The moment she woke up from surgery, Teddy Ralph realized her pain was gone. Teddy had endured daily ankle pain for five years, but that all changed when she became the first patient to undergo total ankle joint replacement surgery using a new-generation, FDA-approved, fixed-bearing prosthesis at Alvarado Hospital.

Her orthopedic surgeon, Eric Horton, MD, has been very pleased with her results. "This patient didn’t have many choices because she was diagnosed with a vascular necrosis, a condition that affects one of the bones of the ankle joint," he said. "The INBONE™ Total Ankle System is the only prosthesis with a stem extension that allows deeper penetration into the bone for more secure anchoring. So far, it has worked out beautifully. Her wound has healed well, and she has 50 degrees range of motion. Patients typically experience only about 30 degrees range of motion after total ankle joint replacement surgery.”

Dr. Horton added that the new-generation ankle joint replacement technique retains significant range of motion for patients. In comparison, ankle fusion surgery typically results in only 10 degrees range of motion that occurs only through the midfoot.

"Teddy walks functionally normal without a limp.” Dr. Horton said. "You cannot tell she has had ankle surgery.” As the first orthopedic foot and ankle specialist in San Diego County performing this specific procedure, Dr. Horton was assisted during Teddy’s surgery by orthopedic surgeon Mark Reiley, MD, who developed the prosthesis.

Alvarado Hospital surgical techn Earl Burt was specifically requested for this surgery because of his experience with similar procedures at a Boston hospital. "Total ankle replacement techniques have developed more slowly than those for the hip or knee because the ankle is a more complicated joint,” Dr. Horton said. "It must accommodate many positions and surfaces, link to other joints within the foot, and withstand more force upon a smaller surface area.”

Earlier total ankle replacement surgeries were not without problems, and Dr. Horton was skeptical at first about the newer techniques. So a few years ago, he took a sabbatical from his medical practice in order to complete a private foot and ankle reconstruction fellowship with pioneering orthopedic surgeon Roger Mann, MD. Dr. Horton reviewed approximately 80 patients who had undergone total ankle joint replacement surgery. In 2006, Dr. Horton presented data at the American Orthopaedic Foot & Ankle Society. His research is pending publication.

"I was intrigued by the procedure. But before I started using it on my patients, I wanted to make sure there were good outcomes,” he said. "We found that 95 percent of patients successfully retained their prosthetic implants up to eight and a half years later. I became a believer.”

But while this delicate procedure offers an exciting new treatment option for ankle disorders, Dr. Horton cautioned that in his experience only about one out of every 10 patients may be a potentially good candidate. Fortunately, Teddy Ralph was one of them. "My foot is fine,” says the 69-year-old Spring Valley resident. "I can’t thank Dr. Horton enough or anyone else at Alvarado Hospital.”

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