Ankle replacement or ankle fusion ?

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This spring, pre surgery.

By Lorraine Dusky

An x-ray confirmed what I knew: I needed surgery. I found my way to Dr. John Yu in Riverhead, N.Y. Earlier in the summer I had a cortisone shot in my ankle, but if it alleviated the pain and made walking easier, I barely noticed. When friends from out of town visited, I did not go sight-seeing in Manhattan with them. That would have been too much walking for me, even with a cane–and I’d used one the time before I was in the city. Getting another cortisone shot seemed pointless. I had been taking various over-the-counter meds for years. I had moved on from plain old glucosamine and chondrotin to Schiff Move Free Ultra, with the mysterious ingredients of “cartilage blend” (potassium chloride and cartilage), boron  and hyaluronic acid. But while it may have alleviated my discomfort a long time ago–that was then, this is now. 

Dr. Yu, who appears to be in his forties, said I am a good candidate for an ankle replacement, rather than a bone fusion since  1) the bone had not deteriorated past the point where an ankle replacement would be possible; and 2) I did not smoke; nor 3) was I over-weight.

He made an ankle replacement sound like a good thing–in contrast to a more complicated bone fusion, which took longer to heal and resulted in less flexibility of the joint–or none at all. He made the replacement sound so much better that I was buoyed by the thought of one. It would be complicated, it would be major surgery, but the pain would end. Not that I had constant throbbing pain; I didn’t; it was just hard to walk. And my ankle was swollen to the size of a grapefruit. Ugh.

Running through my mind is that I should get a second opinion–isn’t that what we are always supposed to do?–so I ask for a CD of my x-ray and pay the $10 feel. Yet on the way out, I stop his nurse and simply asked: Is Dr. Yu a good surgeon?

BONE ON BONE

She was so enthusiastic in her response that I believe her, and after checking Dr. Yu out on the Internet, I decide he’s my guy. I knew enough about arthritis to know that there is no magic cure and that once the cartilage is gone, nothing (yet) replaces it. Dr. Yu had already told me that all my cartilage is worn out, and that I am walking around “bone on bone.” I would only be getting a second opinion to see if I liked the other doctor better, and I liked Dr. Yu plenty. Plus, he would be able to perform the surgery relatively near my home, and not in Manhattan, a hundred miles from home near the end of Long Island, and that would create more and expensive difficulties–as in, staying in Manhattan the night before, would my husband stay in the city for a couple of days while I was in the hospital so I wouldn’t be without visitors?

Everyone I tell about my upcoming surgery acts as if an ankle replacement is rather novel and experimental. Like a robot, I say what I’ve read: that there have been about 25,000 done of them in the U. S. and more in Europe. That Julie Andrews had one and she’s been seen walking around! (This I know because I live not far from her daughter, and well, word gets around.) One of my friends asks: If you have the surgery, will you be able to sing like her?

I take the first date available, early in August, about a month away,  Dr. Yu wants me to start physical therapy immediately because any muscles I build up now will help later; when I am in the bed rest phase, there will be more muscle means I will have more left when I am ready to begin walking. Off I go. The therapist is enthusiastic about the ankle replacement rather than the fusion–she’s seen both, though more of the ankle replacements. I am getting quite excited about the surgery and looking forward to having it be over. So happy to be having the ankle replacement am I!

NOT SO FAST

But through Facebook I get in touch with someone who had both a partial fusion and partial replacement (on the same ankle), and things did not go that well. He was still in pain. Recovery was a bitch. Another doctor who looked at his “after” x-ray told him that possibly the replacement part was too large for his body. The fusion was not healing as fast as it normally did. His doctor had done more than a hundred such operations; Dr. Yu, when I asked, told me that he had done 40 replacements and I would be the 41st. He added that he had never had to go back in and “fix” the problem, which means repeat surgery.

However…now he tells me that in looking over my x-ray carefully, he was not so sure I was a candidate for a replacement as my bones have deteriorated past the point where a replacement will work. Dear Reader, I was crushed. After convincing myself that an ankle replacement was so desirable, the news that I might not be able to get one was well, really disappointing. He wants me to schedule an MRI so he can get a better understanding of the bone structure.

Tip: When choosing the music to listen to, pick something with a loud sound and a heavy beat. I picked Billie Holiday, whom I hadn’t listened to in a while, but it was way too muted a sound. Go for big noise, strong beat. The pinging is, as anyone who’s ever had an MRI knows, LOUD.

Surgery will be at John Mather Memorial Hospital in Port Jefferson on August 8. The usual tests are scheduled: a blood workup, an EKG, a dental clearance, more x-rays. I decide not to find out if the MRI indicated I could not have the ankle replacement but needed the fusion instead. I didn’t want to hear one thing and wake up finding out another. Dr. Yu might have a change of heart once he saw my ankle. At the hospital I meet with a pre-surgery nurse who tells me to stop taking the arthritis meds I am taking as well as most of the various vitamins and minerals I take on a daily basis, as they thin the blood and make clotting more difficult. I am most especially to stop taking aspirin for that reason.

Tip: However, I added to my daily regimen arnica, purchased from my local vitamin/health food emporium, as another doctor who did surgery on me had suggested I take pre-surgery for two weeks. Arnica, a homeopathic med, helps reduce swelling and pain. It comes as very small pills to be put under the tongue; I took three pills twice a day for about 10 days pre-surgery.

Dr. Yu warned that I would be serious pain for a couple of weeks and was dubious when I say that other doctors have said I have a “high pain tolerance,” that is, I exhibit conditions that other patients associate with a lot of pain, when I report little to none. I will need total bed rest for a couple of weeks. I really won’t be putting any pressure at all on my foot for about a month, maybe up to five or six weeks. Crutches, here we come.

A good friend died, I wrote his obituary for the local paper, I spoke at his memorial service (standing) a few days before the surgery. My ankle hurt. I was limping around, I want to get off my feet, I can’t wait until Friday, The Day of Surgery.

Next: Ankle Replacement Surgery

Previous Post: Dairy of an Ankle Replacement: Deciding to go ahead

 

 

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