Ankle arthroscopy: 23 Hour Unit

At Mater Health Services we understand that being in hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients’ needs. It explains briefly the events that may occur during your visit and the things to expect when you are discharged from the hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please ask your doctor or nurse.

Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

Ankle arthroscopy

When an ankle problem fails to respond to physiotherapy, medication or other non-surgical treatments, an ankle arthroscopy is performed. An arthroscopy can be both diagnostic, where a diagnosis can be made to find out what is wrong with the ankle joint, and therapeutic, where correction of the injury or problem is made within the ankle joint.

Two or three puncture wounds are made around the ankle and an arthroscope is inserted through these wounds to allow the surgeon to see and operate inside the joint. Both soft tissue and bone can be operated on.

Expected length of hospital stay

The day following your surgery you will be transferred anytime from 7 am to the Transit Lounge then discharged at the pre-arranged time.

Our expectations

Prior to discharge:

your pain will be well controlled
you will tolerate diet and fluids
you will be able to walk with or without crutches.

Pre-admission clinic

MAH provides a pre-admission service. You will have received this service in any of the following ways:

from the specialty clinic to the pre-admission clinic
at the pre-admission clinic
over the phone.

The pre-admission service gathers information, initiates investigations to prepare you for your surgery, provides information regarding your specific operation and identifies discharge needs.

Things to do before you come to hospital

It is important for you to have completed all the tests which your doctor has ordered prior to coming to hospital. please bring X-rays, any ECG reports and all your blood test results with you to hospital along with your medications. Your medications need to be in their labelled containers or Webster pack.
If you are taking any blood thinning or arthritis medications please follow instructions provided by your pre-admission nurse or pharmacist. Sometimes it is important that these medications be stopped in preparation for your surgery.
It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. Please follow instructions provided by your doctor or pre-admission nurse.
It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products-such as deodorant, perfume, body lotion, powders-are to be used following your shower.
Mater Adult Hospital is unable to accept liability for losses. It is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only. While Mater does not take responsibility for your personal belongings our Security Office will hold any lost property that is handed in.
Read this booklet and have it ready to bring with you to hospital.

Before your operation

When you come to hospital proceed to the Day Procedure Unit, on Level 5 at Mater Adult Hospital, where you will be admitted and prepared for surgery. At different times through out your hospital stay and as a safety requirement, staff will request confirmation of your name, DOB, allergies and procedure.
The assessment form, completed at the pre-admission service, will be reviewed and your health team will plan for your individualised care while in hospital and any support you may require after discharge. Your nurse will also check that your consent form has been signed or organised to be signed before your operation.
Your nurse will discuss with you any concerns that you may have about your surgery and needs that you may have when you are discharged.
It is an infection control requirement at Mater that you will be required to have swabs taken if you have transferred from, or worked at another health care facility, or you have had previous resistant infections. This is usually identified and attended at the pre-admission clinic. Your admission nurse will check if these three swabs have been taken and will complete the test if there are further swabs required.
The medications you brought to hospital will be collected. These will be returned to you when you leave the hospital. Please inform the nurse admitting you if you have been taking any blood thinning or arthritis medications prior to your admission, as these may have needed to be stopped before your operation day. It is usual for you to continue taking your other prescribed medications.
You may walk as much as you like. Please notify staff if you leave the ward.
You will have an identification armband applied. This will stay on for the duration of your stay for identification and safety reasons. If you have any known allergies, you will have a red “allergy” armband applied, for your safety.
Your nurse will take a set of baseline observations (e.g. temperature, pulse, blood pressure), weigh you and may ask you to provide a urine sample for routine testing.
It may be necessary to clip any hair in the surgical area.
You will be asked to dress into theatre clothing.
You may be prescribed a medication before you go to surgery.
Before you leave for theatre a pre-operative check list will be completed with you by your nurse. This check-list will be repeated in the operating reception area. Apart from your wedding band, no jewellery or metal is to be worn to theatre.
You will be escorted to the operating suite.
It is important to practise your breathing and leg exercises which you will need to commence once you have woken up from your operation.

Breathing and circulation exercises

The following exercises help prevent complications such as chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed.

Breathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.

Circulation exercises: on your unaffected side firmly move your ankle up and down to stretch and contract your calf muscle. On the side which had the arthroscopy move as much as is comfortable.

After your operation

You will stay in the recovery room, in the theatre suite, after your operation while you waken from the anaesthetic. You will be transferred on your bed to your room in the Day Procedure Unit.
You will have a dressing over your wound. It may be necessary for you to have a drain in place to remove excess fluid from the site of your operation
Your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) dressings/drains and wound (colour, warmth, sensation and pulses) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital.
Immediately following your surgery, you will be resting in bed. When you feel well enough you will be assisted the first time you get out of bed. You will be instructed on how much weight-bearing you can do according to your doctor’s orders.
About four hours after you return to the ward, your nurse will assist you to have a wash.
You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.
If you have pain or nausea, please tell your nurse as there are medications which can be given to relieve this. It is important to be comfortable.
The drip (IV) is necessary to maintain your fluid intake. This will be removed when you are tolerating adequate amounts of oral fluids.

In preparation of going home

Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
Discharge information will be given to you and your nurse will discuss this with you. If you have any questions, please do not hesitate to ask.
A full assessment will be made prior to transferring you to the Transit Lounge in preparation for discharge to ascertain your condition is safe for you to go home.
You will be transferred to the Transit Lounge anytime from 7 am, the morning following your surgery. This is where you will wait for your transportation home. Those picking you up will find the Transit Lounge:
- on the fourth floor of Mater Adult Hospital
- just inside the ambulance entrance
- opposite the waiting area for the Emergency Department.
It is still recommended to perform deep breathing, coughing and leg exercises while you are resting in bed.
You will recommence your normal medications.
Please tell the nursing staff if you have any pain so that they may give you medication to help relieve it.

What to expect

Recovery from your ankle arthroscopy takes place in the 23 hour unit as well as in your home.

Once you have recovered from the anaesthetic you will be encouraged to be active and move as soon as possible. This reduces complications developing of joint stiffness and deep vein thrombosis.
It is normal to take ankle physiotherapy exercises, walk up and down stairs and cover a gentle distance just a few hours after surgery.
By the time you are ready to go home you will:
- have a simple wound dressing and a bandage over your ankle
- be eating an drinking normally
- be walking unaided
- have your pain controlled on mild pain medication.

What you can do

Eat well by maintaining a high-calorie, high-protein diet for optimal wound healing (meat, eggs, cheese , milk and soya-beans).
Weight bear as directed by your doctor.
Look after your wound by looking for signs of redness, excess swelling or drainage; follow your doctor’s instructions regarding dressing and wound care. Swelling of foot or wound may persist for several months.
Elevate leg for first 48 hours. Place leg in correct alignment.
Maintain personal hygiene while keeping your dressings dry (hint: place your foot in a plastic bag and tape this securely to your leg).
Maintain home exercise program as instructed.

What to avoid

keeping on your feet for a prolonged period of time
avoid putting anything down your cast if you have one.

Contacts

Please contact either your General Practitioner (GP); the Mater Adult Hospital Procedure Unit on 07 3163 8496; or the Mater Adult Hospital Emergency Department on telephone 07 3163 8111, IMMEDIATELY if you experience any of the following after discharge:

fever and chills
increased redness, swelling or drainage at the wound site.
increased pain that is unrelieved by pain medication
swelling unrelieved by elevating leg for at least one hour
Problems relating to your cast:
- toes are cool, swollen, have a change in colour or decrease in sensation
- is redness and irritation of the skin at edges of, and pressure points, in the cast
- increase in drainage or foul odour from the wound.

Post ankle arthroscopy exercises

Day of surgery

Keep your operated leg elevated as much as possible
Commence hourly exercises—toe wriggling, thigh squeezes and bottom squeezes.

Plantar and dorsiflexion

Lying on your back point your toes down then pull your toes back towards you.

Inversion/eversion

Lying on your back, turn the soles of your feet towards each other, then turn your feet away from each other while keeping your knees facing the ceiling.

Walking

Attempt to walk with as much weight through your leg as you are allowed. Usually you are allowed to take full weight through your leg—if not, crutches may be necessary. Place the heel of your operated leg down on the ground before the toes.

Day one and two

Continue with the above exercises as well as a calf stretch using a towel.

Sit with one leg straight out in front of you. Put a towel around your foot. Push down into the towel against resistance. Hold for five seconds.
Gently pull the towel back and feel the stretch in your calf.
Hold for 15 seconds.

Day three

Change your exercise routine to three to four sessions per day, performing a minimum of 30 repetitions of each exercise every session.

Keep walking to a minimum for the first four–five days.

If your ankle becomes more tender and swollen, ease back on your walking and use cold packs regularly. Contact the hospital/ward if swelling does not settle.

No sport, running or squatting until you have consulted your doctor or physiotherapist. Gradually increase your level of activity.

Day five

Daily dressing, apply a layer of tubi-grip over your ankle.

Balance exercises

Stand on your operated leg while keeping your eyes open, trying to keep your balance for as long as possible.
Continue standing on your operated leg progressing now to closing your eyes, trying to keep your balance for as long as possible.

Safe use of crutches

Standing

To stand place your crutches forward and in a straight line, lean on your hands and your un-operated leg.

Walking

Non-weight bearing: with your crutches forward, lean on your hands and swing your body through to land on your un-operated foot.

Partial weight bearing: your surgeon will let you know when to start taking some weight through your operated leg.

Sitting

To sit move backward to the chair until it can be felt by your un-operated leg. Slide the crutches out and hold them in one hand. Hold the arm of the chair with your other hand and gently sit. Place your operated leg on a stool when sitting to prevent swelling.

Stairs

Never vary this sequence when using the stairs:

Going up the stairs: un-operated leg—operated leg—crutches

Going down the stairs: crutches—operated leg—un-operated leg

Be careful to place the crutches well apart and in the middle of the stair. Use the handrail with two crutches under one arm whenever possible.

Note: Never lean or take weight through your armpits—always through your hands.

SEEK MEDICAL ADVICE IMMEDIATELY if you develop pins and needles in your hands or fingers. Remember, if your doctor wants you to use crutches he does so for a good reason—follow his advice strictly.

ALL CRUTCHES ARE THE PROPERTY OF MATER ADULT HOSPITAL. RETURNING THEM PROMPTLY, WHEN YOU NO LONGER REQUIRE THEM, ALLOWS THIS SERVICE TO CONTINUE FOR OTHERS.

Mater Adult Hospital

Mater Adult Hospital is one of Brisbane’s leading health facilities for non-insured patients. It is built on a foundation of clinical excellence and a commitment to safe, compassionate care, that is:

quality focussed
technologically advanced
customised to patients’ needs and lifestyles.

Mater Adult Hospital provides a wide range of surgical, medical and cancer services to non-insured patients. It features a 24-hour emergency department, intensive and coronary care units, day surgery, day oncology, day respite and busy medical, cancer and surgical units.

The hospital’s Division of Medicine offers specialist services in respiratory medicine, endocrinology, gastroenterology, nephrology, cardiology, infectious diseases, dermatology, rheumatology, general surgery and medicine.

Modern facilities accommodate inpatients, outpatients, and day-only patients. General surgery is complemented by recognised surgical expertise in women’s health, orthopaedics, urology, ophthalmology, vascular surgery, oral/faciomaxillary surgery, colorectal surgery, plastic surgery, ear/nose and throat surgery and dermatology.

While in hospital, patients also have access to a range of allied health practitioners (dietitians, physiotherapists, etc.), pharmacy, hairdressing, and chaplaincy services. For more information about Mater Adult Hospital please telephone 07 3163 8111.

Our Mission

In the spirit of the Sisters of Mercy, Mater Health Services offers compassionate service to the sick and needy, promotes an holistic approach to health care in response to changing community needs and fosters high standards in health-related education and research.

Following the example of Christ the healer, we commit ourselves to offering these services to all without discrimination.

Our Values

Mercy: the spirit of responding to one another
Dignity: the spirit of humanity, respecting the worth of each person
Care: the spirit of compassion
Commitment: the spirit of integrity
Quality: the spirit of professionalism

Acknowledgments

Staff of Mater Adult Hospital, Raymond Terrace, South Brisbane, Q 4101

Reference: Milliman CareGuidelines: Inpatient and Surgical Care/Ambulatory surgery/Home Care, 12th Edition, 2008

Mater Adult Hospital
Raymond Terrace, South Brisbane Q 4101

Telephone: 07 3163 8111

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