{"id":24177,"date":"2019-05-20T12:03:17","date_gmt":"2019-05-20T18:03:17","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=24177"},"modified":"2022-09-06T08:06:10","modified_gmt":"2022-09-06T14:06:10","slug":"talus-replacement-surgery-for-a-badly-damaged-ankle","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/talus-replacement-surgery-for-a-badly-damaged-ankle\/","title":{"rendered":"A personalized chunk of metal has her back on slopes and trails"},"content":{"rendered":"
<\/div>

If the ankle is a lever, the talus is its fulcrum. It\u2019s an oddly shaped lump onto which the bones of the lower leg drive the body into the bones of the foot. By late 2018, the fulcrum in Deanne \u201cDee Dee\u201d Carlson\u2019s left ankle had long since given in to the punishments its owner had imparted upon it, and it was dead and crumbling. Until recently, the best option was to fuse the ankle with enough screws to build a deck, which would leave ankle about as flexible as a deck. Now there\u2019s a better way.<\/p>\n

\"Just
Just over three months after Hunt performed the talus surgery on her ankle, Carlson was back skiing at Purgatory on Feb. 28. She had 16 days in by April 29. Photo courtesy Deanne Carlson.<\/figcaption><\/figure>\n

Deep in Dee Dee Carlson\u2019s ankle now resides a roughly two-pound, polished nugget of shiny cobalt chromium. It was 3D printed by New Jersey-based Additive Orthopaedics, based on a mathematical mirror image of CT scans of her healthier right ankle. In November 2018, Dr. Kenneth Hunt<\/a>, a University of Colorado School of Medicine surgeon specializing in foot and ankle orthopedics and the medical director of the UCHealth Foot and Ankle Center<\/a> in Denver\u2019s Stapleton neighborhood, installed the metallic talus in Carlson\u2019s ankle. He also redid the failed ankle replacement during the procedure at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. The personalized-medicine talus replacement was the first such surgery done at UCHealth and among the first in Colorado. It won\u2019t be his last, Hunt says.<\/p>\n

\u201cI think it\u2019s a much better solution than previous approaches,\u201d he said.<\/p>\n

Ankle basher<\/strong><\/h3>\n

You can\u2019t blame Carlson\u2019s talus, really. She may stand just five feet tall, but the 63-year-old has been a bona-fide ankle basher for decades. The Durango resident was a soccer player in her youth, a tenacious wing defender at Colorado College and then on several competitive teams into her forties. She dribbled and kicked through more ankle sprains and strains than she can count. The pounding didn\u2019t abate much as she transitioned to trail running as her career as a veterinarian progressed.<\/p>\n

By her mid-fifties, the cartilage in Carlson\u2019s ankles had worn away. She had her left ankle surgically replaced in April 2012; the right was done a year later. She stopped trail running, but biking the roads and hiking the trails of southwestern Colorado remained passions, and she skied all winter at Purgatory Resort, both for fun and as part of her duties as a ski-patrol emergency medical technician.<\/p>\n

Her right ankle replacement held firm. But with time, the talus in the left ankle died of avascular necrosis<\/a>, in which bone damage stopped already limited blood supply to the talus, killing the bone. It collapsed, shifting the titanium base plate of the ankle replacement down and toward her midline (technically speaking, medially). Things that were supposed to glide now grinded and clattered against each other.<\/p>\n

\"Dr.
Hunt and the carbon-cobalt talus with before (left) and after X-rays of Carlson\u2019s left ankle. Carlson\u2019s previous ankle replacement had failed due to the collapse of the talus bone. Photo by Todd Neff for UCHealth.<\/figcaption><\/figure>\n

The pain was such that, by last fall, her hikes in search of mushrooms, which might have otherwise brought hours of mycological meandering among the lodgepole pine, ended abruptly.<\/p>\n

\u201cI\u2019d be pretty much in tears by the time I was out for 20 minutes,\u201d Carlson said. \u201cEvery step hurt, and there was huge swelling on the medial side of my ankle.\u201d<\/p>\n

Personalized metal<\/strong><\/h3>\n

She was referred to Hunt, who recognized that ankle fusion would seriously limit someone as active as Carlson, Hunt says. They agreed that a new 3D-printed talus was the most promising option.<\/p>\n

Additive Orthopedics created three versions of Carlson\u2019s talus: one sized exactly like the one in her right ankle, one slightly smaller, and one slightly larger. Hunt would use the one that fit best. Typically, the shiny metal talus, once inserted, fits in like a puzzle piece and is held in place by the neighboring bones. In Carlson\u2019s case, because of the shifting that had happened before the surgery, the new talus also had a titanium baseplate that Hunt screwed into Carlson\u2019s heelbone (calcaneus). The base of the new ankle replacement hardware sat on the metal talus, and Hunt also replaced the portion drilled into Carlson\u2019s tibia. The surgery went well; now it was a matter of rehabilitating the ankle.<\/p>\n

On April 29, Carlson was back for a periodic visit with Hunt and colleagues at the UCHealth Foot and Ankle Center \u2013 Stapleton. The 11 a.m. appointment started with a walk across force plates and pressure-tracking mats in the center\u2019s clinical motion and performance laboratory. Eight cameras tracked reflective spheres the size of cereal puffs that UCHealth athletic trainer Danielle Lewis and biomedical engineer Sara Andrews had painstakingly adhered to Carlson\u2019s feet, ankles, legs, knees and hips. The idea is to assess how the kinetic chain, as it\u2019s called, from Carlson\u2019s feet on through to her waist, was faring five months post-surgery. To the casual observer, she walked normally; the fusion of the lab\u2019s various inputs would conclude much the same.<\/p>\n

Back to the mountains<\/strong><\/h3>\n

In the exam room, Carlson told Hunt that she had been skiing since February 28. She reminded him that, shortly after surgery, he had told her that, if she rehabbed vigorously and the ankle progressed, she might even get a few runs in by the spring. It had given her a goal toward which she diligently rehabbed. She had since been out skiing another 15 days, she added.<\/p>\n

\"Dr.
Dr. Kenneth Hunt holds a metallic copy of Deanne Carlson\u2019s talus bone, one of three slightly different-sized versions created for her prior to her November 2018 ankle-repair surgery. Photo by Todd Neff for UCHealth.<\/figcaption><\/figure>\n

\u201cYou took some liberties there, which I appreciate,\u201d Hunt said. \u201cAnd that\u2019s more days than I\u2019ve got.\u201d<\/p>\n

Carlson still has work to do. Hunt is looking for a few more degrees of motion in the ankle, so he wrote up instructions to Carlson\u2019s physical therapist in Durango for more stretching and strengthening. Hunt reminded Carlson that it usually takes about a year to fully strengthen and heal after such a surgery, although additional, incremental gains can happen after that. She\u2019s on track for a great outcome, he told her.<\/p>\n

\u201cI think we\u2019ll get many years of activity, and you\u2019re doing really well,\u201d he said.<\/p>\n

Carlson says she\u2019s walking almost completely pain-free.<\/p>\n

\u201cI had expectations, but they weren\u2019t this high,\u201d she said.<\/p>\n

Carlson planned stay in Denver with sister Lisa Carlson for the next couple of days, but her mind was already on the mountains.<\/p>\n

\u201cI\u2019m thinking of going up to A-Basin on Wednesday morning,\u201d she said.<\/p>\n

 <\/p>\n

Must-see TV: check out CBS 4 Denver\u2019s take on Dee Dee Carlson\u2019s story <\/em>here<\/em><\/a>.<\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

If the ankle is a lever, the talus is its fulcrum. It\u2019s an oddly shaped lump onto which the bones of the lower leg drive the body into the bones of the foot. 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