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San Diego Physician Performs a Rare Ankle-Replacement Procedure
for Patients with Extreme Ankle Pain

If Julie Daniel’s ankle were a car, the check engine light would have been blinking for 40 years. In 1969, Daniel, in her early 20s, broke her tibia in a skiing accident and struggled with tumultuous pain for the years following. For the next four decades Daniel, 62, at times had to get on her hands and knees to climb the stairs in her home, move around the beach or navigate uneven ground. Doctors could not believe the extent of her ankle pain.
Searching for a solution to the pain, 10 years ago Daniel went to her doctor and he found excessive bone cartilage growth and discovered her ankle cartilage had been broken since the accident in 1969. It had gone unnoticed for 30 years. By this time her ankle had become bone-on-bone, decreasing her ankle’s flexibility. A surgeon operated on her ankle to smooth down the cartilage; however, this procedure didn’t do much to alleviate Daniel’s pain.
After waiting a few years, Daniel’s ankle was not improving, and she asked her internist for a recommendation. Daniel’s physician recommend she visit Alvarado Hospital’s orthopedic surgeon, Dr. Eric Horton, who told her about a new FDA-approved procedure called the Scandinavian Total Ankle Replacement System (STAR).
Despite this being a rare procedure, Daniel was eager to find a solution to her pain and agreed to have the surgery done in September of 2009. The new ankle prosthesis is the first of its type—a mobile-bearing device (bearings move across a polyethylene surface). There are several fixed-bearing ankle devices that are already FDA-approved. With fixed-bearing devices, the articulating surface is attached or molded to one of its metallic parts. The STAR presents another option to ankle fusion surgery and is said to more closely function like a natural ankle.
The benefits an ankle replacement versus the traditional ankle fusion is that a replacement preserves the ankle’s range of motion, whereas the fusion fuses the joint bones together with screws and plates making the ankle frozen. The fusion can eliminate pain, but the ankle loses its full range of mobility, which affects the way a person is able to walk and eventually could lead to arthritis in the ankle and hip problems.
Following the surgery, Daniel had to stay off her feet for a couple weeks before moving to a wheel chair, then on to a walker, and then was finally able to walk on her own two months after the surgery. Once on her feet, Daniel was able to attend physical therapy multiple times a week, rehabilitating an ankle that she could not use properly for the past forty years. For the first time in decades, Daniel is finally able to walk straight with heel to toe to the ground and is able to walk, rather than crawl up stairs.
Recovery from Daniel’s* surgery typically takes a full year, and four months out of her surgery, she is walking better than she did in her 20s. The ankle replacement has instilled a new hope in Daniel. In the upcoming months she hopes to walk without stiffness, keep her exercise routine going and be able to ride a bike again.
SIDEBAR: What is the STAR Procedure?
The STAR ankle is the only three-part ankle replacement system that is approved by the FDA. The FDA approved it for use in June of 2009.
The purpose of a total ankle is to relieve pain in the ankle while still allowing the ankle move. Usually this type of pain is caused by arthritis, a condition that can take many forms and may go by many names, including osteoarthritis, post-traumatic arthritis, and rheumatoid arthritis. There are strict criteria for patients eligible to receive this procedure at this time.
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