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Musculoskeletal Services

Ankle Fusion Surgery

IntroductionShow [+]Hide [-]

Your ankle joint is like a hinge, it allows you to bend and straighten your foot.  In a healthy ankle joint the movement is smooth and pain free.  When a joint becomes damaged due to arthritis or injury the surface of the joint becomes rough and movement becomes stiff and painful.  The ankle fusion will prevent the damaged bone surfaces rubbing together and provide stability to the ankle joint.

Before your procedureShow [+]Hide [-]

You will usually be admitted to the ward the day before surgery.  The nursing staff will meet you to show you the ward layout and introduce you to your named nurse.  They will ask you a number of questions, so that they can cater for any individual needs you may have.
Unless you have already been seen at a pre-admission clinic, the ward doctor will see you and arrange for your pre-operation tests.  These are usually an examination, an x-ray and blood tests.
The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have.  The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent.  The anaesthetist will discuss the type of anaesthetic best suited to you; usually the procedure is performed under general anaesthetic.  A spinal anaesthetic is sometimes used.  This means you are numbed from the waist down for the duration of the procedure, a sedative is usually also given.  The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.
The physiotherapist will come and see you before the operation to assess your level of mobility and to teach you the exercises you need to do after the operation, to help you recover.
The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision. Remember that staff are here to help you and answer any questions you may have.

During your procedureShow [+]Hide [-]

You will not be able to eat or drink for a period of time before your operation.  The nursing staff will advise you on admission when you should stop eating and drinking in preparation for your surgery.  
You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre.  A member of nursing staff will escort you to theatre either on a trolley or bed.  Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.
Once in the anaesthetic room you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic.  If the anaesthetist has advised you that you are having a spinal anaesthetic this will be discussed with you fully at the time.

After your procedure Show [+]Hide [-]

After a short stay in the theatre recovery area you will return to the ward.  When you come back from the operation your leg will usually be elevated on pillows to help prevent swelling.

You may have a ‘drip’ in your arm, which ensures that you get plenty of fluids, as you are unable to take any by mouth for a short time after the operation.  Once you are able to eat and drink normally this ‘drip’ will be removed.  This is usually on the first day after your operation.
You will have a below-knee plaster cast in place and you may also have some
metalware to hold your anklebones in a steady position while they heal.
You will also have stitches in the wound and these are usually removed 10-14 days after the operation.
Many patients worry about how painful ankle surgery will be and all staff understand this.  It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable.  Everyone feels differently and it is important that you tell the nurses if you are in pain.
In some instances it is possible for you to be given a type of pain relief that enables you to control the amount of painkiller you receive yourself (Patient Controlled Analgesia).  Further information about this is available on the ward, and will be explained to you if you are to be given this.  You will be monitored closely by the nursing staff after your operation and they will keep you comfortable. 
Getting up and about 
You will remain in bed for approximately 2 days after surgery during which time an x-ray will be taken. Your surgeon will then decide when you can begin to walk about.  
The physiotherapists will assist you out of bed and show you how to use suitable walking aids as you will not be able to put any weight through your operated foot for at least 6 weeks.
The physiotherapists will help you out of bed and supervise your walking.  You will start using a Zimmer frame to support you at first, and progress to using axillary crutches when your mobility improves and you feel more confident.  You will be supervised all the time until you are safe to manage alone.
A wheelchair for outdoor use may be necessary. You may be able to obtain one on loan from the Red Cross, as the hospital is unable to provide wheelchairs on short-term loan.

What problems can occur? 
No operation is without the risk of complication.  Your surgeon will explain any particular risks/complications of your operation before surgery. 
Is the operation always successful? 
The surgeon’s expectation of your operation will be discussed before surgery (usually when initially seen in Outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation.  This information must be taken into account when you make the decision to undergo surgery.

Your discharge from hospitalShow [+]Hide [-]

Once you are moving around freely on your own, you will be discharged home as soon as suitable arrangements can be made. Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.
Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.
If your named nurse feels you and your carer will require extra support she will discuss this with you, and with your permission arrange for you to discuss your needs with the hospital social worker and Occupational Therapist. 
Transport Home 
Please discuss your transport arrangements home with your named nurse before your day of discharge.  It is possible in some instances to organise hospital transport, if required. 
The day of your discharge 
On the day of your discharge your named nurse will give you some things to take home with you, these will include: 

  • A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
  • Medication Any medication you have brought into hospital will be returned to you.  You will also be given a 7-day supply of any new medications.  The nurse will advise you on how and when to take these.
  • Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic.  If transport is required then this can be arranged by contacting your GP, providing a week’s notice where possible.  If for any reason you are unable to attend your appointment please contact the Outpatient Department to rearrange the appointment.
  • Care Plan If you have a care package arranged you would receive a copy of the care plan from the social worker before your discharge home.  This is for your own information.
  • Discharge Record This provides details about your stay and is for your own information.
  • Mobility aids It is important that you have your walking aids, wheelchair and any other equipment that you require.
  • Patient Information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
  • Valuables Please ensure you have all your valuables with you.

General Advice after Discharge  
You should anticipate at least a 12-week period of convalescence at home before you are able to resume your normal activities. 
Walking/stairs Remember to use your crutches until your consultant or Nurse Practitioner Therapist tells you to stop.  Check the rubber ends on your crutches regularly.  If they are wearing smooth consult the Physiotherapy Department at your local hospital, who will arrange to change them. 
Exercises When sitting, keep your leg elevated on a chair or stool.  If possible your leg should be slightly higher than your hip as this will help reduce any swelling.
Remember to take your leg down regularly to do your exercises and prevent your leg becoming stiff. 
Cars and driving It is inadvisable to drive whilst wearing a cast, splint or restrictive bandage.   Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision.  He will advise when he feels driving will cause you no harm. 
Work How soon you are able to return to work will depend on the type of job you do.  It will be at least 6 weeks before you can return but you should discuss this with your surgeon when you see your consultant in the Outpatient Department. 
Wound care Keep your wound dry until your stitches or clips have been removed.  Your clips/stitches will be removed when you attend the Outpatient Clinic.  Once these have been removed, you can shower if you feel able.

Pain Take your painkillers as prescribed.  Do not take more than the stated dose.
Contact your doctor if you have any pain or swelling in your calf or if you have
any chest pain. 
Follow up 

You will be followed up as an outpatient at regular intervals after your discharge from hospital.  Please use this opportunity to ask questions and discuss any concerns you may have.  You are also welcome to call the ward for advice, following your discharge from hospital. 
Return of equipment 
Please return all walking aids to the Physiotherapy Department at the hospital in which you stayed, when they are no longer required.  All other equipment should be returned to the loan equipment store it came from, ring them and they will collect it. 
Useful Contact Numbers
Below are some numbers you may find useful once you have been discharged, please do not hesitate to contact any number for additional help or advice, the staff would be happy to help you. 
Outpatient Clinics 
Newcastle General Hospital Fracture Clinic   (0191) 256 2813

Freeman Hospital Musculo-skeletal Outpatients (0191) 223 1109 / 223 1040 
Newcastle General Hospital
Ward 20  Tel: 256 3520
Ward 21  Tel: 256 3521
Ward 35  Tel: 256 3535
Freeman Hospital  
Ward 17  Tel: 213 7017
Ward 18  Tel: 213 7018
Ward 19  Tel: 213 7019
Ward 20  Tel: 213 7020

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