Republic of the philippines

DIVINE WORD COLLEGE OF BANGUED

Bangued , Abra

NURSING DEPARTMENT

A
CASE
ANALYSIS
IN
UNCLE REPLACEMENT

Submitted to: Mrs Susan V. Barbero RN. MAN

Clinical Instructor

Submitted by: Edd Joshua P. Sausa

Student
Ankle replacement

 « Full Article
 « Definition
 « Alternative Names
 « Description
 « Why The Procedure Is Performed
 « Risks
 « Before The Procedure
 « After The Procedure
 « Outlook (Prognosis)
 « References

Definition

Ankle replacement is surgery to replace the damaged parts of the three bones that make up the
ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. They come in
different sizes to fit different-size people.

Alternative Names

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle
surgery

Description

Ankle replacement surgery may be done while you are under general anesthesia. This means you
will be unconscious and unable to feel pain. Or, you may have spinal anesthesia. You will be
awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be
given medicine to help you relax during the operation.

Your surgeon will make an incision (cut) in the front of your ankle to expose the ankle joint.
Then your surgeon will gently push the tendons, nerves, and blood vessels to the side. After this:

 Your surgeon will remove the damaged bone.

 Your surgeon will reshape 3 of your bones that will remain in place:
o The lower end of your shin bone (tibia)
o The lower end of your smaller lower leg bone (fibula)
o The top of your foot bone (talus) that the leg bones rest on
 The parts of the new artificial joint are then attached. A special glue may be used to hold
them in place. Often, screws are also placed through the two leg bones (fibula and tibia)
to help support the artificial ankle.
  A bone graft is created between the ends of the fibula and tibia. This makes your new
ankle more stable.

After putting the tendons back into place, the surgeon closes the wound with sutures (stitches).
You may need to wear a brace for a while to keep the ankle from moving.

Why The Procedure Is Performed

Ankle replacement surgery may be done if the ankle joint is severely damaged. Your symptoms
may be pain and loss of movement of the ankle. Some causes of damage are:

 Osteoarthritis
 Rheumatoid arthritis
 Bone fracture
 Arthritis caused by ankle surgery in the past

Risks

Risks for any anesthesia are:

 Allergic reactions to medicines

 Breathing problems

Risks for any surgery are:

 Bleeding
 Blood clot
 Infection

Risks for ankle replacement surgery are:

 Loosening of the artificial joint over time

 Nerve damage
 Blood vessel damage
 Bone break during surgery
 Ankle weakness, stiffness, or instability
 Dislocation of the artificial joint
 Allergic reaction to the artificial joint

Before The Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs
you bought without a prescription.

During the 2 weeks before your surgery:

  You may be asked to stop taking drugs that make it harder for your blood to clot. These
include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
 Ask your doctor which drugs you should still take on the day of your surgery.
 If you have diabetes, heart disease, or other medical conditions, your surgeon will ask
you to see your doctor who treats you for these conditions.
 Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
 If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down
wound and bone healing.
 Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness
you may have before your surgery.
 You may want to visit the physical therapist to learn some exercises to do before surgery.
The physical therapist can also teach you how to correctly use crutches.

On the day of your surgery:

 You will usually be asked not to drink or eat anything for 6 to 12 hours before the
procedure.
 Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After The Procedure

After surgery, you will need to stay in the hospital for up to 4 days.

Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the
ankle joint will be left in your ankle for 1 or 2 days. To keep swelling down, you can keep your
foot raised higher than your heart while you are sleeping or resting.

Your doctor may recommend physical therapy to learn exercises that will help with ankle
motion.

Outlook (Prognosis)

A successful ankle replacement will get rid of your pain and allow you to move your ankle to up
and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will
depend on your activity level, overall health, and the amount of damage to your ankle joint
before surgery.
Ankle Replacement

Like every joint in your body, your ankle is capable of suffering from arthritis. The good news is
that replacement surgery is available for the ankle joint. The ankle is a much more complex joint
than your hip or knee and has a lot of parts that all work together. The ankle has to be a very
strong joint since it holds your entire body weight when you stand, 1.5 times your body weight
when you walk and eight times your body weight when you run.

Anatomy of the Ankle

Three main bones connect to make up the ankle – the talus, the fibula and tibia. The talus fits
into a socket at the end of the tibia and fibula. The bottom of the talus then sits on the heelbone
creating a hinge-like joint. Just like your other joints, the inside of the joint is covered with
cartilage which is what can wear down causing pain and inflammation or arthritis.

When the ankle joint is replaced, the worn out surfaces on the end of the shin (tibia) and the top
of the ankle bone (talus) are removed. A metal and/or plastic implant is then inserted to take the
place of the removed bone. The implant will work the same way as the original ankle joint.
Ankle replacement surgery is typically recommended for older patients who are relatively
inactive.

Ankle Replacement

After surgery, while the pain may be much less, or gone completely, patients often times cannot
regain very active lifestyles. Patients who are severely overweight also do not generally have
ankle replacement surgery. The extra weight can put unnecessary stress on the joint causing
problems. Patients who undergo ankle surgery typically only spend one or two nights in the
hospital but complete recovery from the surgery takes about three months.
Ankle replacement involves replacing the damaged parts of the three bones that make up the
ankle joint with artificial joint parts (prosthetic components) made of high-quality metal and
plastic. The parts are typically held in place by bone cement. The artificial joints come in
different sizes to fit the patient.
Photos

Ankle replacement

mobility ankle replacement - operative indications

mobility ankle replacement - operative considerations

Mobility ankle replacement-The approach

Mobility ankle replacement-The tibial cheilus

Mobility ankle replacement-Impact the remaining cancellous bone
mobility ankle replacement-talar jig

Mobility ankle replacement-first talar finishing jig

References

Ishikawa SN. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative
Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 5.

Read more: http://www.righthealth.com/topic/ankle_replacement/overview/adam20?

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