News
"Ankle op has put a spring in my step"
Originally published 22 January 2008 in the Daily Express.
Although Valerie Hoare is almost 80, she is not keen on putting her feet up.
She continues to work as a physiotherapist and gives her grandchildren a good match on the tennis court.
But Valerie has only been able to return to the active life she loves after having a ‘new generation’ ankle replacement.
Although hip and knee replacements are commonplace procedures, attempts to deliver the same solution for the ankle have been dogged by failure.
“The ankle is a much more complex joint to replace than the hip or the knee,” explains Martin Klinke, Consultant Orthopaedic Surgeon of the London Foot and Ankle Centre.
“The ankle needs to flex, allowing the foot to move up and down and to rotate. Because of its size and shape, the ankle receives more strain than any other joint in the body.”
Ankle replacements have frequently loosened under the pressure.
However Valerie is benefiting from the ‘new generation’ of ankle replacements which integrate far more effectively into the ankle joint.
Valerie developed osteoarthritis after a devastating cycling accident. Joining friends for a leg of the London to Brighton bike race, she was suddenly struck by the wing mirror of a speeding motorist.
“The wing mirror hit my shoulder, I went into the curb and over the handle bars,” recalls Valerie from Hassocks, West Sussex. “As I went to the ground, my left leg curled up underneath my body. The pain was excruciating.”
Valerie’s left ankle was so badly fractured that doctors inserted a metal plate and screws into the joint to provide support. But her ankle remained extremely painful and Valerie was forced to use crutches.
“I was in and out of a wheelchair for 15 months and got to the point of despairing that I would ever be pain free and mobile again.”
A friend recommended The London Foot and Ankle Centre, where Mr Klinke is one of a small number of surgeons in the UK undertaking ankle replacement surgery.
“Patients with severe arthritis experience a great deal of pain and consequent loss of movement caused by worn out joints,” explains Mr Klinke.
“The standard treatment for patients like Valerie has been to fuse the ankle bones together. Fusion works very well in terms of eradicating the pain from worn out joints. But patients are left with a rigid ankle.
“An ankle replacement is a very good solution for Valerie because she is active and wants flexibility, but will not put too much pressure on the new ankle.”
The operation took place in April (2007). Ankle replacement involves replacing the natural surfaces of the ankle joint which have degenerated with an artificial cover known as prosthesis. The ankle replacement has three components. Two of the components cover the joint and in the middle there is a third, mobile component. This allows for greater movement and reduces the stress between the bone and the implants.
Mr Klinke explains: “The component which covers the part of the ankle joint known as the tibia is flat. It is integrated into the bone with a short stem.
“The component which covers the part of the ankle joint known as the talus is curved and fixed into place with pegs.
“All the components are covered in a bioactive coating which encourages the patient’s own bone to grow into the artificial fixtures.
“This type of operation allows the patient to preserve the movement that they have and gain a few degrees.
“Its success lies in the way that the ankle replacement integrates into the natural bone.
“The use of a mobile plastic bearing means the prosthesis is under much less stress and will stay in place a lot longer than the old two-part ankle joint replacements.”
Ankle replacements are currently carried out in around 10 specialist orthopaedic hospitals, both privately and in the NHS. Less than 500 patients benefit from the procedure each year.
But now ankle replacement technology has dramatically improved, the operation is expected to be offered much more widely to the many thousands of patients who have advanced arthritis.
“The new generation ankle joint replacements are very successful and will benefit a high proportion of patients with severe arthritis,” says Mr Klinke.
“Ankle replacement will become increasingly common for older patients, providing they have well aligned ankles.
“We hope that ankle joint fusion will only be necessary in the few patients who are not suitable for an ankle joint replacement.
“These will be the relatively small number of young patients because they put their ankles under so much more stress than older patients.
“Developments in ankle replacements are very important because we are seeing more patients with arthritis in their ankles as a result of taking part in high impact sport.”
For Valerie, recovery after surgery was rapid. “I felt a lot better straight after the operation.
“Although I had to wear an Airboot day and night for six weeks, it was great to be pain free and being able to put some weight on my ankle.
“After those first six weeks, I started to put weight on my ankle without the boot and had to work hard on strengthening exercises.
“By the summer, I was able to walk around again and felt totally mobile.
“I put my ankle through its paces. My work means that I’m on my feet all day, but it’s very rewarding.
“I play tennis with my grandchildren – I’m not the standard that I used to be, but I’m not bad for someone who is nearly 80.
“It’s an incredible operation and I hope more people will benefit from it.”