Help for Arthritic Ankles

Joint replacement surgery eliminates pain and preserves mobility.

Three years ago, Michigan native Kathy Hershey attended a seminar at her Sarasota neighborhood YMCA. There, a doctor discussed ankle replacement surgery. Kathy was especially interested because her own ankle, which was wracked with arthritis, left her in constant agony.

Photo by Fred Bellet.

Kathy can now be on her feet in the garden for hours.

“The doctor spoke specifically about ankle problems, since they’re his specialty, and about ankle replacements,” confirms Kathy. “When I was still in Michigan, they didn’t offer those procedures. As I listened to the doctor, I said, This is my guy. I had him replace my left ankle in 2014.”
The doctor was Brian C. Rell, DPM, of Southwest Foot and Ankle, a local practice that works closely with Lakewood Ranch Medical Center in Bradenton. Dr. Rell successfully performed Kathy’s left ankle surgery, so she knew where to turn when she started having trouble with her right ankle as well.
“I suffered a trauma on my right ankle seventeen years ago. I fell on the ice and twisted it,” describes Kathy. “It didn’t bother me initially, so I didn’t have it looked at until five years later. Then, it became arthritic. I went to several orthopaedic doctors, but they all wanted to fuse my ankle, which I wasn’t willing to do, so I just lived with it.
“Over time, the arthritis pain became excruciating. I’d rather have twelve babies than have that pain. It was constant, and it felt like someone took a sledgehammer to my ankle. I also had swelling, and the ankle looked bruised, too. But even with the pain, I still worked hard all day long, every day. I felt like I should just grin and bear it.”
Eventually, Kathy could no longer bear it, and the home remedies she tried were giving her no relief. At that point, she returned to Dr. Rell to inquire about having her right ankle replaced. When she arrived at Southwest Foot and Ankle, she was impressed by the doctor all over again.
“Dr. Rell is great. He explained everything; he even drew pictures,” she relates. “He told me just what to expect and said if I follow his instructions, I will heal well. He was right on the money about that.”

Modern Advancements

Total ankle replacements are generally offered to patients who have progressive arthritis of the ankle. These patients have pain that limits their mobility, and conservative measures have failed to alleviate their symptoms. Typically, the ankle becomes arthritic due to prior trauma, but patients can also develop osteoarthritis or rheumatoid arthritis in the joints.
“Historically, the primary procedure to treat progressive arthritis was an ankle fusion, or what we call ankle arthrodesis,” notes Dr. Rell. “However, a fusion significantly restricts ankle movement and function.
“The implants available today are designed much better than older models. They’re much more anatomical. Aside from reducing pain and maintaining motion, modern implants allow for a more normal gait versus a fusion. It also alleviates strain on the knee.”
The doctor explains that many patients with ankle arthritis may also suffer from underlying knee arthritis. When an ankle is fused, the stress of walking is typically transmitted one joint up and one joint down. As a result of an ankle fusion, there’s a higher stress load placed on the knee joint, which can aggravate the knee arthritis and lead to pain and dysfunction.
Total ankle replacements are performed in a hospital setting. Dr. Rell performs most of his procedures at Lakewood Ranch Medical Center, in part due to the care provided in their specialized orthopaedic surgery unit, The Orthopaedic Spine and Joint Center. Ankle replacement surgery takes several hours to complete, and patients are typically admitted to The Orthopaedic Spine and Joint Center overnight.
“During the procedure, we use general anesthesia. The ankle joint is opened through an incision, and a portion of the top of the ankle, on the tibia, is removed,” educates Dr. Rell. “Then, a portion of the talus on the bottom of the ankle is also removed. Metal prostheses are implanted in the tibia and in the talus. Between these prostheses is a polyethylene spacer.
“This surgery essentially replaces a severely arthritic joint that is bone-on-bone with a new, artificial joint to alleviate pain and maintain motion at the ankle. These replacements can be very successful. They have a greater than ninety percent success rate after ten years, as long as the implants are placed in patients who are appropriate candidates.”
Dr. Rell likes that his patients, including Kathy, can take advantage of the comprehensive, structured program for surgical patients provided through The Orthopaedic Spine and Joint Center. Lakewood Ranch Medical Center’s orthopaedic unit is dedicated to the care of people having spine and joint surgery, including ankle joint replacement. The Orthopaedic Spine and Joint Center program follows specific guidelines and protocols designed to quickly initiate rehabilitation and enhance patient recovery.

Restored Function

Kathy’s time in The Orthopaedic Spine and Joint Center was brief; she stayed overnight after both ankle surgeries. Still, that was enough time to form an impression. She found the Spine and Joint Center and all the people at Lakewood Ranch Medical Center exceptional.
“It’s a beautiful facility,” she shares. “The staff is excellent and very compassionate. I understand why Dr. Rell likes to go to that hospital. He and the surgical staff have a close camaraderie; they work really well together. I could tell by the way they were relating to each other in the operating room before I fell asleep.
“The nurses and the staff at Lakewood Ranch Medical Center are wonderful. They did a great job.”
Dr. Rell offered Kathy a prescription medication for pain, but she declined. She chose to take other steps to relieve her minimal discomfort after surgery. She recalled Dr. Rell’s statement about following his instructions. She took that to heart and achieved great results.
“I didn’t need a lot of pain medication; I don’t really like that stuff,” she reports. “My pain medicine was mostly ice and elevation, and it worked. I also don’t have any more swelling.
“Most of the bruising color has subsided, too. There’s a little shadow yet, but overall, I’m doing really well. I’m back to doing whatever I want, although I don’t do anything competitively, like running. Instead, I stick with water sports, which are my favorite activities anyway.”
When Kathy decided to attend that seminar three years ago, she had no idea it would change her life. For years, she lived in agony with progressive arthritis in her ankles. Now, she has two new ankle joints, with no pain and full function. She’s grateful to everyone involved in her care.
“Dr. Rell is great. I’m very thankful for his skills. I’d recommend him any day. I also recommend Lakewood Ranch Medical Center!”

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