What is an Ankle Arthroscopy?
Arthroscopy is a form of ‘key-hole’ surgery. It involves one or more small cuts in the skin, where a small camera (called an arthroscope) can be inserted to look inside your ankle joint and perform operations, like washing.
The arthroscope is only three to four millimetres wide and is inserted into the ankle through small incisions in the skin. Often your surgeon will make 2 to 3 incisions to perform the operation.
Your surgeon will be able to access your joint and may perform a number of treatments to your ankle joint, including:
- treating cartilage lesions
- removing loose bodies
- removing bone spurs called osteophytes
- cleaning the joint by washing or cutting away infected or damaged tissues.
The operation is often performed under a general anaesthetic as a day case.
Who is this operation for?
The operation may be performed to:
- Diagnose the cause of symptoms
- If your doctor is unsure of the cause of your pain, swelling or stiffness an arthroscopy may be used
- Usually other tests, such as X-rays, CT scans or MRI will be used before an arthroscopy is performed.
- Help management of osteoarthritis or damage to the bone
- Trim damaged cartilage or remove fragments from the joint
- Remove inflamed soft tissue
- Special operations that are performed through arthroscopy:
- Arthrodesis, or fusion, of the ankle.
- Correction of ankle instability
There are a number of reasons why arthroscopy may not be suitable for you. Factors that make arthroscopy less likely to be successful include:
- A small or scarred joint space
- A past history of severe pain after operations
- Poor blood supply to the foot or ankle – often smokers and diabetics are more likely to have compromised blood supply, however this can be discussed with your surgeon (see Angiography).
What are the complications?
Are there any risks associated with a Total Ankle Replacement?
Some complications include:
- Short-term swelling and long-term stiffness of foot and ankle
- Bleeding & infection — All invasive procedures carry a small risk of infection and blood loss.
- Delayed wound healing.
- A joint that continues to be painful.
- Need for further surgery. This can be due to:
- Malpositioning of the joint.
- Irritation or infection of the hardware.
- ‘Failure’ – it’s important to remember that ankle replacements wear out over time and will eventually need to be replaced. Around 90% of ankle replacements last 5 years, and approximately 75% last ten years.
- Injury to nerves – Numbness or tingling can occur at the wound or in the foot. This is usually temporary but sometimes may be permanent.
- The nerve most at risk during an ankle replacement is the deep peroneal nerve which supplies a small area of skin between the toes.
- Blood clots — Deep vein thrombosis (DVT) and pulmonary embolism (PE) are rare. If you or your family have a history of blood clots, tell your surgeon before the operation.
- Numbness, tingling or irritation of the leg – during the operation your surgeon will place a tight bandage (tourniquet) around your thigh to reduce blood loss. This can cause temporary discomfort after the operation.
For more information on the general risks of surgery, see Complications of Surgery.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
If you have chronic lung or heart disease, diabetes or other risk factors for complications during surgery, you may require a detailed anaesthetic assessment.
Tests
Tests that may be ordered for you include:
- blood tests
- X-ray of ankle and/or foot. Sometimes, your surgeon may request X-rays of your other ankle to have a comparison.
- X-ray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Your treating team will advise you which medications you should stop or can continue taking before surgery. Please make sure you inform your doctors if you are taking any blood thinning medications, like warfarin or aspirin.
If you have rheumatoid arthritis, you may need to speak with your rheumatologist about which drugs are safe for surgery.
What happens during the operation?
Ankle replacements can take 1–3 hours to perform. When you are brought to the operating theatre, your surgeon, anaesthetist and theatre nurse will meet you. Your surgeon will perform a quick assessment of your foot then draw lines on your ankle to mark out important structures that need to be avoided. After this, your anaesthetist will put you to sleep (general anaesthetic, or regional/spinal anaesthetic with sedation).
Once in theatre and asleep, your surgeon will prep you for the operation. This usually includes:
- A regional anaesthetic to numb pain from the area.
- Applying a tight bandage (tourniquet) to the thigh to reduce bleeding
- Positioning the leg and ankle.
- Sterilising the skin over and around the ankle.
When this is done, your surgeon can make a cut to reach the ankle joint. The position and length of the incision will vary depending on the type of prosthetic joint being used. Commonly, the incision will be about 10 cm long and on the front of your ankle joint.
Once the cut has been made, your surgeon can carefully separate the muscles and ligaments beneath the skin to reach the joint. The ligaments and capsule around the joint are then divided to expose the bone.
Your surgeon will then place equipment into the joint that will separate and cut the bones. When this is complete, your surgeon will carefully position the implant before fixing it in place.
After this, the tissues around your joint will be pulled back into position and stitched together before your skin is closed.
What happens after the operation?
When you awake from surgery, you will be in the recovery room with a plaster on your leg. At this point, you should feel little if any pain as the anaesthetic injected into your leg by your surgeon will still be working.
Once you are awake, you will be returned to the wards and kept in hospital for 2–3 days. During this time you will need to keep your leg elevated nearly all the time.
Before you can be discharged, physiotherapists will show you how to move around using crutches and without putting any weight on your foot. You should remain non-weight-bearing for the first few weeks after your operation, and can only begin using your leg once an X-ray has confirmed your bones are healing.
Your cast will need to be assessed and changed at 10–14 days after your surgery (see Caring for your Cast). At this first follow-up appointment your surgeon will inspect your ankle and get X-rays to confirm the implant is correctly positioned and your bones are healing well. Your stitches may also be taken out at this point.
To control swelling and help your ankle to heal, keep your leg elevated as much as possible in the first week after surgery by sleeping with your foot raised on pillows and sitting with your leg resting up on a chair.
Recovery and Rehabilitation
What happens after discharge?
You will usually be seen in the orthopaedic outpatient clinic about two weeks after the surgery. The back slab will be removed and your wound will be inspected. If the wounds are healed then a removable boot will be applied for you to walk in. This is to be worn during the day for walking but need not be worn at night. With this boot on, you can begin to take weight through your ankle 2 weeks after your operation. You will need this boot until you are 6 weeks after your operation. During this time it is likely that you will continue to require the use of your crutches. After the backslab has been removed, you will be referred to a physiotherapist as an outpatient. They will give you exercises to move your ankle and teach you to walk with your removable boot.
When can I return to work?
If you have an office-type job and you are able to elevate the leg then you may return to work approximately 4 weeks following surgery. However, if your job is physically demanding and usually involves long periods on your feet then it is advisable not to return for up to 3 to 6 months. This decision will depend on where your type of employment falls between these two extremes.
When is it safe to drive?
If you have a replacement on the left ankle and an automatic car, you can usually drive by two to four weeks after your operation. Otherwise, it will take you about 2 to 3 months to drive with your replaced ankle. You must be able to perform an emergency stop. Your insurance company must be notified regarding the type of operation that you have undergone to ensure that cover is valid.
What should I do if I have a problem?
If you experience severe pain, excessive swelling, discharge, excessive numbness or pins and needles please report it to your GP. If you cannot contact your GP you should visit the Emergency Department as quickly as possible.
F.A.Q.s | Frequently Asked Questions
How long will I be on crutches?
Most people use crutches for a few days to a week, mainly for comfort. Your surgeon will tell you how much weight you can put through the ankle, as this depends on what was done inside the joint.
When can I drive?
Once you can walk without crutches, are off strong pain medicine, and can do an emergency stop without hesitating. For a left ankle in an automatic car this is often sooner.
When can I go back to work?
Desk work is often possible in one to two weeks. Work on your feet takes longer, often four to six weeks.
When can I play sport again?
Usually somewhere between six weeks and three months. It depends on what was found and repaired. Build back up rather than going straight into a game.
Why is my ankle still swollen weeks later?
Swelling after ankle surgery is normal and can come and go for several months. Keeping the foot up and using ice helps. Swelling that is getting worse, with heat and redness, should be checked.
Will the arthroscopy cure my ankle?
It depends on the problem. Removing loose bits, trimming torn tissue or clearing bone spurs often works well. Arthroscopy cannot undo arthritis that has already worn the joint surface.
What are the little cuts on my ankle?
The camera and instruments go in through two or three small cuts, usually at the front of the ankle. They are closed with stitches and leave small scars.
When should I call the doctor?
Call if the pain is severe and your medicine is not helping, if the wounds are red, hot or leaking, if you get a fever, or if your calf becomes painful and swollen.
References
Briggs, T., et al., ‘Operative Orthopaedics: The Stanmore Guide’, Hodder Arnold Ltd., UK, 2010.
Chou, L. B., et al., ‘Osteoarthritis of the Ankle: The Role of Arthroplasty’, Journal of the American Academy of Orthopaedic Surgeons, Vol. 16, No. 5, May 2008, pp. 249–259.
Easley, M. E., ‘Perspectives on Modern Orthopaedics: Total Ankle Arthroplasty’, Journal of the American Academy for Orthopaedic Surgery, Vol. 10, No. 3, May/June, pp 157–167.