Who is Mr Shelain Patel?

Mr Shelain Patel (BSc, MBBS, DipSEM, FRCS) is a consultant orthopaedic surgeon who works exclusively on foot and ankle conditions in London and Stanmore. He is one of only four foot and ankle surgeons at the Royal National Orthopaedic Hospital, the UK's top rated orthopaedic institution.

What conditions does Mr Shelain Patel treat?

He treats the full range of foot and ankle disorders including ankle sprains, ligament damage and instability, ankle arthritis and cartilage injuries, Achilles tendon tears and pain, bunions and big toe arthritis, flat feet and tibialis posterior tendon dysfunction, plantar fasciitis and heel pain, Morton's neuroma, foot drop following nerve and spine injuries, congenital and complex acquired deformities, and trauma including osteochondral lesions.

What surgery does Mr Shelain Patel perform?

Procedures include bunion correction, ankle replacement, ankle fusion, keyhole ankle arthroscopy and microfracture, Broström-Gould ligament repair, Achilles tendon repair and Haglund excision, big toe replacement and fusion, Morton's neuroma excision, flat foot and cavus foot reconstruction, minimally invasive metatarsal osteotomy, and tibialis posterior tendon transfer for foot drop. Only about one in three consultations leads to a discussion of surgery.

Where does Mr Shelain Patel practise?

His private practice is in the Harley Street district of Central London at HCA Princess Grace Hospital and King Edward VII's Hospital, and in North London at Spire Bushey, Elstree Waterfront and RNOH Private Care in Stanmore. The consultation address is 30 Devonshire Street, London, W1G 6PU.

How do I book a consultation with Mr Shelain Patel?

Consultations can be booked by contacting his secretary on 020 3960 1705 or by email at patelpa@gop.health. He accepts both private medical insurance and self pay patients.

Does Mr Shelain Patel offer second opinions?

Yes. Through his role at the Royal National Orthopaedic Hospital he provides specialist second opinions for patients facing complex foot deformity or who have had unsuccessful previous treatment.

Ankle replacement implants

Shelain Patel

Ankle replacement implants have evolved significantly over the past several decades. Modern ankle replacement systems are designed to reproduce the function of the ankle joint while preserving useful movement.

Choosing and positioning an ankle replacement is not simply a matter of selecting an implant from a catalogue. Implant choice needs to be considered alongside the patient's anatomy, alignment, bone quality, ligament stability, previous surgery and overall treatment plan.

Mr Shelain Patel has a specialist interest in ankle arthritis and ankle replacement and is involved in clinical and academic education relating to foot and ankle surgery.

What is an ankle replacement implant?

A total ankle replacement generally replaces the damaged surfaces of the ankle joint with prosthetic components. The ankle is formed primarily by the tibia, fibula and talus.

A replacement generally includes:

A tibial component
A talar component
A bearing component between the two

The exact design differs between implant systems.

How do ankle replacement implants work?

The purpose of the implant is to allow controlled movement between the tibia and talus while reducing the painful contact between arthritic joint surfaces. Modern ankle replacement designs aim to reproduce the complex movement of the ankle more closely than earlier generations of implants. The objective is not simply to create movement but to achieve a stable, appropriately aligned and functional joint.

How have ankle replacements evolved?

Early ankle replacement designs had limitations including problems with fixation, alignment, implant design and long-term survival.

Modern ankle replacements have benefited from improvements in:

Implant geometry
Materials
Fixation
Surgical instrumentation
Imaging
Preoperative planning
Understanding of ankle biomechanics

The development of modern ankle replacement has therefore been a gradual process rather than the result of a single implant design.

Fixed-bearing and mobile-bearing designs

Different ankle replacement systems use different bearing philosophies. Some designs use a mobile bearing, while others use a fixed bearing. The choice of implant depends on multiple factors and should not be reduced to the assumption that one design is universally superior.

Clinical evidence continues to inform understanding of implant performance. The majority of total ankle replacements implanted in the UK are a fixed-bearing deign. Whilst the original concept that a mobile bearing would be more forgiving to malpositioning, this has been borne out in the literature and sub-analysis of the TARVA study which compared replacement and fusion, showed the best performing group of surgical patients has fixed-bearing designs.

How is an implant selected?

Implant selection is influenced by the individual patient's anatomy.

Factors considered include:

Bone anatomy - The size and shape of the tibia and talus influence component sizing and positioning.

Alignment - Varus or valgus deformity may need to be addressed as part of the overall reconstruction.

Bone quality - Bone stock needs to be sufficient to support the implant.

Ligament stability - The ankle replacement needs to function within an appropriately balanced ankle. Instability may require additional procedures.

Previous surgery - Previous fractures, fixation and other operations can alter the anatomy and influence implant choice and surgical planning.

Associated deformity - Hindfoot and foot alignment may influence the ankle replacement and may require correction.

What happens during ankle replacement surgery?

The damaged joint surfaces are exposed and prepared. The tibial and talar surfaces are shaped to accept the components, which are positioned according to the surgical plan. The bearing component is then placed between the tibial and talar components where required by the implant design. The final position and stability of the ankle are assessed during surgery. Additional procedures may be performed if necessary to address deformity, instability or other pathology.

Why is alignment important?

Alignment is fundamental to ankle replacement. An ankle replacement is designed to function within a balanced mechanical environment.

If significant deformity or instability is present, it may place abnormal forces on the implant. For this reason, assessment of the entire foot and ankle is important rather than concentrating only on the arthritic joint.

What investigations help with implant planning?

Planning may include:

Weight-bearing X-rays
Long-leg or alignment imaging where appropriate
CT scanning
Occasionally MRI
Detailed clinical examination

CT can be particularly useful when assessing complex bone anatomy and deformity.

How long do ankle replacement implants last?

No implant has an unlimited lifespan.

Published studies and national joint replacement registries provide information about implant survival, but results vary according to:

Implant design
Patient population
Follow-up duration
Surgical technique
Definition of failure
Patient characteristics

A surgeon should therefore discuss the available evidence rather than guarantee a particular lifespan for an individual patient.

Monitoring an ankle replacement

After surgery, follow-up is important. Clinical assessment and X-rays can be used to monitor:

Component position
Alignment
Bone changes
Implant stability
Wear
Development of other problems

A patient who develops new pain after a previously successful ankle replacement should be assessed rather than simply assuming that the symptoms are part of normal ageing.

What if an implant changes on an X-ray?

Not every radiographic change means that an ankle replacement has failed.

Changes need to be interpreted alongside:

Symptoms
Clinical examination
Previous imaging
Implant type
Time since surgery

Sometimes observation and serial imaging are appropriate. In other circumstances, additional investigations or revision surgery may be required.

Ankle replacement research

Ankle replacement continues to be an area of clinical research. Important areas of research include:

Implant survival
Patient-reported outcomes
Alignment
Implant design
Revision surgery
Complications
Functional outcomes
Comparison with ankle fusion

Mr Patel has an academic interest in foot and ankle surgery and arthritis, and contributes to research and education within the specialty. He started researching joint replacements and bearing surfaces over 15 years ago, and continues to be involved in prospective studies that evaluate new technologies such as bone conserving ankle replacements, and those with modern fixation surfaces and more durable liners, Relevant publications can be found on the Research & Publications page.

Frequently Asked Questions

Are all ankle replacement implants the same?

No. Different implant systems have different designs, components and surgical techniques.

Is one ankle replacement implant better than another?

There is no single implant that is universally best for every patient. Choice depends on the individual circumstances and the surgeon's assessment.

Does the implant contain metal?

The principal components of ankle replacement systems commonly include metal alloys and a bearing component, although the precise materials vary by implant.

Can an ankle replacement be replaced?

Yes. Revision ankle replacement is possible in selected circumstances.

Can an ankle replacement be removed?

In certain situations an implant may need to be revised or removed. The subsequent reconstruction depends on the reason for failure and the condition of the ankle.

Do ankle replacements need monitoring?

Yes. Follow-up allows clinical and radiographic changes to be identified and assessed.

Book a consultation

If you would like to understand whether ankle replacement is appropriate for your arthritis, or you have questions about implant selection or a previous ankle replacement, a specialist assessment can help clarify the options.

Book a consultation with Mr Shelain Patel, Consultant Orthopaedic Foot & Ankle Surgeon in London.