Total Ankle Replacement
Dr. Desai discusses Total Ankle Replacement surgery
ANIMATED VIDEO: Dr. Desai uses the Stryker Prophecy Infinity system. This video demonstrates the standard technique.
ANIMATED VIDEO: Dr. Desai uses the Stryker Prophecy Infinity In bone system in certain more complex cases. This video demonstrates the stemmed technique. Dr. Desai will let you know if this specific variation of the surgery will be used for your surgery.
Pre Operative Instructions
After your consultation with Dr. Desai, Ana will call you within 24-48 hours to book your surgery.
A few weeks before surgery, you will have a pre-operative visit with Dr. Desai’s team. The purpose of this visit:
Educate you on how to prepare for surgery
Review the post operative course
Providing mandatory devices needed for your surgery
Providing optional devices to help with your recovery
Dr. Desai recommends pre-operative immuno-nutrition to optimize your recovery. This will also be offered at your pre-operative visit:
Day of Surgery
Please refer to: Preparing for Surgery for full details on what to expect the day of surgery.
Right before surgery, you will be taken to the “block room” prior to the operating room. You will get a local nerve block by the anesthesiologist. A nerve block is local anesthetic (freezing) that will be injected around your nerves which freezes your leg. This is done under ultrasound guidance which ensures accuracy and safety. The nerve block avoids requiring a general anesthetic (GA) which requires a full intubation. You will still be given some medication to make you sleepy so you won’t hear, feel or remember anything.
First 72 hours
The nerve block stays in place for three days. Your anesthesiologist will call you discuss the management of this while you are at home. They will walk you through removing the nerve block yourself at home on post operative day 3.
You will be getting a prescription for Dilaudid (hydromorphone) which is a narcotic medication. If you have an allergy to this, I will give you a different medication. You can start this medication if needed once the block wears off. The block usually wears off after 3 days. In some cases the block does not last that long. In this circumstance, the Dilaudid can be started. Your anesthesiologist will discuss this with you.
I will provide you with more than enough narcotic medication for your surgery. You will most likely not use all the pills provided. I always give a few extra in case. I do not provide refills for narcotics under any circumstance.
First 2 Weeks After Surgery
Pain:
After the first 72 hours you most likely will not require any pain medications. You may need the occasional Tylenol and/or Advil.
Devices:
After surgery you will be placed directly in a walking boot
If you did not purchase this, you will be placed in a cast for the first two weeks.
Wound/Dressing:
The boot will remain until you see me back in clinic in 2-3 weeks post operatively.
Do not take your boot off any anytime in the first 2-3 weeks.
Do not get your boot wet. Use a bag or cover during your showers.
Weight Bearing:
If you have the fully weight bear immediately. However, for the first two weeks I would be very careful.
You may need crutches to help. A knee walker (Link picture – Knee Walker). is probably the best way to get around the first couple weeks.
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery. The first 2-3 weeks are very important as we want to ensure the wound fully heals.
Light workouts are permitted, but remember, if you work out and sweat your surgical site would sweat as well so keep that in mind.
2 to 6 Weeks After Surgery
Appointment:
At your first post operative appointment (usually 3 weeks after surgery) we will remove your dressing and stitches.
Walking Boot: You will be placed back in the walking boot. This should be used at all times. You may remove the boot for showers and icing only. The walking boot functions as a cast. Instead of casting, I prefer the boot so you can remove the boot to take showers.
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Wound/Dressing:
We will place small bandages called steri-strips. You may begin taking showers immediately; however, I do not recommend immersing the wound in water (bath, hot tub, pool, etc.) for 6 weeks total from the time of surgery. The steri-strips will slowly peel off themselves. There is no need to pull them off or replace them when they do fall off.
Do not place any creams/lotions etc. for 6 weeks.
Weight bearing:
You may fully weight bear.
You may need crutches to help. A knee walker is probably the best way to get around the first few weeks.
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery.
You may start exercising (upper body exercises and core exercises).
You may begin ankle range of motion. Focus on dorsiflexion and plantarflexion only (moving your ankle up and down). I recommend doing 3 sets of 10 repetitions 3-4 times per day. The reason for this to avoid stiffness and also help with swelling
Therapy:
I recommend you see a therapist starting 6-weeks post-operatively. If you have good insurance coverage, then you can certainly start earlier and go more often. Humber River Hospital provides their patients with a few free sessions of therapy at the hospital. I recommend saving these for after the 6-week mark from surgery. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here:
6-12 Weeks After Surgery
Appointment:
At 6-week appointment X-rays will be taken to assess healing.
Devices:
Walking Boot: You may wean off the walking boot. This means you should wear the boot less and less each day (i.e. 16 hours per day, then 14 hours, then 12 hours, etc). In general, you should be out of the boot within 1-2 weeks.
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Compression socks: Compression socks are used after surgery in order to decrease swelling. Medical grade compression recommended – 20-30mmHg pressure. Starts between 6-12 weeks post-operatively. Starting at 6 weeks is ideal but some patients feel more comfortable putting the socks on later in their recovery (8-12 weeks post-operatively).
Weight bearing:
You may fully weight bear.
You may need crutches to help as you wean out of the boot. A knee walker is probably the best way to get around as you are weaning off the boot.
Activity:
No restrictions in activity.
Therapy:
Continue with dorsiflexion and plantar flexion exer
I recommend you see a therapist starting after the 6-week appointment. I generally recommend a therapist 2-3 times per week. If you have good insurance coverage, then you can certainly go more often. Humber River Hospital provides their patients with a few free sessions of therapy at the hospital. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here:
12+ Weeks After Surgery
Appointment
At 12-week appointment X-rays will be taken to assess healing.
6-month and 12-month appointments are for X-ray review. After the 12 month appointment no further follow-up is required.
Devices
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Compression socks: Compression socks are used after surgery in order to decrease swelling. Medical grade compression recommended – 20-30mmHg pressure. Starts between 6-12 weeks post-operatively. Starting at 6 weeks is ideal but some patients feel more comfortable putting the socks on later in their recovery (8-12 weeks post-operatively).
Weight bearing:
You may fully weight bear.
Activity
No restrictions in day-to-day activity.
With a Total Ankle Replacement, I recommend NO running or jumping. All other activities are permitted.
Therapy
I recommend you see a therapist 2-3 times a week if possible. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here: