Ankle Arthroscopy
Ankle arthroscopy is a minimally invasive surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into the ankle joint to evaluate and treat a variety of conditions.
An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects an image of the inside of the joint onto a large screen monitor allowing the surgeon to look for any damage, assess the type of injury, and repair the problem.
Indications
Ankle Arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, has proved to be highly effective in managing various ankle disorders including ankle arthritis, unstable ankle, ankle fracture, osteochondral defects of the talus, infection, and undiagnosed ankle pain.
The benefits of arthroscopy compared to the alternative, open ankle surgery, include:
- Smaller incisions
- Minimal soft tissue trauma
- Less pain
- Faster healing time
- Lower infection rate
- Less scarring
- Earlier mobilization
- Shorter hospital stay
Procedure
Your surgeon will make 2 or 3 small incisions around the ankle joint. Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work.
The larger image on the television monitor allows the surgeon to visualize the joint directly to determine the extent of damage so that it can be surgically treated. Surgical instruments will be inserted through the other tiny incisions to assess and treat the problem.
After the surgery, the instruments are removed, and the incisions are closed and covered with a bandage.
Post-surgical care
After the procedure, you will be taken to a recovery room. The ankle joint will be immobilized with a splint or cast. The nature and duration of immobilization will depend on the type of repair performed and the preference of the surgeon. The surgical site should be kept clean and dry during the healing process. Patients may be prescribed pain medication for the management of pain. Elevation of the ankle and ice application helps to reduce pain and swelling. Follow your post-operative instructions for the best outcome.
Risks and complications
Ankle arthroscopy is a safe procedure and the incidence of complications is low. However, as with any surgery, risks and complications can occur. Some associated risks with ankle surgery can include infection, damage to blood vessels or nerves, bleeding, and compartment syndrome.
Conclusion
Ankle arthroscopy is a less invasive surgical procedure than traditional open surgery for the management of various ankle disorders. Benefits of arthroscopy include faster healing, less pain, and less complications.
Ankle joint replacement
The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia and fibula, with the talus, or ankle bone.
The surface of the ankle bones is covered with an articular cartilage. Damage to this cartilage leads to a condition called arthritic ankle, which results in pain and impaired movement of the ankle. Infection, bone fracture, connective tissue disorder, excessive stress, and certain disease conditions such as rheumatoid arthritis, and osteoarthritis are causes of ankle arthritis.
Diagnosis
Ankle arthritis is diagnosed by your physician after taking a history and performing an examination of the symptomatic ankle. Imaging such as X-ray and MRI may be ordered to confirm the diagnosis.
Treatment
Conservative treatment of ankle arthritis involves oral medications and joint injections. However, for patients who are unresponsive to conservative treatment, ankle joint replacement surgery is recommended.
Ankle joint replacement, also known as total ankle arthroplasty, is a surgical procedure performed to relieve pain and immobility due to ankle arthritis.
Ankle joint replacement is also recommended for elderly patients with a severe fracture from osteoporosis, or presence of a tumor in the ankle joint.
Surgical procedure
Ankle joint replacement surgery is performed under general anesthesia. Your surgeon makes an incision over the front of the ankle. The muscles are retracted and tendons and ligaments are moved away to expose the ankle joint. The damaged part of the tibia, fibula, and talus bone are then removed using special instruments, and the remaining part of the bones are reshaped to fit the new artificial joint or prosthesis. A bone graft is inserted between the tibia and fibula to create a fusion of the two bones and prevent loosening of the prosthesis. The prosthetics are kept in position by using special bone cement and instrumentation such as screws to support the artificial ankle.
At the end of the surgery, tendons and other structures are placed back in position covering the new joint and the wound is sutured closed and covered with a sterile dressing.
Post-operative care
Following ankle joint replacement, the patient may need to stay in the hospital for 2-3 days and will be advised on precautions for a successful recovery.
The treated ankle will be immobilized with the help of splints and a bulky dressing. Patients are advised not to put any weight on the ankle for at least 6 weeks and use crutches for walking. Usually a drain tube is inserted into the joint during surgery for draining blood from the incision, and is removed within 1-2 days after the surgery. Swelling and discomfort can be managed by taking prescription pain medicines, applying ice packs, and also by elevating the ankle above heart level while resting. You will be referred to physical therapy soon after surgery to regain range of motion of the new ankle. Sutures are removed after 10-15 days and one should take care that the incision is kept clean and dry. Patients should avoid smoking, alcohol consumption, and should eat a healthy diet for the best outcome.
Risk and complications
As with any major surgery, there are potential risks involved. The possible complications associated with ankle joint replacement include infection, fracture of the tibia or fibula bone, dislocation of the ankle, damage to nerves or blood vessels, blood clots (Deep Venous Thrombosis), loosening of artificial components, failure to relieve pain, instability and stiffness.
Total ankle replacement surgery is used to treat the pain and immobility of severe end stage arthritis that has not responded to non-surgical treatments. The goal of ankle joint replacement surgery is to eliminate your pain and increase the mobility of your ankle joint.
