Ankle fusion vs total ankle replacement?

Hope this helps. I am 63 years old. I would say I’m in good shape for my age. And still climb pretty hard,. I’ve been climbing my whole life and a year ago started having pain in my ankle within the last five months. It’s got to the point where I can’t hike to climbing spots, I struggle, even in the climbing gym doing more than four or five climbs before my ankle is so swollen that I can’t get a shoe on and the pain Isn’t good. I made the choice to see a doctor and and they found pretty significant arthritis. I decided after conversation to go with an ankle replacement due to all of the new technology within the last year. My surgeon has insured me that I will be climbing again it’s something I love doing and can see myself doing with my friends for the next several years. I am in my fifth day of healing after surgery. I will post updates of how this has gone for me.

@Billy Orum - what TAR did you get? Also, please do post updates. I am following this thread. With discomfort I can walk dogs, walk uphill, bike and gym climb, but cannot walk downhill. Always have a twinge on every step, but not debilitating. I am bone on bone and arthritis so tight they cannot even get a needle in the joint. Hoping for a natural fusion:)

Cam, best of luck on your surgery.  Please share how it goes, if you don't mind.  

I haven't made any decisions yet.  After I got the second opinion in June, I got a steroid injection and it was like magic.  My pain has been significantly reduced.  I can walk much better and can be on my feet for longer period of time and still be able to stand up to get to bed later.  I've been able to do more in PT also.  Still limited ROM, but some improvement.  I had the injection July 22 and so far it seems to still be working.  I can get 3 per year.  I'm hoping the injections will allow me to delay surgery for a while.  I caught a pretty large whipper over the weekend and got pulled up.  My feet impacted the wall pretty hard, and that was painful.  It felt like a spike going through my ankle.  It was pretty achy yesterday, but better today.  I'm hoping to enjoy a good ski season before I have to think about surgery again.  

Lisa Frinziwrote:

Cam, best of luck on your surgery.  Please share how it goes, if you don't mind.  

I haven't made any decisions yet.  After I got the second opinion in June, I got a steroid injection and it was like magic.  My pain has been significantly reduced.  I can walk much better and can be on my feet for longer period of time and still be able to stand up to get to bed later.  I've been able to do more in PT also.  Still limited ROM, but some improvement.  I had the injection July 22 and so far it seems to still be working.  I can get 3 per year.  I'm hoping the injections will allow me to delay surgery for a while.  I caught a pretty large whipper over the weekend and got pulled up.  My feet impacted the wall pretty hard, and that was painful.  It felt like a spike going through my ankle.  It was pretty achy yesterday, but better today.  I'm hoping to enjoy a good ski season before I have to think about surgery again.  

I'll plan on sharing my experience with my ankle replacement. I had my pre-op checkin this morning and my surgery is scheduled in one week (Monday, Nov. 25th). I'm definitely nervous about the procedure but I feel a fairly confident that I'm making the right decision. Here is a link to the ankle replacement I'll be receiving if anyone is interested.

https://paragon28.com/products/apex-3d-tar/

On another interesting note... I'm in the process of finishing nursing school and I've been in the operating room as part of my clinical time. I'll likely be assisting with an ankle replacement this Thursday as part of my RN clinical experience. 

I had my total ankle replacement surgery this morning and I’m back home recovering. I thought I’d share for those interested.  

Pre op and current view of my right ankle. The climbing shoes provide a reference point for my pre op ankle.

Thanks Cam, my bad ankle looks the same in my climbing shoe. Wishing you a speedy return and I'll be following your posts.

I had my surgery splint removed two days ago and a cast put on. After my splint was removed, my surgeon flexed my ankle up and down without pain in my joint and I had more ROM than I did before surgery.

I’ll have my cast removed, my incision staples out and progress to a walking boot on Friday, Dec. 13th.

I’ll start wearing a normal shoe again around the new year and hopefully TRing in January and February until I feel my ankle is strong enough for lead climbing falls.

Cam Brownwrote:

 until I feel my ankle is strong enough for lead climbing falls.

I’m sure you’re more than aware but, assuming you don’t hit anything, your ankle is always strong enough for a lead fall.

And if you do hit something, nobody’s ankle is strong enough for a lead fall.

There’s a pretty broad gray area in between, it would definitely keep me on toprope longer than average. I’d want to be totally solid for those bumps and bruises.

Best of luck.

congratulations on your new ankle. please be really  careful for a while.  that was a huge surgery you went through, basically an amputation of your ankle, and a lead fall can mess up a good ankle pretty good, imagine what it can do to some metal and plastic. enjoy pain free movement while ya can. 

it's a gift

TK421wrote:

congratulations on your new ankle. please be really  careful for a while.  that was a huge surgery you went through, basically an amputation of your ankle, and a lead fall can mess up a good ankle pretty good, imagine what it can do to some metal and plastic. enjoy pain free movement while ya can. 

it's a gift

Which TAR do you have yourself? Do you have any images to share or you TAR?

I had some screws removed from my right ankle in november and am having the ankle replaced in feb.I have had surgery on that leg before and spent 3 months in a fixater and know the patience required for it I waited as long as I could as the technology for replacement is much better now than even a few years ago.

Kevinmurraywrote:

I had some screws removed from my right ankle in november and am having the ankle replaced in feb.I have had surgery on that leg before and spent 3 months in a fixater and know the patience required for it I waited as long as I could as the technology for replacement is much better now than even a few years ago.

Kevin,

Thanks for sharing. I get my cast off in two days and will progress into a walking boot for two weeks or so. I’m feeling optimistic about my eventual outcome with my ankle replacement. I’ll continue to post and share my journey as I progress. 

My ortho said I would be in a regular shoe in three months but I am 72 so old stuff takes longer to heal. I have had a lot of stuff done to we right foot over the years and when it is all done the scars are going to look like a web spun by a spider that was given lsd. 

@Cam and @Kevin any of you ice climb? Would need to kick with a TAR (not hard, but repetitively), that is why I am considering a fusion over TAR. A little worried that my ankle with a fusion would still hurt and/or ache on approaches and going steep up/down hill. Doc I went to was nebuluos when I asked about that. Currently I can motor up hill but coming down is epic and I semi limp when walking dogs. Also, saw a an earlier post in this thread about TAR catastrophic failure means you cannot get a new TAR and then looking at amputation. Did yours Docs mention anything about what level of TAR damage is "catastrophic" and what that would look like and if it could be fixed? I am pushing 70, but would like to have a few more years of climbing. 

Terry Parkerwrote:

@Cam and @Kevin any of you ice climb? Would need to kick with a TAR (not hard, but repetitively), that is why I am considering a fusion over TAR. A little worried that my ankle with a fusion would still hurt and/or ache on approaches and going steep up/down hill. Doc I went to was nebuluos when I asked about that. Currently I can motor up hill but coming down is epic and I semi limp when walking dogs. Also, saw a an earlier post in this thread about TAR catastrophic failure means you cannot get a new TAR and then looking at amputation. Did yours Docs mention anything about what level of TAR damage is "catastrophic" and what that would look like and if it could be fixed? I am pushing 70, but would like to have a few more years of climbing. 

My TAR is working out well and I've been climbing with it and absolutely love it compared to my previous arthritic ankle. My TAR feels and acts like a normal ankle but with a slightly limited range of motion due to my previous history of post traumatic end stage arthritis. TARs have come a long way over the years and have become preferred over a fusion for most patients, including younger and active patients. TARs can be revised and parts can be updated and replaced as needed as time goes on. In all my research on TARs, I've not heard of any amputations, even in the most complex TAR procedures and revisions. The components and options for TARs have also improved over the years with many advancements that address a persons specific anatomy and medical history. 3D printed components have also become common place. Many of the latest generation of TARs are created based on a patient's weight bearing CT scan. 

My TAR currently feels and acts like an improved version of my previous ankle before TAR, but with no pain and improved range of motion. 

I'd find a good surgeon who has done thousands of TARs and get it done. There are also several TAR facebook groups as well. Just beware that the most vocal people on the group are the ones who have difficulties with their TAR. Most TARs have successful outcomes and the latest generation of TARs should out perform the previous generation, but only time will tell.

I used to ice climb but having an ankle replacement isn't about being able to keep doing all the hard things you used to do it is about being able to still do things with a lot less pain and more mobility. At least that is why I am having it done.

Hello again! This thread has helped so much over the last year or so hearing others stories. I have seen many ankle specialists and finally found the one that thinks TAR is a viable and effective choice for someone my age (25). He wants to do it in two surgeries, HWR first then TAR 2-4 weeks later, followed by about 6 weeks of recovery and progressing to wearing a normal shoe. I’m really unsure of what I’ll do as I work as a climbing guide and live in a van, making recovery from a surgery like this quite complicated. But I’ll update if I choose to go through with it. I’m very tempted and excited by the prospect of reduced pain and increased mobility!

Did others have their surgery done in two parts? What did you feel post HWR? Like are you able to just walk or could you climb, hike etc post HWR?
Was the 6 weeks post TAR recovery timeline accurate for you? How long until you felt back to ‘normal’? 

Martha Helsleywrote:

Hello again! This thread has helped so much over the last year or so hearing others stories. I have seen many ankle specialists and finally found the one that thinks TAR is a viable and effective choice for someone my age (25). He wants to do it in two surgeries, HWR first then TAR 2-4 weeks later, followed by about 6 weeks of recovery and progressing to wearing a normal shoe. I’m really unsure of what I’ll do as I work as a climbing guide and live in a van, making recovery from a surgery like this quite complicated. But I’ll update if I choose to go through with it. I’m very tempted and excited by the prospect of reduced pain and increased mobility!

Did others have their surgery done in two parts? What did you feel post HWR? Like are you able to just walk or could you climb, hike etc post HWR?
Was the 6 weeks post TAR recovery timeline accurate for you? How long until you felt back to ‘normal’? 

I had my tar done on Feb 6 and am now in a cast till March 19. I had the Zimmer device used which is a side of the foot incision instead of the top of the foot type. I don’t know how recovery and weight bearing are going to go as everyone is different but why doctor likes the way everything looks. I have had multiple surgeries on my right foot and when I am done that foot is going to have scars like a web spun by a spider on acid. 

Cam Brownwrote:

I had my total ankle replacement surgery this morning and I’m back home recovering. I thought I’d share for those interested.  

Pre op and current view of my right ankle. The climbing shoes provide a reference point for my pre op ankle.

I had a wound vac exactly like that. Did you have a bag of nerve blocker with a catheter? Mine lasted about 4 days and I  pulled it out when it was empty. I had no pain but the splint and now the cast are the worst part of the whole procedure so far. 

Martha Helsleywrote:

Hello again! This thread has helped so much over the last year or so hearing others stories. I have seen many ankle specialists and finally found the one that thinks TAR is a viable and effective choice for someone my age (25). He wants to do it in two surgeries, HWR first then TAR 2-4 weeks later, followed by about 6 weeks of recovery and progressing to wearing a normal shoe. I’m really unsure of what I’ll do as I work as a climbing guide and live in a van, making recovery from a surgery like this quite complicated. But I’ll update if I choose to go through with it. I’m very tempted and excited by the prospect of reduced pain and increased mobility!

Did others have their surgery done in two parts? What did you feel post HWR? Like are you able to just walk or could you climb, hike etc post HWR?
Was the 6 weeks post TAR recovery timeline accurate for you? How long until you felt back to ‘normal’? 

Martha,

I'm excited for you and your TAR journey. I'm 15 weeks post op and back to climbing hard (for me) outdoors again. My biggest limitation at the moment is walking/hiking for more than 2 miles at a time. I expect that over the coming months, my ankle will begin to better tolerate longer hikes and I'm hoping to return to alpine rock climbing with long approaches this summer.

The first first six weeks after surgery will demand a lot of patience. I'd strongly advise that you post up in a house for 6 six weeks or so after surgery and have a person that can assist you during the first week after surgery as the first few days are the toughest and when your mobility will be the most limited.

A knee scooter was my preferred way of getting around until I progressed to a walking boot on day 16 post op. Once you are in a walking boot, you will most likely be advised to progress to full weight bearing and full days on your boot over a week or more. 

There is a lot to unpack here so if you'd ever want to jump on the phone for a few minutes, I'd be happy to talk and share my own knowledge. If you want to chat about TAR, send me a PM and I'll forward you my cell phone number. I've also worked as an alpine and rock guide as well over the years and I may be able to offer you some perspective on recovery and what to expect.

-Cam Brown