Dwight's Active Again

Like so many patients with severe ankle arthritis, Dwight Johnsen of Cordova spent years trying various solutions for his debilitating, chronic ankle pain. After reading about ankle fusion surgery performed at Bryan Medical Center by surgeon Joshua Vest, DPM, FACFAS, of Capital Foot and Ankle, Dwight met with Dr. Vest to see if that procedure was right for him.

“Ankle fusion certainly would have solved Mr. Johnsen’s pain problem,” says Dr. Vest, “but I knew we could provide him with something even better.

Ankle Replacement Serves as Best Option

“Although he did have severe ankle arthritis, he had also previously been very physically active and even at 79 years of age was otherwise quite healthy. As ankle fusion results in a rigidly fixed ankle that limits mobility, he and I decided that the newest generation of ankle joint replacement was ideal for him because it provided both extensive pain relief and full ankle mobility.

“Ankle replacement procedures have gone through a lot of changes in recent years. The first few generations had problems and a high failure rate, so ankle fusion was the gold standard for patients with severe ankle arthritis at that time.”

Newer ankle implants have, however, flipped that scenario, and replacement is now a viable option for many patients. Fusion is still the most common procedure — there were 16,000 ankle replacements versus 80,000 ankle fusions performed worldwide in 2014 — but this trend likely will change as replacement procedures become increasingly more sophisticated.

“The most significant recent change is that the newest generation of ankle replacement procedures utilizes CT scanning to generate a computerized image of the patient’s ankle,” says Dr. Vest. “An exact replica of the ankle and a surgical template arethen created by a 3-D printer, and we use the replica and template to prepare for the procedure before entering the surgery suite."

Benefits to Ankle Replacement Surgery

“The main benefit of this new approach is that there are fewer surprises. This reduces guesswork and problem-solving at the time of surgery and can decrease surgery and anesthesia time by about 50 percent, compared to previous-generation replacements. Patients also have significantly less radiation exposure with the newer approach because there is less need for intraoperative X-ray.“

He adds, “One advantage of ankle fusion is that it is performed only once in a patient’s life, while replacement ankle joints wear out over time. But they can be repaired, often by simply replacing a spacer in the implant. We typically leave in the rest of the device, resulting in a much shorter second surgery. In the future, advancements will no doubt be made in materials used in the artificial ankle, so replacements will last longer and likely can become a one-time procedure for most patients.

“A significant drawback of ankle fusion is that patients must stay off the operated ankle for 8-12 weeks, so they require considerable help at home after the surgery. And, up to 10 percent of patients experience delayed bone fusion, so they end up with an unstable, nonfused ankle joint that typically requires reoperation. In contrast, patients with ankle replacements are able to move the joint immediately after surgery and return to weight-bearing on the operated ankle in as little as two weeks.”

Pain-Free and Active Again

Dwight says he is “110 percent satisfied” with his ankle replacement.

“I have no pain in the joint now, and I’m able to flex it all around. I stay quite active — always mowing or doing something in the summertime, and I don’t worry about spraining my ankle, so I don’t have to baby it. I feel my ankle is like when I was younger — so much stronger than when I first went to see Dr. Vest,” he adds.

“It’s exciting to have this new generation of ankle replacement available here,” Dr. Vest says. “Before that, some patients were traveling outside Lincoln or even out of state for the procedure. That this is unique to Bryan is one more example of the quality of care offered by Bryan Health.”

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