ARTHROSCOPICALLY ASSISTED ANKLE ARTHRODESIS

By Simon Moyes

An ankle arthrodesis/Ankle fusion is a specialist orthopaedic procedure used to treat patients with painful worn arthritic ankles. It can be performed under a general anaesthetic epidural or regionalanaesthesia. It takes approximately one hour to complete.

 

Each patient is assessed on an individual basis, but most patients are discharged after one night in hospital. The procedure involves removal of all articular cartilage (complex living tissue that lines the bony surface of the joints) as well as the osteophytes (bony projections that form along the edges of the joints and senior conditions such as osteoarthritis). This procedure can now be done arthroscopically using three small holes and minimallyinvasive instruments.

 

The advantage of doing the procedure arthroscopically is that there is less scarring, there is less damage to surrounding tissue and less disruption to the blood supply of the bones the surgeons are fusing. Recovery rates are therefore quicker, complications rates lower and fusions rates higher. The ankle is finally fused together using two cannulated screws carefully guided across the joint both arthroscopically and on real time X-ray control.

 

Patients are mobilised progressively weight bearing and are normally fused at six to eight weeks. Prior to this technique being developed, patients were in plaster casts for at least three months and had extensive scarring and higher rates of complication such as infection and stiffness

 

About the author:

Simon Moyes was inspired to train as an arthroscopic (key-hole) surgeon by his early boss David Dandy who was one of the first surgeons to use arthroscopy in 1983. Since then, Simon has become one of the UK’s leading practitioners in this field, performing countless operations in the specialist areas of the shoulder, knee, foot and in particular ankle. Research interests currently include development of minimally invasive and arthroscopic techniques for the knee, shoulder, foot and ankle. Simon is also an accomplished writer in the field of sports injuries and joint ailments, having written articles for a variety of publications including Vogue, GQ, GP Magazine and broadcasting on radio stations like LBC and Radio 4.

Simon’s medical career started when he qualified from The Middlesex Hospital in 1982. His first house job was with the Queen's Orthopaedic Surgeon, Sir Rodney Sweetnam, at his teaching hospital. Following this he went on to Cambridge to do a Trauma rotation for a year before returning to London to study for his primary FRCS, the first part of the Fellowship of The Royal College of Surgeons.

After achieving this he commenced in 1985 a surgical SHO rotation based at St Bartholomew's Hospital whereby he rotated through The National Hospital for Nervous Diseases, Queen Square, amongst other central London hospitals. He then spent one year at Cheltenham General Hospital gaining considerable operative experience in general vascular and neurological surgery, also passing his General Surgical Fellowship, the "FRCS" at the same time.

Mr Simon Moyes then returned to London to commence his specific orthopaedic surgical training at The Westminster Hospital as an Orthopaedic Surgical Registrar. He spent two years on this programme before obtaining a Senior Registrar's rotation out of The Royal National Orthopaedic Hospital. This he commenced in 1989. He also won a research fellowship that allowed him to take six months out of his training programme at The Royal National Orthopaedic Hospital to work at the Clinical Research Centre in Northwick Park Hospital. Whilst the Senior Registrar at The Royal National Orthopaedic Hospital he was able to rotate through other centres of excellence, including Great Ormond Street Hospital and University College Hospital.

Mr Moyes was one of the first Senior Registrars in the country to sit the New Specialist exit exam for orthopaedic surgeons, the intercollegiate FRCS Orth, which he sat and passed in 1991. He then continued on his rotation and became a lecturer in Orthopaedics at The Royal National Orthopaedic Hospital in 1992, this being a twelve month post. Also during this time he had organised visiting fellowships in the Royal North Shore Hospital in Sydney and the Southern California Orthopaedic Institute in Los Angeles.

Simon Moyes took up a post of Consultant Orthopaedic Surgeon at UCL Hospitals in London in 1994 with a special interest in arthroscopic surgery in sports medicine. He went into full time private practice in 1997 and continues this.

Mr Moyes consults out of The Wellington Hospital in St John's Wood, The City of London Medical Centre in the City and also 30 Devonshire Street in the West End. He does seven private clinics a week and two full operating lists per week. Simon Moyes performs around 600 arthroscopic operations a year.