Ankle replacements gaining ground

Elizabeth Lucas couldn't stand the idea of letting her long-ago crushed ankle keep her from fully participating in the fun at her daughter's wedding.

"I did a bad thing and danced," said Lucas, who lives in the Cedar Creek area of northern Richland County. "It was only about 10 minutes, but my ankle swelled up. I was on crutches for three days."

That incident three years ago was the final straw for Lucas. She didn't care that every doctor she had talked to for more than three decades had told her she had to live with a nearly useless left ankle, which had been mangled in a bicycle accident. She was going to try again.

She discovered that breakthroughs in technology in recent years have changed the outlook for some people with severe ankle problems. The U.S. Food and Drug Administration has approved at least five new prosthetic devices for ankle replacement in the past decade, and surgeons who shied away from the procedure in the past have begun to offer it as an alternative to some patients.

Ankle replacements probably never will be as common as hip and knee replacements because the makeup and requirements of those joints are less taxing on surgeons and prosthetic devices. Nearly half a million hip and knee replacements are done in the United States each year, compared to about 2,500 ankle replacements.

But if Lucas' case is any indication, that gap could begin to close.

"This is as close to a miracle as you could imagine," said Lucas. 67. "God worked through (her surgeons) to give me my life back."

Her surgeons, Drs. Bill James and Robert Santrock of Midlands Orthopaedics in Columbia, caution that the surgery isn't for everyone. But it wasn't there for anyone a few years ago.

They went through special training on one of the new devices - Inbone Total Ankle - two years ago. They've done 17 replacement surgeries in the past year.

"It's easier to implant prosthetics in knees and hips," Santrock said. "The ankle, because of its shape, didn't lend itself to prosthetics. But the new prosthetics fit better. We can put prosthetics in that more mimic the joint."

In reality, most people with long-term ankle problems from injuries or arthritis are better off with ankle fusion surgery. In that procedure, the worn-out joint surface is removed and the ankle bones are bound together with metal implants. The repaired ankle is stiff, but patients usually can walk on it without pain.

James and Santrock still do at least four times as many ankle fusion surgeries as ankle replacements.

"We won't know if these new designs (hold up) better than the old ones for 10-15 years," James said. "That's why we tend to be very selective" in which patients are candidates for surgery.

Dr. Thomas N. Joseph of Camden is even more conservative in recommending ankle replacement. He went through training on a different implant made by Depuy Orthopaedics six years ago, and he does only two or three ankle replacement surgeries each year.

"Ankle fusion is still the gold standard of treatment," Joseph said.

He recommends replacement surgery only for patients over 50, who aren't obese and who have good bone quality with no significant deformation in the ankle. Young people shouldn't get replacements because they are more likely to be active and put severe stress on the device and because the devices could wear out in 15-20 years and need replacement.

Someone with a replacement ankle probably can play golf without any problem, but running a marathon or skydiving is out of the question, Joseph said.

Lucas simply wanted to be able to go grocery shopping without having to ride in a motorized cart. Since her surgery in July 2008, she revels in helping others in those carts reach items on the top shelves.

The ankle, which was held together stiffly by a screw since her bike accident, now moves in four directions. More importantly, it doesn't hurt or swell with a little use.

"Last Christmas, I was on my feet for three hours shopping," Lucas said. "For the first time, my children could come to my house for Christmas dinner because I could stand up to cook.

"I can't jog or play tennis, but I was on the verge of being in a wheelchair for the rest of my life."