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The Bionic Ankle
Apologies to potential patients and to Stephen Milner for not updating this page as often as I should have done. The reason is simply that, from six months after the operation, the ankle was no longer really an issue! I understand from my review appointments that this page has helped a number of Mr Milnerís patients and I hope that many more will be encouraged to go for the STAR ankle replacement.
At the 11 April 2011 review (five
years on from the operation) the news was not so good -
the plastic component of the ankle implant had obviously
failed (there are some x-rays and a short video of the
replacement joint - not mine! - here.). The damage was repaired on
the 18 May and by the 7 June I was fully mobile and
pretty well pain-free.
It's now September 2014 and the bad news is that
the ankle with the replacement recently failed again.
This time it was the bones below the implant rather than
the implant itself that failed. It's a complicated and
ongoing story which I'm documenting from day to day, so
rather than put it on this page I've installed the
the document, which is growing from day to day, here.
Even with these two setbacks, my answer to the question 'Should you go for a Total Ankle Replacement if youíre told you need one?' remains an unhesitating and resounding YES. Since the original surgery, Iíve done several 7-mile hikes. And once, powered by panic, I discovered that I could actually RUN! Even more recently Iíve been clocking up a minimum of thirty minutesí hard walking six days out of seven - over 950 miles since August 2009 (no more running, though!). Read on for the whole story or skip to the end for the latest news...
Around 2002 or 2003 my right ankle took over as the most troublesome of several joints, all of which had varying degrees of osteoarthritis (basically a posh word for severe wear-and-tear leading to swelling and pain). Iíve always been prone to twisting my ankles, and this one had obviously had a few twists too many.
(Generally I manage my joint problems with exercise. Click here to read about the routines Iíve developed for my neck, shoulders and back, and for legs and feet...)
I had previously got my GP to refer me to a specialist for both ankles and both knees, and she opted for a rheumatologist rather than an orthopaedic surgeon - a decision I supported at the time as surgery should obviously be the final solution, and my parents had had one or two dire experiences with orthopods. I spent a couple of years visiting the rheumatology department at Derbyshire (now Derby) Royal Infirmary, but all they seemed to do was recommend exercise and juggle with my anti-inflammatory drugs, including prescribing Vioxx and Celebrex, members of a family called COX-2 Inhibitors. These were believed to be less harmful than non-steroid anti-inflammatories because they didnít attack the stomach linining, but they were subsequently withdrawn when found to have very adverse effects on patients prone to strokes and heart attacks - which I, fortunately, donít seem to be particularly susceptible to (cross fingers)! More recently, Diclofenac, the anti-inflammatory Iíve been happiest with, has also been shown to have similar risks.
The best thing they recommended was weight-loss (take the load off the worn joints) and this finally motivated me to shed a couple of stone with a combination of disciplined eating and loads of exercise. The sad conclusion I reached during this period was that itís horribly easy to absorb excess calories and requires an awful lot of exercise to burn them off again. If you donít believe me, check out the calories in a Snickers bar and the amount of walking required to use them all up!
At one point they tried cortisone injections in one knee and one ankle. Things felt great for a day or two, so I started to do more and in no time I was back where I started.
When the ankle got really bad I asked for physiotherapy, and after a few weeksí treatment - actually self-administered, since it was all about carefully planned and monitored exercise - the senior physio wrote to the consultant rheumatologist suggesting that he refer me to an orthopaedic surgeon. He wasnít best pleased to be ítold his jobí by a member of a junior profession, but he at least gave me the choice - a sign of the times in the NHS. I opted for the engineering approach, because Iíd recently noticed -seeing my ankle reflected in the oven door while barefoot one day - that my leg seemed to be slowly falling off my foot.
I was referred to Mr Stephen Milner, a specialist in foot and knee surgery who looked far too young to be a consultant (I found his CV on the Web - heís 38) and was far too nice to be a surgeon (Iíve met a few of the old school!). He thought my description of the leg falling off the foot was a pretty exact description of what was going on, and after less than half an hour he said I was an ideal case for Total Ankle Replacement. He offered to put me on his waiting list (then about a six-month wait), and I accepted eagerly. I was given lots of information to read, including links to various websites, and learned that I would be fitted with a Swedish Total Ankle Replacement (STAR), about which there is masses of stuff on the Web (google it yourself or have a look at this site).
I was called for the op after almost exactly six months. Unfortunately weíd just moved house and had also had a bereavement, so I asked for a delay until after the 1 February 2006. I actually received a letter written on that date offering me an operation on the 9 March, which I accepted. I had my pre-operative assessment on the 21 February and was duly admitted on the 9 March.
I think I had better gloss over this part, because the experience of the actual op and its immediate aftermath was brilliant. Suffice it to say that, if bed management in hospitals was even a tenth as good as surgery and immediate post-operative care, the experience would be a lot less stressful for the patient and the hospital would probably be able to get through many more operations.
Anyway, after wasting most of the day I eventually got a bed and was scheduled for surgery at around 6:30pm. I was wheeled down to meet the surgical team, who were cheerful and friendly and really put me at my ease. I was given (not necessarily in this order) an epidural anaesthetic, which went straight into the cerebro-spinal fluid below the end of my spinal cord, a sciatic nerve block (another kind of local anaesthetic) and a sedative injection. The result was that I dozed off and missed the whole thing (including, thankfully, being catheterised)! So as good as a general anaesthetic but with none of the risks.
I came to just as the team were tidying me up, with the foot in a plaster cast, in time to be wheeled into Recovery, where they seem to have a special breed of really great nurses (I was in there twice a while ago after the Pulvertaft Hand Clinic team cleaned up one my most recent and most severe woodworking injuries). In due course I was carted back to my bed in what turned out to be called the Extended Recovery Unit, where I was advised not to have a sandwich but to have some toast made freshly by one of the male nurses (and normally reserved for the nurses). I was also allowed to order two cups of tea. Since Iíd had breakfast at 5:45am and nothing since, this frugal supper was a great treat.
Being numb from the waist down was really weird, especially when I decided to check whether some of the more important bits and pieces were still there. They felt very dead. This wore off relatively quickly, but the sciatic nerve block kept my toes numb for a good 24 hours.
The following morning I was pronounced fit for transfer to the ordinary orthopaedic ward and was rolled up there via a quick x-ray, which looked as if I had a Lego brick in my ankle (well it is a Scandiavian implant!). I was put in a bay with three other guys whoíd had an assortment of hip and knee replacements. Unfortunately there was a diarrhoea bug in some wards, so we were deprived of things like the League of Friends trolley, the newspaper guy and even early-morning tea and morning coffee. Visiting hours were also severely reduced, which made Patriciaís three-hour round trips pretty frustrating.
On Friday night Mr Milner came in and said I should ask the staff to remove my catheter at midnight, and hinted that as far as he was concerned I could go home as soon as I could ípee independentlyí. The catheter was duly removed (íwhipped outí was the phrase used by the male nurse who did the deed, and it felt like it), leaving me with mild urethritis for a couple of days, and I was able to use a bottle that night. Next morning the physios came round and introduced me to the Zimmer frame. That got me round to the loo in one piece, allowing me to pee like a grownup, so as far as Mr Milner was concerned I would be a candidate for discharge.
Unfortunately, it was now Saturday, and hospitals seem to go into suspended animation for the weekend for all but the direst emergencies. This is another example of ward routine getting in the way of brilliant treatments - surely they could manage a 7-day surgical week. So on Sunday morning I got my 15-minute training with a pair of elbow crutches, and had to wait until Monday to see Mr Milner and get permission to go home.
Again, best not to dwell on the next bit. Suffice it to say that I was told at 9:30am that Iíd be going home that day but didnít get off the ward until 4:30pm. I had to wait for my medication (which turned out to be nothing more than a big box of paracetamol, of which I already had plenty at home) and for the nurse in charge to complete my paperwork. That presumably explained the íbed blockí that had made the admission process so stressful for me. Patricia even had to go off and steal a wheelchair from somewhere and push me off the ward herself - otherwise Iíd probably still be waiting for a porter.
(I found a movie of the joint replacement attached to a demonstration skeleton on the web when I started writing this page, but it has been withdrawn - not surprising, perhaps, since Mr Milner told me the bottom element had been fitted back-to-front! However, it was useful in helping me understand The Thing in my ankle - I hadnít realised that the STAR provided a swivel as well as a hinge, so in effect itís a universal joint! You can find masses of information by googling ístar ankle replacementí, including pictures, but I havenít found another movie.)
Home - sheer bliss. Iíd been pretty well resigned to sleeping on the narrow bed in my office. Then I thought I might get up our crazy spiral staircase on my bum. But when I tried I discovered that I could actually do it standing and going backwards - one hand on the handrail, one on a convenient step and one good leg to lift on. The reverse process got me down again. The first morning I was determined to have some sort of shower, so I managed to get a plastic bag over my cast, seal it (ish) with a rubber band, get into our corner bath (which has a sort of seat in the corner - tailor-made for the job) and hose myself down. What luxury - but what a knackering experience. By the time Iíd finished and got dressed I was dripping sweat and ready for a good nightís sleep!
Walking one-legged with elbow crutches is very hard work. Even more so when the physios donít teach you to do it properly. I was timidly moving the crutches forward and hopping to catch them up until I suddenly discovered that the way to do it is to bring the crutches level with your foot, then fall forward, swinging the good foot through to land well ahead of the crutch tips. A bit scary, but a darned sight less energetic! Tell you what, though: doing it in the dark to get to the loo at night is really difficult.
Eleven days after the operation I had my first follow-up appointment. Mr Milner told me the ankle joint had been so badly damaged that if it had been left much longer it would have been too far gone for the operation. The x-ray was apparently fine, so the cast came off and I was sent to Orthotics for The Big Black Boot - a bit like a ski or snowboard boot with an inflatable fleece liner. Better, I was told that I could actually take this off for washing and even, if it felt OK, for sleeping. I did try sleep with it on for the first night, but by about midnight Iíd taken it off. A few twinges when turning over, but no real problems. Without the boot the gymnastics round the bath were really scary, with the thought that if I slipped and landed on the bad foot I might break the prosthesis out, but I got awqay without any mishaps. I was also told to try taking ísome weightí (whatever than meant) on the foot while wearing the boot. Moving around a lot more meant the foot was giving me more pain - particulary since the bootís inflatable liner had a slow puncture! - but the sense of liberation was great.
Over the next two weeks I hit a number of landmarks. First, putting the booted foot down with the crutch tips made walking vastly easier, and through the fortnight I took more and more weight on it. Then I began to walk short distances without the crutches. Then I began putting the bare foot down and taking some weight on it while using the crutches (making nocturnal trips to the loo a lot less scary and a lot quicker, as I didnít have to put The Boot on just to walk across the bedroom into the en-suite and then wake Patricia by ripping the three velcro straps apart!). Finally, I managed to walk a few steps without either boot or crutches. Which meant I could try using our en-suite shower.
This took a bit of working out, but it went like this. Walk to the shower on the crutches. Lean them somewhere within easy reach of the cubicle door. Stand on the bad foot and step up with the good one, holding the sides of the cubicle door. Lift up on the good foot and walk into the cubicle. Shower more-or-less normally. Try to wash the good foot and discover that you can actually stand on the bad one with the support of the walls! To exit, lean out and pick up the crutches, put them on the floor outside, step down with the bad foot and follow with the good one.
The last couple of days before my second follow-up on the 10 April, I seemed to be progressing in leaps and bounds (well, not literally) so I took my right Reebok and a sock with me to the hospital. The x-ray was good, the examination was good - and I was given a Tubigrip bandage (which seemed a bit puny as a substitute for The Big Black Boot) and told to put my shoe and sock on and not to come back for two months. In the next 24 hours I almost abandoned the crutches - I even walked the full length of the garden after a couple of days. Some pain focussed on the inside of the ankle - end of the tibia where it overhangs the talus - see this picture.
Update Wednesday 12 April 2006
I probably overdid it a bit yesterday - quite painful and swollen by bedtime. However, it seemed none the worse this morning. Iíve been out and walked around Matalan using one crutch like a walking stick, on the opposite side from the bad foot, and the ankle feels quite comfortable.
Monday 17 April
I havenít used two crutches at all recently, not even for an extended hike around Sainsburyís in the Easter Saturday mayhem! One, used like a walking stick on the left side to take a controlled amount of weight off the right leg got me through that, and also the 200 metres or so each way to get the papers yesterday. Otherwise, I walk round the house without help. The ankle gets painful and swollen after a lot of use (like helping Pat to cook for nine of us on Easter Sunday, with a lot of preparation on Saturday!), but it mostly recovers overnight. Had quite a lazy day today and managed even without the Tubigrip, which has had its first wash. Iíve dug out my neoprene sports supports to try, but they needed a wash too.
Put one of the ProSport supports (bought from Boots) on later. When I took it off at bedtime it seemed to have prevented almost all the usual swelling.
Thursday 20 April
A good night with the ankle and it looked almost normal on Tuesday morning. Put the ProSport support back on - very comfortable. Yesterday I used it again for an unavoidable trip to Meadowhall(hell), the huge out-of-town shopping centre on the edge of Sheffield. When youíre getting married you have to bite the bullet and buy the clothes! I took one elbow-crutch, with which Iím now becoming quite skilled at gauging how much support to give the poorly ankle. I donít know if it was the perfectly level floors or what, but the more I walked the better things seemed to get. I covered a lot of ground, visiting the menswear departments of around ten shops, and found I could walk with virtually no support from the crutch and even start lifting the heel a bit before the other foot took the load. Amazing!
There was a downside. Like an idiot, I didnít take paracetamol before I went to bed and in the middle of the night the ankle was quite painful. By morning, though, it was feeling strong again.
I decided to go back to the Tubigrip for today, if only to avoid sweat rashes from the neoprene. The morning went fine, and I decided after lunch to try moving the car on the forecourt. I experimented with a few dummy emergency stops and discovered that I could brake so hard with the new ankle that I lifted my bum right off the seat, yet I had good, delicate control of the accelerator.
So, six weeks to the day after the operation, I took the car out for a run and I was fine. The sense of freedom was amazing after being cooped up or dependent on Patricia for chauffeuring for so long.
The ankle is still mildly painful (remarkable after the epic walk round Meadowhall yesterday!), but basically Iím back in business. About the only real problem I have is walking down the spiral staircase from our bedroom - alternating feet properly isnít quite working yet. But maybe tomorrow...
Three months on - 14 June 2006
I saw Mr Milner for my three-month checkup two days ago, and he tells me heís been referring other candidates for ankle replacement to this site. So apologies to anyone who has been disappointed by the lack of up-to-date information - thatís down to the fact that things are going so well I havenít felt the need (or had the time) to keep this page up. So...
There was a follow-up visit to Meadowhall a week or so after the one on the 19 April. We were halfway there (me driving!) when I realised Iíd forgotten to bring the crutches. After a moment of indecision I decided to carry on and manage without. To my amazement, I did a full lap of two floors quite easily, though the ankle punished me for a couple of days afterwards.
Iím not sure how long ago it was, but I remember a day a few weeks ago when we parked across the road from our village Post Office and I got out of the car, crossed the road and went up the drive to the PO. Partway across I realised that I was taking long strides - probably longer than I had for a couple of years at least. I was walking properly - like I had before the ankle went bad! What a fantastic feeling.
I had to stop using theProSport support because it caused a sort of dry eczema that takes ages to cure with a greasy steroid ointment. I havenít used any sort of support since - except my mountain boots when I strimmed the grass and undergrowth at our French house towards the end of May. This is 800 square metres of rough, tussocky pasture where you never know what youíre stepping on until you do - your foot can be tipped in any direction and at any ankle. I got the job done over two days - with help from our good friend Bernard Olivier - and was none the worse for the experience. I spent the next week painting and plastering, and the ankle behaved impeccably.
So where is it now?
The crutches have been pensioned off, and I am walking more normally than I have for several years. The foot doesnít turn out as it did before the operation. The ball of my foot doesnít slap down in an uncontrolled way as soon as my heel hits the ground as it used to. My foot rolls naturally from heel to toe when I walk, like the other one, whereas before I didnít lift the heel until the other foot hit the ground and took the weight. I can walk on tiptoes for the first time in ages, and I can balance on the right leg to put trousers on, take socks off etc. I can even stand on the one leg and - with a hand on something for balance, rise onto tiptoe in a controlled way. Before the operation, the physio who actually initiated my referral to Mr Milner was trying to get me to do this, and it was impossible.
So, functionally, the ankle is doing great.
It still swells partway through a hard day, but nowhere near as much as it used to and the swelling always goes down overnight. There is pain, but nothing like I had before the operation. It varies in location and intensity, but tends to be mostly on the inside of the joint (the bottom of the tibia). It feels like inflamed tendons more than anything else when I rub it. Also, I think the other joints in the foot are finding the going a bit hard after such a long lay-off, so they protest a bit, too!
Basically, Iím thrilled to bits with the speed and degree of recovery, as I told Mr Milner on Monday. Iíd recommend anyone to whom he offers Total Ankle Replacement to go for it.
The only problem is that, now the ankle doesnít hurt as much, Iím realising what a mess my knees and back are in - and Mr Milner only goes up as far as the knees!
Nine months on - January 2007
Again, nothing but good news, which is why I havenít updated this page for ages - the ankle just isnít an issue any more.
As well as continuing to walk around, I can now do what I call a sprint-walk for the mile-or-so round trip to the village post office - probably walking faster than I have for a few years.
More exciting, Iíve had my mountain boots on three times over the last couple of months and walked five, five and seven miles over rough woodland and field footpaths - and thatís something I havenít been able to do for five years or more.
No more swelling now, and only occasional pain which is probably unrelated to the implant. Wish I could say the same for knees, lower back, neck, right shoulder - but, hey, thatís what you get for being 64!
What I have omitted to mention previously on this page is that my right calf muscles had become very wasted as the ankle deteriorated and I was unable to tense one of them - the big one on the inside - at all. The overall muscle bulk has now recovered almost to match the good legís, and the weak muscle will now harden, though not yet to the same extent as the other one. For practical purposes, though, the right leg is as useful as the left!
I expect a call to attend for my 12-month review soon, and it looks like being 100% positive.
Annual review - 19 March 2007
Today I had my 12-month review, and it seems everything is fine. The x-ray looked good and the young registrar I saw was happy to leave it that theyíd send me another appointment for a year from now but I could phone for an earlier one if I had any problems.
So, unless there are problems, I donít expect to be updating this page.
I have no hesitation in advising anyone who is recommended to have this operation to go for it. I never thought Iíd enjoy hiking again, but I can now!
I can run (3 May 2007)!
It must be several years since I managed anything better than a sort of shambling jog to avoid traffic when crossing the road, but this morning I ran about 100 metres - really ran!
It wasnít planned. Iíd realised that we were short of milk for breakfast and popped across to our local shop to get some. Partway back I suddenly remembered that Iíd left the porridge on the gas, and I knew that Patricia would probably still be upstairs. So, without a thought, I ran. It only dawned on me when I got back to our front gate that I didnít do running.
I salvaged the smoking porridge just before it caught fire and then stopped to think. My ankle felt a little strange. but not really painful.
A couple of hours later I walked the mile to the village Post Office and back really quickly. Now, several hours later, everything feels okay.
A clean bill of health - 26 November 2007
I was called for my next review only eight months after the previous one, and was lucky enough to see Stephen Milner himself as both his registrar and his nurse practitioner were away. I was therefore able to pass on in person my absolute delight with the outcome so far. It was great to see that the x-ray was absolutely unchanged from the one taken in March, and to hear him confirm that my ankle mobility was excellent. He was amazed by the running story (above) and the fact that Iíd done a 7-mile hike only nine months after the operation.
Two years plus
9 April 2008 Two years and one month from the operation, I have effectively forgotten that this isnít a natural ankle in very good condition. I get odd painful days, but it could be from anywhere in this complex mass of joints and it never lasts long.
Three years on
On the 2 March 2009 I had my three-year check-up at Derbyshire Royal Infirmary. I had been rather concerned because the ankle had undergone a lot of extra stress for a total of six months while my other leg was disabled following two emergency knee operations (full story here). I had been on crutches and forbidden to put any weight on the damaged leg for over three months, which meant that the other leg took quite a pounding, and I had had some pain in the ankle. I was very relieved when the new x-rays showed that the two components of the replacement joint were still firmly anchored to the bone and the plastic bearing was still in place. Joint mobility was very good, and I was passed fit for another year.
I think this is a real tribute to the quality of the artificial joint and to the quality of Mr Milnerís work. Itís one thing to provide a new joint that restores normal functioning, but quite another for it to cope with being banged about by a 14-stone-plus oldie whoís a bit of an idiot on crutches! Not to mention one who goes out and has to sprint back home to save a pan of burning porridge...
On Monday 15 March 2010 I had my annual review at the new Derby City Hospital - very confusing! The x-rays - now taken with the patient standing, which is a lot easier - were fine. For the second year my appointment was with Claire Stevens, the nurse-practitioner, but she was pleased enough with my progress to ask Mr Milner to come and see me.
Since the last appointment, I have had to do a lot of hard walking to tackle another health problem. If anything the ankle feels better for it.
Apparently there have been one or two íhinge failuresí in which the polyethylene ícartilegeí between the two metal parts of the ankle implant conks out, but this can be replaced. Thatís reassuring!
That last paragraph has proved to be prophetic.
I was doing fine when the letter came through for my March 2011 review, which I had to delay until the 11 April because of family commitments. Between the original date and the actual visit it all went wrong.
A few weeks before, I had increased my minimum walking commitment from six half-hour walks to five 45-minute ones a week, giving me an extra 45 minutes each week but with two rest days rather than one. This was becoming routine when, on the 4 April, I found that my ankle was too painful. I reduced the walk to my half-hour route, but it took over 36 minutes - time to take a rest.
I was still managing to mow the lawn, march up and down it delivering weed-and-feed and water our forecourt with weedkiller, but by the day of my appointment the ankle was becoming much more painful. Nevertheless, I drove the car from Worksop to Derby and back again and walked the long distances from the carpark to Orthopaedic Outpatients and back, but the pain and swelling were both pretty worrying. After the standing x-rays and an examination, Claire spoke to Mr Milner and he managed to arrange a more-or-less immediate CT scan - a new experience for me.
The results showed clear evidence that the polyethylene hinge had failed. This has little wires embedded in it so that its shape and position show up clearly on x-rays. There was evidence of severe distortion from these, and it appeared that a tiny piece of the wire had become detached and had lodged quite a long way from the joint implant. Claire spotted this first, and said Mr Milner would probably say that it wasnít wire at all and she was paranoid, but in fact he agreed with her reading. It was obvious that the two metal components of the implant were no longer parallel and that the upper part (the one attached to the tibia) was slipping sideways The scan confirmed all this.
Mr Milner came in to discuss options. Clearly more surgery was unavoidable.
The best option would obviously be simply to replace the hinge, in which case I would be able to bear weight on the joint immediately and recovery would be quick.
The second (if the metal components had been damaged) would be to detach and replace the whole implant (Mr Milner assured me that a sharp tap normally separated the metal from the bones!), in which case I would presumably be looking at another (nicotine-free!) six-week wait for the bone and metal to bond fully - back to crutches and The Big Black Boot.
The third would be to fuse the talus bone to the tibia, which if I remember rightly involved driving screws obliquely through the tibia into the talus. We didnít get as far as discussing the recovery period for this one.
Sodís Law then came into play. Mr Milnerís day for his more major operations is Friday, and the 22 April is Good Friday - normally the only bank holiday that doesnít fall on a Monday. I say ínormallyí because the following Friday, just for 2011, is another public holiday so we can all watch William and Kate get married and then have a street party. So it looked as if the earliest possibility would be the 6 May, until when I was advised to used crutches to relieve some of the pressure on the ankle, though I donít have to wave the leg around in the air!
I had quite a lot of pain and swelling after the trip to Derby - probably due to hiking around their vast new hospital. Prior to that Iíd been walking fairly normally, though with increasing pain towards the end of each day. I thought this would ease, but by Thursday it hadnít - much. I tried using one crutch on the same side as the problem ankle, which did help, but not as much as Iíd hoped. I was much more disabled than Iíd been before going to the hospital. I tried a neoprene sports support from the bad old days before the replacement, but it didnít seem to help. A crÍpe-bandage figure-of-eight strapping helped more, but I was still getting pretty depressed about another three weeksí wait for surgery. On the Saturday I decided to try using the crutch on the other side, and had the best day so far, with very little pain through the morning and afternoon. Using the crutch this way enabled me to take more weight off the vulnerable foot - though I was aware of some strain on my lower back!
Most recently, Iíve been using two crutches whenever practical, because Iíve had some more severe pain when Iíve overworked the faulty foot. Mostly I plant the crutches and the foot together and lean hard on my hands, taking a lot of the weight off the foot. However, Iíve been doing some íproperí crutch walking (bad foot not touching the ground at all), partly to reduce the stress even more and partly in preparation for the worst-case scenario of being allowed no weight-bearing at all following whatever surgery I need. I remember all-too-painfully learning to do this with my foot in The Big Black Boot following the original ankle op, having had about ten minutesí instruction from the hospital physios. Not much fun, that!
Monday 9 May 2011 On the 3 May, when it was clear that the 6th wouldnít happen, I sent a text to Claire saying I was concerned that both the pain and the mobility were getting much worse, and she phoned back to say sheíd talked to Mr Milnerís secretary, who had spoken to the man himself, and that Iíd be dealt with as soon as possible. He was still keen to get me sorted as soon as possible. On the 6 May the secretary rang to say I was booked into the Day Surgery Unit on Wednesday 18 May, and she booked my pre-op assessment on the spot for the 11 May. That set my mind racing, of course, because it suggested that Mr Milner wasnít expecting to have to go to either Plan B or Plan C - he was confident that heíd be able to replace the plastic hinge under a local anaesthetic and send me on my way. The only possible explanation was that the radiologist must have reported back favourably on the CT scan. This seems like the best possible news, and Iím hoping it will be confirmed on the 11th.
Meanwhile, if I give the ankle a reasonably easy day, itís much less painful now. I even managed to accompany Pat to Meadowhall (Sheffieldís huge out-of-town shopping mall) last week to buy her birthday present, and then to Ziniz in Bawtry for an excellent Tuscan lunch! I wonder if the tendons, ligaments and others squidgy bits are managing to recover from the stress caused when the implant first failed.
Monday 16 May 2011
I had my pre-op assessment last Wednesday (11 May), and everything seemed to go well. I havenít heard anything since then, so Iím assuming my MRSA swab was clear!
The one piece of hard information I got was that Mr Milner had scheduled me for íhinge replacement or arthrodesisí. Arthrodesis is joint fusion, so he has obviously decided that completely replacing the implant is going to be either unnecessary or not feasible.
I have to be on the ward at 7am on Wednesday 18 May, having had no solid food since 3am and then only íclearí drinks (water, black coffee or black tea) up to 6am. As weíll have to leave home at six, this wonít be much of a problem. Mr Milner is only operating during the morning, so by lunchtime I should know where I stand. (The diet restrictions apply even if I opt for a local anaesthetic, which I will, because if this doenít do the trick I may need a general.)
Thursday 19 May 2011
We managed to get onto the ward on time yesterday, only to discover that - contrary to what I had been told - I was on an all-day list rather than a morning one, and that I was number six out of six.
I saw Mr Milner quite early, and he confirmed the two possible outcomes mentioned above. The bad news was that, if the metal components of the implant had been damaged - particularly if the bearing surfaces had been scratched so that they would damage a new hinge - the only alternative, the fusion, would have a three-month recovery period, the first six weeks with no weight-bearing. After my miserable experience with my two quadriceps-tendon repairs in 2008, this was very depressing news. I decided not to pass it on to Patricia: no point in upsetting her prematurely. He also told me that I would almost certainly have to stay in hospital overnight, so I followed his advice and went to the waiting area to send her home.
Then began a long wait with ínil by mouthí - not so much as a sip of water. Early in the afternoon I had a discussion with the consultant anaesthetist, deciding that I would prefer a spinal anaesthetic to a general, and then settled down to wait. I was called sooner than expected - before 3pm if my rather foggy recollection is correct.
After a pretty dismal experience over the past eight hours or so, the time in theatre was quite enjoyable! The anaesthetist and the senior theatre nurse took me through preparation and the administration of the spinal, with lots of joking, and although the spinal itself was very painful despite the preliminary local, I was feeling calm and cheerful when I was wheeled into the theatre. The cheery mood was sustained by all present, until the moment of huge relief when Mr Milner confirmed that the metal components were undamaged and he would replace the hinge.
I had managed somehow to break the hinge cleanly in half across the axis of the joint, presumably at the point where the concave curve on the underside comes closest to the flat upper side. The front half came out easily and looked pretty tidy, but there was some concern that the rear half might not be accessible as it had slipped right back. I assume that it had ended up lodged against the Achilles tendon, which would account for the intermittent pain Iíd had in that area over the preceding weeks. The team tried a number of forceps, tweezers and other implements and finally resorted to covering the jaws of the chosen tool with fingers cut from a rubber glove to prevent damage to the metal bearing surfaces! Eventually the second bit came out, looking pretty ragged and bloodstained.
The thicker (7mm) hinge went in after a bit of a struggle, and then Mr Milner spent quite a while tidying up, including the removal of some scar tissue. To my delight, he then announced that the op had been a complete success and that I should be able to start bearing my full body weight on the ankle as soon as the anaesthetic had worn off.
I enquired about the fragment of wire weíd seen on the x-rays, and he said that he was leaving that as it would cause no problems and removing it would be a long and potentially damaging job. As this has become a permanent feature of my ankle, and for reasons which will be clear if youíve read about my annual review, I have christened it íClaireís wee bit of wireí.
In a general atmosphere of jollity, I was moved from the theatre to the recovery ward where, well looked after by the delightful nursing staff, I was allowed a small cup of cold water - what bliss!. I had begun to move the legs a little from the hips even before leaving theatre, and by the time I could be moved to the ward for the night quite a lot of control had been restored.
I am so totally chuffed with the outcome that I wonít dwell too much on the frustrations of my remaining hours in hospital. The first disappointment was that the mobile-phone coverage in Ward 208 was even worse than that in 207 and I was unable to contact Patricia except with a very brief text message. Then there was confusion over recovering my personal effects. And then there was the food-and-drink situation. I was gagging for a cup of tea, but was told to stick to water. Then, a lot later, a plate of lasagne and broccoli arrived, but I was still told that I couldnít have a cuppa! I managed to eat, and even enjoy, the food (though there was no dessert), and eventually I did get some tea.
Once the spinal had completely worn off, I had quite a lot of pain, but it was bearable and I managed to get to the lavatory using my crutches but taking some weight on the ankle. In order to check my fluid throughput, I had to pee in one of those weird papier-machť urinal bottles and leave it in the washbasin to be collected. I even dozed on and off until the late drinks trolley arrived at about 9:30pm. I had to ask if there were any biscuits, and got a packet of Highland Shortcakes. Then my two bay-mates asked if there were any sandwiches. There were, and I decided I couldnít lie there watching them eat theirs without having one myself. I got an egg mayonnaise butty - not much egg on very thick brown bread, but I managed to eat and enjoy this - and the buscuits - with another cuppa.
As always in hospital, it was a long and disturbed night. I had had some pain-killers when the spinal was wearing off, but by 3am I was really suffering. Iíd had my full daily ration of paracetamol, so I was offered morphine or codeine. If youíve read the story of the knee youíll understand why I decided to grin and bear the pain. I eventually found the most comfortable position, on my stomach with the poorly leg cocked to the side and supported on a spare pillow, and to my amazement I woke again at 6am with only a mild nagging ache. I managed to walk to the bathroom fairly easily, with only light support from the crutches.
I eventually escaped at about 9:30am, having borrowed a ward phone to call Patricia at around 9am. The plan was to walk, carrying my overnight bag, the quarter-mile or so to the nice little coffee-bar where weíd had lunch before the pre-op assessment, so I could have a leisurely drink and a sticky bun while awating her arrival. So protracted were the final bureaucratic obstacles to my escape, however, involving finding the junior doctor to complete my íE-dischargeí document, being excused the passage of the physio barrier and finally having my refusal of pain-killers accepted, that I almost ran out of time. It took me quite a while to find the optimum way of moving myself, my heavy bag and two crutches all the way to the coffee-bar (with hindsight, probably a pretty stupid thing to do) - only to see our car pulling up outside the door as I arrived!
Not to worry. I was free. My ankle was back in business. And I knew that the coffee at home would be much better!
Been home now for about five hours. The pain and fatigue from the long walk at the hospital have faded and the ankle feels strong - though the heavy dressing is restricting movement somewhat. After nearly six weeks of quite serious impairment, I am walking around the house confidently without crutches - though I will use them, at least as a backup, when outdoors.
My heartfelt thanks to Stephen Milner and his brilliant team for putting me back together again!
Monday 23 May 2011
On Friday, after less than 24 hours at home, I felt comfortable enough to be driven to our newly-opened Asda store. I walked, carrying one crutch íjust in caseí, as advised my Mr Milner, into the shop and then stowed the crutch in the trolley, which I wheeled up and down every aisle and then back to the car - some discomfort when I had to stop it running sideways down a sloping pavement, but no other problems. I unloaded it, parked it and got back to the car unaided.
Since then, I have been pretty well fully mobile - even both up and down our spiral staircase. On Saturday I was on my feet without crutches more-or-less all day, preparing and serving food for a family group while Patricia entertained the grandchildren (definitely the more exhausting option!). I walked up to the local shop for the Sunday papers yesterday, carrying but not using one crutch, and did the same for two four-pint bottles of milk this morning. Iíve just made two batches of sourdough bread and am about to go and carry our heavy Sebo vacuum-cleaner down the spiral stairs.
Any pain resulting from awkward movements subsides quite quickly, and Iím not really hampered at all now. I was advised not to try driving for a couple of weeks, but only in case a sudden twinge made me take my foot off the brake in an emergency stop.
So all seems well. I get my dressing changed and the wound checked at the GP practice on Thursday (I presume the nurse will know about follow-ups), and I donít go back to the hospital until the 27 June.
Wednesday 25 May 2011
This morning I had my first visit to Worksop market since the ankle failed. I managed to walk, carrying but not using one crutch, the whole length of the town centre, about 800 metres, and then back carrying increasingly heavy shopping bags. After depositing these in the car I then went back to the top of the market for another heavy bag of fruit and veg - probably another 400 metres, making about a mile and a half in total. The ankle was rather sore by the time I got home, but by the evening it felt fine - better, in fact, than at any time since the joint failed. It now has a ítighterí feel, as if the tendons and ligaments have settled down and adjusted.
12:40pm Iíve just had my wound examined and the dressing changed. There was no visible swelling of the ankle (in spite of intermittent moderate pain after walking), no inflammation of the wound (quite a bit shorter than the original one) and no visible stitches (presumably there are some internal ones, but they will dissolve without help). I now have a much lighter bandage on, and the nurse told me I could take this off in a few days and leave everything uncovered. It will be nice to have a proper shower, without the íelephantís condomí I bought to protect the casts on my knee two years ago. So everything is looking good...
Tuesday 31 May 2011
The light bandage put on by the nurse got a bit messed up putting on my sock on Saturday, but I didnít have time to do anything about it. After a hectic day at our grandsonís fourth birthday party the ankle was rather painful.
I took the bandage off in the evening and everything looked fine, so I left it off over night and the pain had subsided by morining. Then Ifinally had an íunprotected showerí - bliss. There were a few tiny beads of scab along the line of the incision so I decided to err on the side of caution: I folded a gauze swab into three and fixed it over the incision with several bits of Micropore plaster. This is still on, and Iíve been pretty pain-free a lot of the time, though there have been uncomfortable spells. Ever since the implant failed, the worst pain has been at the bottom of the tibia on the inside of the ankle, and thatís still the dodgiest area. Having said that, Iíve been on my feet most of the faternoon, wandering around spot-weeding the lawn and our various paths and gravel patches, and then checking and correcting the tyre pressures on the car (though I used a vompressor rather than the usual foot pump!), without any real discomfort.
The next milestone will be trying to drive the car tomorrow, two weeks after the operation. I did a quick and careful test on the brake pedal on Saturday and it seemed okay, so Iím optimistic that life may be about to return to normal...
Monday 6 June 2011
Last Wednesday, exactly two weeks after the repair operation, after another brake-pedal test, I drove the car for the first time: a 20-mile round trip, with Patricia ready to take over at any time. My right leg felt a bit odd for the first few miles, but then the nerves and muscles slipped back into what theyíd been doing since January 1960, and the whole trip went without problems. On Thursday I did another longish run with Patricia. On Friday I was driven to a funeral by a friend, wearing hard shoes I havenít worn for over five years, and had a long walk through a tussocky chuchyard to the villasge cemetery. Then on Saturday I was ílet out by myselfí in the car - only up to the village Co-op, but the feeling of freedom was wonderful!
After quite a busy weekend, spending many hours on my feet - including manhandling our heavy motor-mower round the lawn and barbecuing for ten people - I decided to try a walk this morning. I wore my lightweight boots as a precaution, and decided to do just 30 minutes, regardless of distance. The ankle produced a few twinges, but I had no difficulty doing about 2Ĺ kilometres in 29 minutes (I do nearer 3 in 30 minutes when Iím in training). Now, after changing the bed and having a shower, the ankle feels fine.
Tuesday 7 June 2011
This morning, just a day short of three weeks since surgery, I went for another walk, doing over 2Ĺ kilometres in 31Ĺ minutes, this time in my favourite trainers. After breakfast I felt well enough to drag two huge bags of garden refuse (the ones they deliver sand and gravel in), manhandle them into the back of the car, drive to the tip and empty them into the green-waste skip (the heavier one with a helping hand from a kind fellow ídumperí. Back home, I felt fine - well enough to wheel out the vacuum-cleaner and clean the car boot!
The ankle isnít totally pain-free, but then neither are the other ankle, both knees, my thumbs and my right shoulder! However, it does feel strong now - and if this is as good as it gets, and the repaired implant lasts me at least another five years, Iíll be more than satisfied.
Wednesday 15 June 2011
I managed my five walks last week without problems, and have so far done three of this weekís. I have stuck to my regular route, turning back when I reach the gate which, at my best, I get to in 15 minutes and back from in 30. So far I havenít got back down to that ínormalí time, but I got back in just under 33 minutes yesterday after two daysí rest.
I have spent large parts of yesterday and today clambering around decorating our long, narrow sittingoom: todayís work was mostly on our infuriating spiral staircase, which involved painting in some seriously weird positions - with no complaints from the ankle, which still isnít completely pain-free but has been better than the ígoodí one this week!
Tuesday 5 July 2011
I?m a bit embarrassed that I haven't updated this page for three weeks, because when I saw Claire at the hospital yesterday she told me that Mr Milner knew I was OK because he?d been reading my ?blog?! So here?s the update...
By the end of last week I?d done four full five-day weeks of walks. The last one last week was back to the full 4 kilometres, taking just over 45 minutes and extending from smooth tarmac onto stony farm tracks. I had no trouble from The Ankle, but after Friday?s walk something was amiss with the other foot! I was having quite a lot of pain, but it was intermittent and moved around the foot, which was reassuring because it suggested that there was no serious localised injury. Still, I decided not to walk yesterday and haven?t done so today, though I did mow the lawn on Sunday).
The serious ankle, once it recovered from decorating, has been pretty well pain-free for a week or more and feels really strong and mobile. After Claire had had a quick look and a brief word with Mr Milner, it was decided that I didn?t need an x-ray (a great relief as the clinic was running very late and we wanted to avoid the Derby rush-hour) and that I?d go back to the old routine of annual reviews beginning in March 2012.
Brilliant! All I have to do now is keep the other
Update Autumn 2014
The ankle - rather than the implant - failed rather
dramatically at the end of the Summer. I'm maintaining a
diary of events following this disappointing development
as a document rather than on this web page. You can keep
up with the story here.
Personal site for Paul Marsden: frustrated writer; experimental cook and all-round foodie; amateur wine-importer; former copywriter and press-officer; former teacher, teacher-trainer, educational software developer and documenter; still a professional web-developer but mostly retired.
This site was transferred in June 2005 to the Sites4Doctors Site Management System, and has been developed and maintained there ever since.