Total Ankle Replacement
“I opted for piecing it back together,” Hope says. “I ended up with a bad ankle as a result, but I could move around and I even played tennis for many years. When I couldn’t do that any longer, I tried golf.”
Fifty years later, however, the pain from arthritis in his ankle, brought on by his decades-old injury, had worsened to the point where he couldn’t walk.
“Around 2011, I saw a surgeon at UC Irvine who was the only one at that time who’d agree to do an ankle replacement,” Hope says. The procedure had been introduced in the U.S. around 2000.
“The success rate then was very low and if it didn’t work, they’d have to fuse my ankle,” he continues, referring to a procedure in which screws, plates and other hardware are used to fuse the bones together. Fusion helps to relieve the pain but it also limits the ankle’s range of motion.
Hope underwent ankle replacement in 2013, “but they did it in a way that left my foot tilted, so I was walking on the outside edge of my right foot,” he says. “It only made things worse.”
A year later, he went back to the University of California, Irvine to have the ankle replacement revised. “I thought they fixed it, but over the next decade it again got to the point where walking became difficult and painful,” he says.
By this time, Hope - a pioneer in the electronic medical records software field - and his wife were living in Banning. He decided to seek a consultation with a surgeon at Eisenhower Desert Orthopedic Center. In 2023, he saw David Friscia, MD, Board Certified in Orthopedic Surgery, who is fellowship-trained in foot and ankle surgery and has been in practice for more than 30 years. Dr. Friscia has been involved in research and teaching and is part of a 10-year multicenter study of total ankle replacements.
“It was clear from his X-rays and symptoms that Mr. Hope’s ankle replacement was loosening and failing,” Dr. Friscia explains, noting that this wasn’t unusual given the older, second-generation type of prosthesis that was used at that time.
“In the last ten to fifteen years, the prosthesis design and techniques for ankle replacement have improved significantly so that today, the procedure has reliably low complication rates, good outcomes and high patient satisfaction rates compared to fusion,” he continues. “In fact, for most patients, ankle replacement is now the standard of care versus fusion.”
“We use a personalized preoperative navigation system,” Dr. Friscia says. “Using a CT scan of the patient’s ankle in advance of surgery, the manufacturer creates a plan for sizing and aligning the implant to the patient’s unique anatomy for a precise fit. Then, they produce custom 3D-printed guides made specifically for each patient that we use in the operating room to ensure accuracy.”
“Also, current studies show today’s prostheses are lasting much longer than earlier versions,” he adds, which means a growing number of patients in their 40s or 50s can be appropriate candidates for ankle replacement.
Dr. Friscia performs 60 to 70 ankle replacement procedures a year, a significant volume (one of the largest in Southern California, in fact) given that ankle arthritis is far less common than knee arthritis. To put it in context, recent data shows that an estimated 1 million knee replacements are performed each year in the U.S., while 10,000 ankle replacements are performed.
“The number keeps increasing as people stay more active as they age as well as survive accidents like Mr. Hope’s,” he says. “Also, it’s possible to do ankle replacement after fusion - the former standard of care - helping patients regain their range of motion.”
After meeting with Dr. Friscia, Hope decided to go ahead and undergo a third ankle replacement procedure in February 2024.
“When he told me he thought he could resolve this, I said, ‘Okay, let’s do it ... I’m not going to get any better unless someone does something,’” Hope says.
In late September, the 82-year-old said, “I’m still doing post-op physical therapy, and it’s working very well. My gait is still a little off, but I’m able to walk. What’s more, I’m playing golf again.”
“I am absolutely delighted with the results,” he added. “Dr. Friscia did a great job.”
To learn more about Eisenhower Desert Orthopedic Center services,
visit EisenhowerHealth.org/EDOC, or call 760.773.4545.