Ian Whitmore - total ankle replacement surgery
Ian Whitmore, 68, had a total ankle replacement at Spire Leeds Hospital under the care of consultant foot and ankle surgeon, Mr Nick Harris.
When Anatomy Professor and Flying Instructor, Ian Whitmore, was involved in a mid air collision and suffered multiple injuries he thought his flying days might be over.
For the 68-year-old Doctor and Professor of Anatomy at Stanford University, California, flying is his passion. Professor Whitmore is also a helicopter flight instructor, who spends six months each year in California and summers back home in Redditch, England.
The accident happened at Wycombe Air Park in 1989. He was piloting a Cessna 182 single-engine light airplane, following behind another light aircraft. Both were coming in to land on the runway when the plane in front, containing a student and instructor, failed to clear the runway quickly enough, making the Cessna 182 go around and two aircrafts touched in mid air. It happened at a height of around 50 feet, and sent the two airplanes crashing to the ground. “It’s amazing that anybody survived. We were very lucky, we all four survived.” said Professor Whitmore.
He fractured his left femur (thighbone), left tibia (shinbone) and fibula (calf bone), six ribs and a finger. One of his injuries, his fractured and dislocated right ankle, was to cause more problems in future years. Having spent 12 weeks in hospital, it took a year before he was able get back to a relatively normal life, although with reduced movement. The professor was left with 1.5 inches of shortening in his left leg and had to wear a shoe built up by that amount.
Professor Whitmore says he delayed surgery as long as possible as total ankle replacement was a quite new proceedure compared to hips and knees. However, twelve years later with the onset of arthritis his ankle became increasingly painful until he reached a point where he knew he would have to do something about it, “The pain worsened over the years and became unmanageable without strong painkillers," said Professor Whitmore. “It was becoming impossible to do my job and to fly – the two things that drive my life.”
After considerable research, both in the USA and UK, he chose to have the procedure done in the UK by Mr Nick Harris, a consultant orthopaedic surgeon specialising in foot and ankle surgery, at Spire Leeds Hospital. “In the UK Mr Harris has considerable experience in the procedure, more than 400 I believe, and a few inquiries I made in the profession informed me of his good reputation,” added Professor Whitmore.
So in May 2012, he underwent surgery at Spire Leeds Hospital. The procedure, known as Rebalance Total Ankle Replacement (Biomet UK) is one of the newest replacements available.
Mr Harris said, “Professor Whitmore had reached a point where he could only walk about 100 yards due to the pain, which was keeping him awake at night and he had difficulty standing for long periods. He was keen to keep as much movement in his ankle especially in view of his work as a flying instructor. We discussed the options, including ankle fusion. As increased ankle mobility was especially important to Professor Whitmore, he elected to undergo an ankle replacement.”
Mr Harris explains the procedure he performed, “Through an anterior incision over the ankle the end of the tibia and the top of the talus are removed and replaced with metal implants. The metal implants have a special coating to encourage the bone in the ankle to grow onto the implant and fix it. This coating is used in hip replacements with 98% survivorship at 10 years. Between the two metal implants a plastic bearing is inserted. The plastic bearing in the Rebalance ankle is called ‘E- poly’ and has 85% lower wear rates compared with conventional poly. The aim with the Rebalance ankle replacement is to make it as reproducible as possible with the lowest risks of complications such as osteolysis and edge loading. The Rebalance ankle replacement is currently being used in selected centres in six countries around the world and the early results look very encouraging.”
“Within a few days of the operation the pain had gone,” said Professor Whitmore. “When I moved from a cast to a removable walking boot two weeks after surgery I was delighted to be able to start walking with partial weight bearing. The boot came off after six weeks and I was able to walk fully and start driving. I flew a test to see if I was fit to return to flying at ten weeks.”
“I now have good mobility in my ankle, I can fly and drive, and stand for long periods without any problems” he said. “I would recommend Mr. Harris enthusiastically to anyone considering an ankle replacement. I cannot praise him highly enough for the excellent job he has done.”
Rebalance Total Ankle Replacement
This is the first type of ankle replacement to use E-poly, a highly cross linked polyethylene bearing, which has been shown in in-vitro studies to reduce wear by 85%. The surface coating of the implant (Bonemaster™) uses existing technology from hip replacements with 95% survivorship at 15 years*.
Total Ankle Replacement
Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is increasingly being chosen for patients, replacing the conventional use of arthrodesis (fusion of the bones). The restoration of range of motion is the key feature in favour of ankle replacement with respect to arthrodesis.
Ankle joint replacement is a newer operation than the well established operations for knee and hip joints. Whereas the hip is a ball in socket joint and the knee is fundamentally a hinge joint, the ability of the ankle and forefoot to flex, extend, invert and evert makes is a complex joint. These actions are necessary to be able to walk over uneven ground**.
* Information provided by Mr. Nick Harris, consultant orthopaedic surgeon, Spire Leeds Hospital.