DONOR ANKLE IMPLANT
Both age and injury to an ankle can lead to osteoarthritis. The cartilage between bones breaks down and the person is left with bone rubbing on bone and a great deal of pain. Patients have treatment options to stop the pain but they often leave them with limited movement and a reduction in their quality of life. There's a new option that keeps these patients moving.
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Glenn Bramble loves his motorcycles despite an accident 26 years ago.
Glenn Bramble
Has osteoarthritis
"The motorcycle went down on the left side and my toe was twisted, my whole foot was turned around backwards, and it was actually four separate breaks and a dislocation of the ankle."
The injury hasn't stopped Glenn, but it has continued to cause problems.
Glenn Bramble
"It's gotten to the point where there's no cartilage at all, it's just bone on bone and it's quite a discomfort."
Doctors suggested fusion, a common treatment that limits movement. Orthopedic surgeon Mark Myerson has been offering patients something different.
Mark Myerson, M.D.
Orthopedic Surgeon
Mercy Medical Center
Baltimore, MD
"We're actually transplanting bone and cartilage from a cadaver donor, just like is done for other donor transplants."
Doctor Myerson says for patients who are younger and more active, this procedure offers a better alternative.
Mark Myerson, M.D.
"The big thing about that is it gives you movement unlike an ankle fusion."
One disadvantage is waiting for a donor. On the day of surgery, Glenn learned about another potential problem with the procedure.
Glenn Bramble
"One of the tendons attached to the joint had developed a bacteria and Dr. Myerson said they were not going to be able to use it because of the bacteria."
Glenn will have to settle for a traditional ankle replacement, but he's not letting it dampen his spirits.
Doctor Myerson says, historically, doctors have been hesitant to adopt this procedure because, as compared to the traditional fusion, there was a greater risk of failure. In recent years, that risk of failure has dropped from 75% to 15%.
BACKGROUND: Both age and injury to an ankle can result osteoarthritis of the ankle. The cartilage on the bone breaks down and the patient is left with bone rubbing on bone. They often experience a tremendous amount of pain. The most common treatment for this condition is fusion where the bones of the joint are fused together. The problem with this is the patient loses a tremendous amount of flexibility, which can impact the person's quality of life. A relatively new procedure allows for an implant to take the place of the ankle. Now, doctors in Baltimore are taking an even different approach.
DONOR ANKLE: Mark Myerson, M.D., an orthopedic surgeon at Mercy Medical Center, is treating ankle replacement like any other organ replacement. He's using an ankle from a cadaver in a procedure known as ankle allograft replacement. He says doctors have been slow to pick up this procedure because they have had other options that have a lower risk of failure – although these affect the quality of life. He says the risk of failure is worth the benefits for certain patients, specifically those who are younger, more active and who may be heavier.
The surgery to replace the ankle with the cadaver ankle takes about two hours to perform and the person goes through about a three month recovery period. For the first two months, they are not able to walk on the new ankle and then they go through physical therapy for another month. Dr. Myerson says the procedure has a shorter follow-up period as compared to the more traditional methods.
RISKS: As stated above, this procedure comes with a relatively high risk of failure. The risk is that the tissue will develop an infection, which would preclude it from being used. Also, the person has to have a perfect size match for the donor ankle to be used. The good news, though, is in recent years, that risk of failure has dropped from 75 percent to 15 percent.
Dr. Myerson notes, in the cases performed so far, there does not appear to be any immune response or rejection of the implanted material. It is, however, still much too early to know whether this treatment is going to be a viable alternative to total ankle replacement.
The Institute for Foot and Ankle Reconstruction
Mercy Medical Center
301 St. Paul Place
Baltimore, MD 21202
(410) 659-2800
footandankle.mdmercy.com/
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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