Wednesday, December 9, 1998

Boca Raton athletic coach gets a new $7,000 ankle

Ankle Replacement gains surgical toehold

A Boca Raton coach hopes the new technique will relieve him of chronic pain

By Peter Donald
Palm Beach Post Staff Writer

Five years ago, Boca Raton athletic coach John Fogleman went to an orthopedic surgeon for relief from chronic pain in his right ankle, which he'd broken playing basketball in college.
Dr. Peter Merkle made some minor surgical repairs, but that was all he could do, given the limits of medicine at the time.
On Tuesday, the Pompano doctor performed a 4 -hour operation to replace Fogleman's ankle completely. He said he is the first doctor in South Florida to use a replacement joint known as the "Agility Ankle."
Only 30 doctors in the country have been trained to use the device, which costs up to $7,000, he said.
Fogleman, a 57-year-old teacher and coach at St. Andrew's School in suburban Boca Raton, was recovering Tuesday night at North Broward Medical Center. Fogleman's wife, Dotsy, said they had been nervous about the new procedure but were ready to try anything.
"Anything would be better than what he was going through," she said. His ankle was "swelling to the size of a grapefruit."
The surgery took longer than expected but went nicely, Merkle said.
"The ankle's in," he said. "The ankle's safe. There's no grinding."
Fogleman, who teaches physical education and coaches tennis, football and girls' basketball, may be able to test his new ankle today. He had general anesthesia for the operation, which will cost about $20,000 with the hospital stay. He expects to go home today.
Until recently, many orthopedic surgeons steered clear of replacing ankle joints. More than 25 different prosthetic ankles have been introduced since 1972, but their results were so poor that almost all have been abandoned, said Dr. Frank G. Alvine, an orthopedic surgeon in Sioux falls, S.D., who has been fine-tuning the Agility Ankle since 1984.
Replacing the ankle joint offers an alternative to fusion, in which bone is fused directly to bone, eliminating ankle mobility.
In an ankle replacement, damaged bone is removed and a prosthetic device made of metal and plastic is implanted to keep bones from rubbing against each other and causing pain. The new device creates a buffer that mimics cartilage and allows ankle movement.
It's used to relieve the pain that arthritis causes.
Alvine said he has performed 350 total ankle replacements since he started using the device. Most patients are doing as well as those who have received total hip or knee replacements, he said.
However, one physician was quoted in a July 1997 issue of Orthopedics Today saying that it's not known how well the device will work after 20 years.
The Agility Ankle is manufactured by DePuy, a Johnson & Johnson company based in Warsaw, Ind.
The product is so new that foot and ankle specialists must travel to special seminars in Chicago and Seattle, where they practice using the device on cadavers.
"Doctors can't just pick up the phone and order this from a catalog," Alvine said. "They have to get the training from us first."
In Florida, he said, Merkle and two Tampa doctors are using the device.
"I've been waiting for this for five years," Fogleman said.