How is the Surgery Performed?

The operation you have depends on which joints are causing you pain. If a joint is worn out through wear and tear or inflammatory arthritis, we normally give you an injection of local anaesthetic into the joint as an initial procedure. If this relieves pain, then we can be sure that the joint we are addressing is the cause of your pain.

As rubbing of bone on bone causes the pain, the aim of surgery is to prevent any further movement. This is achieved by joining two adjacent bones together to form one solid bone.

Alternatively, in the ankle joint, an artificial joint can be inserted that allows movement and relieves pain. However, strict criteria exist to determine who can have an ankle replacement. An ankle replacement that goes wrong through infection or loosening can result in a worse problem than the initial pain. If the ankle is already not moving, then the artificial ankle will not allow a useful range of movement after surgery, and would not be worthwhile. For patients not fitting the criteria, fusion surgery is the best option.

Through an incision, the joint is cleared of any remaining cartilage and then prepared to give it a chance of healing to the adjacent bone. Sometimes, we add honeycomb bone taken from inside the shin bone to stimulate the healing process.

The bones are fixed together with screws or special staples, both of which compress the raw surfaces together to give the maximum chance of success.

Surgery is carried out under general anaesthetic, but can be augmented with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home 48 hours later, as long as the pain is controlled and you are mobile with crutches.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

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