From left: Anesthesiologist Michael Ietta, M.D.; Bruce Becker; and orthopedic surgeon and foot/ankle specialist Andrew A. Brief, M.D.
A licensed clinical social worker from Ringwood, who for 20 years has experienced the painful after-effects of a complex ankle fracture, is the first patient to undergo total ankle replacement surgery at The Valley Hospital.
Orthopedic surgeon and foot/ankle specialist Andrew A. Brief, M.D., performed the procedure on Bruce Becker, 65. The father of three sons was hiking with two of them in Camp Tamarack Boy Scout Camp in Oakland in 1990 when he dropped several feet from a swinging rope, landed hard on a rock, and shattered his ankle bones, which resulted in significant damage to the cartilage in his ankle joint.
Emergency surgery repaired the fracture, but over the next two years Becker underwent four additional surgeries to remove scar tissue, hardware placed in the bones, and areas of bone worn down by arthritis.
"The injury interfered with my life,” he recalls. “I wasn’t able to run with my children, the range-of-motion in my ankle was limited, and I was in constant pain from arthritis that got worse over the years. I finally sought out a physical therapist two years ago to help me get some movement back."
Total ankle replacement surgery is similar to total hip and total knee replacement surgery in that damaged joints are replaced by metal and plastic implants. Though total ankle replacement surgery has been performed for about 30 years, it is only over the last three years that the technically demanding procedure has gained momentum. Thanks to recent engineering breakthroughs in implant design, prosthetic materials, and instrumentation, dramatically improved success rates have been observed in total ankle replacement patients.
"Up until this time, ankle fusion surgery was the 'gold standard' of treatment for ankle arthritis after other options, including cortisone injections, oral medications and physical therapy, were exhausted," says Dr. Brief, who completed a fellowship in foot and ankle surgery at the Hospital for Special Surgery in New York City. "Although ankle fusion is effective for pain relief, it causes permanent loss of ankle motion. Research studies on total ankle replacement are ongoing, but the latest data are enormously encouraging. Though this procedure is technically demanding, it has proven to be safe, effective, and allows patients to return to activities that they had to give up, such as golf, biking, and hiking. At last, we have another option."
Upon the recommendation of his physical therapist, Becker researched ankle replacement surgery and sought out Dr. Brief. With Valley orthopedic foot/ankle surgeon Kenneth A. Levitsky, M.D., assisting, Dr. Brief used the Tornier Salto Talaris® total ankle prosthesis to replace Becker’s damaged ankle joint.
Becker’s anesthesia was administered by Michael A. Ietta, M.D., Director of the Department of Anesthesiology. Dr. Ietta’s approach was to introduce a perineural catheter through the back of Becker’s knee and then place it along his sciatic nerve, which provides the majority of nerve sensations to the ankle and foot. An anesthesia solution was continuously infused through the catheter, which numbed the sciatic nerve and rendered most of Becker’s leg incapable of feeling pain sensations. A single injection of a long-acting anesthetic to Becker’s sural nerve completed the numbing effect. The catheter was left in place after surgery to provide continuous pain relief. Becker experienced no pain throughout his hospitalization.
"This anesthetic approach enables the anesthesiologist to administer much less systemic medication to the whole body during surgery so patients recover quickly with almost no side effects,” says Dr. Ietta. “Mr. Becker emerged from his anesthesia without pain or nausea, and he was able to get a good night's sleep." He was discharged from the hospital the next day and returned to work at Turn the Page Counseling Center in West Milford three weeks later.
During the first six weeks, Becker will not be able to bear weight on his left ankle. He will transition to walking with a cane and then undergo several weeks of outpatient physical therapy. Within six months, his mobility should be substantially improved.
"The future looks bright for Mr. Becker," says Dr. Brief. "I expect him to be able to participate in many activities that he was unable to partake in prior to his surgery."
That's good news for Becker, who looks forward to hiking again in Ringwood State Park with his white husky, Colby. "I appreciate all Dr. Brief did for me," says Becker. "His surgery has restored my life."
For more information about orthopedic surgery at The Valley Hospital, call 1-800-VALLEY 1 (1-800-825-5391).