When arthritis affects the ankle simply walking can be excruciating. Fusing the ankle joint or putting in a metal implant can help, but for active patients they could wear out quickly. Now, there is a new procedure that one doctor believes has the potential to last a lifetime.
“I’ve been riding for almost 40 years now,” David Reid, ankle arthritis patient, told Ivanhoe.
Harley salesman David Reid’s put a lot of miles on his wheels, but ankle arthritis took the fun out of riding bikes.
“It was not only painful, but it would also lock up,” David told Ivanhoe.
An ankle fusion would limit his flexibility.
“Once it is fused, the motion is gone 100 percent,” Fernando Pena, MD, Orthopaedic Surgeon at University of Minnesota Physicians and Assistant Professor in the Department of Orthopaedic Surgery at the University of Minnesota, told Ivanhoe.
Dr. Pena says like the tires on a car, an ankle replacement could wear out quickly in an active person.
“You will destroy it in very, very few years,” Dr. Pena explained.
However, a new procedure Pena pioneered might last a lot longer. The doctor cut out the defective surface of David’s lower ankle joint.
“We are just removing the dome of the bone,” Dr. Pena said.
Then, he transplants bone and cartilage from a cadaver.
“We make a similar cut on the piece of the bone that we got from the cadaver and just put it in and fix it with screws,” Dr. Pena explained.
Within six weeks the transplant melded into David’s ankle.
“We have healthy bone with healthy cartilage all the way across the joint,” Dr. Pena said.
“It feels like a new ankle. I’m now taking the stairs again. It’s made just a huge difference in my life,” David said.
With a new ankle, David’s back to his old hobby.
Recovery time for the procedure is about three months. The doctor says it’s for active patients from their teens to their forties who only have arthritis on the bottom half of their ankle joint. That type of arthritis is usually the result of a break, severe sprain, or ligament damage and can develop years after the injury. The doctor started doing this procedure four years ago. He’s now following patients to find out how long it will last, but he thinks it could be for life. A few other centers around the country are doing similar, but not exact procedures.
BACKGROUND: Arthritis is a broad term for many conditions that destroy the workings of a normal joint. It can occur in the neck, hips, knees, back, hands, shoulders, feet, and ankles. About half of people who are in their 60s and 70s have arthritis of the foot and/or ankle that may not cause symptoms. There are various types of arthritis. The most common type is called osteoarthritis, which results from wear and tear damage to joint cartilage that comes with age. Inflammation, swelling, redness, and pain in the joint come as a result. Rheumatoid arthritis is another common type. It is an inflammatory condition caused by an irritation of the joint lining. People with this type of arthritis for at least ten years almost always develop arthritis in some part of the foot or ankle. Other types of inflammatory arthritis include lupus, gout, psoriatic arthritis, and ankylosing spondylitis. (Source: www.aofas.org)
FOOT ANATOMY: The foot has 28 bones and more than 30 joints. Tough bands of tissue called ligaments hold the bones and joints together. The tendons, muscles, and ligaments work together with joints of the foot to control motion. This smooth motion makes it possible for a person to walk. When arthritis develops in the foot or ankle, a patient develops pain and limited motion, so that they cannot walk as well. The most common foot joints affected by arthritis include:
- The joint of the big toe and foot bone
- The three joints of the foot that involve the heal bone, the inner mid-foot bone, and the outer mid-foot bone
- The joint where the ankle and shinbone meet (Source:
NEW TECHNOLOGY: Dr. Fernando Pena says that he came up with an idea that is equivalent to doing an ankle transplant because ankle fusions and ankle replacements are not ideal for younger people. He says that they replace half of the ankle joint with a piece of bone and cartilage from a cadaver. So, he is bringing a live tissue to the patient’s ankle and then basically swapping the defective surface from the patient with the new surface from the cadaver. He has been doing this procedure for three years and has seen good results. For example, Dr. Pena told Ivanhoe that, “Probably, one of the most dramatic cases that I have seen is a woman who was 17 years old. She had history of leukemia and was blasted with steroids. She had a bunch of bones dying in her body, and both of her ankles suffered significantly from this. We did this procedure, and when she was first presented to my clinic, she was in a wheelchair and unable to walk, but now she is going to college without any type of handicap. She just got pregnant and is moving forward with life, and she is just three years out from the procedures we performed.” He describes the procedure as the implantation of a fresh osteochondral allograft, which is basically a fancy word for a piece of bone and cartilage from a cadaver that is going to be implanted into the patient’s bone. Dr. Pena says the procedure has been performed by other professionals in the United States, but there are different approaches to the ankle joint. He says that the ankle joint is very constrained; making it difficult to have access to the joint regardless of what angle you look at it. Some people cut the bone towards the outside of the ankle joint to gain access to the ankle and then work on the surface to replace and swap surfaces. Dr. Pena uses the same approach he uses for ankle replacement, which is to come from the front. Once he is looking at the ankle from the front, he makes a cut through the surface of the bone, pulls that piece out, and makes a similar cut in the piece of the bone that he got from the cadaver. Then, he puts it in and fixes it with two screws. “We are not disturbing any other ligaments, bones, or structures within the ankle joint.We are just come from the front, grab it, swap it, and then we are done,” Dr. Pena said. (Source: Interview with Dr. Fernando Pena)