Joel D. Stewart, MD
You and your orthopaedic surgeon have made the decision that TAA (total ankle arthroplasty) is the right treatment decision for you. Curious about what is going to happen at the hospital and in the operating room? I’m going to pull back the curtain and give you an insider’s view of what will occur the day of your surgery.
You will report to the hospital at the time given you by your surgical scheduler, and check in as either same day or inpatient, depending upon your health and what you, I and your other doctors feel is in your best interest regarding recovery. You will be required to wear a mask, have your temperature checked immediately upon entering the hospital, and you may or may not be allowed a companion to accompany you into the pre-op holding area, all due to COVID-19.
Once you have been taken to the Pre-op area, you will be asked to cleanse yourself with warmed disinfectant wipes and nose swabs. Then you will put on a hospital gown and get into the transport bed. A nurse will come to visit, ask you lots of questions about who you are and the procedure you are having. This is done for your safety, so be patient if the questions seem redundant. An IV line will be started, and you will be given pre-surgical antibiotics. You will also be hooked up to an EKG and pulse oximeter to measure your heart rate and oxygen levels.
Your anesthesiologist will come to visit you and ask you more questions about any negative experiences you’ve had with anesthesia, if you have dentures or gastric reflux. All of these are important to ensure your safety while under anesthesia. Often for a large surgery like TAA, they will offer you a nerve block. A nerve block can reduce the amount of pain you have after the surgery, and reduce the amount of pain medication you will need after the surgery, but it has some risks. The anesthesiologist will explain this and as a team, we will choose the option right for you.
As your surgeon, I will also check in with you before surgery to provide reassurance, talk about what to expect and to answer any last-minute questions you may have. Often the day of surgery can be stressful, don’t be afraid to write down any last-minute questions you or your family have so they can be answered.
A few minutes before you are wheeled into the operating room, a member of the anesthesia team will administer a relaxant medication into your IV that will make you feel sleepy and ease any nervousness you may feel. Some folks fall asleep at this point and others stay awake and remember being wheeled into the OR and being moved from the transport bed to the operating room table. You will then be draped and prepared for surgery by the OR surgical team. Soon, your anesthesiologist will put you under sedation and protect your airway with a tube or mask, so that the ventilator can keep your breathing controlled while you are asleep during surgery. For some patients we use a spinal or epidural, but they can make you sleepy so you don’t have to listen to the surgery. After your anesthesia sets up we can start your surgery. We do a “time out” to make sure we have everything we need, review your allergies, and the correct ankle to be replaced before we start operating.
The ankle joint is the intersection of the three bones, the tibia and the fibula, that run from your knee to your ankle, to the talus, the connecting bone in the foot. As these bones are often rough and covered with osteophytes (bone spurs), we cut and shape these bones to prepare them for the placement of the implant. The implant is made from titanium and other metal alloys with spikes and pegs to attach to the bone and a gliding surface that is made out of a polyethylene (plastic) that allows the artificial joint to move smoothly. These prostheses are created to replicate the natural movement and function of the ankle joint. They are specially created with a type of porous surface which allows your bone to grow into the implant itself, firmly securing it in place.
Ankle replacement surgery can be relatively simple or extremely complex, depending upon the surgical approach used, the type of prosthesis needed and any additional musculoskeletal issues that must be corrected. I may need to reconstruct a ligament, lengthen a tendon, or cut the heel bone and reattach it so that it better aligns with your ankle and leg to make walking easier. Ankle replacement surgery can take anywhere from 2-4+ hours, depending on the factors given above.
Once the surgery is complete, your incision is closed with sutures and a sterile dressing and bandage is placed over it for protection. I then apply something called a Bulky Jones Dressing, which is composed of cotton padding and plaster, kind of like a cast, covered with an Ace bandage. After your surgery is complete, I’ll phone your spouse or companion to let them know how your surgery went.
You’ll then be taken to the PACU (post-anesthesia recovery unit) to fully awaken from surgery, while your vital signs are closely monitored. Once you are awake and aware, you will be given something to drink and perhaps some crackers to eat. Most patients will experience a bit of a sore throat after being intubated (for placement on a ventilator) and a cool drink is usually greatly appreciated at this point.
Pain management after an ankle replacement surgery is very important. Most patients receive a nerve block so that your foot and ankle will be numb for 12-18 hours post surgically. We also inject medications around your ankle to reduce bleeding, pain and infection. You may have pain in your thigh if I have to use a tourniquet to minimize blood loss during surgery. You’ll also receive IV and oral pain medications if you need them and more antibiotics while in the hospital. Once your pain is adequately controlled, you can be released from the hospital to recover at home or you’ll be transferred to your inpatient room to spend the night under the watchful eye of the orthopaedic floor nursing staff. You’ll be given detailed written instructions before leaving the hospital and your responsible person will be updated on these before you are discharged to go home.
Make an appointment with Dr. Stewart or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.