Kaler, who is from Long Island, says the surgery changed her life. She can now engage in activities most people take for granted – walking normally without pain, wearing shoes she likes, being able to do her job, working in her backyard.
“You have no idea how grateful I am. Before the surgery, my left ankle was collapsing, it could barely support my weight,” says Kaler, a slim 5 foot 7. “All my shoes were worn out on one side.” Her ankle was so unstable, she lived in fear that she would fall or break it, despite the rigid plastic brace she wore from her foot to her knee, day in and day out. She could only wear one type of shoe that she needed to replace every three months.
As a child, Kaler recalls constantly twisting her ankle. Her parents took her to several doctors, and she was given a shoe insert to help with her high foot arches. Years later, arthritis set in, and the pain worsened and became more debilitating. Cortisone shots could only do so much, and she resumed the search for a long-lasting solution. Four doctors said nothing could be done. One orthopedic surgeon said the problem might be corrected with four separate surgeries, which she declined.
Then she learned about total ankle replacement during an appointment with a doctor at HSS Long Island. It’s a complex surgery performed by relatively few orthopedic surgeons, and she was referred to Dr. Demetracopoulos, director of the HSS Total Ankle Replacement Center at the main hospital in Manhattan.
“One of the few centers of its kind, we have a team of foot and ankle specialists, anesthesiologists, radiologists, nurses and physical therapists who have extensive experience in ankle replacement,” he explains. “We strive to provide the best possible care for each of our patients and have grown our volume to become one of the top institutions nationwide in ankle replacement.”
Kaler says her consultation with Dr. Demetracopoulos gave her hope, and she would not be disappointed. She had the surgery in April 2021. “He saved my life. I never cry, but I cried in front of him, I was so grateful,” she says.
“Ankle replacement is considered when patients are no longer able to manage arthritis pain with nonsurgical treatments such as physical therapy, appropriate footwear, an ankle brace or anti-inflammatory medication,” Dr. Demetracopoulos explains. “They have consistent pain that limits their activities and affects their quality of life.”
Like other types of joint replacements, the surgery involves replacing the damaged bone and cartilage in the ankle with a prosthesis. The implant, made of metal and plastic, has the shape of a natural joint and seeks to provide normal, pain-free movement.
The last 15 years have brought vast improvements in ankle replacement implants, technology and surgical techniques, making it a viable option for many patients suffering from severe arthritis, says Scott Ellis, MD, another orthopedic surgeon specializing in foot and ankle surgery at HSS.
One of the most noteworthy advances in ankle replacement is patient-specific instrumentation, or PSI, Dr. Ellis says. It entails obtaining a CT scan of the patient’s ankle and developing a customized presurgical plan tailored to the individual’s anatomy. “PSI has been a game changer. It enables us to choose an implant that is the perfect size and map out a very precise surgery for optimal alignment and positioning,” he says.
For people considering an ankle replacement, the first step is a thorough assessment of the ankle and the foot, and a discussion of patient goals and expectations. Imaging and other tests determine if a patient is a candidate. For someone whose ankle is very stiff with limited mobility or a severe deformity, a fusion of the ankle bones might be a better option and is also very successful in relieving pain, the HSS experts say. An ankle fusion would also be a better option for someone with weakened bones or osteoporosis. The benefit of ankle replacement over fusion is better movement after surgery.
Sometimes an ankle replacement needs to be combined with another procedure, as it was in Kaler’s case. “Hers was a complex surgery. She had a type of foot that predisposed her to ankle instability,” Dr. Demetracopoulos explained. “In addition to treating her arthritis with the ankle replacement, we needed to treat the instability by repairing the ligaments in her ankle and by correcting the alignment in her foot, so it was in the right position.”
Kaler says she experienced no pain after surgery, which Dr. Demetracopoulos attributes to advances in nerve block anesthesia and pain management protocols after the procedure. He notes that each patient experiences pain differently, though.
The HSS doctors expect 90 percent of ankle replacements to last 10 years. If the implant wears out, patients could be candidates for a revision ankle replacement or an ankle fusion. The physicians follow and monitor patients in a joint replacement registry at HSS. “One of our core missions at HSS is not only to deliver the care and do the best surgery we can for our patients, but to collect data over time that we can share with other surgeons and clinicians,” Dr. Demetracopoulos says.
Kaler says the surgery has enabled her to regain her confidence. She can now drive her stick-shift Mini Cooper and carry out her demanding job responsibilities at a major home improvement store. “I’m all over the place, to the point where my friends and colleagues are saying, ‘slow down,'” she adds, making up for lost time and living life to the fullest.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.