes the bone is fracturing under the implant. Three years ago I had a bone density scan and tested normal. None since then. The surgeon commented that he believes the bone suffered fractures due to bone density issue and ordered lab tests to rule out infection and/ or vitamin D deficiency, etc I am now back in the walking boot and no PT. The outlook is dismal. What, if anything should have been done differently, and what should be done going forward, or what can I expect please?
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So sorry that you are going through this. Have you had another dexa scan to determine if you you do have Osteoporosis?
I've had my TAR for a long time now and they are monitoring things. The doc said if I need surgery on it a standing CT scan would be needed. A year or so ago I had a nuclear medicine scan. I don’t know if these are appropriate for your situation. So sorry you have such a difficult situation. Avoiding infection is so important.
I should have said that I'm scheduled for lab work to rule out infection and Vitamin D deficiency, and yes, I will have a CT scan in a few weeks. But, it seems to me that the surgeon should have ordered this when he first noted the lack of bone density; not wait til there was a fracture. wth. 🙁
my lab work all came back normal so I have no Vitamin D deficiencies, infections, etc. I have read a lot about this type of fracture and it is not uncommon. I appreciate the sympathies but I'm hoping to find someone who has had a similar experience or even others who have had this surgery, and what their experience has been. My ankle is also very stiff because of the long recovery time in the cast, so I'm pretty sure the device will never function the way it's supposed to, but again, i don't know. My doctor does not say much. I feel like if he knew my leg bone was soft six weeks ago (which he did) and he now suspects osteopenia, that he should have been monitoring more closely and maybe caught the break earlier. I am pretty disappointed; I spent a lot of time researching and trying to select the best surgeon. My opinion with surgeons altogether lately as that there are very few who have the time to take a personal interest in their patients, we're all cattle going down the chute. :/
I have a similar situation although maybe not as extensive as yours. I did not have my surgery at Mayo, I had it elsewhere. I had total ankle replacement 11 months ago. I am walking gingerly with a cane. I am 52. I was active up until the year prior to surgery where I could barely walk. I researched doctors as well. My surgeon took tons of interest in me prior to the surgery...after I was left on my own. I was told during surgery that a bone broke so he had to place a plate to secure it. I have pain pretty much all day every day. I was told the bone broke during surgery because of my "osteoporosis". Of course I got checked and do not have it. I have very mild osteopenia. In follow-up with the surgeon he tells me "ditch the cane"! My foot swells immediately and is hard as a rock if I try to walk unassisted. How do I do that? It is my PT's opinion that I was left immobile too long. I have terrible range of motion and am feeling very hopeless. I feel for you I really do.
That's horrible. Have you consulted with another doctor? I have heard so many stories from people about continual problems with ankle surgery, or that bones in the leg and foot do not heal, or do not heal well. Same as you, I was active prior to surgery and was told I would be able to continue all the activities I was used to doing, horseback riding and hiking, specifically. I was told I was an excellent candidate.
My doctor mentioned osteopenia too, but said it was from being off my feet for so long. I really feel like these doctors do not have sufficient time to relate to each patient's individual needs, and their situation, and in my opinion that is 90 % of the problems people incur,
I did a lot of research in selecting my surgeon and he is, supposedly, Nationally renowned and very experienced, which is why it surprised me when he was so stunned when he saw the fracture, and said it LOOKED like a fracture, but he wasn't sure. Um, it looks like a fracture to me. I think the bone probably broke from my PT doing range of motion manipulation and exercises, which is what he was instructed to do by the surgeon. I really love my PT. I do not have much pain or swelling from the fracture. The PT says that is because it appears not to be a load bearing bone. (it's on the side of my ankle) It also seems that over the past couple of weeks, the swelling has reduced. I had my CT scan Friday and will meet with the surgeon to review the results this coming Friday. I was able to walk up the steps to the CT machine and back down, barefoot, with no pain. I am still normally wearing a walking boot. I am terrified to meet with the surgeon, I am so afraid he will tell me to go back in the cast, or, worse, go back for more surgery. I just can't do that, it will ruin the rest of my life, I'm pretty sure. I've read that sometimes these fractures can heal on their own. My GP has recommended not going forward with either cast or surgery without getting a second opinion. I feel like that is good advice. I still respect my surgeon but again, I feel that time limitations these doctors have are a huge problem for their patients.