Algorithm for postoperative management of patients after ankle replacement surgery

Introduction Total ankle arthroplasty (TAA) can be associated with postoperative difficulties during the rehabilitation phase. A unified, tailored approach to rehabilitation and postoperative care is essential for the patients.
The objective was to evaluate clinical effectiveness of the algorithm developed for postoperative management of TAA patients to improve functional recovery, reduce postoperative complications for greater patient satisfaction.
Material and methods The study included 28 patients with impaired distal tibia and the ankle. The surgical treatment performed after a comprehensive examination included segmental resection of the distal tibia and ankle replacement of the original design. The implant had an articulating ankle joint and the distal tibia replacement. The algorithm developed for postoperative rehabilitation relied on a six-level approach borrowed from rehabilitation guidelines for total ankle arthroplasty devised at the Massachusetts General Hospital.
Results Postoperative management included multimodal analgesia with a regional component, multi‑level prophylaxis of infection, antithrombotic protection and staged immobilization with early controlled loading. Primary wound healing was observed in all patients. The mean postoperative swelling measured with  the  visual  swelling scale decreased from  (3.8 ± 0.6) to  (0.9 ± 0.4) scores after six weeks. Dorsiflexion measured (20 ± 3)°, plantar flexion was (36 ± 4)°, and 100 % of patients could regain a stable biphasic gait pattern at 16 weeks.
Discussion There are few detailed protocols for postoperative care and rehabilitation of TAA patients. The algorithm offered showed the effectiveness with the gait being almost normal with the range of motion and strength restored at four months. Patients reported high satisfaction measured with functional scales and subjective quality of life assessment.
Conclusion The step-by-step six-phase algorithm developed for postoperative management and rehabilitation of patients treated with segmental tibia resection and TAA facilitated a lower risk of postoperative complications, reduced function recovery time and high satisfaction ratings.

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