AlliedNews.com - Grove City, Pennsylvania

May 3, 2013

Local doc now offering improved ankle surgery here

By Monica Pryts/Staff Writer
Allied News

MERCER COUNTY — A local foot and ankle specialist is the only physician in the area trained to perform an advanced ankle replacement procedure that has improved the quality of life for several patients.

"I'm doing real well," said John George, 69, of Jackson Center, who is very happy with his results after having the surgery done by Dr. Allan Evangelista of Specialty Orthopaedics, Hermitage.

The practice, which recently started offering office hours at the Grove City Medical Center, Pine Township, where the staff can also perform surgeries, is the first in western Pennsylvania to perform the Scandinavian Total Ankle Replacement, or STAR.

"This really stands out. This is kind of a break-through," Evangelista said of the three-piece implant, made of metal and polyethylene, which is medical-grade plastic.

The procedure has been around for about 20 years in Europe and was approved by the Food and Drug Administration for use in the United States in 2009.

The surgery itself and the implant are more ideal compared to previous options to replace an ankle, which involve longer recoveries and provide limited mobility, he said.

"The designs were not optimal. There were a lot failures," Evangelista said.

STAR was developed for the United States by Small Bone Innovations Inc., Morrisville, Pa., and Evangelista completed training to learn how to perform the surgery, which he recommends for patients in good health who had serious injuries or complications like arthritis and have exhausted all other options to improve use of their affected ankle.

It's unique because the implant allows full use of the ankle after the patient has recovered; other implants result in an up-and-down movement only, meaning the ankle can't rotate.

Other ankle replacement surgeries involve cement between the bone and metal, which may not last very long and carry risks like infection. They could also require some bone removal because the implant is larger and contains more hardware than STAR, he said.

STAR includes a helmet-shaped piece over the ankle bone for prevention of subsidence, a side effect seen in older implants that can cause pain because the bone may grow out of the hardware over time.

"Long term this is much more effective," Evangelista said, adding the plastic part of the STAR replacement can be easily replaced if it ever wears out.

The surgery takes about two to five hours and a small incision is made down the front of the ankle. The patients wears a cast below the knee for about two weeks after surgery.

Then they switch to a walking boot while they continue with physical therapy for four to six weeks, after which they can return to normal activities "within reason," he said of how high impact movements like jumping should be avoided.

Other procedures require a cast for about eight weeks and more physical therapy.

STAR went through about 20 years of rigorous research, trials and testing before the FDA approved what he considers a "tried and true" procedure for one of the body's major weight-bearing joints.

"I think it was worth the wait," he said, noting it's covered by most health insurance companies.

Evangelista has done the STAR surgery three times for Specialty Orthopaedics patients, and he's had success with all of them, the youngest one in his early 30s. Only time will tell if part of the implant will need replaced in younger patients, he said.

George is a good example of the ideal STAR patient: he had some damage to his right ankle joint and suffered from osteoarthritis and got little relief from other treatments that for many could include physical therapy, injections, medications, braces and arch supports.

"It got so bad I couldn't even walk," he said of the pain.

George had the surgery in June and is back to doing everything he could before. He's a retired dairy farmer but still helps his son with the farm, which was very difficult with his ankle pain.

"I'm very pleased. It's as good as you can get," he said, adding he appreciated Evangelista calling him at home to check on his recovery.

For more information, contact Specialty Orthopaedics, 3120 Highland Road, Hermitage, at 724-342-2663 or visit www.SpecialtyOrthopaedics.com, www.StarAnkleReplacement.com or www.foot-ankle.mysite.com

Published April 17, 2013, in Allied News. Pick up a copy at 201 A Erie St., Grove City.