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Joint Replacement

Life pivots on new ankle

Total ankle replacement surgery helps patients get moving again

By Jacob Luecke

 

Mary Blocker loves taking long walks, going out dancing and exercising several days a week.

It’s a lifestyle would be considered active for a woman half her age, 72.

But two and a half years ago, she started feeling pain in her left ankle. Over time, the pain became more severe. Her left ankle would also occasionally give out as she walked, causing her to fall.

“I was getting pretty scared because I could walk across the room and just trip and fall,” she said.

The ankle problems put a stop to her hobbies and she only left home to do shopping and other necessary chores.

Blocker was initially hesitant to see a surgeon about fixing her ankle when she learned that the most common procedure for her problem fused the ankle bones together, limiting movement.

“What I had heard was all they could do was go in and fuse the ankle and your ankle would be stiff,” she said. “I didn’t want that. I could just see myself trying to dance with a stiff ankle.”

Yet Blocker, of Lucerne, Mo., eventually decided to travel to Columbia where she met with Brian Kleiber, MD, an orthopedic surgeon with Columbia Orthopaedic Group who practices at Boone Hospital Center.

Dr. Kleiber is unique in mid-Missouri in that he can perform an advanced total ankle replacement procedure. Compared to fusion, ankle replacement provides a much wider range of ankle motion after surgery.

While not every patient is a good candidate for ankle replacement at this point, Blocker was a perfect fit. She agreed.

“He said he would give me some time to think about what I was going to do,” she said. “But by the time I walked out of his office, I knew what I was doing.”

On September 19, 2011, she came to Boone Hospital and had her left ankle successfully replaced.

She still had a long road of therapy ahead of her to recover, but the promise was there to eventually get back to doing the things she loved.


Dr. Brian Kleiber

Total ankle replacement is one of many foot and lower leg procedures performed by Dr. Kleiber.

He said foot and ankle surgery is interesting, as every situation is unique and finding a good solution often requires ingenuity.

“I like the creativity that comes along with this, a lot of the time we can’t just follow a cookie cutter plan,” Dr. Kleiber said.

Dr. Kleiber was raised in St. Louis and attended the University of Missouri for undergrad and medical school.

He completed his orthopedic surgery residency at the University of Nebraska and a foot and ankle fellowship at Washington University.

He and his wife, Allison, have two sons David, 3, and Matthew, 19 months.

Dr. Kleiber has been practicing at Boone Hospital for the last year and a half and said he has been pleased by the care provided to his patients.

“The staff is very friendly and helpful,” he said. “I’ve been impressed with the nurses on the floors and the attention to detail in caring for patients.”

In his work, Dr. Kleiber also relies on the expert staff at Columbia Orthopaedic group such as Amy Sanders, RN, PA-C; Savannah Sandison, LPN and Rhonda Maydwell, administrative assistant.

His practice is unique for an orthopedic surgeon as he focuses almost solely on foot and ankle disorders. Because of his specialized expertise, he sees patients who have sometimes struggled for years to find answers to very specific foot and ankle problems. Correct diagnosis and treatment can truly make a difference for these people.

“A lot of times that can be very gratifying because the patient is just looking to be better, and we’re able to help solve some of those problems,” he said.

Ankle replacement is still a relatively uncommon surgery, but it will likely become more common in the future.

Today, the most common surgery for severe ankle arthritis is a fusion. Also called arthrodesis fusion is successful at solving pain issues, but can greatly reduce ankle motion. Ankle replacement both alleviates pain and preserves motion.

However, because the current ankle replacement implants are still fairly new technology, studies of the implants’ longevity are only out to about 10 years.

This means that currently ankle replacements are still largely offered to those patients who are healthy and typically older than 60. All patients are made aware that any joint replacement can wear out.

“As technology improves and as those results available to us, we’ll start seeing total ankles being utilized in younger patients,” Dr. Kleiber said.

Back in Lucerne, Blocker said she worked with therapists as her strength and mobility improved over the course of months.

“It’s not just wham, bam you’re back,” she said. “It takes time.”

As she recovered, she went from wheelchair, to walker, to crutches and then to a cane. Now, she’s been without a cane for the last three months.

She’s also back to her active life of walking, dancing and exercising at Curves.

“Since I’ve had the surgery, I’m back to doing everything I was doing,” she said.

Dr. Kleiber said these kind of results make his job rewarding. It’s about seeing people heal and get back to their lives.

“It’s nice to be able to help fix people,” he said.

 

Sidebar: For healthy feet and ankles, find a shoe that fits

While there is no surefire way to prevent foot and ankle problems, one easy and important preventative practice is simply buying shoes that fit.

Many people haven’t had their feet sized in years, or even decades. That can be a problem since feet tend to splay out over a lifetime.

“You may have wore a size nine in your 20s,” Dr. Kleiber said. “But now that you’re in your 50s, that’s probably changed.”

He also suggested that people ease into exercise routines, such as running, that place stress on feet and ankles.

“It’s important to maintain an overall fitness level,” he said “Don’t just decide to do six miles of running one day to start.”
Dr. Brian Kleiber