The first total ankle arthroplasty (commonly referred to as total ankle replacement) in the Panhandle occurred approximately six months ago at Box Butte General Hospita. The procedure, conducted by Orthopedic Surgery Foot and Ankle specialist Dr. Stuart Myers, was a success and the patient is doing “fantastic,” according to Myers.
“Total ankle arthroplasty (TAA) is a procedure that’s fairly rare when compared to, say, the number of total hip replacement procedures done,” he said. “I would estimate there are 30 times as many total hip replacements as there are TAAs. At my practice at Colorado Orthopedic Consultants in Aurora, Colorado, I’d say I do a TAA every six to eight weeks or so.”
Myers has been with Greater Nebraska Medical & Surgical Services’ (GNMSS) Orthopedic Foot and Ankle Clinic since 2016 through his association with Rural Partners in Medicine.
“Over those two years, this is the first Nebraska patient I’ve done the procedure on,” he said. “So that’s an indication of how often it’s called for. I’ve done two since then at Regional West Medical Center in Scottsbluff, but the one at BBGH was the first.”
TAA is a surgical procedure that foot and ankle orthopedic surgeons use to treat ankle arthritis.
“Ankle arthritis can occur from normal wear and tear due to aging, but most times it occurs from injuries earlier in life, such as a broken ankle or dislocation,” Myers said. The arthritis eventually leads to loss of cartilage, pain and/or deformity.
“I usually don’t recommend TAA until the patient no longer responds to more conservative management treatments, such as anti-inflammatory medication, bracing, physical therapy or injections,” he said. “I also take the age of the patient into account. Around 15 to 20 years ago, a common statistic had it that one out of 10 patients would need to have a revision procedure done due to the replacement wearing out. The technology has improved since then, so that statistic is probably lower now.”
Even with the new materials, (TAA uses metal and plastic components to create the artificial ankle joint) they can still wear out eventually.
“So if a patient is relatively young, and conservative treatments are no longer working, I’ll recommend fusing the ankle,” Myers said. “That’s a more common procedure and limits the motion of the ankle. I do more ankle fusions than TAAs. But if the patient is say, in his or her early 60s whose physical activities are just normal ones, a TAA is more viable. The technology has become a lot better over the last 10 years or so (increasing durability). The patient I did the procedure on here at BBGH is doing great and is very pleased with the result.”
Unlike total hip replacements, which can be performed by general orthopedic surgeons, specialty joint surgeons, or sports medicine surgeons, TAAs are performed only by orthopedic foot and ankle surgeons. “That’s because we often have to do an additional procedure at the same time to ensure the foot and ankle are properly aligned. Ankle arthritis often causes a deformity. The deformity has to be corrected so that everything is aligned properly to ensure the implant functions properly and lasts as long as possible. That often requires a pin, or screw to correct the deformity. That’s what you see in the before and after images accompanying this story … the ankle replacement implant (I used a Wright Medical ‘Prophecy’ ankle replacement), and an additional calcaneal osteotomy, which is a cut through the heel bone to reposition. The screw holds it in position.”
He concluded saying he performs all of the procedures at BBGH that he normally does in Colorado. “The staff here did great, and we always have a technician on hand who makes sure everything required for the procedure is in place and follows best practice.”
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