World’s First All-Plastic Total Ankle Surgery Performed at MedStar Georgetown University Hospital

A patient who is allergic to all metals became the first person to receive an all-plastic total ankle.

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WASHINGTON — MedStar Health is announcing the world’s first all-plastic total ankle replacement surgery, successfully performed at MedStar Georgetown University Hospital. 71-year-old Margaret “Meghan” Lembesis of Washington Grove, Maryland has been allergic to metal her whole life. Her x-rays showed she had little to no cartilage remaining in her right foot. Over time, this made walking extremely difficult for her. Meghan consulted with Paul Cooper, MD, foot and ankle orthopedic specialist at MedStar Georgetown University Hospital, who offered the ground-breaking alternative treatment option.

“The patient, with severe documented sensitivities to a variety of metals would have few, if any options otherwise,” said Dr. Cooper, (also a also a professor of orthopedic surgery at Georgetown University’s School of Medicine) who performed the surgery. “Even ankle fusion, an alternative to replacement at the expense of eliminating ankle joint motion, would not be possible without the use of some form of metal to achieve successful outcome. The plastic ankle offers pain relief while preserving joint mobility, which the vast majority of patients currently prefer over fusion.”

Since artificial joint replacements became commercially available for patients to alleviate joint arthritis, the material has consistently been made of metal. Despite a brief attempt to use ceramics, the material has remained the same for over 60 years. This has severely limited options that joint surgeons could offer as a substitute, compromising outcomes and making replacements a non-option for those with sensitivities.

Plastics, or more specifically thermomoldable polymers, have been used for years in limited roles for spacers and wedges. They confer many of the advantages of conventional metal implants while avoiding many of the downsides, including sensitivity to one or more of the materials used for metal implants. Poly ether ketone ketone (PEKK), the material used to create the implant inserted at MedStar Georgetown, was developed in the early 1960’s with the aerospace field in mind. Extremely strong but also significantly lighter, these polymers also have numerous advantages including being trimable, antibacterial, shapable, and MRI friendly. This material is an evolution for the use in orthopedics and has been successfully applied for over 10 years for partial skull replacement, spine and other fusions in the body.