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 risks and complications

Shelain Patel

Ankle replacement can provide significant pain relief and preserve useful movement for appropriately selected patients with advanced ankle arthritis. However, like all major surgery, it carries potential risks and complications.

Understanding these risks is an important part of deciding whether ankle replacement is appropriate.

Mr Shelain Patel discusses the potential benefits, limitations and complications of ankle replacement as part of the decision-making process, taking into account the individual patient's anatomy, previous surgery, health, activity levels and expectations.

General risks of surgery

Potential risks associated with ankle replacement include:

Infection
Bleeding
Blood clots
Anaesthetic complications
Wound-healing problems
Nerve irritation or injury
Blood-vessel injury
Persistent pain
Swelling
Stiffness

The likelihood of complications varies according to the individual patient and the complexity of the procedure.

Infection

Infection is an important potential complication of any joint replacement. Infection can occur superficially around the wound or involve the ankle replacement itself.

Treatment depends on the timing and severity of infection and may involve antibiotics, further surgery or, in more serious circumstances, removal of the implant. Patients with previous infections or other factors that increase infection risk require particularly careful assessment.

Wound-healing problems

The skin around the ankle has relatively limited soft-tissue coverage. Wound problems can therefore occur following ankle replacement.

Risk may be influenced by:

Previous surgery
Scarring
Smoking
Diabetes
Circulatory problems
Swelling
Soft-tissue condition

Careful surgical technique and appropriate postoperative wound management are important.

Nerve and tendon problems

The nerves and tendons around the ankle can be affected by surgery. Patients may experience temporary numbness or altered sensation around the scar. More significant nerve or tendon injury is uncommon but recognised as a potential complication.

Blood clots

Major lower-limb surgery can increase the risk of venous thromboembolism. The appropriate approach to thromboprophylaxis depends on the patient's individual risk factors and the nature of the operation.

Persistent pain

The aim of ankle replacement is to reduce pain, but it cannot guarantee complete pain relief. Persistent symptoms can arise from:

The ankle replacement
Adjacent joints
Tendons
Nerves
Alignment
Scar tissue
Other conditions affecting the foot and ankle

Persistent pain requires careful assessment to establish its cause.

Stiffness

Although ankle replacement is designed to preserve movement, postoperative stiffness can occur.

The amount of movement achieved varies between patients and depends on:

Preoperative movement
Arthritis severity
Soft-tissue condition
Alignment
Rehabilitation
Additional procedures

An ankle replacement does not create a completely normal ankle.

Loosening

The components of an ankle replacement need to remain securely positioned within the bone. Over time, an implant may become loose. Loosening may cause pain and changes on X-rays and can sometimes require revision surgery.

Subsidence

Subsidence refers to sinking or settling of an implant component into the surrounding bone. The significance varies depending on the degree of subsidence and whether it affects the function or stability of the replacement. Further investigation and monitoring may be required.

Implant wear

An ankle replacement contains moving components. Over time, wear can occur within the bearing surfaces. The clinical significance depends on the degree and location of wear and the overall condition of the replacement.

Instability

An ankle replacement needs to function in a stable and appropriately aligned ankle. Ligament problems, deformity or changes in alignment can contribute to instability. In selected cases, additional surgery may be required to address the underlying problem.

Fracture

Fractures can occur around an ankle replacement, either during surgery or subsequently.

Treatment depends on:

Location of the fracture
Implant stability
Bone quality
Alignment
Soft-tissue condition

Some fractures can be treated without surgery, while others require fixation or revision surgery.

Malalignment

Correct alignment is an important part of ankle replacement surgery. Pre-existing deformity or postoperative changes in alignment can influence implant function and longevity.

This is one reason why careful preoperative assessment and planning are particularly important in complex ankle arthritis.

Failure of an ankle replacement

An ankle replacement may eventually fail for a number of reasons. These can include:

Loosening
Wear
Subsidence
Instability
Fracture
Infection
Persistent pain
Progressive bone loss

Failure does not necessarily mean that the ankle replacement simply has to be removed. The appropriate treatment depends on the cause of failure.

What happens if an ankle replacement fails?

Possible treatments include:

Observation and monitoring
Non-operative treatment
Revision ankle replacement
Bone grafting
Additional corrective procedures
Conversion to ankle fusion

A detailed assessment is required before deciding on treatment.

Revision surgery

Revision ankle replacement is more complex than primary ankle replacement in many circumstances.

Previous surgery can result in:

Bone loss
Scar tissue
Altered anatomy
Soft-tissue problems
Implant-related bone changes

Revision surgery therefore requires careful planning.

How long does an ankle replacement last?

There is no single lifespan that applies to every ankle replacement. Published survival rates vary according to the implant, patient population, duration of follow-up, definition of failure and surgical technique.

It is therefore preferable to discuss published evidence for the specific implant and patient circumstances rather than promise that an ankle replacement will last for a particular number of years.

Factors that can influence outcome

Factors that may influence the outcome include:

Bone quality
Alignment
Deformity
Previous surgery
Ligament stability
Smoking
Diabetes
Weight
Activity levels
Implant selection
Surgical technique
Rehabilitation

These factors do not necessarily determine the outcome, but they are considered when planning treatment.

The importance of patient selection

Ankle replacement is not simply a procedure for replacing an arthritic joint. Successful treatment depends on selecting an appropriate patient, understanding the anatomy, correcting relevant deformity and planning the operation carefully.

For this reason, a detailed specialist assessment is particularly important.

Frequently Asked Questions

Is ankle replacement surgery safe?

Ankle replacement is an established operation, but it carries recognised surgical and implant-related risks.

Can an ankle replacement become infected years later?

Late infection is possible but uncommon. New pain or swelling in a previously well-functioning replacement should be assessed.

What happens if my implant becomes loose?

Depending on the severity and cause, monitoring or revision surgery may be considered.

Can a failed ankle replacement be replaced?

In selected patients, revision ankle replacement is possible.

Can a failed ankle replacement be converted to a fusion?

Yes. Conversion to ankle fusion is an established treatment option in selected cases.

Will I need another operation?

Not necessarily. Many ankle replacements function well without further surgery, but revision is a recognised possibility over the lifetime of the implant.

Book a consultation

If you have an ankle replacement that is causing pain, instability or other concerns, or you are considering ankle replacement surgery and would like to understand the potential risks, specialist assessment can help clarify your options.

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