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Keyhole Surgery:  Arthroscopy,  MIS Bunion

Arthroscopy is a surgical procedure to examine a joint from the inside through a telescope (arthroscope). A small camera is attached to the end of the telescope that projects the image of the inside of the joint onto a television screen. The surgeon can then perform surgical therapeutic procedures through a small key hole.

Our surgeon practices following arthroscopic and MIS techniques:

   Anterior Ankle Arthroscopy: Key hole procedure to examine and treat the front of the ankle joint.

   Posterior Ankle Arthroscopy: Key hole procedure to examine and treat the back of the ankle joint.

   Hindfoot (subtalar joint)  Arthroscopy: Key hole procedure to examine and treat the joint under the ankle point. (subtalar joint)

   Calcaneoplasty: Key hole procedure to examine and treat problems with the back of the heel.

   First MTP (Big toe) Joint Arthroscopy: Key hole procedure to examine and treat the big toe joint.

   Knee Arthroscopy: Key hole procedure to examine and treat the knee joint.

   Minimally Invasive Bunion Surgery (MIS): Key hole procedure to correct Bunion.



Patient Information: FAQ

Anterior Arthroscopy of the ankle:

What is an arthroscopy of the ankle?

An arthroscopy is an operation on a joint which is done by a “keyhole” technique. An instrument which contains a video camera is inserted through small cuts into the joint so the surgeon can examine the inside. The surgeon can also treat problems inside the joint with special probes and instruments inserted through the same small cuts.

What are the benefits of an arthroscopy?

It allows the surgeon to see in detail what the problem with your ankle is, and determine the degree of damage, if any. It is possible to treat many problems in the ankle with an arthroscopy, such as:

  • Inflammation of the lining of the joint (synovitis)
  • Arthritis (debridement)
  • Infection
  • Loose tissue in the ankle stopping it from moving properly (debridement)
  • Remove part of bone suspected of causing pain (impingement)
  • Treat damaged cartilage (OCL)
  • Assess and treat ankle ligament injury (capsular shrinkage)

Doing it through small cuts makes it less painful afterwards and there is less of a wound to heal.

Are there any alternatives to surgery?

Usually, we will have already tried any other treatments that would be suitable for your ankle problem, as surgery is usually only suggested if these haven’t worked. Ankle injuries usually heal themselves, and physiotherapy often helps to get a good result. If the inside of the ankle is inflamed after an injury, or if you have arthritis, an injection of cortisone may help.

If you have damaged the joint surface, or there is loose tissue or a severe inflammation, we would usually recommend surgery early as these problems probably won’t get better with any other treatment, and can get worse if not treated. Mild infections might be treated with a long course of antibiotics.

In the past, a lot of arthroscopies were done mainly to work out what was wrong with your joint. Careful examination, Xrays and tests like MRI scans now mean that we usually know what is the matter before surgery, but sometimes an arthroscopy makes it clearer and helps us to work out what treatment plan to follow.

What if I decide not to have the operation?

In most cases, the alternative to having an arthroscopy is to put up with the problems you have, as other treatments will already have been tried. We will advise you if there is a risk your problem could become worse or result in permanent damage without surgery.

What does the operation involve?

Your anaesthetist will advise you whether it is best for you to go to sleep or have your leg made numb for the operation. The anaesthetist will also make sure you get good pain control after the operation.

The surgeon will examine your ankle carefully and may take some special X-rays. Then the surgeon will make small cuts around your ankle (usually between 2 and 4 cuts are needed, each about 1cm long). The camera and instruments will then be put into the joint. The surgeon will examine the joint and do any necessary treatment. The ankle is then washed out, a single dissolving stitch is put in each of the cuts and local anaesthetic injected to prevent pain in the cut as you wake up.

Occasionally it may be necessary to make one of the cuts bigger to get a larger instrument into the ankle. Your surgeon will discuss with you if this might be necessary for your operation.

If you are otherwise fit, and there is someone who can collect you afterwards and stay with you overnight, the operation can be done as a day case. If you have other medical problems, or have no-one at home with you, you will have to stay overnight, and you may have to come into hospital the day before for medical tests or treatment. Your hospital stay will be discussed and arranged in the clinic when surgery is offered. Most ankle arthroscopies are done as day case operations.

What will it be like afterwards?

There will be a bulky dressing round your ankle. When you have recovered from your anaesthetic, you can get up, walking freely on your ankle. We try to discuss the findings of your operation with you before you go home, but if you have not recovered by the time the surgeon leaves the hospital, or if you are ready to go home before the surgeon is free, the ward staff will simply tell you any important message from the surgeon and the findings will be discussed in clinic. Please note that if you have had a general anaesthetic, you may not remember what is said to you and so it will all be repeated in clinic.

We will see you in the dressing clinic 2 days after the operation. We will take off the first dressing, check the cuts and put a lighter dressing on so you can start exercising your ankle, using both up-and-down and side-to-side movements (you will be given advice on this in the clinic). The ankle will still be fairly swollen, bruised and stiff at this stage, so you should keep it up when not walking or exercising. If it gets very swollen, you can put some ice on it for 10-15 minutes.

We will see you again in the outpatient clinic 10-14 days after your operation. Your ankle will be examined. The findings of your arthroscopy will be discussed with you, and any further treatment that is necessary will be arranged. Physiotherapy is often prescribed at this stage, but many people do not need it and can exercise on their own. If no further treatment is required and your ankle is healing well, you may not need to come back again, or a further check-up may be arranged if we need to check your progress.

The stitches are usually made of dissolving material and dissolve after 3-4 weeks without needing to be removed. If you have trouble with them, contact the Fracture Clinic.

How painful will it be?

There will be some pain from the cuts and from the inside of your ankle. We will put some local anaesthetic in the ankle at the end of the operation to make it numb for a few hours. We will give you pain-killers to take home. Start taking these as soon as you feel pain – don’t wait for it to get bad. Most people need to take some pain-killers for 1-2 weeks after an arthroscopy.

How soon can I…

Walk on the ankle?

You can walk on the ankle immediately you have recovered from your anaesthetic. It may be quite sore for a few days and some people need crutches to take some of the weight off their ankle. Almost everyone can walk with their full weight on the ankle within a week.

Go back to work?

If you are comfortable and your work is not too demanding, you could go back to work within a week. However, if you have a heavy manual job, or have had extensive surgery within the ankle, you may not be able to go back for a month or more.

Please note, if you have had an arthroscopy of your knee before, that the recovery from an ankle arthroscopy takes about half as long again as a knee procedure.

Drive?

If you have an automatic car and have an operation on your left ankle, you could drive within a couple of days of the operation! Otherwise you can drive about 1-2 weeks after surgery, depending mainly on your comfort and safe control of the vehicle.

Play sport?

As you recover from your operation, you can gradually increase your activity, determined by comfort and the amount of swelling and flexibility in the ankle. Start with walking and cycling, then light running. Make sure your foot and ankle are fairly flexible before moving to twisting or impact activities, and make sure you can turn and jump comfortably before returning to contact sports.

Your return to sport will also depend on the damage to your ankle which caused you to have surgery in the first place, and on any other necessary treatment. As this operation tends to be done for problems following an injury, this is an important factor in recovery for many people.

All other things being equal, most people will get back to their previous level of activity in 2-3 months.

What are the risks of an arthroscopy?

Our team will try to make your operation as safe as possible. However, things can go wrong, which we can’t always prevent. Most problems are a nuisance which may slow up your recovery and may need further treatment. On occasion it may mean that the result of your operation is poor. As with any procedure that involves anaesthetic there are risks which in extreme circumstances may lead to a fatality.

We have listed the main problems which can occur after an arthroscopy. Where possible, we have given an idea of the chance of this problem happening, taken from research on people who had an arthroscopy. The team will advise if your risk is different.

  • Medical problems of having an operation, such as problems with your heart, lungs or kidneys, or reactions to drugs you are given. These are rare in arthroscopies.
     
  • Blood clots in the veins of the leg (deep-vein thrombosis or DVT), which if breaks off and move to the lungs, blocking the circulation and making it difficult to breathe (Pulmonary Embolism).  This is also very rare in arthroscopy (probably about 1 in 200), unless you have certain medical problems. If you are at a higher risk, we will give you treatment to make your blood less likely to clot. For most people this is not necessary.
     
  • Difficulty passing urine following spinal anesthetic (risk 1 in 300). If this happens, you may need a tube (catheter) in your bladder for a day or so. Unless you have other problems with your bladder or prostate gland, there are usually no permanent problems.
     
  • Infection in the cuts, or in the ankle. The cuts usually heal up quite quickly, but a few discharge some fluid and take 2-3 weeks to heal. Usually dressing the wounds carefully is all that is required to get them to heal; sometimes antibiotics are needed too. The risk of infection in the cuts is about 1 in 75. Infection in the ankle joint is much rarer (1 in 300), but is much more serious. You would usually need another operation to wash out the ankle and a long course of antibiotics. Infection in the ankle can cause permanent damage
     
  • Damage to a nerve near the ankle (risk 1 in 10). The commonest problem after an ankle arthroscopy is numbness over the top of the foot or outer toes. This is because the cuts are made close to the nerves to these areas, and the nerves have to be pushed aside to get access to the joint. Although this is done very carefully with an instrument, sometimes this stretches the nerves and they stop working. Usually this numbness recovers within 2 months, but a few people have small areas of permanent numbness
     
  • Bleeding into the ankle. This can cause swelling and pain. Often it will get better with simple treatment, but you might need another arthroscopy to wash out the blood and your ankle might be stiffer than usual afterwards
     
  • Regional pain syndrome (risk 1 in 600). The nerves in your leg and foot become abnormally sensitive, leading to severe pain, swelling and stiffness. We don’t really know why this happens. Pain-killing drugs and physiotherapy can help, but some people will get a rather stiff, sensitive leg and foot permanently
     
  • Compartment syndrome (very rare with ankle arthroscopy). If fluid leaks out of your ankle into your calf muscles during the operation, the muscles can swell so much the blood circulation is cut off. If this happens, you may need another operation to release the muscles. A skin graft may be necessary to repair the leg afterwards, and most people have rather unsightly scars and often some weakness or stiffness in the leg

What part can I play to help make the operation a success?

  • If you smoke, try to stop smoking now. If you stop several weeks or more before an operation, your risks of medical complications, blood clots and infection are less
     
  • If you are overweight, losing weight will make it easier to get going after the operation and reduce your risk of complications
     
  • If you need help to stop smoking or to lose weight, there is lots of assistance and guidance to do so, please ask the team or your GP for the relevant information

Medication

  • You should continue your usual medication unless we advise otherwise. You will be given instructions with your admission letter about taking medication on the day of surgery
     
  • Please tell us if you are on warfarin, clopidogrel or the contraceptive pill. Hormone replacement therapy (HRT) isn’t usually a problem but please tell us if you take it

Summary

An arthroscopy of the ankle is a good way to treat many problems, especially ankle injuries and arthritis. The keyhole technique makes it less painful afterwards and avoids big scars. The success rate could be about 70-80% depending on what your problem is. However, some complications can happen after an arthroscopy. You need to know about them to decide whether an operation is best for you. Please discuss this with your surgeon.


MIS Bunion surgery:

Bunions and other foot problems can now be successfully treated with keyhole surgery. This normally does not require any large surgical incisions or stitches. The soft tissue envelope is protected resulting in minimal scarring, less pain and speadier recovery.
The MIS (minimally Invasive Surgery) for bunion is now available at our clinic.

Suitability for minimally invasive forefoot surgery:

Specialist expertise ensures that treatment is most appropriate for each individual patient. After having a specialist consultation & assessment we can advise whether minimally invasive forefoot surgery is appropriate for you. Typically, patients with mild to moderate deformities are suitable for this type of ‘keyhole’ surgery.
Our surgeon provides expert advice on all aspects of foot & ankle surgery. His aim is to ensure that the treatment he provides at his clinic leads to the best possible outcome for our patients.

How is minimally invasive forefoot surgery performed?

At Lancashire Foot Clinic, we offer the most advanced techniques to achieve successful treatment & optimal recovery.
The surgeon makes 3 mm incisions through which to perform the correction using a 2 mm diameter cutting device to shave or cut the bone in a controlled manner under x-ray guidance.
Where shaving excess bone from the foot the surgeon then carefully removes this unwanted bone. If a correction is needed the correct position is attained and a screw is placed in the bone to maintain this position until the bone heals. These screws are small and designed to sit inside the bone reducing their need for removal.
It is important that minimally invasive forefoot surgery is carried out by a specialist foot and ankle surgeon with extensive experience of open forefoot surgery, which forms the fundamentals of this technique.

 

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Mr. Aamir I Zubairy - Lancashire - Foot & Ankle Clinic
Consultant Orthopaedic Surgeon Specialising..
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