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Same Day Discharge After Joint Replacement

Same Day Joint Replacement Surgery Offers Many Benefits With Decreased Risk

 

Ankle Sprain

An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.

Cause

Your foot can twist unexpectedly during many different activities, such as:

  • Walking or exercising on an uneven surface
  • Falling down
  • Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
  • During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.
Bruising and swelling are common signs of a sprained ankle.

Bruising and swelling are common signs of a sprained ankle.

Treatment

Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately.

 

Home Treatments

For milder sprains, your doctor may recommend simple home treatment.

The RICE protocol. Follow the RICE protocol as soon as possible after your injury:

  • Rest your ankle by not walking on it.
  • Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin.
  • Compression dressings, bandages or ace-wraps will immobilize and support your injured ankle.
  • Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. Because they improve function by both reducing swelling and controlling pain, they are a better option for mild sprains than narcotic pain medicines.

Nonsurgical Treatment

Some sprains will require treatment in addition to the RICE protocol and medications.

Crutches. In most cases, swelling and pain will last from 2 to 3 days. Walking may be difficult during this time and your doctor may recommend that you use crutches as needed.

Immobilization. During the early phase of healing, it is important to support your ankle and protect it from sudden movements. For a Grade 2 sprain, a removable plastic device such as a cast-boot or air stirrup-type brace can provide support. Grade 3 sprains may require a short leg cast or cast-brace for 2 to 3 weeks.

Your doctor may encourage you to put some weight on your ankle while it is protected. This can help with healing.

Physical therapy. Rehabilitation exercises are used to prevent stiffness, increase ankle strength, and prevent chronic ankle problems.

  • Early motion. To prevent stiffness, your doctor or physical therapist will provide you with exercises that involve range-of-motion or controlled movements of your ankle without resistance.
  • Strengthening exercises. Once you can bear weight without increased pain or swelling, exercises to strengthen the muscles and tendons in the front and back of your leg and foot will be added to your treatment plan. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Exercises with resistance are added as tolerated.
  • Proprioception (balance) training. Poor balance often leads to repeat sprains and ankle instability. A good example of a balance exercise is standing on the affected foot with the opposite foot raised and eyes closed. Balance boards are often used in this stage of rehabilitation.
  • Endurance and agility exercises. Once you are pain-free, other exercises may be added, such as agility drills. Running in progressively smaller figures-of-8 is excellent for agility and calf and ankle strength. The goal is to increase strength and range of motion as balance improves over time.

Surgical Treatment

Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.


Surgical options may include:

  • Arthroscopy. During arthroscopy, your doctor uses a small camera, called an arthroscope, to look inside your ankle joint. Miniature instruments are used to remove any loose fragments of bone or cartilage, or parts of the ligament that may be caught in the joint.
  • Reconstruction. Your doctor may be able to repair the torn ligament with stitches or sutures. In some cases, he or she will reconstruct the damaged ligament by replacing it with a tissue graft obtained from other ligaments and/or tendons found in the foot and around the ankle.

PRP Questions

Platelet-rich Plasma Injections

What are platelets?

Platelets are small cells in the blood that help form clots to stop bleeding.
 

What is platelet-rich plasma?

Platelet-rich plasma (PRP) is a patient’s own concentrated platelets. PRP contains a large number growth factors. These growth factors stimulate healing.
 

What are the goals of a PRP injection?

When PRP is injected, it can aid the body’s natural healing of injuries. The goal is not only to relieve symptoms but to create actual healing. In some cases, PRP may reduce the need for medication and/or surgery.


When is a PRP injection helpful?

It has been used to treat tendon, ligament, cartilage and bone injuries, as well as arthritis. 
 

When should I avoid a PRP injection?

PRP injections are not recommended for the treatment of infections or cancer.
 

General Details of PRP Injection Therapy

A small amount of a patient’s blood is drawn and then spun at high speed. The platelets are concentrated. This liquid is then injected around or near the area of injury being treated. The PRP at this stage contains three to five times the concentration of growth factors compared to normal human blood.
 
A physician may recommend a single injection or a series of injections based on the injury being treated and a patient’s initial response to the therapy. Your doctor may use ultrasound or an X-ray as a guide to placing the injection.
 

What happens after a PRP injection?

You may experience mild pain and irritation of the area for several days following the injection. Some doctors may ask patients to limit motion or weight-bearing activity immediately following the injection. The use of a brace, boot or cast may be recommended during the early post-injection course.
 
Three to seven days after the injection, you may gradually return to normal physical activities. The return to full activity is determined based on response to the therapy and the recommendation of your surgeon.
 

Potential Complications

As PRP is obtained from your own blood, the risk of reaction is low. As with any injection, there is a small risk of injury to any structures in the area as well as a very small risk of infection.
 

Frequently Asked Questions

How many PRP injections can I have?
A treatment may require a series of injections, perhaps three to five. However, multiple injections are often not recommended if there is no improvement in symptoms following the first or second treatment.

Call Today to Schedule a Consultation

If you suffer from painful joints, PRP Injections may be your answer.  Ask your OSOC doctor about this new and exciting procedure!
248-335-2977

Total Ankle Replacement FAQ

  • Who should consider an ankle replacement?

    When ankle arthritis pain prevents routine daily activities, and non-surgical treatments have failed, you may be a candidate for total ankle replacement surgery (TAA).

  • Why haven’t I heard about ankle replacements as much as I’ve heard about hip and knee replacement?

    Ankle arthritis that requires surgery is not as common on a condition. Early attempts at TAA, more than 20 years ago, typically were not as successful. The implant Dr. Howard uses is a third generation of one, first successfully used in 2005, with an excellent history of stability and pain relief.

  • What Doctors are best trained to do my total ankle replacement surgery?

    Total Ankle Replacement surgery should be performed by an orthopedic surgeon with extra training in foot and ankle conditions, and training in TAA surgery.

  • Is all ankle arthritis best treated by total ankle replacement surgery?

    Milder forms of ankle arthritis can be treated non-operatively with physical therapy medications and bracing. Moderate forms of ankle arthritis may benefit from less involved surgeries, such as ankle arthroscopy or open spur excision. Depending on many factors, your surgeon may suggest an ankle fusion surgery instead of a total ankle replacement.

  • If I have a total ankle replacement, where and how is it performed?

    Dr. Tisdel performs total ankle replacement surgery at St. Joseph Mercy Oakland and Royal Oak Beaumont Hospitals. It is done under a general or spinal anesthetic. Blood loss and transfusion are not typically an issue because a tourniquet is used during surgery. Surgery takes about 2 hours. Most patients also receive a nerve block for pain relief that lasts 1 -4 days. Most patients have a one night hospital stay.

  • What is total ankle replacement post-operative recovery like?

    Patients are in a splint, then a cast for the first 2-3 weeks after surgery. During this time, no weight is allowed on the operative foot, using crutches or either regular or roll-about walker. Most of the first 2-3 weeks should be spent resting with your foot elevated above your heart to prevent swelling, and help heal your incision. At 2-3 weeks, a removable walking cast is applied. You can start to apply partial weight on foot, and begin gentle range of motion of the ankle. Six weeks after surgery, with x-ray confirmation, the TAA implant is usually healed enough to put full weight on the foot in a cast boot, and to begin formal physical therapy. By 10 weeks, most patients are putting a shoe on. Your ankle continues to improve for many months.

  • After I’m fully healed, what can I expect?

    After full recovery, most people have little or no ankle pain, and greatly improved flexibility. You may return to confidently performing all normal daily activities. Although most low impact sports and exercise can be enjoyed again (golf, light tennis, yoga, biking, swimming, exercise walking), to reserve the life of the implant running, jumping and higher impact activities are not recommended.

  • How long should the total ankle replacement surgery last?

    The current implants have been lasting 10 or more years in greater than 90% of patients. In general, we hope for 15 to 20 years of ongoing great results.

Ankle Replacement

Learn More About Ankle Replacement

Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis.

Joint Replacement

Learn More

Hip Replacement

Hip replacement surgery (THA) has proven to be one of the most successful operations in medicine.THA surgery can help relieve pain, increase mobility and improve a patient’s quality of life.  

Learn More

Knee Replacement

Knee replacement (TKA) is a surgical procedure that replaces a damaged knee joint, usually a result of arthritis, with an implant.  The dedicated physicians at Orthopedic Specialists of Oakland County are experts in caring for patients with knee pain. 

Learn More

Ankle Replacement

Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis. The goal of TAA is to improve ankle motion so the patient has less pain during activity. 

Learn More

Shoulder Replacement

Shoulder joint replacement (TSA) is less common than knee or hip replacement, however, it is just as successful in relieving joint pain and restoring a patient’s quality of life. 

Ankle Replacement

Total Ankle Arthroplasty

What is total ankle arthroplasty?

Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis. Arthritic changes may be a result of normal wear and tear due to aging or from an injury such as a broken ankle or dislocation. Arthritis eventually leads to loss of cartilage, pain and/or deformity.
 

What are the goals of TAA?

The goal of TAA is to improve ankle motion so the patient has less pain during activity. 

What signs indicate TAA may be needed?

TAA is considered in patients that experience ankle pain and decreased function from arthritis after trying conservative management. Conservative management includes anti-inflammatory medication, bracing, physical therapy, activity modification and pain medication. Patients with rheumatoid arthritis are usually good candidates for the ankle joint replacement. Other patients that should be considered are those that need but do not want a fusion-type procedure that would eliminate the motion at the ankle joint.

When should I avoid a TAA?

TAA is not suited for patients with significant deformity or dead bone in the talus, which is the bottom bone of the ankle joint. Prior or current infections of the ankle, significant lower extremity neuropathy, inadequate or absent leg muscle function, poor blood flow of the leg, or inadequate soft tissues are also signs that TAA should be avoided.

General Details of Procedure

TAA is performed either under general anesthetic or nerve block. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that re-create the ankle joint. Sometimes the patient will have a tight calf muscle or tight Achilles tendon that needs to be lengthened to improve range of motion of the ankle. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implants to heal in place.

Specific Technique

Either before or after the ankle replacement is put in place, the orthopaedic foot and ankle surgeon will determine if the calf muscle or Achilles is tight. A tight calf muscle or Achilles tendon is addressed with a lengthening procedure. This is important to improve motion after the surgery, as well as to take stress off the ankle replacement.

What happens after surgery?

Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The procedure is usually performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for many days after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, some orthopedic foot and ankle surgeons will allow the patient to start working on gentle range-of-motion activities even if they are non-weightbearing. Weightbearing usually begins a few weeks after surgery if X-rays show good healing.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication of ankle replacement. Wound healing can be a problem in patients that smoke or have diabetes, or in patients that have rheumatoid arthritis. Another complication that is sometimes seen is the failure of the ankle implant to heal into the bone.

Frequently Asked Questions

There are two surgical approaches for treatment of arthritis: ankle fusion and total ankle replacement. Why should I consider an ankle replacement?
When motion of the ankle is preserved in a TAA, the surrounding joints are protected from increased wear. This helps preserve the surrounding joints from arthritis. It is usual for people with ankle fusions to have progressive arthritis in the surrounding joints in about 10 to 15 years.
The number of ankle replacements being performed is increasing dramatically. This is a result of improved outcomes. Newer implant designs and improved surgical techniques are helping patients be more active after a TAA than they were previously.
Who should I see to have a total ankle replacement?
An orthopedic foot and ankle surgeon should be seen for management of ankle arthritis. Orthopedic surgeons who specialize in foot and ankle surgery are specifically trained to perform ankle replacements as well as take care of any complications should they arise.
 
Read more Frequently Asked Questions about ankle replacements
 

Dr. Howard

Dr. Robert Howard
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Robert Howard, DO

Dr. Howard is primarily focused on diagnosing and treating foot and ankle conditions with the latest techniques. Dr. Howard is one of the few orthopedic surgeons specifically trained in conditions of the foot and ankle. 

Heel Pain

Plantar fasciitis (plan-ter fash-ee-eye-tiss) is pain in the heel or arch of the foot. It is caused by irritation of the plantar fascia—the band of tissue that goes from the heel to the ball of the foot.

 heelspot

Plantar fasciitis is a common condition. It is also called jogger’s heel. The main symptom is pain in the heel when you stand up after sleeping or resting. The pain usually gets better when you walk around.

Treatment

  •  More than 90% of patients will improve of starting simple treatment. 
  • It usually goes away on its own in less than six months.
  • Achilles Stretching by leaning forward against a wall with your foot planted  will help.  

achillesstretch

  • Using medication such as Ibuprofen or Naproxen may help (always consult your physician before taking these medications).
  • Physical Therapy. We offer expert P.T. at both of our office locations.  
  • Heel pad or lift may help.
  • Cortisone Injections which can act a powerful anti-inflammatory to reduce inflammation. 
  • Ice on the back of the heel may help. 

If the above treatments do not work then surgery may be an option. Here are some things you should know before you consider surgery. Read the Consumers Reports Choose Wisely handout.

Read More: High Heels and Foot Pain

Dr. Robert Howard
Learn More

Robert Howard, DO

Dr. Howard is primarily focused on diagnosing and treating foot and ankle conditions with the latest techniques. Dr. Howard is one of the few orthopedic surgeons specifically trained in conditions of the foot and ankle. 

Elbow Pain Golfer vs. Tennis

Even if you’ve never played a set of tennis or a round of golf, you can still suffer from these elbow injuries. Both are overuse injuries that are caused by any activity that requires repetitive motion of the arm and wrist. The difference between the two conditions lies in where the elbow is inflamed.

Both Tennis Elbow and Golfer’s Elbow are forms of epicondylitis, an inflammation of tendons that attach to the elbow. Tennis Elbow affects the lateral, or outside, epicondyle and Golfer’s Elbow affects the medial, or inside, epicondyle.

tennis golfers

Tennis Elbow
Tennis Elbow, or lateral epicondylitis, is most common in adults between the ages of 30-50. It is an overuse and muscle strain injury that results in an inflammation of the outside of the elbow and forearm areas.  With repeated use of your forehand and backhand, those muscles are often overworked, becoming inflamed. Plumbers, carpenters, painters, and cooks are prone to Tennis Elbow due to the repetitive nature of their occupations. Seasonal activities such as raking, gardening and cutting wood can cause Tennis Elbow as well.

Symptoms
Pain may radiate from the outside of the elbow to your forearm and wrist.  It can be a constant ache in the elbow area, or you may only feel it while performing activities that involve reaching, grasping or lifting. 

Treatment

Treatment can range from simple stretching exercises, physical therapy and/or injections. Surgery is sometimes needed for pain that does not improve with the above treatments.  It is important to see a doctor to ensure that you receive a correct diagnosis and treatment for the cause of your pain.


Golfer’s Elbow

Medial epicondylitis, or Golfer’s Elbow, is an irritation on the inner side of the arm and elbow. This condition can be caused by any activity that requires repeated twisting or flexing (bending downwards) of the wrist. Generally, it is an overuse of the forearm muscles during such tasks as gardening, shoveling, throwing a ball, playing golf or tennis. Repeated lifting, especially when your elbow is extended and your palm is facing down, can also cause Golfer’s Elbow. In addition to golf, other activities may cause this condition such as racquet sports, baseball or softball, weightlifting, carpentry, painting and other similar activities.

Symptoms
Symptoms include pain on the inside of the elbow when lifting the wrist or hand, pain when twisting the forearm, or when making a fist. The area may be slightly swollen or tender to the touch. If the problem has lasted for a while, additional symptoms can include stiffness in the elbow or weakness in the hands or wrist.

Treatment

Treatment can range from simple stretching exercises, physical therapy and/or injections. Surgery is sometimes needed for pain that does not improve with the above treatments.  It is important to see a doctor to ensure that you receive a correct diagnosis and treatment for the cause of your pain.

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