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POST OP CARE

ANKLE REPLACEMENT SURGERY

If Dr Crane feels that an ankle replacement (arthroplasty) is needed to replace a worn out ankle joint and that it would be best suited for your specific case, this patient guide is designed to give you some general details about the surgery and what to expect following it.

Why might you need an ankle replacement?
An ankle replacement is considered for those who have severe pain caused by ankle arthritis. Dr Crane will only consider an ankle replacement if he has found that all other conservative treatments have been attempted. For patients who are young, very physically active or have a severe foot deformity, an ankle fusion (arthrodesis) would be advised instead.

What does an ankle replacement surgery involve?
Under general anaesthesia, Dr Crane will make an incision over the front of the ankle, roughly 15cm long. Next he will remove the worn out joint surfaces and replace them with prosthetic components made of metal. A piece of plastic will then be inserted between the new metal joint spaces to allow the joint to glide smoothly. Because the prosthesis that Dr Crane uses has a honeycomb shape, it can be pressed into place and over time the bone can grow and fuse with the prosthesis.

What can I expect after surgery?
Most people will be able to go home after spending a night or two in hospital for observation. After surgery, your leg will be fitted with a “backslab” cast (which is a half plaster cast with the front being only bandages). You can expect some pain and swelling after surgery, but Dr Crane will prescribe you medication to help.

After two weeks the swelling should have gone down enough, you will then have your ankle put into a complete cast or moonboot to aid recovery for the next 6 weeks. You will get crutches to help you walk, for the first two weeks you will not be able to put any pressure on the foot. Thereafter for the next 6 weeks you will be allowed to put progressive weight through the foot while you still use the crutches.

Once Dr Crane gives you the go-ahead, you can bear weight on the foot. 6 weeks after your ankle replacement your boot or plaster cast will be removed so that Dr Crane can take an x-ray of the ankle. From here he can see if all is well and you will be sent to physiotherapy to begin mobilizing the ankle and start regaining strength now that the boost or plaster cast has been removed.

You should be able to return to work after 3-4 weeks if you are able to elevate your foot at work. For those with manual jobs that require them to be on their feet, they may need to take as much as 6 months off work before they can be physically active again. Once your plaster is off and you can fully bear weight on the foot, you may drive. If you cannot make an emergency stop, you should not be driving.

Resuming physical activity and sport may require up to a year of recovery, with most patients just starting with swimming and spinning at 8 weeks after the ankle replacement. There may also be certain types of impact sports that you will no longer be able partake in after

pdf Ankle Replacement Surgery Post Op Care (PDF download)

FOOT AND ANKLE SURGERY

If all other non-surgical treatment options have been explored, Dr Crane may advise surgery. There are various foot and ankle surgeries that may treat a variety of conditions. While Dr Crane will discuss the finer details with you prior to surgery, this is a rough outline of what you can expect after surgery.

How long would I be in hospital?
You will need to spend a night or two in the hospital for observation. Most people are in the hospital for 2-3 days after a foot or ankle surgery. Once you are able to walk with crutches and your wound, seem to be healing well you may be discharged and go home.

What can I expect after surgery?
After surgery, you can expect your foot and ankle to swell significantly. You will need to keep your foot elevated in your hospital bed to allow the swelling to decrease. Once the swelling has decreased, Dr Crane will fit a “black slab” cast onto your leg, from your knee to your toes. This cast is half plaster with the front being only bandages. This will protect your foot and ankle and keep the foot in a stable position for healing. You can expect some pain after surgery, but Dr Crane will prescribe you medication to help with this. Before you are discharged from the hospital, you will have the physiotherapists show you how to walk with crutches. When you do this, you will not be able to put any weight on your operated foot.

Your cast will stay on for roughly 8-12 weeks to allow the bones, cartilage, ligaments and tendons in your foot or ankle to heal. For the first 2 weeks, you should avoid putting any weight on your foot and rest at home with your foot elevated as much as possible. After about 2 weeks you will see Dr Crane for a follow-up. He will check your incisions, and your foot will be placed in the plaster cast again. Depending on your healing, he will then allow you to slowly add weight to your foot, while you still use the crutches. After 6 weeks you can put all your weight through your foot.

You will come for another follow up with Dr Crane after 8-12 weeks. He will then remove the cast completely and may use an x-ray to check your recovery and fusion of bones. Depending on the recovery, you may be placed in a brace for another month or so to allow for stability while healing. From here, if Dr Crane gives the go ahead, you can begin physiotherapy to mobilising the foot and ankle and start regaining strength now that the plaster cast has been removed.

You should be able to return to work after 3-4 weeks if you can elevate your foot at work. For those with manual jobs that require them to be on their feet, they may need to take as much as 6 months off work before they can be physically active again. Once your plaster is off, and you can fully bear weight on the foot, you may drive. If you cannot make an emergency stop, you should not be driving.

Resuming physical activity and sport may require up to a year of recovery. It is best to start slowly with walking or cycling once you are out of the plaster cast, building up to more vigorous exercise as your recovery allows. There may also be certain types of activities that may be difficult after a specific foot or ankle surgery, but this will be discussed with your prior to surgery.

pdf Foot and Ankle Surgery Post Op Care (PDF download)

KNEE SURGERY

You have just undergone major joint surgery, it is usual for you to experience some pain or discomfort. Take your prescribed pain killers regularly before the onset of pain. If the pain is severe and is not relieved by strong pain killers, then please phone myself or the emergency department.

After your operation you will experience swelling, the area will looked bruised and there may be a small amount of blood on the wound dressing. Do not take off the dressing and do not get the dressing wet. If you are concerned about extensive bleeding or a wet dressing please contact your GP or emergency department to change the dressing for you.

Please elevate your leg and apply the ice pack that you have received onto the wound for 20 minutes every hour. You have been given crutches to aid balance and take the weight off the injured limb. Please use these for 6 weeks unless otherwise discussed with me. The physiotherapist will discuss all the do’s and don’ts with you as well as help you modify your activities of daily living.

If you have received a knee brace it will be locked in the straight position for 2 weeks. At follow I will unlock the brace and allow you to bend the knee to 90 degrees.

You have been given a follow up appointment between 10 and 14 days after the operation, at this time I will remove the dressing, check the wounds and if indicated send you for a follow up x-ray.

pdf Knee Surgery Post Op Care (PDF download)

DR JASON CRANE

As a full time orthopaedic surgeon at Mediclinic Cape Town, Doctor Jason Crane offers advanced orthopaedic care in a state-of-the-art medical facility on the slopes of Table Mountain.

CONTACT

telephone Click here to reveal phone number

email jason@capetownorthopaedic.co.za

location Mediclinic Cape Town, Suite B105, 1st Floor (Doctors Block)
21 Hof Street, Oranjezicht, Cape Town, South Africa