The arthritis in David’s ankle made everyday activities very painful. Thanks to an innovative procedure developed by Fernando Pena, MD, that involves transplanting ankle bone and cartilage, David is back to his normal routine and doing the things he loves – like riding his motorcycle.
"It feels like a new ankle. It's made a world of difference in my life," David said.
Derailed by progressive pain
For years, David had been dealing with ankle arthritis pain as a result of injury. It began to limit his normal activity. Finishing yard work, walking up stairs and doing his job as a Harley Davidson sales person became very difficult.
When David looked for medical help, the first option he found was ankle fusion. But, he learned that once his ankle was permanently fused, he would have no movement in the joint. He passed on the procedure because the lack of flexibility would make it impossible to ride his motorcycle. Instead, he struggled daily through pain, often missing work. And he gave up riding his bike.
“I used to put four to five thousand miles on the bike,” David said. “But, I couldn’t do it because it was too painful and sometimes my ankle would lock up.”
A few years later, he met with Dr. Pena, an orthopaedic surgeon with University of Minnesota Physicians. Dr. Pena presented David with a new option: He had developed an innovative procedure to remove the diseased surface of the ankle bone and replace it with healthy bone and cartilage. David was a perfect candidate.
Innovation leads to new surgical option
Patients suffering with ankle arthritis typically have two options: ankle fusion or ankle replacement. However, for young, active patients the permanent loss of motion resulting from ankle fusion is problematic. Ankle replacement involves removing the entire joint and replacing it with metal components. Depending on the patient and situation, the artificial joint can last from 10 to 15 years, which poses another problem for younger patients.
Unsatisfied with current practice, Dr. Pena envisioned a new ankle transplant procedure: He would replace the defective ankle bone surface with a new bone and cartilage from a cadaver.
During the operation, Dr. Pena accesses the ankle joint from the front of the ankle, leaving the other ligaments, bones and structures within the ankle joint undisturbed. After removing the damaged portions of bone, Dr. Pena inserts new tissue and bone from the donor. Because of the small size of the transplanted tissue and bone segments, the surgery requires a high degree of precision.
“It is quite stressful from my point of view,” Dr. Pena said. “But, if you take the proper steps, everything works well.”
Ideal ankle transplant candidates are young and only have arthritis on the bone coming from the foot, which is the most common location. Transplants have not worked as well for patients with arthritis on both surfaces of the joint.
Dr. Pena and his team have been performing ankle transplants for three years with positive results and hope to publish their research soon. Two other centers in the US are doing a similar procedure with promising outcomes, which Dr. Pena thinks may provide another option for patients.
“I don’t think ankle transplant will replace ankle fusion or replacement surgery. But it is a good alternative for certain patients and can dramatically improve their quality of life,” Dr. Pena says.
Back on the road
David’s recovery time was about three months, which is typical for ankle transplant patients. Within six months he was happily back to a very active lifestyle, including riding his motorcycle.
“I feel great. I’m taking the stairs again and looking forward to putting some miles on my bike.”