Category Archives: Surgery

It is possible that after surgery, your hammertoe may come back. If this happens and you have discomfort in the toe, an additional surgery may be needed to address the pain.

Depending on the specific surgery used, you may or may not be able to bend your toe once it has healed. Ask your orthopaedic surgeon what type of surgery is needed for your hammertoe.

Before you leave the hospital, your toes will be wrapped in bandages to hold them in place and you will receive instructions on maintaining those dressings and on wearing a special post-surgical shoe to protect your foot. You may need to use a cane or crutches for the first several days and to be careful about putting weight on your foot. You should try to keep your foot elevated and treated with ice as directed for several days. While your stitches may be removed in a couple of weeks, you will continue to need to utilize the bandages and shoe for as long as eight weeks. You should plan on wearing athletic shoes or soft leather shoes — and no high heels — for several months once your bandages have been removed. Your doctor may prescribe exercises to improve the range-of-motion of your toes, such as stretching them and picking up objects such as marbles and handkerchiefs with them.

Wear roomier shoes

• Seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed.
• Make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe.
• Make sure the ball of your foot fits comfortably in the widest part of the shoe.
• Since feet normally swell during the course of the day, shop for shoes at the end of the day, when your feet are at their largest.
• Don’t be vain about your shoe size — sizes vary by brand, so concentrate on making certain your shoes are comfortable.
• Remember that your two feet are very likely to be different sizes and fit your shoe size to the larger foot.

Don’t wear high-heel shoes

• Avoid high heels, which shift all your body weight onto your toes, increasing the pressure on your toes and their joints tremendously.
• Wear shoes with low (less than two inches) or flat heels that fit your foot comfortably.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

“Hallux” mean big toe and “Rigidus” mean stiff. It is a medical term, describing degeneration of the joint at the base of the big toe – called metatarsophalangeal, or MTP joint. It is the most common site of arthritis in the foot region. It is an important joint, as it has to bend every time you walk and propelling your body forward. Walking can be painful or limited as it is degenerated and stiffened. Most of the time, a bony overgrow (osteophyte) can cause a painful bump over the dorsal base of the big toe, resulted in painful impinging shoe-wear.

Hallux rigidus usually develops in adults at the ages between 30 and 60 years. No exact cause is agreed so far. It can be secondary to previous trauma, or due to the underlying abnormal foot anatomy, abnormal joint surface, surrounding soft tissue imbalance that increases stress on the joint. It is more common in distant runner or dancer who have repeatedly exert hyperextension of the big toe.

The patient may experience pain in the joint when you walk, especially as you push-off on the toes when walking up/ down stair.   There is swelling around the base of the big toe, especially over the dorsum (top) of the big toe with an associated bony bump. The joint will be stiff at a late stage due to the degeneration and the dorsal bony bump.

History: pain, stiff, dorsal bunion

Examination: Limited big toe bending, especially on upward movement, bump over the top of the base of the big toe. The physician will try to differentiate if the symptom is arising from the bony bump, or the joint so as to decide the type of surgery if indicated.

X-ray: Narrowing of the MTP joint due to wear of joint cartilage, bony spurs (osteophyte). They are clinically graded into early stage (with the joint still preserved) and late stage (with the joint being obliterated).

Non-surgical treatment

• Non-steriodal anti-inflammatory drug (NSAID) such as ibuprofen may help reduce the active swelling and pain relief.
• Ice packs or taking contrast baths may help for a short period of time.
• Shoe modification with a widen toe box to accommodate the bump, stiff-soled shoe with a rocker bottom design may help to prevent bending force on the joint. Orthotic with a steel shank or metal brace in the sole can be measured with similar action. These are not effective to stop the condition from progressing but just symptomatic relief.
• Injections – a. Steroid, b. hyaluronic acid.

Surgical treatment: Different types of surgical treatment are commonly practiced depending on the clinical examination and radiological grading of degeneration.

• Cheilectomy operation: This is a simple operation to remove the osteophytes that limit the range of motion. It improves range of motion for wearing higher heel shoes or for running, and, though it often reduces pain, this is not guaranteed. It takes 3 months to recover 80% and 6 months to fully recover. Naturally, this does not alter the natural history of the underlying problem of arthritis; it merely reduces the pain from impingement of the osteophytes, which are caused by the arthritis. The potential problem is risk of further joint degeneration and require further surgical procedure, it is however a buy-time procedure.

• Autologous interposition arthroplasty: It is using a free ipsilateral gracilis tendon graft is for patients with severe hallux rigidus with moderate to high activity levels and who do not wish to undergo fusion.

• Fusion operation. This is a procedure to remove the joint and join the bones of the foot and toe together. This reliably removes pain and allows one to return to running.This is a procedure indicated for those with pain due to both bony spur and the joint. It is a more assuring procedure as the diseased joint is converted to a stable one-piece bone. The trade-off is the big toe become stiff, but we usually fused it in a physiological position for walking. A plate and screws are used to stabilize the fixation for the bone surface to heal by 6-8weeks.

• Arthroplasty (excision of the whole joint +/- replacing with a spacer or an artificial prosthesis) is a joint replacement, which significantly reduces pain and allows good function. It may have a limited life of approximately 10 years and require revision or a fusion operation later. This is an alternative procedure to arthrodesis for those older people who place few functional demands on the feet. It is not well accepted as the potential risk of prosthesis complications eg. wear, dislocation, loosening, etc.

Surgery is usually done under general / spinal / regional anaesthesia. This includes a general risk of anaesthetic drug and specific risks which our anaesthetist will explain to you before the operation accordingly. General surgical risk includes infection, nerve injury, tourniquet risk, swelling and stiffness

• Specific risk for Cheilectomy: recurrence / progression of symptom
• Specific risk for Arthrodesis: stiff joint, implant loosening, impingement, non-union, delayed union. Shortening of big toe.
• Specific risk for Arthroplasty: prosthesis dislocation / loosening

Steriod injection is done by some GP / Surgeon, but it is only a temporary effect and potential risk of infection, bony necrosis. Minimal invasive with percutaneous screw fixation is advocated but only short-term and small series report.

Cheilectomy: Since there is no joint procedure done, but only bone spur excision, immediate return to normal walking is allowed. The wound will usually take 10-14 days to heal. Early passive big toe movement is advised to prevent the joint stiffness is the main physiotherapy recommended. Takes months to settle.

Arthrodesis: This requires longer rehabilitation as it involves timing for stable bone growth, which usually takes 6-8 weeks. Patient will be protected with cast immediate post-operation and educated for non-weight bearing walking during initial 6 weeks. Radiological check will make at around 6 weeks to confirm if full weight bearing walking is advisable. Patient will be unable to wear high-heeled shoes due to the stiffened big toe (or we sometimes modify the position of fusion so as to tailor the patient’s reasonable need in terms of shoewear).

Arthroplasty: The rehabilitation is similar as arthrodesis, but early mobilization is essential to keep with the surgical benefit. Weight bearing is avoided for soft tissue stabilization, which usually takes 4-6 weeks.

It depends on the type of procedure as well as the occupation requirement of the individual. 2 – 6 weeks as mentioned under different procedures.

Yes with both cheilectomy and arthrodesis, but with limited big toe flexibility in the later case.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Shoulder resurfacing is much like hip resurfacing. The ball part of the shoulder is smoothed (made back into round) with a shaping tool. A metal shell of the exact natural size is then placed on the bone to recreate a completely smooth new humeral head. A similar shaping and placement of a new surface is performed for the shoulder socket (glenoid). The shoulder is put back together and then it will function typically in a completely normal fashion.

During a shoulder replacement the ball part of the joint is entirely removed and replacement with an artificial ball that is held in place with a spike (stem) inside the shaft of the upper arm bone (humerus).

A resurfacing procedure is a less invasive procedure and it will have more functional capability than a shoulder replacement. Both procedures reliably reduce pain and increase function.

The recovery time of a shoulder resurfacing procedure varies depending on each individual patient. Patients will have to avoid heavy lifting and strenuous exercise after their surgery. Your doctor may also encourage a physical therapy regimen to restore and strengthen the joint after surgery. Shoulder resurfacing in India provides desired shoulder relief at an affordable price.

Advantages of Shoulder Resurfacing

1. Restoration of normal anatomy.
2. Less traumatic surgery
3. No risk of fat embolus
4. Resurfacing can be done even if the bone is deformed.
5. Normal loading of the bone.
6. No stress riser effect
7. No risk of fracture at the tip of the prosthesis.
8. Range of movements better than shoulder replacement.
9. Easy revision surgery if needed.

Indications for shoulder Resurfacing

1.Osteoarthritis

2.Rheumatoid arthritis

3.Avascular necrosis

4.Rotator cuff arthropathy

5.Instability arthropathy

6.Post trauma arthritis

Significant pain and disability is often associated with rotator cuff arthropathy. Individuals often have difficult with simple daily activities such as feeding themselves, getting dressed and combing their hair because of a significant loss of shoulder motion and strength. There is often associated pain, especially at night-time which interferes with normal sleep. Pseudo-paralysis and rotator cuff arthropathy can be seen in older patients with a degenerative massive rotator cuff tear.

Other causes of cuff arthropathy include prior failed rotator cuff repairs,  or individuals with prior failed shoulder replacement surgery. A reverse shoulder replacement  can also be useful in the cases of severe fractures of the proximal humerus (shoulder joint) in older individuals. In individuals with a massive rotator cuff tear that is not repairable, an initial trial of physical therapy may help restore function to an acceptable levels. If, however, significant functional loss and associated pain persist despite a course of conservative therapy, reverse arthroplasty is often the only surgical option.

Patients will work with a physical therapist to resume daily activities and strengthen shoulder muscles. Often the physical therapy is initiated during the hospital stay. The patient is taught a simple set of exercises that they can do on their own at home. Typically, full recovery is achieved by 3-4 months post-operatively. A reverse shoulder replacement can significantly decrease pain and improve function for patients and contribute significantly to an improved quality of life.

The Joint Replacement Surgery Hospital India center for complex shoulder problems and as such, we are specifically equipped to handle this type of complex operation. Patients benefit from our multidisciplinary approach to the treatment of shoulder disorders and have access to a full range of care. Our experienced team of physicians, certified physical therapists, and support staff all work together to help patients achieve success. In addition, our affiliated occupational and physical therapists are specially trained in rehabilitation of the shoulder and elbow prior to and after surgical reconstruction.

The surgical procedure is conducted under general or local anesthesia; and generally takes about 1 to 1½ hours to complete.

For decades, sufferers of severe shoulder arthritis have relied on traditional total shoulder replacement as a proven solution. But for individuals with more complex shoulder issues, such as a torn rotator cuff, this was not the best option. In recent years, a new shoulder replacement option called reverse total shoulder replacement has offered relief from pain and lack of mobility to those with more difficult shoulder problems.

In a traditional shoulder replacement, a plastic socket is placed in the shoulder and a metal ball and stem are inserted into the upper arm bone; the two fit together to form the new artificial joint. This solution still relies on a patient’s rotator cuff to move the arm.

Conversely, in a reverse total should replacement, the plastic socket is fitted into the arm bone and the metal ball is attached to the shoulder bone instead. This configuration is better for people with damaged rotator cuffs because the new joint does not rely on this muscle for movement of the arm. Instead, the deltoid muscle is used to move the arm.

Most patients are able to return to activities within a few months.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Cemented hip replacements may fail after 10 to 15 years, or occasionally sooner due to loosening, wear or breaking of parts. A hip revision operation also known as revision hip arthroplasty is thus needed to replace the hip replacement that has worn out, loosened or has developed a problem.

If you have unrelieved pain in the hip that was replaced, your orthopedic surgeon can detect and determine whether you need a hip revision procedure using regular X-ray examinations. If a problem is detected, i.e. if the X-rays show damage has occurred to the hip replacement causing its failure, you may need to have a revision surgery before a major problem develops.

Component failure- The most common reason for hip implant failure is the wearing down of the plastic insert in the hip socket. In some other cases, the hip implant may shift slightly after surgery leading to unbalanced weight distribution and premature implant failure. Depending on the the kind of failure and the extent of the wear, only the plastic component or the entire implant together with the metal components will be replaced.

Osteolysis- The wearing down of the plastic component leaves tiny plastic particles in your body that are attacked by your body’s immune system, and this immune response also attacks the healthy bone around your implant. This leads to a condition called osteolysis, in which the bone in the area around the joint implant softens as it is absorbed by the body, thus making your implant unstable and in need of revision.

Hip Dislocation- Some patients do experience dislocation of the implant after surgery. In approximately half of these cases, your physician may be able to put your hip implant back in place without surgery. However, if your surgeon determines the implant was damaged, certain components of the ball-and-socket joint may need to be replaced in a revision procedure.

Fracture- If the bone next to your primary implant is fractured in an accident, revision surgery may be required in order to provide a safe, stable joint. In this case, the original implant may need to be removed, the fracture addressed and a revision joint implanted.

Infection- In a low percentage of cases, your hip may become infected after surgery. Although it may be successfully treated with antibiotics, there are severe cases where a follow-up revision surgery may be required.

Asceptic loosening- Aseptic loosening occurs when the hip implants become loose within the bone. A loose hip implant tends to be painful, and usually requires revision hip replacement. Reconstruction is possible through different methods including cemented or cementless components, with or without bone grafting, and the use of additional metalware such as screws, plates and cages to reinforce fixation.

In revision hip arthroplasty, compared with primary total hip arthroplasty, the environment of the hip joint is poor, and therefore, an implant appropriate for the purpose of the revision should be selected.

The total revision hip implant is comprised of four parts:

• A metal hip stem that is inserted into the top of your thighbone
• A metal cup which holds the cup liner
• A cup liner which holds the femoral head
• The femoral head or ball which is attached to the top of the hip stem and is inserted into the liner to form the ball-and-socket joint.

Hip revision implants are not one-size-fits-all, therefore your surgeon will choose the right hip implant for your body. Depending on the type of revision surgery needed (e.g. acetabular cup revison), different implants and components may be used (e.g. special cup, augment, reinforcement). The revision stem  like the S-ROM is the most commonly used. Your surgeon will determine which of the four component’s design options will work best together to restore your accurate leg length, while minimizing the risks of post-operative dislocation and premature implant wear.

Postoperative care for revision hip surgery is the same as that for total hip replacement surgery. Patients receive a combination of home health care, physical and occupational therapy home health care and other forms of rehabilitation.

You should have near-normal range of motion and adequate strength in your hip to perform most daily activities after completing the post-operative hip rehabilitation process. Many patients have less pain and better mobility after revision hip surgery. They have successfully returned to activities such as walking, driving, swimming, golf and stationary cycling. However, you should avoid running, jumping, heavy lifting, crawling and climbing.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Hemiarthroplasties are favored as a treatment for hip fractures in the following situations:

1) The fracture has disrupted the blood supply to the femoral head: in this case even if the fracture heals, the head of the femur will crumble. This is known as avascular necrosis and will lead to the hip joint failing.

2) Severe osteoporosis: if the bone is too brittle, other methods of fracture treatment will not be successful

3) A fracture that has been present for several days

Some tests that may be ordered to check that you’re fit for surgery include:

• Blood tests
• Chest X-Ray
• Urine test
• ECG

The anaesthetic team will see you and decide the type of anaesthetic that’s best for you. The different types of anaesthesia include:

General Anaesthetic: This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.

Spinal Anaesthetic: An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.

Nerve Blocks: This special injection is used to help with your pain after the operation and often used in conjunction with a general anaesthetic.

Patients are usually able to go home after spending 4 – 7 days in the hospital. You are ready to go home when you can safely get in and out of bed, walk up to 20 meters with your crutches or walker, go up and down stairs safely, and understand your hip precautions. Patients who still need extra care may be sent to a different hospital ward for further rehabilitation before they go home.

• Breathing: To avoid lung problems after surgery, you will be asked to breathe deeply and cough frequently. This will help avoid pneumonia and lung collapse.
• Walking: Walking and light activity are important to your recovery and will begin the day of or the day after your surgery. Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physiotherapist the day after surgery.

The physiotherapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

It is important to keep your wound as dry as possible. Most patients are discharged home with a waterproof dressing, which can be left on for showering. During the first 24 hours, it is normal to have some minor bleeding. After being discharged home, there should be no discharge, redness or bleeding around the wound. If there is redness, discharge or a foul odour, please seek medical attention as soon as possible.

There are a number of ways your wounds may be closed those include either with the non-absorbable stitches, absorbable stitches or surgical staples. The stitches or staples are usually removed 10-14 days after surgery.

There are usually no specific diet or extra vitamins / nutrients needed to recover from a total hip operation. It is important to have a normal healthy, balanced diet and plenty of nonalcoholic fluids.

One of the possible complications of hip replacement surgery is dislocation. Dislocation is most common during the first year after surgery, but can occur at any time.

There are certain positions and precautions that must be avoided.

• Do not cross your legs.
• Do not bend your hips more than a right angle (90°).
• Do not turn your feet excessively inward or outward.
• Do not twist on your operated leg when turning
• Do not bend down to pick things up off the floor

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

You will need to be in the hospital 1-2 days.

Absorbable suture are mainly used. If staples are used they will be removed at your 2 week post operative appointment.

You will return to see the physician 2 weeks after your surgery.

You will have a back corset brace for 6 weeks. It will need to be worn for sitting, standing and walking.

You will have a dressing until your first post operative visit (2 weeks). Your dressing will need to be changed daily using dry gauze. No ointments.

You may shower after 48 hours but keep your incision dry. Make sure you change your dressing after you shower.

You will have Physical Therapy by Home Health and will graduate to outpatient therapy at 6 weeks.

You will not need to be on blood thinners.

You will not be able to drive while you are taking medication. You will be advised when you can start driving by your physician. When you do start driving we suggest you start with short trips. You will need to make sure you can apply the brakes and gas easily.

Approximately 4-6 weeks. How long you will be out of work depends on the type of work you do.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

The collarbone (clavicle) is located between the ribcage (sternum) and the shoulder blade (scapula), and it connects the arm to the body. The clavicle lies above several important nerves and blood vessels.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

We accept different methods of payment like, cash, plastic cash, via net banking, etc.

• To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Clinical data show that woman are actually as much as ten times more likely to develop carpal tunnel syndrome than men are. This is largely due to the fact that women tend to have smaller hands and thus a narrower carpal tunnel.

If needed, it is possible to address both hands in one operation. Doing so does not generally have any effect upon recovery time, but can increase the discomfort and pain experienced after surgery. The choice to treat both hands separately or at once is left to each individual patient’s discretion.

Carpal tunnel release surgery can be performed under local anesthesia. This makes it a fairly simple, outpatient operation. This means that patients can return home on the day of surgery without requiring overnight care.

Endoscopic surgery is a minimally invasive approach performed using an advanced surgical tool called an endoscope. The endoscope is composed of a thin tube with a miniature light and a camera on the end. In an endoscopic carpal tunnel release, the endoscope is inserted through a small incision in the palm. The area to be operated upon is then magnified and projected on a screen. The surgeon uses the images on the screen to guide the surgery, which is performed using a small instrument inserted through another small incision.

Minimally invasive or endoscopic surgery for treatment of carpal tunnel syndrome can dramatically increase the risk for complication. It can also make for a faster recovery, less pain and less scarring. One must of course bear in mind are risks involved in any form of surgery. Your surgeon can and will inform you these before your surgery.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

• We accept different methods of payment like, cash, plastic cash, via net banking, etc.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

• After obtaining medical evaluation from your primary care provider you are admitted to the hospital for elective surgery. An anesthetic is placed and the ankle joint is exposed by careful separation of the tendons, vessels and nerves in front of the joint. The diseased portion of the ankle is precisely removed and the replacement is impacted into position. The layers are closed and a dressing is applied. Additional procedures may be performed at the same time as necessary. The procedure lasts 2 to 3 hours.

When compared to the other major joints, arthritis of the ankle is uncommon. Many people know of someone who has found pain relief from hip or knee replacement, but few know someone who has had an ankle replacement. It is true that ankle replacement is not as common as hip and knee replacement, but the number of procedures is growing fast.

• As with any surgical procedure, experience matters. Ankle replacement is a complex procedure, and is best performed by a surgeon who specializes in foot and ankle surgery, and not just knee and hip replacement.

The typical patient spends one or two nights in the hospital after ankle replacement. However, the length of the hospital stay can depend on many other factors. Your surgeon will advise you on what he/she believes is likely for your specific situation.

A foot and ankle surgeon who is experienced in ankle replacement surgery can evaluate your particular situation and determine whether you are a candidate for the procedure. All patients must exhaust other non-surgical treatment methods prior to proceeding with ankle replacement. No age limits have been established for the ankle replacement, but the performance of a prosthetic joint and how long it will last depends on many factors, including the type of implant used, your physical condition, bone quality, activity level and lifestyle.

It is very important that your surgeon be aware of all medications that you are taking, especially, steroids and blood thinners. You will be advised if you need to make any changes in your medication schedule. Generally, patients are advised to stop taking prescription or over the counter anti-inflammatory medication, including aspirin or ibuprofen five days before surgery. These medications thin the blood and can lead to excessive bleeding during surgery.

The arthritic ankle is expected to be less swollen but not completely normal. Also, there will be a visible scar on the front of the ankle from the incision.

There are several components that make up the ankle replacement device. All of the parts are made from highly biocompatible materials, including titanium and cobalt chrome metals on the tibial and talus sides of the joint. Between those two components, a third component made of a biocompatible plastic called polyethylene is attached to the tibial component to help the components glide against each other. These are identical materials to those used in hip and knee replacements. All of the materials have a long and successful track record for use in human joint replacements.

Advances in technology and materials have made ankle replacement more and more reliable. An increasing number of foot and ankle surgeons are using ankle replacement surgery with confidence to relieve pain and restore mobility in patients with compromised ankle function.

Although still a small niche segment, the ankle replacement market is growing rapidly. In 2009, about 2,300 procedures were performed in the US alone.

How long an ankle replacement lasts depends on many factors, including the type of implant used, and the patient’s physical condition, activity level and lifestyle.

While prosthetic joints can provide increased mobility and pain relief for many years, it is a fact that they are mechanical bearings and may not last for the rest of the patient’s life. Most patients can expect their ankle replacement to last 10-20 years.

The components used for ankle replacement are not different for men and women specifically; what differs is simply the size of the components based on the patient’s anatomy. During the procedure, the surgeon carefully chooses the components that best match your ankle joint. The implants are available in a range of sizes and combinations for a customized fit.

Sedentary patients may be better served by an ankle fusion. Increased body mass index (BMI) is just one factor that will be carefully considered by your surgeon. Increased BMI can be associated with mechanical failure of the implant.

As with any surgery, there is always a risk of complications. Risks include nerve injury, vessel injury, tendon injury, bone injury, infection, failure and persistent pain.

All patients will experience some level of pain after surgery. Many patients are off prescription pain medication five to seven days after surgery. After the initial pain from the surgery subsides, you should not have any chronic pain as a result of the implant. You may have some soreness, but that will begin to improve in the weeks and months following surgery. Call your physician if you have any increased pain, swelling, fever or abnormal incision drainage.

Although the recovery program varies by patient and surgeon preference, many patients are in the hospital for 1 to 3 nights. The stitches used to close the incision are removed between 10 and 21 days after surgery. Once stitches are removed the patient is allowed to move the ankle. Bearing weight on the ankle is allowed 6 weeks after surgery, at that time, physical therapy is started to accelerate the resolution of swelling, pain and stiffness and to eventually improve strength and coordination. Protective devices such as a cast boot or brace, along with physical therapy, are discontinued 12 weeks after surgery. Your physician will schedule regular follow-up appointments with you during that time.

Physical therapy is critical to the success of your new ankle. Your rehabilitation program often begins as early as the day of your surgery, when your health care team advises about the rehabilitation process. You will be instructed in the exercises to perform at home, which are designed to gradually increase the use of your ankle. It is important to follow your doctor’s instructions exactly and do your exercises regularly. In general, initial therapy involves stretching to help regain the normal ankle range of motion. Later, strengthening exercises are added if necessary. Your surgeon will provide you with any specific restrictions based upon your individual situation. It is important to follow those restrictions closely.

Most people are able to return to normal everyday activities such as dressing themselves and grooming within the first 2 weeks after successful ankle replacement surgery. Your ambulation will be restricted for 6-8 weeks until you start your rehabilitation therapy. Your doctor will advise you on specific limitations, including the amount of walking you can do on the ankle that was operated on. Many surgeons restrict their patient’s ambulation for a period of time. Your doctor will also let you know when you can begin ambulating more freely, and when you can return to other activities. Contact sports may be restricted in the long term.

• Once you return home, it’s a good idea to have a family member or friend available to help you with daily activities such as washing, dressing and preparing meals.

This is especially important during the first week or two following surgery. If you do not have home support, ask your health care provider about an agency or facility that may be able to provide the help you need.

You must be off all pain medication before you consider returning to driving. Patients with minimal discomfort and access to a vehicle with an automatic transmission can usually return to driving about two months following surgery.

The decision to return to work is individualized and is influenced by your job, your employer and your post-operative course. In most circumstances, patients can return to office work in 2 to 3 weeks if accommodations are made for transportation, parking, office access, rest and foot elevation. Patients that perform physical work may return to work once they recover endurance for standing and walking, this is at least three to four months after surgery.

The recovery of full ankle function may take up to 6 months, provided you followed the recommended physical therapy regimen. Most improvements are maximized by six months after surgery and residual swelling persists for 6 to 12 months.

People who have had an ankle replacement are generally advised to avoid contact sports and to refrain from repetitive impact activities that will accelerate wear of the implant, as these can place too much strain on your ankle implant. Consult your physician about the specific activities that might affect your new ankle.

It is impossible to state how much motion will recover after ankle replacement. However, patients with severely restricted motion that has been present for many years may be unable to achieve full motion despite a properly performed operation and dedicated physical therapy.

Ankle replacement surgery can help you return to normal daily activities that were previously limited by the ankle disease. Even though the ankle replacement addresses the most likely pain source, other sources of pain remain in the ankle and foot. Pain is likely to be reduced but it is not always eliminated.

When ankle arthritis pain begins limiting your daily activities, causing you to lose sleep, and is not responding to other treatment alternatives, it may be time to consider ankle replacement surgery. By waiting too long, your range of motion can become severely limited, making the surgery more difficult and the results less certain. It is a good idea to discuss your condition early on with a foot and ankle surgeon, and learn about the options and timing that might be right for you.

Early recommendations for arthritis treatment may include rest, walking with a cane in the opposite hand, over the counter or prescription anti-inflammatory medications, and medication for pain relief. Physical therapy may be prescribed in the early stages, although this can become less effective and even damaging as the arthritis advances. Cortisone injections can provide temporary relief of pain, although this is not generally considered a long-term solution. Occasionally, arthroscopic surgery is used to remove bone spurs and debris from the joint. When these solutions are not effective, your foot and ankle surgeon may discuss surgical alternatives with you, such as ankle fusion or ankle replacement surgery.