JOINT REPLACEMENT: ANKLE

JOINT REPLACEMENT: ANKLE • Make a well-informed decision • Prepare for the best possible results before, during and after surgery If you have questi...
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JOINT REPLACEMENT: ANKLE • Make a well-informed decision • Prepare for the best possible results before, during and after surgery If you have questions or concerns, please call 8 a.m. – 5 p.m. weekdays Podiatry – La Crosse (608) 775-2427 (800) 362-9567, ext. 52427

Thomas S. Roukis, DPM, PhD, FACFAS Orthopaedics, Podiatry and Sports Medicine Total Ankle Replacement Dr. Roukis is trained to implant all ankle replacement devices cleared or approved by the Food and Drug Administration (FDA). Go to gundersenhealth.org to learn more about your ankle replacement surgeon. Under Find a Doctor, type Roukis in the search box and click Submit. Review his credentials and click Total Ankle Replacement in the right menu for more information. Contact information This booklet will help you decide whether ankle replacement is right for you. If you have questions, call: Podiatry in La Crosse 8 a.m. – 5 p.m. weekdays (608) 775-2427 or (800) 362-9567, ext. 52427 Cost estimates Revenue Integrity 8 a.m. – 3:30 p.m. weekdays (608) 775-1699 or (800) 362-9567, ext. 51699 To find out what is covered, call your insurance company or the government program in which you are enrolled. After hours, weekends and holidays Telephone Nurse Advisor (608) 775-4454 or (800) 858-1050

TABLE OF CONTENTS How your ankle works..................................................................................................................................................................................... 3 Why consider replacement.......................................................................................................................................................................3 Risks, benefits and alternatives................................................................................................................................................... 3, 4 Getting ready for surgery............................................................................................................................................................................4 Nicotine: A note of caution.......................................................................................................................................................................6 Where will I recover?..........................................................................................................................................................................................6 12-week timeline....................................................................................................................................................................................................7 Next steps........................................................................................................................................................................................................................7 More resources...................................................................................................................................... 8 Key phone numbers............................................................................................................................ 8 Nicotine cessation support............................................................................................................... 8 Advance directive................................................................................................................................. 8 Online programs about ankle replacement............................................................................... 8 For more information.......................................................................................................................... 8 Antibiotics............................................................................................................................................... 9 Get ready for recovery........................................................................................................................ 9 Patient testimonials ........................................................................................................................ 4,7

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Before you decide to have an ankle replaced, you should know what happens before, during and after this major surgery. This booklet can help you prepare for honest, open talks with your surgeon. It cannot replace these conversations! But, it can help you think of questions and concerns you want to cover before you decide what to do – and when. In many ways, having a joint replaced is like going on a journey. You have to fully commit before you start. Are you prepared to invest time, energy and money in a process that could change the rest of your life? Are you ready to endure some short-term pain to have less pain and more movement in the future? You should be aware of all your risks before you agree to proceed. You need to know what it takes for recovery to be a success. And, you need to think about where you can or should live for the early weeks after surgery. You will be a partner with your Podiatry team before, during and after surgery. You expect certain skills and

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support from us. We, in turn, think of you as more than our patient. You have the final say over whether your journey will be a success. No matter what others do for you, it is what you do for yourself that will matter most. After all, it’s your body, your future and your decision.

HOW DOES YOUR ANKLE WORK?

• Traumatic injury

• Chronic ankle sprains • Rheumatoid arthritis • Gout • Primary osteoarthritis In and around a damaged ankle: • Thin spots and gaps in cartilage let bone ends wear down. • Bones rub together and cause pain. •M  uscles and ligaments that support the ankle become stiff and sore.

The ankle joint is a complex junction of three bones. The tibia (TIH-bee-ya) is a thick lower leg bone. The fibula (FIH-byoo-la) is a thinner bone in your calf. These leg bones meet the talus (a foot bone) to form a joint that moves much like a hinge. Most of your body weight presses down through this intersection onto the heel bone. Tendons and ligaments surround and bind bones, keeping them stable and aligned for normal motion. Membranes secrete fluid and cartilage cushions bone ends in a healthy ankle. All these allow smooth, gliding action as you walk, run or jump.

WHY CONSIDER ANKLE REPLACEMENT?

Trauma, aging, arthritis and other problems or injuries can disrupt the balance and strength of this unique joint. An injured ankle can make daily living painful and difficult. It can be replaced if there has been severe damage due to:

Up until now you may have tried what we call “conservative options.” Pain medicine, physical therapy, wearing a brace or special shoes, and using a cane or walker may not have worked for you. Keep in mind that joint replacement is not a certain one-time solution. A new joint might wear out before you do. (It depends on your age and other factors.) But if your pain is often more than you can bear, having your ankle replaced may be your best option – not just your last resort. If you seek long-term pain relief and improved mobility, you have come to the right place. Gundersen Health System offers the skilled surgical team and technology you need.

RISKS

There is always a chance results will be less than perfect. We explain risks to inform you – not scare you. It would not be honest to promise you could have a joint replaced with no risk at all. But, when you face years of pain or being dependent, benefits may outweigh risks. These are problems some patients have after joint replacement. They are not frequent, but each person has some degree of risk for all of them. Talk to your doctor about what your

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surgery involves. Ask how your current health raises or lowers your risk for: • Infection that requires antibiotics or further surgery • Wound opens or is slow to heal – may require prolonged wound care or further surgery • Prosthesis loosens or no longer aligns as designed – Requires more surgery to replace parts or fuse the joint – Less range of motion than before surgery • Blood clot in leg – Any leg surgery can put you at risk for blood clots – Risk is higher while you are less active during recovery – Blood thinning medicine will be prescribed to keep your risk as low as possible •N  erve damage leading to numbness or tingling that may be permanent

BENEFITS

You may achieve some or all of these after you recover from surgery: • Feel less pain • Be as mobile as you want or need to be • Maintain your independence • Perform daily routines without help from others • Be active again except for high-impact sports • Sleep better Improved ankle implants last 10 years or more in most patients.

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ALTERNATIVES

Your options may include: • Continue conservative measures • Ankle fusion or osteotomy •A  nkle brace and/or special shoe with straps • Change your work and activities • Injections into the ankle joint • Physical therapy •O  ral medicine (anti-inflammatory, narcotic or anticonvulsant) • No treatment at all

GETTING READY FOR SURGERY

Most patients take these steps to get ready. Your list may be longer if you have unique demands on your time and energy. In the weeks ahead, ask all the questions you can think of. Write them down between visits. The better informed you are, the more likely you are to achieve the long-term benefits you hope for. Find someone willing to go with you to pre-op appointments This person should be physically able and prepared to assist you during recovery without hurting himself or herself. “I followed Dr. Roukis’ guidelines for recovery including no weight on my new ankle for eight weeks after surgery. For the first time in years, I’m walking without pain. I don’t have to stop for breaks now. I would totally recommend the INBONE® Total Ankle Replacement. I’ve already referred friends. It has made such a difference in my life.” —-Shirley Besl, INBONE® Total Ankle Replacement patient

Keep all required appointments 1. Pre-op evaluation – After a thorough exam, your surgeon will teach you how to prepare for surgery and recovery. A social worker will be involved if needed. Key topics are listed on p. 6 under Where will I recover? 2. Preadmission phone call or visit – You will talk with a nurse about your medicine, advance directive, what to bring to the hospital and other topics. 3. Physical therapy – Before surgery you will learn ways to keep weight off your ankle for 8 weeks. We call this non-weight bearing (NWB) status. The therapist will help you decide which of these is safest for you: • Walker or knee walker • Crutches • Wheelchair You might use more than one aid. It depends on: • Your strength and balance • Other health problems you have • Cost and what your insurance covers • Features of your living space (stairs, door width, carpet or hard surface floors) Think about where you should stay while you recover from surgery. • In your home, if you can arrange for the help you will need • With a family member • In a skilled nursing facility or rehabilitation center The section Where will I recover? (p. 6) may help you decide. See your primary doctor. Discuss how your other health problems, if any, could affect your risks and results. Ask your primary care

provider if you need these vaccines: • Pneumovax® – Age 65 or older • Shingles – Age 65 or older • Flu – Depends on time of year Have a dental checkup. Severe gum disease, an abscess or other oral infection would delay surgery. Germs from your mouth carried by your blood could infect the new joint. For the rest of your life, you must take an antibiotic before routine cleaning and all other dental care. This will limit risk of blood-borne bacteria released by dental work causing infection inside your new joint. (See p. 9) Complete an advance directive (plan of care for end of life). It should be part of your medical record before surgery. (See More Resources, p. 8) Arrange for rides to the clinic. Most patients cannot drive after surgery for 8 to 12 weeks. Before you can drive again, you will have follow-up visits in Podiatry about once a week.

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Rent or buy walking aids. Practice using them. It takes time to adjust to a walking aid or wheelchair. You cannot put weight on your foot and ankle for 8 weeks after surgery. Learn how to move around your home and bathroom. Practice getting in and out of a car. The more you practice, the less likely you are to fall or harm your healing ankle. Prepare your home. See Get ready for recovery (p. 8).

NICOTINE: A NOTE OF CAUTION

Your risk of some complications is higher if you use tobacco or nicotine replacement products such as e-cigarettes. For example: It takes wounds 40 times longer and bones 10 times longer to heal if you use any nicotine at all. This is why we urge you to stop smoking or chewing as soon as you can. For the best results, it may be wise to delay surgery until you give up smoking or chewing for good. Talk with your primary care doctor about ways to meet this challenge. Medicine can be prescribed to lower your need for nicotine. You could enroll in one of our low-cost programs (see p. 8). Do you already wear a patch or chew gum to control nicotine urges? For best results, stop using either product for at least 6 weeks before and after surgery.

WHERE WILL I RECOVER?

Most patients remain in the hospital for 3 to 4 days after surgery. This allows time for nurses and doctors to be sure you are making normal progress. Nurses will often ask about your pain level and other aspects of your comfort. Therapy begins while you are still in the hospital.

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A social worker will come to your room to review topics covered during pre-op Podiatry visits: • Types of support and care you may need • Insurance questions •H  ow discharge needs are arranged and covered by most plans • What local agencies and companies can assist you •C  oncerns about how to prepare for recovery at home. Common questions include: – Will I need a bed on the first floor? – Is there a toilet I can use without climbing stairs? – Will I be able to enter and move around in my home with a wheeled walker?

– Will I need help with some or all of my meals? – If I live alone, could a friend or family member move in for a few weeks? – Could I ask someone who lives nearby to help me at certain times of the day? – How do I hire and pay for a temporary home health aide if I need one? – Will I need to buy or rent equipment for my safety or to help me move around? Patients who are otherwise in good health may go straight home. If this is true in your case, arrange well in advance for a friend or relative to stay with you. This person must be physically able to: • Help you prepare meals and do other activities in your home for about 2 weeks. • Help you take sponge baths or are nearby while you bathe yourself. • Drive you to office visits. Being discharged to a skilled nursing facility or rehabilitation center may be the right choice if: • No one can help you at home. • You have more health problems than a joint that should be replaced. • Your doctor or therapist recommends this.

2-WEEK RECOVERY TIMELINE

Think positive and keep in touch with your healthcare team. Be patient and respect these activity limits: • Weeks 0 to 8 – No weight on your new ankle. • Weeks 8 to 12 – You will have X-rays and may start physical therapy in week 8. Wear a special strapped boot that can be removed. Your doctor will decide when you can switch to a tennis shoe and brace. Weight bearing will be started and slowly increased over the next month. • Week 12 until fully healed – Tennis shoe with brace

WHAT ARE MY NEXT STEPS?

1. S ee your primary care doctor. He or she needs to clear you for surgery. You may need more tests. Health issues like these can affect the advice your doctor gives you: • Lung weakness or disease • Heart disease • Diabetes • High blood pressure • S moking or use of other tobacco products If you need to quit smoking, talk with your primary care doctor. (See p. 5.) Get Pneumovax®, shingles and flu shots if you need them.

“I would definitely recommend this surgery to others. It’s an easy decision to make if you can’t get around or are in pain. I can walk much easier today and can take the stairs, on occasion, which would have been impossible before the surgery.”

2. C  all Podiatry at (608) 775-2427 or (800) 362-9567, ext. 52427. Based on the date you choose, we will also schedule: •O  ne or two pre-op visits with your surgeon • Pre-admission phone call or visit • Several post-op visits with your surgeon

—-Nancy Steele, INBONE® Total Ankle Replacement patient

3. If you have not had recent dental care,schedule a checkup well before surgery.

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MORE RESOURCES

We hope this booklet has helped you decide what is best for you. Let us know if and when you want to continue your ankle replacement journey with Gundersen. When you are ready to commit to this challenge, we will help you achieve your goals. If you have more questions, call: Podiatry in La Crosse 8 a.m. – 5 p.m. weekdays (608) 775-2427 or (800) 362-9567, ext. 52427 Cost estimates Revenue Integrity 8 a.m. – 3:30 p.m. weekdays (608) 775-1699 or (800) 362-9567, ext. 51699 If you have coverage questions, call your insurance company or the government program in which you are enrolled.

NICOTINE CESSATION SUPPORT

Are you ready to get nicotine out of your system – and out of your life? No matter how many years you have used tobacco, it is never too late to quit. Gundersen Health System offers options for those who are: • Thinking of quitting • Trying to quit •C  oping daily with the urge to smoke or chew again For more information about what Gundersen Health System offers, call (608) 775-5442 or (800) 362-9567, ext. 55442. Let us help you start to stop! Wisconsin, Iowa and Minnesota also have programs. You can receive self-help guides, expert advice and phone support. You might even get a free starter kit of nicotine replacement product. Find out what your state offers. Call this national toll-free number: (800) QUIT NOW (784-8669).

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ADVANCE DIRECTIVE: MAKE YOUR WISHES KNOWN

Your written plan for end-of-life care should be in your medical record before surgery. Chances are very slim that staff will have to use your plan. All patients are urged to have an advance directive, not only those having a joint replaced. To start this process, call Pastoral Care at (608) 775-1347 or (800) 362-9567, ext. 51347. Ask to speak with someone about writing an advance directive. A trained staff member will assist you. There is no cost for this service.

ONLINE PROGRAMS ABOUT ANKLE REPLACEMENT

1. G  o to gundersenhealth.org/podiatry/totalankle-replacement. 2. R  ead the text in the center of the page. 3. C  lick the link for Prophecy® INBONE® Total Ankle System to see a video and hear a radio program by Dr. Roukis.

FOR MORE INFORMATION

The John & Nettie Mooney Libraries and the Stanek Cancer Library provide current health information from expert sources. On our website (gundersenhealth.org/libraries) you can: • View titles of books and DVDs you can borrow. • L ink to websites we trust and recommend. For help finding answers to your questions, ask any Gundersen Health System librarian. •C  all: (608) 775-5995 or (800) 362-9567, ext. 55995 • Email: [email protected] • I n person: La Crosse and Onalaska campuses and East Building

ANTIBIOTICS: REQUIRED FOR YOUR LIFETIME

Antibiotics are required before many procedures to keep germs or infection from spreading to your joint. This is called prophylaxis (pro-fi-LAK-sis). Your surgeon may give you other advice based on unique aspects of your case. These cautions are meant to protect your new joint and future health. Doctors and dentists must prescribe antibiotics before: • Routine teeth cleaning • Root canal • Gum disease treatment • Proctoscopy • Bladder exam or treatment • Colonoscopy • Any other invasive procedure If you are not sure, call Podiatry at (608) 775-2427 or (800) 362-9567, ext. 52427.

GET READY FOR RECOVERY

• F ind someone to care for your lawn, garden and sidewalks. •A  rrange to have mail and newspapers brought to your door or picked up by someone who brings them inside. • F ind a sitter or kennel for your pet. •C  hoose the easiest entrance to use with a walking aid or wheelchair. Add one or two rails if needed. •B  e sure all lights work in rooms and hallways. Your bedroom to bathroom pathway is most important. • Arrange to borrow a cell or cordless phone if you do not have one. A phone in your pocket makes it easy to take or make calls. •H  ave someone move your bed to make it easy to get in and out. Create a wide path on both sides.

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Gundersen Lutheran Medical Center, Inc. Gundersen Clinic, Ltd. 1900 South Avenue, La Crosse, WI 54601 (608) 782-7300 or (800) 362-9567 gundersenhealth.org #13-9790-1 Podiatry

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