25-year-old Louisa is at the Freeman Hospital with her mum Amanda – Louisa was diagnosed with juvenile inflammatory arthritis when she was just six.
In recent weeks her condition has deteriorated so much she has to use crutches to walk. “It was scary being diagnosed at such a young age – when I was growing up it was quite difficult – I think I always just wanted to fit in, I wasn’t able to do everything that I wanted to do. I was a big dancer and then I couldn’t do that! I did also get bullied for having arthritis which is a bit crazy.” Explains Louisa.
The arthritis started in Louisa’s right knee then as she got older started in her left ankle. When she was around 14 her ankle deteriorated and she had surgery aged only 16 which was a big success.
“I was living a really great life – I went to university in Leeds, had a great social life then it started to deteriorate again at around 22 – basically my ankle bone has collapsed so its very painful.”
Louisa is now only able to walk using her crutches – she can walk without them but not without significant pain. She explains “If I didn’t move I’d be in pain, if I move too much I’m in pain so its finding that balance really”
Louisa’s surgeon is Professor Malik Siddique – who has known her since she was little. “Louisa came to see me when she was 16 – you don’t expect children to have this condition at that age.”
While Malik examines Louisa it’s clear the damage to her ankle is noticeable and causes her a lot of discomfort. Over time the joint has not only worn out but has fractured which meant there was this near dislocated ankle.
Before surgery Louisa explains what she’s most looking forward to once it’s all over: “I’m really looking forward to not being in pain I’ve been in agony for 2 years just being able to go out and enjoy myself without thinking oh I’m in pain – I think that’s what I’m looking forward to most.”
This surgery could be life changing for Louisa – Malik says: “This surgery is complex but it is one chance – you get it right first time and then it’s life changing – you cant really promise anything else.”
On ward 19 its time for Louisa to head to theatre for an operation to replace her ankle. Malik hopes to create a new ankle joint for her using two metal implants which will give her normal movement and flexibility but it’s going to be challenging.
Malik explains: “Louisa’s operation is going to be complex we hope we’re going to give her an ankle replacement – that’s what we plan as option one but if for some reason we don’t have bone joint that we can give her normal motion in her new joint then only will we have to do an ankle fusion operation.
“If you fuse the ankle, it will be like a wooden foot. I am known for being an ankle replacement surgeon I’m not a fuser – I don’t like welding bones together my aim of life has been to keep the mobility of the joints going.”
Malik and his team have won international awards for surgery and in theatre 6 he’s hoping he can create a new ankle for Louisa and improve her life.
The team use a tourniquet – a special device you put on the area above the knee so that the operative filed isn’t covered with blood. Time is limited once it’s on though – they have two hours. “If you go beyond two hours you’re going to cause problems with the nerves that could be temporary or permanent so in a way it’s a timebomb in surgery.”
The clock starts.
Louisa’s ankle can only be repaired if there is enough good bone left for Malik to attach the implants and unfortunately her bones are more damaged than expected.
Malik explains: “The ankle bones are not where they should be and the front part of the bone has come out that’s what makes this a little more complicated. We have replaced bad ankles but not as bad as this.”
If there isn’t enough good one to work with Malik wont be able to repair Luisa’s ankle. “If the good bone quality is not found the implant cannot grown bone so we can not really expect a miracle to happen when there is no bone to grown on it.” He continues.
After more than an hour in surgery there is finally some good news
“I think this quality of bone is very reasonable now where I am on one side now we need to go to the other side” says Malik.
But there’s a new challenge – Louisa’s ankle is held together with metal pins from previous surgery if the procedure is to work Malik needs to remove them and time is running out.
The titanium screws have been in for almost 11 years so are difficult to remove – once they’re out Malik has only 30 minutes before the tourniquet needs to be removed, Malik is assessing if it can be replaced – finally he’s reached a decision and the replacement can go ahead.
There are only 20 mins before tourniquet needs be removed so they must work quickly – once it is removed blood will return to her foot and visibility will be more difficult. Time is running out 1:56 only 4 minutes to go. The time is up and the tourniquet comes off.
Major part of the surgery is complete and it’s time to make the adjustments and check the vessels. Next job is to insert the metal implants which must be a perfect fit – if it’s not right it will dislocate.
Some of Louisa’s bone is inserted into the implant to help it grow into her shin bone – this will help it form a strong bond.
Malik is now ready to attach the implants the most critical part of the operation, starting with tibia followed by the ankle bone.
“Perfect – no fractures – I’m happy now.” Says Malik.
He continues: “It’s emotional in a way that I know her family very well, I know her mum very well and she used to come to see me as a child.
“We’ve done an ankle replacement which this morning we didn’t even know if it would be possible – it looks beautiful it really moves she’s never had that ankle motion.
“It’s not just surgery, its not just skills, its that attachment that gives you the joy and a relief and happiness that they can actually enjoy getting their life back.”
With surgery over Louisa is now home and pain free and saying yes to everything! Later – she returns to the Freeman to give Malik a very special gift to say thank you – a beautiful bowtie!
