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Joint Preservation

Joint preservation surgery can be carried out to treat ankle arthritis, in order to delay or even avoid having ankle replacement or fusion surgery in the future. In younger patients, who retain some ankle movement despite having an arthritic joint, Mr Heidari offers distraction arthrolysis, an innovative procedure that is minimally invasive, and focuses on joint preservation and restoration. The procedure involves staying in hospital for 2-3 days and is carried out under a general anaesthetic.

Why can distraction arthrolysis be a better option than joint replacement surgery?

Although having joint replacement preserves the movement of the joint, it also replaces worn surfaces with metal and plastic and is a lengthy, invasive procedure that carries a number of risks. Distraction arthrolysis can delay the need for ankle replacement and helps minimise any other arthritis in the joint. It still allows for ankle replacement at some point in the future if necessary.

Ankle arthritis xray
Xrays showing ankle arthritis

Joint distraction xrays
Intraoperative xrays showing joint distraction (lateral projection)

Ankle joint distracted
Intraoperative image showing the ankle joint distracted (AP projection)

What does surgery involve?

  • At your first appointment Mr Heidari will examine the ankle and discuss the procedure with you so that you can decide whether ankle arthrolysis is the right operation for you. He may also arrange for you to have an X-ray to diagnose any deformities and an MRI scan to examine the soft tissue around the joint
  • Using arthroscopy (keyhole surgery), Mr Heidari cleans out the joint and removes any bone spurs (bony lumps) in the front of the ankle that restrict movement
  • If necessary, the hind foot is realigned (distal tibial and calcaneal osteotomies)
  • He then fixes an external frame across the joint, a type of scaffold that remains outside the body during treatment. This allows the ankle to be ‘distracted’ (pulled apart by 5-8 mm) during the procedure. The frame has hinges built in to allow unrestricted ankle mobility
  • In most cases, the frame is worn for around 12 weeks to allow the tissues to regrow inside the ankle. It’s then removed under a light anaesthetic 

Before surgery

You can help improve the outcome of surgery by attending a pre-assessment screening where you’ll have blood tests to check for levels of Vitamin D and swabs to rule out infection or other problems. You’ll also be weighed and have an opportunity to discuss your medical history. This is important so that any anaesthetics problems can be identified.

Please note: it’s important to stop smoking at least eight weeks before your procedure; this is because smoking can affect the body’s ability to heal and causes health problems including an increased risk of blood clots forming in the lungs (pulmonary embolism) or calf (deep vein thrombosis).

What happens after surgery?

  • When you wake up from the anaesthetic your foot will be surrounded by the frame; it will be numb and pain-free and will be raised to minimise swelling
  • You’ll see one of our physiotherapists the day after the operation to begin a personalised exercise programme that includes exercises designed to strengthen your ankle and retain strength and flexibility in your body. Following this exercise programme will help you gain the maximum benefit from your surgery
  • You’ll be shown how to look after yourself while you are wearing the frame
  • You’ll need to return to the clinic each week so that the frame can be checked and cleaned, and you may have a number of X-rays to check whether the frame needs to be adjusted. It’s important to keep the frame and pins as clean and dry as possible and we’ll advise you about how to care for them before you go home. You can buy material covers to fit over the frame or you may be able to wear loose fitting clothes over it. You should know that trousers may need to be altered to provide room for the frame
  • You’ll also be given information about how to avoid infection in the pin sites. The occupational therapist will also be able to offer you any additional equipment you may need to make washing easier

Sport and holidays

Mr Heidari will be able to advise you about which sports are safe to continue, including swimming.

Being able to go on holiday and the best way to travel will depend on the stage you have reached in your frame treatment, but Mr Heidari will be able to advise you about this. If you’re travelling by plane you will need to inform the airline and your insurance company.

It’s important not to expose your frame to extreme temperatures (either very hot or very cold), so if you sunbathe for example, you need to keep your frame covered.

When can I start to drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is when you can stamp down hard with the foot to stop the car during an emergency stop. 

Although Mr Heidari will advise you about when it’s safe to start driving again, it is your own responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This depends on the type of work you do and how quickly you recover. In most cases, if your job involves sitting down for most of the time, you should be able to return to work after four weeks; if it involves manual work, you may need to have up to 16 weeks off.   

What is the long term outlook?

Your ankle strength and flexibility should improve over time, allowing you to return to your normal activities. However, it can take up to a year to experience the full benefits of the procedure.

What are the risks of this type of surgery?

All surgery carries risks. These include:

  • A small risk of infection in pins that attach the frame around the ankle joint, and in some cases, these pins can break and need to be replaced during the treatment period
  • Any joint or muscle stiffness associated with surgery can usually be avoided by carefully following your exercise programme
  • In rare cases, there may be nerve damage which can result in numbness around the joint. Although this usually wears off, it can become permanent
  • After surgery, there may be some bruising or bleeding around the pin sites but this normally settles over a few days
  • There is a small chance of deep vein thrombosis (DVT) following any surgery, although this is unusual following this type of surgery. However, you may be given blood-thinning medication after surgery as a precaution or if you are at higher risk, and you’ll also be given support socks and exercises to reduce the chances of DVT