Total Ankle Replacement (TAR) Surgery

Welcome to this comprehensive guide on Total Ankle Replacement (TAR) surgery with Patient-Specific Instrumentation (PSI) guides. In this page, we will explore Dr. Alttahir's approach, including  indications for surgery, presenting symptoms, examination findings,  pre-operative investigations with PSI guides, the surgical technique  utilising PSI guides, post-operative care, and long-term outcomes. We  will also discuss how the incorporation of PSI guides adds to the  precision and success of TAR surgery.

Total ankle replacement (TAR) surgery involves replacing the damaged ankle joint with a prosthetic implant, leading to improved mobility and reduced pain. Over the years, TAR has become a popular alternative to ankle fusion surgery, demonstrating potential advantages. 

Dr. Mustafa Alttahir recommends total ankle replacement surgery for patients who have severe ankle arthritis that does not respond to conservative treatments such as medication, physical therapy, and assistive devices. Common indications include osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, and avascular necrosis of the talus.

Patients with advanced ankle arthritis may present chronic pain, swelling, stiffness, limited range of motion, instability, and difficulty walking or bearing weight. These symptoms significantly impact daily activities and reduce the overall quality of life.

Dr. Mustafa Alttahir conducts a comprehensive clinical examination to identify signs of ankle arthritis, such as tenderness over the ankle  joint, joint effusion, crepitus, limited range of motion, and  instability. Imaging tests, including X-rays, CT scans, and MRIs, combined with PSI guides, aid in assessing the severity of arthritis and guiding treatment decisions. 

In the pre-operative phase, Dr. Alttahir utilizes PSI guides to enhance  the planning process. These guides are created based on a patient's  individual anatomy, providing a customized and accurate surgical plan.  Combining advanced imaging techniques with computer modeling, PSI guides assist in evaluating joint condition, bone quality, ligament integrity, and alignment, enabling precise implant sizing and placement. 

During total ankle replacement surgery, the damaged joint surfaces are carefully removed, and the prosthetic components are implanted. The procedure can be performed under general anesthesia or regional anesthesia. Dr. Mustafa Alttahir uses specialised instruments to prepare the bone surfaces, and the prosthetic components, including a metal tibial component, a plastic spacer, and a metal talar component, are securely fixed in place. This is performed using PSI guides to ensure precise execution of the surgical plan. The guides act as personalized tools, facilitating the removal of damaged joint surfaces and guiding the placement of prosthetic components. With the aid of PSI guides, Dr. Alttahir achieves optimal alignment, restoration of joint stability, and accurate positioning of the prosthetic  components, leading to improved joint function and longevity. The procedure aims to restore joint mobility and stability, maintain proper alignment, and provide a functioning ankle joint.

In certain cases of total ankle replacement (TAR) surgery, adjunct procedures may be necessary to optimise the surgical outcomes and ensure the best possible results. These additional procedures, performed in conjunction with TAR, address specific conditions or complications  associated with ankle arthritis or joint deformities. 

Adjunct procedures are often required in TAR surgery to address specific conditions, deformities, or complications. Some common reasons for adjunct procedures include:

1. Realignment of Deformities: In cases of severe deformities, such as significant ankle varus or valgus alignment, adjunct procedures may be necessary to correct these abnormalities and restore proper joint alignment. These procedures can included minimally invasive hindfoot osteotomies, midfoot osteotomies or fusions, or forefoot osteotomies or fusions.
2. Soft Tissue Balancing: Adjunct procedures can involve addressing soft tissue imbalances, including tightening or lengthening tendons, ligaments, or joint capsules, to optimise joint stability and prevent postoperative complications.
3. Bone Deficiency Management: In instances where there is significant bone loss or deficiency due to arthritis or previous surgeries, adjunct procedures such as bone grafting or structural augmentation may be required to provide adequate support for the implant and ensure long-term stability. In cases where the bone deficiency is too great, pre-operative planning allows the use of more constrained ankle replacement implants, and in severe cases, Dr. Alttahir has the expertise to design custom 3D printed patient specific metal implants individualised to his patients.

By tailoring these additional procedures to each patient's unique needs, Dr. Alttahir ensures optimal joint alignment, stability, and long-term function. With his expertise, patients undergoing TAR surgery receive the highest level of care, with the aim of improved surgical outcomes and an enhanced quality of life. 

Following TAR surgery, patients receive dedicated post-operative care under the supervision of Dr. Mustafa Alttahir. Pain management and wound care are administered during the hospital stay, which typically lasts a few days. Removal of sutures if often performed 14 days post-operatively. Early initiation of physical therapy, tailored to each patient's needs, promotes strength, range of motion, and gait improvement. Typically, patients are immobilised in a boot, and encouraged to commence gentle early range of motion as early as day 1 post-operatively. Gradual weight-bearing is introduced, initially with the assistance of crutches or a walker, depending on whether any adjunct procedures are performed as part of the ankle replacement surgery. Full weightbearing is commenced by week 6 in a boot, with unrestricted activity commencing week 10-12. Regular follow-up visits monitor healing progress, address concerns, and ensure a successful recovery. Dr. Alttahir continues to follow-up his TAR patients on a minimum yearly basis for life.

Total ankle replacement has the potential to offer several advantages over ankle fusion surgery, which involves fusing the ankle bones to eliminate motion. TAR allows for better preservation of joint movement, which may significantly improve walking and running abilities. It also helps to reduce stress on adjacent joints, potentially preventing degeneration in those areas. Furthermore, TAR can result in a more natural gait pattern and increased patient satisfaction, as compared to ankle fusion surgery. However, it is essential to consider individual patient factors, such as age, activity level, and bone quality, when determining the most suitable surgical approach.

The incorporation of PSI guides into TAR surgery enhances the accuracy and precision of the procedure, with the aim of achieving more positive long-term outcomes. With the expertise of Dr. Mustafa Alttahir, it is the ultimate goal that patients experience improved pain relief, enhanced joint function, increased mobility, and reduced complications. The aim of the personalized nature of PSI guides is to contribute to better implant alignment, potentially reduced wear and loosening, increased patient satisfaction, ultimately improving long-term outcomes.

Dr. Mustafa Alttahir's proficiency in TAR surgery with PSI guides offers  patients suffering from end-stage ankle arthritis an advanced and  precise treatment option. By combining personalized pre-operative  planning with PSI guides, the accuracy and success of total ankle  replacement may be significantly enhanced. With a focus on patient  selection, comprehensive evaluation, and advanced surgical techniques, Dr. Alttahir aims to achieve optimal outcomes and improved quality of life for his patients. Total ankle replacement surgery with PSI guides is emerging as a potential superior choice, providing enhanced accuracy with the goal of ensuring the best possible results under Dr. Alttahir's expert care.