For Mark Davies, Matthew Solan & James Davis at St John & St Elizabeth Hospital and OneWelbeck

For Martin Klinke at London Bridge, Cromwell Hospital, Chiswick Outpatients, New Victoria Hospital & One Welbeck

Case of the month by Martin Klinke – Ankle replacement

Mrs Black had a nasty road traffic accident aged 20 which involved a complicated injury to her left ankle. At the age of 32 she sustained another but less severe injury to her left ankle.

Over the years her ankle became more and more arthritic but despite the injury, she kept on being very active. Mrs Black had three children and continued with various sports exercises. Initially, she was still able to perform impact exercises involving running and jumping but with time she had to reduce her sports activities more and more. She adjusted her lifestyle and was still able to take care of her children and her ill mum. Mrs Black saw me first time in 2014 and she had seen two other orthopaedic surgeons before who offered various treatment options. As Mrs Black was still able to do most things, even though with some discomfort we agreed that surgery was not necessary bearing in mind that she was only 49 years of age.

Unfortunately, but as expected her symptoms deteriorated and her ankle stiffened up more and more. Mrs Black had difficulties going up and particularly downstairs and finally, she even had pain at rest and at night. Mrs Black, therefore, saw me again end of December 2016 and new x-ray where done which confirmed the severity of arthritis of the ankle with big bony spurs at the front and cysts in the bone. She still had good movement downwards but upwards was restricted. Clinically she presented with swelling around the ankle and pain on palpation mainly across the front of the ankle joint.  Mrs Black felt that something now needed to be done as there were days when she could not really walk anymore. Different treatment options were discussed and we agreed that an ankle replacement would be the best choice for her. The operation was performed in February 2017 and we implanted an ankle joint replacement and we had to lengthen the Achilles tendon in order to increase the restricted upwards movement of the ankle joint. Postoperatively Mrs Black was in a plaster for a good week and then in a boot in which she started weight bearing after 9 days. One month after the operation Mrs Black was fully weight bearing in the boot without any pain and after six weeks she started walking around without the boot without problems. She had a good range of movement with particularly much-improved movement upwards, her gait pattern had changed markedly and looked very different to before the operation.

The post-operative X rays looked very good, the alignment was well preserved with good bony integration of the components.

Since then her symptoms have improved further and in May she reported how happy she was. She describes her improvement as

“I love being able to get off to sleep easily and then sleep solidly rather than being jolted awake by the pain several times at night and it is great to have no locking and no pain in the joint when I walk. “

Mrs Black’s progress continues and in November she confirmed that she now had no pain in the joint and “is thrilled with my new ankle”.

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