David Kearing, MD, battled for years with post-traumatic ankle arthritis caused by years of repeated sports-related ankle sprains, one of which included a dislocation. He had two operations to address the arthritis, and he had taken so much over-the-counter pain medication that he began to develop an ulcer.
However, David’s ankle pain continued, and it affected his home and work lives. “I couldn’t walk on the beach with my family during vacations,” he explains. “Even a middle-of-the-night trip to the bathroom was excruciating.” On his job, the situation was just as challenging. “As an ER physician, I need to be able to move around, and I was just hobbling,” he says.
Ultimately, David’s arthritis reached its end stage, his joint having deteriorated to the point that he could no longer tolerate the pain.
David sought several opinions from foot and ankle specialists in the Northeast. Each recommended ankle fusion surgery, which connects the bottom of the shinbone to the top of the foot. Although those who have this surgery no longer experience pain from arthritis, they can no longer move their feet up or down. This option would not work for David.
David knew that ankle fusion would limit his active life. As an avid skier and cyclist, he wanted to examine other options, and he performed some online research. His search led him to the fall 2009 issue of the MyGeorgetownMD newsletter and an article about a soccer dad who had an ankle replacement using the STAR™ device. STAR stands for Scandinavian Total Ankle Replacement, because it was designed by a famous Scandinavian surgeon. The three-piece device moves much like a natural ankle.
After reading the article, David called Paul Cooper, MD, orthopaedic surgeon and director of the Foot and Ankle Center at MedStar Georgetown University Hospital. Dr. Cooper had performed the soccer dad’s ankle replacement—the first in the United States following the approval of the STAR device by the Food and Drug Administration in 2009.
In September 2010, Dr. Cooper performed David’s STAR surgery. David was in and out of the hospital in one day and able to walk within two weeks. Three months later, he was on skis.
Had David had an ankle fusion, he would have spent longer in the hospital and been in a cast for 12 weeks. Also, since he would not have been able to move his foot up and down, skiing would have been out of the question.
“To be able to offer this latest generation of ankle replacement to our patients is nothing short of revolutionary,” says Dr. Cooper, who has performed more than 600 ankle replacements, of which about 160 were with the new STAR device.
His results with the device have been overwhelmingly positive. Patients spend less time in the hospital, recover more quickly and are able to remain active because they have better movement in the joint than an ankle fusion would allow. Dr. Cooper anticipates that demand for the procedure will continue to grow because more people who are ages 65 or younger are experiencing end-stage ankle disease or osteoarthritis. Such conditions are caused by recurring athletic injuries or significant traumas, like those associated with car accidents.
“When you are in your 40s, 50s or even older and accustomed to being active, the inability to move your foot due to ankle fusion is not acceptable,” says Dr. Cooper. Additionally, the joints that surround the fused ankle can become increasingly stressed, which can lead to arthritis. “It can become a vicious cycle. In severe cases, we end up fusing other bones in the foot and ankle, and within five to ten years, we have fused so many bones that nothing moves.”
In addition to the STAR surgery, which has been used in Europe for more than 20 years, there are various other surgical and nonsurgical treatment options for ankle arthritis. “Many people can avoid ankle replacement or fusion if we see them early enough. Often, there are medical and more conservative surgical solutions we can use to keep patients pain free and mobile before their arthritis reaches the end stage,” says Dr. Cooper. “When we become involved with patients earlier, we can offer them a wider range of treatment options and, often, better outcomes without needing to replace the ankle.”
Facts about STAR™
STAR has many benefits compared to ankle fusion:
|STAR Ankle Replacement Surgery||Ankle Fusion Surgery|
|Durability/Duration of Repair||10–15 years||Lifetime|
|Average Recovery Time||Two weeks in a splint
Walking boot with daily physical therapy for two to 12 weeks
Ankle brace until no longer needed
|12 weeks in a cast followed by a walking boot through the initial rehabilitation period|
|Patient Mobility||Able to move foot up and down and continue with most activity||Unable to lift or lower foot from the ankle|
|Average Hospital Stay||23 hours or less (same-day surgery)||24–48 hours|
|Treatment Flexibility||If an ankle replacement fails, the ankle can be fused at a later time||Once an ankle is fused, it cannot be replaced|