The Artificial Joint

Of all the body's joints, the ankle is one of the most complex. It is an intricate hinge that not only supports the weight of the entire body but allows the foot to rotate and tilt through a range of angles. Doctors have learned to replace diseased or injured finger joints, hips, shoulders and knees with effective, man-made spares. But they have had only limited success with artificial ankles. In many cases the best they could do was to put in a hinge that allowed the foot to move only up or down. The accepted treatment for most patients with badly damaged ankles has been to fuse the bones, an operation that locks the ankle and radically reduces mobility. Now there is additional hope for patients whose ankles might otherwise have to be immobilized. A California physician has improved on earlier models by designing an artificial ankle joint that closely duplicates the action of the original.

No Pain. Developed by Dr. Theodore Waugh, 48, an orthopedic surgeon at the University of California at Irvine (U.C.I.), the new joint is a two-piece arrangement that weighs only five ounces. One part of Waugh's "U.C.I, ankle" is an inverted T made of a chromium and cobalt alloy with a concave tip. The other part is an alloy half dome.

In an operation that takes a half-hour, Waugh makes an incision in the front of the ankle, saws off the top of the talus, or anklebone, and cuts a wedge-shaped opening in the bottom of the tibia, the larger of the two lower leg bones. He then inserts the metal into the tibia and fastens the dome to the talus. Each part is held in place with a special bone cement. The tension of the leg and ankle tendons holds the joint together and keeps the T in contact with--but able to move on--the dome. Most of the three dozen patients who have received the U.C.I, ankle (Waugh performed 15 of the operations himself) were up and walking on crutches five days after surgery; many were walking unaided less than one month later. Most experienced no pain except from the operation itself.

Hole in One. Waugh, who also developed an effective artificial knee joint three years ago, is currently working on a smaller version of the U.C.I, ankle for children. He will soon leave for Sweden to teach other surgeons his ankle-replacement technique, which may prove particularly valuable for dealing with severe arthritis. Says he: "One of the good things about this operation is that any competent orthopedic surgeon can do it without much problem. It should bring tremendous relief to thousands of crippled persons." Waugh's patients share his enthusiasm for the ankle, which costs $375, plus the cost of the operation. Ben Lujan, 35, a Los Angeles insurance salesman whose right ankle was immobilized after four operations to correct an old athletic injury, thought he would have to give up sports before he underwent an implant operation. "Letting Waugh put in the ankle was the best decision I ever made," he says. Lujan has reason to be enthusiastic. Two months after surgery, he was back walking a golf course. He also made his first hole in one.

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