My health story: total ankle replacement

03 January 2019

This little-known operation helped me go from being dependent on sticks for mobility to walking miles unaided, writes Chris Brierley.



In December 2015, the brilliant, yet modest and self-effacing surgeon Mr Rajeev Suneja replaced my left ankle joint with finely engineered pieces of metal and plastic. Then he repeated the process on my right ankle in July 2017.

The results have completely transformed the quality of my life. For years I could barely hobble 50 yards without the aid of sticks and in considerable pain and discomfort. Now I can walk for miles, unaided and pain free, ride my road bike much further and even manage the odd round of golf.

All this was done free by our wonderful NHS.

So how did a 60-year-old man get to the point where he needed such precise and intricate surgery to help him walk down the street?

Osteoarthritis affects everyone at some stage. It’s all part of the ageing process. Because of genetics some people are affected more than others. I’m one of those.

I speeded up the decline by being fanatical about sport. As a teenager I was obsessed with playing football, never gave injuries a chance to heal and kept playing well into my fifth decade, ignoring the aches and pains. Add to that squash, marathons and fell running, and you get the picture. My cartilages just didn’t have a chance.

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So in my mid-forties my joints started to seize up. I soldiered on, but had to have my left hip replaced at 53, and in the following years my ankles continued to decline. The lower halves of my legs looked like gnarled old tree trunks at this stage. I could manage the pain, but the disability meant that I could hardly walk in a straight line.

The first surgeon I saw told me my ankles were shot and that he could fuse the joints together to take away the pain.

That’s when I discovered Mr Suneja. Using a football analogy, he told me that there were lots of bones that enable your foot to move, but if you take away the ankle joint it’s ‘like losing your best midfield player: the whole team suffers’.

I was booked in at the Oaklands, a private hospital used extensively by Salford Royal NHS for orthopaedic assessments and surgery.

The spinal anaesthetic involves an injection in your back. Then it feels like warm water running down your legs. And then you don’t feel your legs at all.

I was also given a sedative during surgery, which lasted about two hours, and woke up with a crepe bandage around my foot and up my calf. The surgeon told me my ankle was as bad as any he had seen and that it was a difficult operation because of the ‘unique’ shape of my tibia, but he was happy with the results.

The op was not nearly as painful as I thought it would be. After 24 hours I was reasonably comfortable and I moved my new ankle very carefully straight away.

I had to wear a surgical boot when moving around with crutches for the next six weeks. I could take the orthopaedic boot off when sitting down or in bed. Sleep was manageable, lying flat on my back with my foot propped between pillows.

I needed plenty of TLC and couldn’t have managed without the constant help of my wife.

Physio sessions started straight away and I also used an exercise bike, building up slowly from just a few minutes to half an hour a day.

After the boot came off, I was confident going for short walks with crutches and then, after 10 to 12 weeks, gradually riding my road bike; just short distances at first, but building up week by week.

As soon as the wounds were fully healed I was in the swimming pool.

It was an easy decision to have the other ankle operated on, but this was delayed because the same make of prosthesis wasn’t available. So eventually I went ahead with a different one. If the first choice is ‘like a Mercedes’, said Mr Suneja, ‘the second is like an Audi’.

Staying active and keeping my weight under control was a key factor in what I feel was a speedy rehabilitation on both occasions.

I have watched simulations of this operation online and continue to be amazed at the detail, intricacy and engineering of the prosthesis, and the professionalism and technical skills of the medical staff.

I could have been heading for a wheelchair, but so far the only wheels I’ve been turning are of the cycling variety. I have been warned not to overdo it, but sometimes it’s hard to hold back.

I did not rush into writing this article because I wanted to make sure that the surgery was completely successful, and X-rays have shown that the joints are bearing up well.

Every time I walk with my grandkids around the park or clip in to my pedals on the bike, I have to pinch myself. I think, ‘Am I really doing this?’

Then I say, ‘Thank you, Mr Suneja; thank you NHS,’ and just get on with it.

Need to know

Ten million people in the UK suffer from osteoarthritis, when the cartilage between the bones in our joints wears away.

Out of 30,000 cases of ankle osteoarthritis seen every year in the UK, only 1,200 undergo TAR.

Ankle fusion – when the joint is screwed together – is more common than TAR, but the latter maintains flexibility.

TAR involves prising open the joint and fitting a template lined up with the knee, which enables the surgeon to make precision cuts to the tibia (leg bone) and talus (ankle). Pieces of metal are screwed to the bones, with plastic in between to take the place of the cartilage.

The wound is about six inches long and bleeds a lot. The incision cuts through nerves in the foot and this leads to slight numbness during the recovery process and beyond.



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