Ankle Arthroscopy

Summary

This operation is performed for a variety of conditions affecting the ankle joint itself.  Most commonly, ankle arthroscopy is performed after an injury to the ankle has occurred causing damage to the joint surfaces or scar tissue to build up in the joint.  It is also helpful in the treatment of ankle arthritis, ankle instability, infection and impingement.

Factors to Consider

Ankle arthroscopy is keyhole surgery to the ankle.  This minimally invasive technique is useful for treating a number of ankle conditions.  It is likely that you have already tried non-surgical treatments for your ankle problem such as physiotherapy and splints.  If these measures have not improved your symptoms then the next logical step is to consider surgery.  Your surgeon will discuss whether ankle arthroscopy would be useful to treat you ankle condition.  

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is usually performed through at least 2 small incisions at the front of the ankle.  A fibre-optic camera is placed into the ankle through one of the incisions and the ankle is filled with saline to allow for direct vision of the ankle problem.  Intruments can then be introduced through the other incision to treat the problem.  Sutures are used to close the wounds and a bulky bandage or boot is placed on the ankle depending on the procedure that has been performed.

The operation takes about 1 hour.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  Some patients will experience numbness or “pins and needles” over the top of the foot after surgery.  This will usually settle over time.

Any surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Plaster/Immobilisation

You will wake up with your foot in a bandage or boot.  The surgeon will give you instructions specific to your operation regarding when you can start to weight bear. 

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes 6 weeks, unless your surgery is to your left ankle and you drive an automatic car.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.