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Decades-long Pain from Post-Traumatic Arthritis Treated Successfully at the Paley Institute


The pain from arthritis could be extremely unbearable, with most days seeing patients finding it increasingly difficult to carry out everyday tasks. For Jean, 64, having to live with this pain in her ankle for more than 15 years was no easy task. However, thanks to the team of doctors at the Paley Institute who performed an advanced ankle replacement surgery, Jean has embraced a new life, with little to no pain impairing her daily life.

Jean had lived with post-traumatic arthritis for more than three decades. About 35 years ago, while roller skating, she had a terrible fall and broke her left ankle in three places. Her orthopedic surgeon corrected the multiple fractures with plates and screws, which were removed a few years after. Ever since it’s been a continuous struggle with the painful ankle as Jean developed post-traumatic arthritis over the course of the years following the accident.

Post-traumatic arthritis is caused by wearing out of a joint following any kind of physical injury. It is most commonly caused by wearing out of the soft tissue that pads the surfaces of adjoining bones of a joint. When this tissue wears off, the bones glide on each other directly, producing excruciating pains.

For Jean, the injury caused severe loss of the cartilage in the tibiotalar joint (joint between the long bone of the leg (tibia) and the large foot bone - the talus). Each step she took caused both bone surfaces to glide directly on each other, causing severe pain that continued even when at rest.

Jean’s doctors prescribed several pain medications to manage the pain but those only provided transient relief. However, 15 years ago, her doctor broke what seemed to be good news to her - she could undergo total ankle replacement surgery to get lasting relief.

However, since the procedure was not advanced and yielded poor results at the time, she declined and decided to wait.

After waiting for close to two decades, Jean got suggestions from a few of her family members - who worked in allied medical fields - in West Palm Beach, Florida, to visit surgeons at the Paley Institute, located also in West Palm Beach, FL.

Jean met with Dr. Bradley Lamm in August 2018 at the institute. Dr. Lamm reviewed Jean’s medical history and previous investigations and ordered new X-rays. He discussed the options and informed her about the best choice -  a total ankle replacement surgery.

This time, with greater advances and knowledge in ankle surgery, Jean was all in.

On September 12th, 2018, Jean had the surgery. Dr. Lamm performed the replacement surgery using the Integra Cadence Total Ankle System.

The Integra Cadence Total Ankle System uses a prosthesis that is modeled after the natural structure of the ankle. The surgery involves replacing the entire ankle with the prosthesis to enable the patient to reproduce similar movements produced by the natural ankle. The Integra Cadence Total Ankle System was designed after years of studying the biomechanics of the human ankle; a factor that was still obscure 15 years ago.

The earlier generations of prostheses were prone to complications such as excessive constraint on ankle motion, increasing wearing out of parts of the prostheses, and the risk of partial dislocation of the prosthesis, all of which the Cadence system precludes.  

The Integra Cadence total ankle replacement surgery did not require a long recovery period. After two nights at the hospital, Jean was discharged on a cast for one month. During this period, she graduated to wearing a recovery boot to support the foot and ankle.

Barely six weeks after the surgery and a few weeks of physical therapy at the Paley Rehabilitation Center, Jean had improved significantly: she began to walk freely without any walking aids or support.

Jean reported daily improvement in the range of motion across her ankle with each ankle rehabilitation session. This, she says, has given her a more steady gait when she walks.

Now 8 weeks post-surgery, Jean walks with regular shoes and no ankle braces. She says she only experiences minimal pain and stiffness in her ankle. “Dr. Lamm says I should be able to run with this new ankle,” she stated.

After living for many years with the limitations and pain caused by post-traumatic arthritis of her ankle, Jean is set to have a new life. She will be returning to her active job in a few weeks.

Dr. Lamm is a board-certified Podiatric foot and ankle surgeon who leads the Foot and Ankle Deformity Correction Center at the Paley Institute. Dr. Lamm has extensive experience in treating acquired and congenital deformities of the foot, ankle, and lower leg in both children and adults.

Dr. Lamm joined the Paley Institute in 2016 after leading the Foot and Ankle Surgery Unit of the International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics at Sinai Hospital in Baltimore.  He is also a Rotation Director and Professor at Harvard Medical School.

The Paley Orthopedic and Spine Institute, located within the campus of St. Mary’s Medical Center in West Palm Beach, Florida, is a world-class center that offers the most technologically advanced treatments for complex orthopedic conditions.  

Since its launch in 2009, the Paley Institute has provided world-class care for thousands of children and adults from different parts of the world.

The Institute also has an on-site Center for Rehabilitation and Physical Therapy where expert physical therapists provide rehabilitative care for post-surgery patients.

As she recovers, Jean continues to extol the expertise of and the support provided by doctors, nurses, and physical therapists at the Paley Institute involved in her care. Jean says she highly recommends the center for anyone seeking treatment for any kind of orthopedic condition.

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