My blog this afternoon concerns Lee. If I hadn’t just gotten off the phone with her, I would have never believed this story. We had a phone conference to see if she was a candidate for the Regenexx-C stem cell procedure for non-union of her ankle fusion. I asked her if I could place her story on the blog, so that others in her position might give pause. Her story starts with a simple ankle sprain, something we now treat with any number of injection techniques, and ends with a woman in a wheel chair with multiple medical problems, most related to a failed ankle ligament surgery and subsequent attempts at ankle replacement surgery. I have just pasted my notes from the call, with some annotations to make them more understandable.
Lee’s original injury was in 1995, she sprained her ankle with ligament damage as well as sustaining injuries to her upper back, neck, and low back. She was referred to a podiatrist who attempted a ligament tightening of her ankle. In that surgery, the debridement caused several bone chips which were left in the ankle and these lead to internal injuries in the joint. After 6 weeks in PT, the bone chips had also caused multiple neuromas (injuries to nerves). She underwent surgery for excision of the bone chips and debridement. She then developed Complex Regional Pain Syndrome (CRPS). She then underwent an arthroplasty of the ankle (ankle joint replacement) with failure of engraftment (the ankle prosthesis failed to take hold of the bone). She then had surgical removal of the prosthesis with a second prothesis inserted which also suffered from failure of engraftment. Her immune system also rejected the prosthesis. She then had subsequent surgeries and then had a second prosthesis removal and attempt at fusion with subsequent non-union (the bones failed to heal). She has failed numerous attempts at getting the ankle fusion to heal (bone simulators, etc…). She has considered amputation with 9 different surgical opinions, but the consensus opinion is currently that an amputation would likely cause spreading of the CRPS. The ankle non-union continues to throw off pulmonary emboli, DVT’s,(blood clots) etc… She is currently on permanent blood thinner injections to prevent those blood clots from harming her further. In 1998 she developed a bowel mal-absorption syndrome which they believed secondary to immune suppressants, steroids, and NSAID’s given to her to prevent rejection of the ankle prosthesis. This ultimately lead to the removal of large portions of her bowel with an ostomy pouch (three sub-total collectomies-ostomy means that she now wears a bag to collect fecal matter). She is wheel chair bound.
I asked her permission to place this on the blog. She says she has identified many patients in the Pacific Northwest area with this type of titantium ankle replacement prothesis who are now considering amputation due to immune rejection or failure to engraft. They have apparently stopped using this type of ankle replacement. While I won’t make any comments in that area, her story is compelling and educational.