Back in the Swing
Winning golf tournaments is part of Mimi Hoffman’s DNA. But debilitating ankle pain threatened to derail her success. When she competed in the 2013 USGA Senior Women’s Amateur Championship, the pain was so severe she could barely walk the course. “I realized if I didn’t do something, my golf career was over,” says the 58-year-old from Springfield.
Hoffman knew where to turn for help: Steven Neufeld, MD, orthopedic surgeon at The Orthopaedic Foot & Ankle Center, and Medical Director of Inova Fairfax Hospital’s comprehensive total ankle replacement program. Dr. Neufeld had treated Hoffman’s ankle issues for years and she trusted him completely.
“He has a degree in engineering; I have a degree in mechanical engineering,” she says. “I knew he had the ability to take my ankle apart and put it back together again.” When X-rays revealed a broken tibia and bone-on-bone arthritis, the verdict was in — Hoffman would need a total ankle replacement.
Ankle replacements are on the rise in the United States thanks to technological advances in ankle implants, as well as growing demand from aging baby boomers who want to stay active. The procedure involves replacing the damaged ankle joint with a combination of metal and medical-grade plastic. Industry breakthroughs have expanded the choice of effective implants. In the late 1990s, only one ankle prosthesis was FDA-approved. Today, surgeons can select from four FDA-sanctioned models.
“Using the latest generation of ankle implants, we are now able to relieve pain, restore motion and improve quality of life,” Dr. Neufeld says. “Good candidates for ankle replacement are patients with debilitating pain who have failed to respond to conservative measures such as anti-inflammatory medications, braces, cortisone injections or physical therapy.”
For Hoffman’s replacement, Dr. Neufeld recommended the Salto Talaris™ Total Ankle Prosthesis — one of the newest implants on the market. It mimics the anatomy and natural flexion of the ankle joint for optimal range of motion.
After her procedure at Inova Fairfax Hospital, Hoffman faced three months of rigorous rehabilitation to regain strength and relearn her golf swing. The effects have been transformative. She feels stronger than she’s been in years and says there’s nothing she can’t do. Dr. Neufeld credits Hoffman’s hard work and positive attitude for her smooth recovery.
“She had reasonable expectations, she was very motivated in her physical therapy and she followed all instructions. All of these elements help ensure that patients have a good outcome,” he says.
With zero pain, Hoffman is now tearing up the golf course once again. In June, she won the VSGA Senior Women’s Stroke Play championship. Two months later, she captured the VSGA Senior Women’s Amateur championship. Only two women in Virginia history have won both majors in the same year.
She is grateful for the care she received at Inova Fairfax Hospital and recommends Dr. Neufeld to all who ask. “He’s an incredible doctor,” she says. “Every time I say his name I start to smile and then I start to cry. He gave me my life back. And that’s a beautiful thing.”
Ankle Replacement Parts
Several components make up the ankle replacement device, according to manufacturer Tornier, who makes the Salto Talaris™ Total Ankle Prosthesis. All of the parts are made from highly biocompatible materials, including titanium and cobalt chrome metals on the tibial and talus sides of the joint. A third component made of a biocompatible plastic called polyethylene is attached to the tibial component to help the components glide against each other. These are materials identical to those used in hip and knee replacements.
Who is a Good Ankle Replacement Candidate?
Never heard of someone with an ankle replacement? That’s because ankle replacement is not as common as other kinds of joint replacements, such as those for hip and knee. Still, the number of procedures is growing fast.
Ankle arthritis occurs when ankle joint cartilage wears out, causing pain, loss of motion, swelling and difficulty walking. Patients with debilitating pain are first treated by conservative measures, such as anti-inflammatory medications, braces, cortisone injections and physical therapy.
Ideal candidates for replacement surgery are 50 and older, in good general health and have severe ankle pain from arthritis or cartilage injury.
During the procedure, the orthopedic surgeon removes the diseased cartilage and bone and replaces it with a metal-and-plastic bearing that reduces pain while maintaining ankle motion.
The procedure lasts about an hour and a half, and most patients go home the next day. People can expect their ankle replacements to last 10 to 20 years.