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 vs. Ankle fusion

Shelain Patel

For patients with advanced ankle arthritis, ankle replacement and ankle fusion are two established surgical treatment options. They are fundamentally different operations.

Ankle replacement is designed to remove the painful arthritic surfaces and preserve movement at the ankle. Ankle fusion removes the arthritic joint surfaces and joins the tibia and talus together, eliminating movement at the ankle joint.

The decision between the two is individual. There is no single operation that is appropriate for every patient with severe ankle arthritis.

Mr Shelain Patel is a Consultant Orthopaedic Foot & Ankle Surgeon with a specialist interest in ankle arthritis and ankle replacement. During consultation, he assesses the condition of the ankle and surrounding foot before discussing the most appropriate treatment options.

What is an ankle replacement?

Ankle replacement, or total ankle arthroplasty, involves removing the damaged surfaces of the ankle joint and replacing them with prosthetic components.

The principal aim is to:

Reduce pain
Preserve useful ankle movement
Improve walking and function
Maintain the biomechanics of the ankle and foot as far as possible

An ankle replacement does not restore a normal ankle. It is a prosthetic joint and requires careful patient selection and surgical planning.

What is an ankle fusion?

Ankle fusion, also called ankle arthrodesis, involves removing the damaged joint surfaces and fixing the tibia and talus together until they unite as one bone.

The principal aim is to provide reliable pain relief by eliminating movement through the arthritic joint. The ankle no longer moves after a successful fusion, although movement remains available through other joints of the foot and hindfoot.

The main difference

The fundamental difference is simple: Ankle replacement aims to preserve movement whereas ankle fusion eliminates movement at the ankle joint.

This difference has implications for walking, gait, adjacent joints and the activities a patient may wish to undertake.

Potential advantages of ankle replacement

One of the principal attractions of ankle replacement is preservation of ankle movement.

Maintaining movement may help patients achieve a more natural walking pattern and may reduce some of the changes in biomechanics that occur when the ankle is fused.

An ankle replacement may be particularly attractive for selected patients who value preservation of movement and have anatomy suitable for the procedure.

However, an ankle replacement introduces a prosthetic joint and therefore has its own potential complications and the possibility of further surgery.

Potential disadvantages of ankle replacement

Potential complications include:

Infection
Wound problems
Nerve or tendon problems
Component loosening
Subsidence
Wear
Instability
Fracture
Persistent pain
Malalignment
Need for revision surgery

The longevity of an ankle replacement varies between patients and implant systems.

Potential advantages of ankle fusion

Ankle fusion is a well-established treatment for severe ankle arthritis. Its principal advantage is that it removes movement through the painful arthritic joint. A successful fusion can provide substantial pain relief. There is no ankle replacement implant to loosen or wear.

Fusion may therefore be appropriate for patients whose anatomy, previous surgery, activity or other circumstances make replacement less suitable.

Potential disadvantages of ankle fusion

The principal disadvantage is loss of movement at the ankle. Although the ankle itself no longer moves, other joints of the foot continue to provide movement. However, the biomechanics of walking change following fusion.

The increased demands placed on neighbouring joints may be relevant, particularly over the longer term. Some patients may also find certain activities more difficult after fusion.

Which operation is better?

There is no universally superior operation.

The appropriate procedure depends on the individual patient's:

Age
Symptoms
Activity levels
Alignment
Bone quality
Degree of deformity
Ligament stability
Previous surgery
Adjacent-joint arthritis
Expectations
General health

A treatment that is appropriate for one patient may not be appropriate for another.

How is the decision made?

The decision starts with understanding the patient's symptoms.

Two patients can have similar X-rays but very different levels of pain and disability.

A detailed assessment includes:

Clinical history - How long symptoms have been present, how they affect walking and activities, previous treatment and the patient's goals.

Clinical examination - Assessment of ankle movement, alignment, stability, hindfoot position, tendons and the remainder of the foot.

Weight-bearing imaging - X-rays or standing CT scans show the degree of arthritis and help assess alignment.

Additional imaging - CT or MRI may be required in selected patients.

Discussion of expectations - The patient's lifestyle and expectations are an important part of choosing treatment.

What about deformity?

Deformity can influence the decision significantly.

Some patients with ankle arthritis have:

Varus deformity
Valgus deformity
Hindfoot malalignment
Ligament instability
Previous fracture deformity

Some deformities can be corrected at the time of ankle replacement. Others may make replacement unsuitable or require additional reconstructive procedures.

What about the other joints of the foot?

The ankle does not work in isolation. Assessment should consider the:

Subtalar joint
Talonavicular joint
Midfoot
Great toe
Hindfoot alignment

Existing arthritis in these joints may influence both symptoms and the choice of treatment.

Can a fusion be converted to a replacement?

Conversion of an ankle fusion to an ankle replacement is possible in selected circumstances, but it is a complex procedure. Factors including bone stock, alignment, previous surgery and the condition of the surrounding joints need to be carefully assessed. It should not be considered a routine or guaranteed option.

Can a failed replacement be converted to a fusion?

Yes. In selected cases, a failed ankle replacement can be converted to an ankle fusion. The appropriate treatment depends on why the replacement has failed and the condition of the bone and surrounding soft tissues.

Making the decision

Choosing between ankle replacement and fusion should be a shared decision between the patient and surgeon.

The aim is to understand:

What is causing the symptoms?
What treatments have already been tried?
What does the ankle and surrounding foot look like?
What activities are important to the patient?
What are the potential advantages and disadvantages of each operation?
What is the most appropriate treatment for the individual patient?

Frequently Asked Questions

Does an ankle replacement preserve movement?

Yes. Ankle replacement is designed to preserve useful movement, although the amount of movement varies between patients.

Does ankle fusion mean the whole foot becomes stiff?

No. The ankle is fused, but the other joints of the foot continue to move.

Which has the faster recovery?

Recovery varies according to the individual, the procedure and whether additional surgery is required. It is not appropriate to promise a particular recovery time for every patient.

Can I run after ankle replacement?

High-impact activities may place greater demands on a replacement. Advice should be individualised according to the patient and implant.

Can I play golf after ankle fusion?

Many patients can return to recreational activities after fusion, but the ability to participate depends on the individual and their recovery.

What happens if an ankle replacement fails?

Depending on the cause of failure, options may include revision ankle replacement or conversion to fusion.

Book a consultation

If you have advanced ankle arthritis and are considering ankle replacement or ankle fusion, a specialist assessment can help you understand the options that are appropriate for your ankle and lifestyle.

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