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Yale-New Haven Hospital news release
Release date: Nov. 29, 2007
Media contact: (203) 688-2488

Yale-New Haven Hospital performs
Connecticut's first total ankle replacement

The procedure was performed on the left ankle of a 38-year-old gentleman from New Haven who had suffered severe injuries in a life-threatening car accident in 1994.

During ankle replacement surgery, the worn-out joint surfaces of the end of the shin bone (tibia) and top of the ankle bone (talus) are removed to create a level surface for the implanted prosthesis. Then a metal-and-plastic implant is placed into the bone ends to function as a new ankle joint.

"My patient's one love of life is dancing," said Dr. Reach. "As a result of his car accident, his right foot and ankle were amputated 13 years ago. However, he aggressively tackled rehabilitation and was able to return to dancing until the pain of post-traumatic arthritis in his remaining ankle forced him to stop. With total ankle replacement, we expect he will be able to dance again."

Dr. Reach is one of the few surgeons in the United States certified in all currently available total ankle replacements. Dr. Reach, who is also an assistant professor of orthopedics and rehabilitation at Yale School of Medicine, joined the medical staff at Yale-New Haven earlier this fall, after completing a fellowship in orthopedics at Duke University Medical Center, with a specialty in ankle and foot surgery and reconstruction.

"It is gratifying to welcome Dr. Reach to YNHH and the Yale Medical Group and to make his special expertise available to those in need," said Gary E. Friedlaender, M.D., chief of orthopedics and rehabilitation at Yale-New Haven Hospital, and chair of the department of orthopedics at the Yale School of Medicine.

"Previously, orthopedic surgeons were faced with limited options for patients - medications, braces and joint fusion, which continues to be a good solution for some patents with arthritic pain," said Dr. Reach. "However, motion-preserving joint replacement - which has proven to show superior outcomes with hips, knees, shoulders and elbows - now allows us to provide the same benefits to patients with ankle arthritis."

Prosthetic ankle joints can be a viable alternative for patients with arthritis who previously had to either live with the pain, or undergo surgery called arthrodesis to fuse the ankle joint together. Where fusion can relieve the pain generated by bone-on-bone arthritis, it leaves the foot fixed solidly in one set position, eliminating the normal ankle flexion of 60 degrees. When the ankle is fused, other joints in the leg and spine are pressured to compensate for the limited ankle motion, which can lead to arthritis in the other joints.

"Our ability to accurately replace the worn out cartridge and bone in an arthritic ankle joint with an artificial joint now expands our capability to relieve pain, restore function and range of motion and allow the patient to resume as close to a normal walking motion as possible," said Dr. Reach. "The recent FDA approval of these implants finally gives our patients the ability to choose between motion preserving surgery or gait-restricting fusion."

Recovery from ankle replacement can take between one and two months, with the procedure being done under general, spinal or regional anesthesia. According to Dr. Reach, eventually the procedure will become streamlined enough to be done on an outpatient basis.

Dr. Reach received his B.A. from Yale University, and his M.D. from Georgetown University School of Medicine. He completed his residency at the Mayo Clinic in Rochester, MN where he was chief resident in orthopedic surgery. He earned a Master's degree in biomedical science from the Mayo School of medicine.

Dr. Reach's other clinical interests include tendon and ligament repair, rheumatoid arthritis, lower extremity deformity correction and lengthening, amputations and limb preservation, great toe deformity and total knee replacements. He is a pioneer in the use of advanced musculoskeletal ultrasound for the diagnosis of soft-tissue and sports pathology.

Yale-New Haven Hospital is a 944-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826 and today, the hospital complex includes Yale-New Haven Children's Hospital and Yale-New Haven Psychiatric Hospital, with a combined medical staff of about 2,400 university and community physicians practicing in more than 100 specialties. See www.ynhh.org for additional information.

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Last revised: Nov. 29, 2007 (dh)

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