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A Patient's Guide to Ankle Arthroscopy

The foot and ankle unit at the Royal National Orthopaedic Hospital (RNOH)isamulti-disciplinaryteam.Theteamconsistsoftwospecialist orthopaedic foot and ankle consultant surgeons (Mr Singh and Mr Cullen),specialistdoctorsintraining,aclinicalnursespecialist,orthotist, physiotherapists and a physician assistant. All team members are specialisedinfootandanklecareandworktogethertoprovideand deliveraqualityservice.

What is an ankle arthroscopy?

Ananklearthroscopyisaprocedurethatinvolvesmakingtwoorthree smallpuncturewoundsusuallyinfrontoftheankle.Asmallarthroscope (threetofivemillimetresindiameter)isinsertedintotheankleallowing thesurgeontoseeandoperateinsidetheanklejoint. A number of different soft tissue and bony conditions can be treated arthroscopically, for example, the removal of bony spurs, loose bone fragmentsorshavingofsofttissueinflammation(synovitis).Successand recoveryratesvarydependinguponthespecific conditionbeingtreatedand willbediscussed withyoupriortosurgery. Anklearthroscopyisusuallycarriedoutunder generalanaesthesia,eitherasadaycaseorin someinstancesasanovernightstayinhospital.

Arthroscope intheankle

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Benefits of surgery

Toreducepain/discomfortandimprovefunction,forexample,walking andsports.

What to expect after an ankle arthroscopy

Followingtheprocedure,apaddedbandagewillbeapplied.Youwill usually be advised to remove the bandage (but not the dry wound dressing)about48hoursfollowingsurgeryandtoapplyatubigriponthe ankle.Thepuncturewoundswillhaveastitchinplace­thisistokeep theedgesoftheincisionstogether.Stitchesareremovedinclinicabout 14daysfollowingtheprocedure.Itiscommonforthejointtobecome inflamedfollowingthearthroscopy.Itisadvisabletoelevatethelegand limittheamountofwalkingfortwoweeksfollowingtheprocedure,then graduallyincreaseasyoubecomemoreable.Aftersomeprocedures,a castmaybeappliedtoresttheanklefortwoweeksfollowingthesurgery; crutchesmayberequiredforashortduration.Advicefromphysiotherapists, doctorsornurseswillbegivenregardingthis.

Important post-operative advice

Gently mobilisetheankleassoonasable(thispreventsstiffnessand strengthensmuscles).Aphysiotherapistmayassesswalkingandexplain exercisesthatareeffectivetoaidrecovery.Refertotheendoftheleaflet foranexerciseregime.

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Wound(s) mustbekeptdryforuptotwoorthreeweeksfollowingthe procedure.Keepwoundsitescovered.Ameporedressingwillbeinplace followingtheprocedure.However,itispossibletotakeashowerafter 48hoursprovidingawaterproofdressingisapplied.Avoidtakingabath. Driving ­ manualcarscanbedrivenusuallysevendaysfollowingan arthroscopyiftheanklefeelscomfortable.Automaticcarsmaybedriven soonerifpatientshaveundergonesurgeryontheleftankleonly.Itis importanttobeabletoperformanemergencystop.YouMUST notify yourinsurancecompanyoftheprocedurethathasbeenundertakento ensurethatyourcoverisvalid. Sport ­ gentleactivitycanoftenberesumedapproximatelysixweeks afteranarthroscopy.Competitivesportsuchasfootball,rugbyorsquash maytakelongerbutitalsodependsonthetypeofsurgerycarriedout. Askforadvicefromyourdoctor/nurse. Recovery to a pre-operative state usually takes three to six weeks for soft tissue procedures, and twice this time for bony procedures. However, recovery is unique to the individual.

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Follow the RICE regime

R ­ rest when able. Returning to work will depend on your type of employment, the procedure that you have undergone, individual circumstances and speed of recovery. Those who have an office or sedentarytypeofemploymentwillusuallybeabletoreturntowork within seven days of the procedure taking place. Those whose employmentinvolveslongperiodsontheirfeetmaybeabsentfrom workforfourweeks. I ­ ice.Applyanicepack.Thismayhelpreduceswellingandassistwith painrelief.Itisimportanttoprotecttheaffectedareawithadamptowel priortoapplication;oftenabagoffrozenpeasisveryeffective.When thewoundhashealedandnooozeispresent,fillabowlwithwater,add someicecubesandsubmergeyourankleinthis(donotleaveyourankle forlongerthan10minutes).Thismayberepeateduptofourtimesa day. C ­ compression intheformofatubigripsupportshouldbewornduring theday.Itprovidessupporttotheankleanditalsohelpsreducepost operativeswelling.Thetubigripmustnotbewornatnight. E ­ elevate whenable.Itisadvisedtokeeptheaffectedareaabovegroin levelasthishelpstosignificantlyreduceswelling.Antiinflammatorypain reliefsuchasnurofen,ibuprofencombinedwithparacetamoliseffective. Askforadvicefromyourdoctorbeforetakinganymedications.

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Risks of surgery

Infection ­ thereisasmallrisk(1in600).Thisisincreasedinpatientswho arediabetic,sufferfromrheumatoiddiseaseandthosewhosmoke.The surgeonmaydeclinetoperformsurgeryunlessyourefrainfromsmoking. Scarring ­ anytypeofsurgerywillleaveascar,occasionallythismaybe painfulandinflamed. Numbness or tingling ­ thiscanoccurontopofthefootasaresultof minordamagetosmallnerves.Oftenitistemporary;however,numbness orasensitisedareacanbepermanent.

Exercises

1. Sitwithyouroperatedlegstraightoutinfront,putabeltround thefoot. Gently pull the belt until a stretch is felt in your calf. Hold for 20secondsandthenrelax. Repeat10times,threetofourtimesperday. 2. Placearubberexercisebandaroundyourfoot.Pushyourfootaway usingthebandasresistance,slowlyreturntoyourstartingposition. Repeat10times,threetofourtimesperday.

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3. Placearubberexercisebandaroundyourfoot.Pullyourfootup towardsyourbodyusingthebandasresistancethengentlyreturn toyourstartingposition. Repeat10times,threetofourtimesperday. 4. Placeyourheelonthegroundandturnyourfootinwards(asifto lookatthesoleofthefoot). Repeat10times,threetofourtimesperday. 5. Placeyourheelonthegroundandturnyourfootoutwards(asif tolookattheoutsideofthefoot). Repeat10times,threetofourtimesperday. Report any excessive pain, swelling, redness or discharge to your General Practitioner or contact the foot and ankle team.

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Ifyouhaveanycommentsregardingthisleafletcontacttheclinical governancedepartmenton02089095628. RoyalNationalOrthopaedicHospitalNHSTrust BrockleyHill Stanmore Middlesex HA74LP Tel:02089095305 MrSingh'ssecretary:02089095842 MrCullen'ssecretary:02089095695 www.rnoh.nhs.uk RNOH10249 ©RNOHFebruary2010 Author:KarenAlligan

If you need this document to be translated into another language/large print, please contact the clinicalgovernancedepartmenton02089095439.

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Articulate Issue June/July

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