Ankle Arthroscopy

What is an Ankle Arthroscopy?

An arthroscope is a fiberoptic pencil sized instrument that can be inserted through small stab incisions into the ankle joint. It is fitted with a camera and a lighting system and allows the surgeon to look into the ankle joint. The images are projected onto a screen for viewing. During an ankle arthroscopy, normally two and sometimes three small stab incisions will be made. One of these incisions (also called ‘portals’) will be used to insert the arthroscope into the joint and the other portal will be used to insert various special instruments such as probes, forceps and shavers. These instruments are used to clean the joint area of scar tissue, inflamed tissue that lines the joint, and bony outgrowths (spurs). An ankle arthroscopy is performed for several indications such as:

• Diagnostic arthroscopy
• Arthroscopic cheilectomy – shaving of bony spur
• Arthroscopic ankle fusion
• OCD lesions ( joint surface lesions which need cleaning out)
• Debridement ( cleaning out the joint surfaces or removing inflammed/scar tissue)

Type of procedure

This is a day case procedure and same day discharge is usual.

Type of anaesthesia

The operation will be undertaken under a light general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

This depends on the type of procedure being carried out.Usually 30 minutes to 60 minutes

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with minimal risks of:

Infection

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is extremely rare. Overall risk is 1%.

Numbness:

There may be accidental damage to a small branch of the nerve which supplies sensation to the top of the foot. This may result in numbness or pins and needles. Risk is  approximately 5%

Recovery from surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot. The physiotherapists will make sure that you are safe on your feet before discharge. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 – 7

Ensure that you keep your foot elevated on pillows to help reduce swelling.

Foot wrapped in bulky bandage

Allowed to walk in a stiff sole shoe.

Ice, elevate, take pain medication

Expect numbness in foot 12-24 hours then moderate pain

Do not change bandage.

Day 14

You will have a follow up visit in clinic.

Your wound will be inspected. You will have non absorbable sutures so they will need to be removed.

You can walk normally in your own shoes by this time.

6 weeks

Final follow up clinic visit prior to discharge.

If you are having a fusion then further follow up may be necessary.

When are the post operative clinic visit schedule

2 weeks after surgery – wound check and advice regarding basic hygiene

6 weeks after surgery – final follow up clinical exam and discharge

When can I begin to walk?

This varies depending on the type of operation performed. You can discuss this with your surgeon in clinic prior to the surgery.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is within 2 weeks after surgery.

What advantages does arthroscopic surgery offer?

The main advantage is that it is performed through very small incisions. Therefore the amount of tissue damage is minimal and the recovery period can be expected to be quicker compared to traditional open surgery.

Return to work and rehabilitation can be expected to be faster.

However a note of caution, certain procedures may require the same amount of time non weight bearing particularly a fusion of the ankle whether it is done open or arthroscopically.

What are the disadvantages of arthroscopic surgery?

In some instances it may be impossible to access parts of the ankle joint arthroscopically. In these circumstances your surgeon may have to opt to revert to open surgery.