Broadcast News Interview Transcript with Mark Feldman, D.P.M., Podiatric Surgeon, Parkway
and Hialeah, Miami TOPIC: ANKLE RELPACEMENT,
When did this ankle replacement procedure first become available?
Dr. Feldman: The Buechel-Pappas total ankle prosthesis became available to Americans in
October of 1998. It was used in Europe for almost 15 years. Multiple European surgeons
have used the implant and have reported that 81 or 82 percent of almost 1,000 patients
have totally pain free ankles after ten years. That statistically approaches the hip and
the knee success rates.
How many surgeons are approved to do this procedure? Dr. Feldman: The FDA now permits the surgery to be done in the United
States by 10 selected surgeons. There will be more after a year or two, but for now, the
FDA classifies this as an investigational device.
What does that mean?
Dr. Feldman: Investigational means it can be implanted by a limited number of surgeons.
The FDA will take the statistical results and then expand it. Considering the remarkable
success of the European surgeons, I expect it will take less than a year to become
available for a multiplicity of surgeons.
So right now it is approved, but not every doctor can do it? Dr. Feldman: Correct. There will never be a time when every doctor who
wants to do it can do it. The procedure is very much like heart surgery in that they're
going to limit the number of surgeons who can do it because of technical difficulty. Not
every surgeon can implant the heart, and not every surgeon will be able to implant the
ankle. A year from now, there will be significantly more surgeons permitted to perform the
When did you start doing the procedure yourself? Dr. Feldman:
I started in December of 1998. It takes a while for the patient population to realize that
the ankle is available. I'm quite certain that when patients know it is available, there
will be a greater interest. The number of patients with rheumatoid arthritis or arthritis
from a broken ankle in the United States is, I estimate, more than 20,000. There are
a lot of patients who are desperately seeking this procedure because it is the only other
option to a new ankle joint besides the fusion of their foot to their ankle. One of the
significant features of the Buechel-Pappas is that I can take down an ankle that was fused
and give that patient a functioning ankle joint again. After 20 years in development, it's
an extraordinary implant and will be able to help so
many thousands of patients.
Describe the procedure.
Dr. Feldman: The implant is the Buechel-Pappas total ankle replacement. It is a
three-piece ankle joint made of titanium and ultra high molecular weight polyethylene. It
is implanted both in the tibia at the ankle and the bone beneath it, the talus. A portion
of the bone is removed, and the implant is inserted.
Is the procedure similar to the hip
or knee implant? Dr. Feldman: It is
similar, except it's much smaller. Development took a long time because ankles support
five times their body's weight every time a step is taken. The hip and the knee only take
twice their body's weight. It's a much more complicated device, much smaller and much more
difficult to insert because the operation area is much smaller.
What are the advantages of the ankle
replacement? Dr. Feldman: The advantage
is that patients can walk, swim and climb stairs after the ankle replacement. They have an
80 percent chance of being totally pain-free. Generally, patients who need this procedure
are in such pain that sometimes they want their limbs removed. These are patients who have
rheumatoid arthritis or who have arthritis from a broken ankle. Many waited for years for
the ankle replacement to be perfected because the only alternative is to have their ankles
fused. When that is done, the patient walks with a limp. Four or five years later, because
stress that the ankle takes up is now taken up by the foot, two or three joints that are
affected in the foot have to be fused. It's a devastating operation to fuse an ankle, but
now we have the implant.
Why is this considered such an
incredible medical breakthrough? Dr.
Feldman: This was in development for a little over 20 years. In the early 70s, there were
a number of different ankle prosthesis that failed. The designs were poor because they
were cemented. Now the metal and the designs are totally different.
Would you say this is a breakthrough? How would you describe it? Dr. Feldman: I would call
it a limb-saving device. It gives life back to patients with severe pain. I've seen that
happen over and over, all over the world.
How many patients have benefited from
this? Dr. Feldman: According to the
United States government, there are almost 10,000 patients over 65 five years of age that
break their ankles every year. The numbers are similar under that age. If you multiply
that through the last 10 years as an example, that's a very large number of patients who
severe arthritis from rheumatoid disease or patients who have fractured their ankles. That
gives you some indication of the numbers of patients in the United States who stand to
benefit from this new ankle joint.
What is the success rate?
Dr. Feldman: The success rate is right at 81 to 82 percent. This is figured after patients
have used the ankle for 10 years of longer.
Is there a rehabilitation period?
Dr. Feldman: Yes. After surgery the patient is put in a short leg cast that goes from just
below the knee to the end of the toe. That stays on for six weeks. After six weeks, they
begin to walk and go to rehab for another six weeks, two to three times a week. After the
six weeks of rehabilitation, they go back to their normal daily lives.
This procedure isn't for everyone, is
it? Dr. Feldman: No. This is for
patients who have severe rheumatoid disease in their ankles or who have severe arthritis
secondary to an ankle fracture.
What is the cost?
Dr. Feldman: I don't know the hospital charges, but I can say that between surgeons fees,
hospital bills and the implant itself, it's right around $20,000. That is far less than
having a few of your teeth implanted, especially for such a significant device.
On a scale of one to 10, how would you
rate this breakthrough? Dr. Feldman: You
should ask that question to the patients. They would probably say it's comparable to
having a new heart since it allows them to walk again. As a surgeon, I'm delighted to see
that it came along during my career because I've been interested in the ankle for many
years. I've seen quite a few similar things fail. Since this has been so successful for so
many years, it's a joy to have and use.
How many patients are currently waiting
to have the procedure done in the future? Dr. Feldman: I will perform six and possibly even eight in the
month of March.
How do you identify candidates for
Dr. Feldman: We require two things, a set of X-rays that is very specific in terms of
ankle position and an examination. The X-rays help me determine whether I can implant the
ankle replacement and whether or not I can take down a patient's fusion and give them an
ankle joint again. END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used
as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional
interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or
accuracy of physician statements. Procedures or medicines apply to different people and
medical factors; always consult your physician on medical matters.
Copyright, 1999, Ivanhoe Medical Breakthroughs.