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Home » Our Services » Arthritis/Joint Replacement » “Ankle Replacement Is a First”

Omaha World-Herald - Sunrise Edition - Friday, June 15, 2001

Betty Lou Palmer's right ankle has always given her trouble.

When she was a child, her ankle was sprained more often than it was healthy. By the time she was 30, arthritis had made her ankle stiff and painful.

But Palmer and her doctors hope that won't be the case much longer.

Palmer is schedule for surgery today to replace her damaged ankle joint with an artificial device that will do the work of her joint, but without the pain. Her surgery is a first for her orthopedic surgeon, Dr. Clifford Boese, and could be the first of its kind in Nebraska and western Iowa.

"I'll just be glad when the pain is gone," said Palmer, 68, who lives in Glenwood, Iowa. "Even with arthritis medicine, you still have some bad days."

Artificial joints, including ankles, hips and knees, were developed in the 1970's. But while hip and knee replacements have become common, the first artificial ankles proved unreliable and were discontinued.

Boese said effective replacement ankles were difficult to design because the ankle bears more of the body's weight than the knee or hip. The first artificial ankle joints worked well at first but wore out quickly.

Since then, doctors and medical companies have continued to design and test replacement ankle joints. There are several artificial ones on the market, with varying rates of success.

The artificial joint that Boese plans to use on Palmer is called the Agility Ankle by DePuy, which was designed in the 1980's by Dr. Frank Alvine, a professor of orthopedic surgery at the University of South Dakota. Boese said he trained with Alvine and has spent countless hours practicing for his first replacement surgery.

Boese believes he is the only doctor in Nebraska or western Iowa trained to use the Agility Ankle. A check of Omaha-area doctors showed no others doing total ankle replacements.

To understand how the replacement ankle works, it helps to know more about arthritis. Technically known as osteoarthritis, it happens when cartilage - which cushions the ends of bones - breaks down after heavy use or injury. Without the cushion, the bones rub together and the joint wears out. That causes the pain.

The Agility Ankle doesn't replace the whole joint, Boese said. Instead, it essentially stops the pieces of bone from rubbing together. During the procedure, doctors shave away the arthritic bones and cap the ends of the bone with pieces of plastic that hook together inside a metal box.

"Instead of bone rubbing against bone, it's metal rubbing against plastic," Boese said. "And since metal and plastic don't have nerves, it doesn't hurt."

While Boese is satisfied with the long-term results of the ankle, some doctors are still skeptical of the procedure. Some don't recommend it for young people, and others still prefer to fuse the ankle together with screws. The American Orthopedic Foot and Ankle Society's official position is that the procedure is still investigational. It advises people interested in ankle replacement to be aware that long-term success rates are limited.

But Palmer said that hasn't deterred her form having the surgery, which will be performed at the Southwest Iowa Medical Center in Council Bluffs. If it takes away pain, and Boese is confident it will, then she is willing to give it a try. Fusing the ankle could make her unable to drive, something she isn't willing to consider.

If Palmer's surgery is successful, Boese expects to be doing more of the operations. He estimates doing about 20 replacements a year. But that doesn't mean it is for everybody. Some might be better off with fusion, he said.

The recovery period from the replacement might be a deterrent by itself. Patients are told not to put any weight on the ankle for at least six weeks, and it may be six months or more before they are fully recovered.

"We still leave it up to the patient to decide if, and when, they need surgery," Boese said. "But when they are totally fed up with the pain, we can offer them this option, too."