Hyperlife Medical Centre

010 020 5050 | 80 Van Bergen St,
Brackenhurst, Alberton

Morningside Mediclinic

011 883 1719 | Rivonia Rd, Hill Rd,
Sandton, 2057

ANKLE ALLOGRAFT REPLACEMENT

ANKLE ALLOGRAFT REPLACEMENT

ANKLE ALLOGRAFT REPLACEMENT

What is it?

In an ankle allograft replacement, an entirely new joint surface (made of bone and cartilage from a fresh cadaver) is implanted instead of replacing the ankle joint with a replacement made of metal and plastic. This procedure offers a unique alternative to the management of ankle arthiritis without “burning any bridges”. It is a new procedure that requires much shorter follw-up. It also requires a very specialized team of ankle reconstructive surgeons as well as a good working one bank to provide the donor graft required for implantation. The advantage of this type of procedure is the potential for replacement of the entire ankle joint with viable living cartilage cells. In the cases performed thus far there does not appear to be any immune response or rejection of the implanted material. It is, however, still much too early to know whether this treatment is going to be a viable alternative to total ankle replacement as described above.

General Recovery Facts

⦁ You will not be walking on the leg for about 2 days
⦁ The surgery is obviously painful and although you are allowed to put weights on the foot as soon as you tolerate it, this is initially difficult.
⦁ You will therefore be using crutches, a walker, a wheelchair or a scooter device called roll-about during the first few weeks of your recovery until you are able to put full weight on the foot.
⦁ There will be a large bandage applied to the leg for 2 days.
⦁ Your first follow up visit with wound sister will be at approximately 2 days to change the bandages.
⦁ Once the bandage is changed you will now use a removable boot.
⦁ There are no stitches that are used that need to be removed. We only use dissolving stitches.
⦁ If the surgery is on your left ankle, you should be able to drive an automatic vehicle at two weeks. If the surgery is on the right ankle, you may drive at about 4 weeks, but this varies from patient to patient. If you want to drive sooner, you may buy a “left foot accelerator”. This is easy to purchase, and you can buy this on line and take it to your garage where they are able to add it to the pedals quite easily.
⦁ You will be wearing the boot for approximately 4-6 weeks following the surgery.
⦁ Please wear the boot at night. It keeps the ankle in a good position and prevents the Achilles tendon in the back of your leg from getting tight. If this gets tight you will lose motion in the ankle.
⦁ There is a scarring of the big toe tendon that will occasionally develop at around 2-3 weeks. If this happens you will note that you are not able to bend the big toe downwards well. This is very important and if the big toe gets still, you must let Dr. Myerson know since it can be easily treated. See below for the exercises to the big toe that need to be done.

⦁ Exercises and range of movement of the ankle and big toe are started at about 2 weeks after surgery.
⦁ Exercise may depend on how quickly the skin incision heals. If there is any inflammation of the skin, we may want you to hold off on the stretching exercises of the ankle to give the skin a chance to heal.
⦁ If you have access to a swimming pool, we encourage you to use this as soon as the incisions are completely dry and healed, which will be at about 3 weeks. Swimming will significantly improve your recovery and allow you to begin bearing weight on the leg in the pool. The best way to regain movement is to put fins or flippers on to the foot and move the ankle up and down in the water.

You may drive by about 3 weeks if it is your left foot that has been operated on and you drive an automatic transmission vehicle. If you have surgery on the right foot it is not easy nor safe to drive with the boot and you may need to make alternative plans to drive for 6 weeks plus……

⦁ You may begin to walk without the boot at about 8 weeks, depending upon your level of discomfort and instructions given to you by Dr. Nunes. There may be certain circumstances where because of additional surgery to the foot and ankle we limit the time out of the boot
⦁ Physical therapy is very important and begins at 5 weeks.
⦁ We have a specific protocol for your physical therapist and please make sure that we give you this outline.
⦁ You should plan to use a physical therapist for about 2 months.
⦁ There will be moderate swelling of the ankle and leg for about 6 months.
⦁ It is helpful to use a compression stocking to help reduce the swelling. You can also ask your therapist about the use of a compression bandage called “Coban” which you can purchase at the pharmacy. The same bandage can be bought at any pet store and is called “vet wrap”.
⦁ You should plan to ride a stationary bicycle and use machines to help regain your strength and movement.
⦁ You will continue to improve your strength and movement for about 9 months.

For many individuals, a return to an active lifestyle is our goal following this surgery. For some, this may mean the ability to walk without pain, and for others, a more regular exercise routine may be more important. Regular exercise in a gym is always to be encouraged, and the use of all machines including a stationary bicycle, treadmill, stair climber, and elliptical machines are excellent to regain strength and movement of the ankle. It is not recommended that you run. You may however engage in golf, prolonged hiking or walking, doubles tennis and bicycling, and skiing. As noted above, swimming and cycling are excellent and will help regain the movement in the ankle.

Before & After Pics

Specific post-operative recovery

⦁ Foot is wrapped in bulky bandage and splint.
⦁ Elevate the leg and take pain medication regularly.
⦁ Expect numbness in foot 12-24 hours then moderate to severe pain.
⦁ Bloody drainage through bandage is to be expected.
⦁ Use crutches, walker, wheelchair or a roll-a-bout for the first few days.
⦁ Do not change dressing/splint and do not get the leg wet.

⦁ X-rays are taken and the dressing is changed.
⦁ A below knee cast is applied.
⦁ This remains in place for 4 weeks.

⦁ Cast is removed and removable boot is applied.
⦁ Physio is commenced.
⦁ Start ankle motion out of the boot as instructed. You will usually be asked to do lunging exercises with the replaced ankle in front to improve the range of motion of the ankle. Hold on to a support while doing these exercises. While you are allowed to put full weight on the ankle, it is painful at the beginning. These exercises should be done for five minutes five times daily.
⦁ Start exercises for motion of the big toe. It is common for the big toe to lose downward movement due to scarring around the ankle and you should gently manipulate the big toe downwards three times a day to ensure it does not become stiff. Occasionally if the big toe is stuck and cannot bend down, you must let us know so that Dr. Nunes can manipulate it for you in the office.

⦁ You can shower after boot is removed, provided the incision is clean and dry. Please do not stand barefoot in the shower. Use a stool or bench. You may get the ankle wet and clean it with soapy water. Following showering, apply antibiotic ointment to the incision.
⦁ As soon as you are comfortable you must begin lunging exercises of the ankle. This is very important. It is obviously difficult to do at first because of pain. When you lunge forward the knee must extend in front of the ankle.

⦁ You need to apply a dry micropore dressing to the ankle for two weeks with Bactroban ointment. After this it is not necessary to have any dressing on the ankle unless there are problems with the incision.
⦁ Start in a swimming pool using a flipper to help movement of the ankle once the incision is completely healed and dry. This is usually at 3 weeks. You can bear weight on the leg and ankle in the pool if there is no discomfort or pain.
⦁ At 4 weeks use a stationary bike, but with little pressure and resistance on the ankle.

⦁ Full weight bearing is usually started in a shoe. You should plan to walk as long for as long as you want as long as there is no pain in the ankle.
⦁ You will be given a prescription to start physical therapy at 4 weeks, and by 6 weeks should start walking out of the boot if comfortable.
⦁ Attend physical therapy usually twice weekly for about 6-8 weeks, and increase activity according to instructions from Dr. Nunes.