ADVANCED COMBINATION SURGERY TREATS ANKLE ARTHRITIS COMBINED WITH SEVERE FOOT DEFORMITY

MQ Health orthopaedic surgeons utilise external fixation and percutaneous minimal incision surgery to correct a foot deformity followed by a total ankle replacement in a complex case of severe rheumatoid arthritis.

Wendy Favorito developed rheumatoid arthritis at the age of six. One of the first manifestations of the disease was in her feet and ankles. Over time she developed severe foot and ankle deformity. Early in 2018, in her late forties, Wendy had developed significant foot and ankle deformity associated with debilitating ankle arthritis. Wendy found out she had also been walking on an undiagnosed fracture.

Her foot and ankle specialist referred her to Dr Tim O’Carrigan, Orthopaedic Surgeon with MQ Health’s Limb Reconstruction Centre. Dr O’Carrigan specialises in foot and ankle surgery, total ankle replacement and complex deformity correction. He is often referred patients from other orthopaedic surgeons.

“The consequences of Wendy’s arthritis were deformities of the hindfoot (heel) and forefoot that led to Wendy walking unevenly, causing pain and suffering from malalignment and uneven forces through her foot and ankle,” said Dr O’Carrigan.

“Staged surgery was required to first correct the foot deformity and then replace the ankle joint. Correcting the deformity was an essential first stage to a successful ankle replacement. I was uniquely placed to do this type of combination surgery required. Wendy would more likely be offered an ankle fusion elsewhere.”

In August of last year, Dr O’Carrigan operated to address the deformity through an innovative approach combining minimal incision surgery to perform osteotomies (bone cuts) and application of an external fixateur to maintain the correction while the osteotomies healed.

The frame was removed at three months and at six months Wendy had a protocol specific CT scan that was then analysed by a team of engineers and a detailed pre-operative plan was developed. This was reviewed and approved by Dr O’Carrigan. From there, Prophecy patient-specific jigs were 3D printed and made available at the time of the operation. The Infinity Ankle Replacement used is one of a suite of ankle replacements manufactured by Wright Medical, which cover primary and revision total ankle replacement.

These jigs are the link that facilitates executing the preoperative plan as accurately as possible in theatre.

Patient Specific Instrumentation (PSI) has been available for some time in knee replacement but this is the only total ankle replacement system utilising this technology to assist the surgeon and Dr O’Carrigan is one of the most experienced surgeons in Australia using this technique.

“There is overwhelming evidence that the more accurately an ankle replacement is inserted, the better the patient outcomes in terms of pain relief, gait and longevity of the joint replacement,” said Dr O’Carrigan. “This is particularly challenging in the ankle joint because all forms of deformity have to be addressed both within and outside of the ankle joint – the reason why the surgery was staged in Wendy’s case.” Wendy says that the surgery has changed her life.

“It was hard, painful and, at times, incapacitating not being able to walk – along with the uncertainty around the future and emotional impact on our children,” she said.

“But it’s been so worth it. I’ve increased my work capacity and accept social invitations without hesitation. I’m a happy mum again attending my kids’ activities. I’m walking or doing hydrotherapy for almost an hour every day.

“To think I was actively winding my life down at the age of 48 – having reduced my work hours and hardly going out – before I was referred to Tim, and now I have my life back. It is just phenomena

Limb Reconstruction Centre at MQ Health

The Limb Reconstruction Centre at MQ Health is unique in its capacity to perform innovative and complex procedures.

The current team includes Associate Professor Munjed Al Muderis, Associate Professor Kevin Tetsworth, Dr Razvan Stoita and Dr Tim O’Carrigan. Complex patients are often seen by all four surgeons in the same room at the same time and detailed assessment and discussion undertaken and a comprehensive diagnosis and treatment plan determined. This same approach is undertaken in theatre with two of the team operating together on each patient.

The team collaborates with spinal, plastic and vascular surgeons from Macquarie, as required, with each patient getting a unique tailored solution.

The Limb Reconstruction Team also involve psychologist, physicians, pain specialist, physiotherapists and a limb reconstruction-trained Clinical Nurse Consultant to provide patient education and close support to the patient during their treatment journey.

This unique model has the Limb Reconstruction Centre at MQ Health well positioned to become the pre-eminent Limb Reconstruction Centre in Australasia.