Mike Frenna was only 16 when he shattered his ankle in a freak accident while working at a dude ranch high in Northern California’s Trinity Alps. “They rushed me to Red Bluff, but the doctor there couldn’t help me so I was sent to Redding,” Mike recalls. The surgeon in Redding patched his broken ankle back together with pins, plates and screws and a warning that it would most likely become arthritic down the road.
Despite the surgeon’s cautions, Mike did not curtail his activities once his injury healed, running track for his high school team and playing basketball, baseball and softball on the side. He continued his active lifestyle into adulthood, raising two children in Pacifica with his wife, Lynelle, and serving as the West Bay director of the United Food and Commercial International Workers Union, Local 5.
Eventually, Mike did develop arthritis in his ankle, yet he remained active, as much as his pain would allow. He began researching ankle replacement surgery more than a decade ago, but what he learned back then did not sell him on the idea. One doctor even advised against the surgery, due to a high risk of complications.
But in September 2017, Mike’s day of reckoning finally came. “I had walked about eight miles with Lynelle, and when I came home, my ankle had had enough,” he says. “I knew I’d been compensating for the arthritis pain for some time and it was limiting my activity with my family. But after that day, I could barely move.”
Desperate to do something about his ankle, Mike took another hard look at total ankle replacement surgery. He discovered that outcomes had improved in recent years and that effective techniques used in Europe were now being implemented in the U.S. So, after finding multiple outstanding recommendations for Todd Kim, M.D., an orthopedic surgeon at Mills-Peninsula Medical Center, Mike, at age 55, paid the doctor a visit.
“I watched Mike walk down the hall and his ankle was not just arthritic, but stuck in a downward position,” Dr. Kim says. “It was very stiff so he was limping severely and obviously dealing with pain on a daily basis. I told him we could relieve that pain with surgery.”
Total Ankle Replacement 2.0
Forty years ago, as knee and hip replacement surgeries were becoming commonplace, attempts at ankle replacement were much less successful, with high rates of complications — exactly what Mike had found in his early research. The standard of care instead became ankle fusing, which is reliable for pain relief but causes patients to lose motion in their ankle.
But times have changed, and thanks to vast improvements in surgical techniques, ankle replacement surgery is now much more effective. Over the last 20 years, Dr. Kim and fellow foot and ankle specialists Andrew Haskell, M.D., chair of orthopedic surgery for the Palo Alto Foundation Medical Group, and Shannon Rush, DPM, have performed hundreds of complex ankle replacement surgeries, proving that this procedure is highly reliable and successful.
“We hear from patients all the time that they’d been advised against ankle replacement,” Dr. Haskell says. “But actually, it’s not as painful as other surgeries and the outcomes are very positive.”
A big reason for this is the relatively small implants available today. “These devices help us retain more of the patient’s bone and minimize harm to the surrounding soft tissue, which helps lower the risk of infection,” Dr. Kim says. “Additionally, our presurgical planning with detailed imaging and modeling lets us line up implants precisely.”
Improved pain management therapies also contribute to the procedure’s effectiveness, specifically regional nerve blocks. About five years ago, thanks to generous community donors, Mills-Peninsula created nerve block rooms where, prior to surgery, anesthesiologists use ultrasound guidance to place numbing medicine directly on the proper nerve, which relieves pain for 12 to 24 hours. This also cuts back on the need for general anesthesia, reducing the risk of side effects and complications.
“We approach pain as a team,” Dr. Kim explains. “After the anesthesiologist places the nerve block, we add pain medicine at the joint site to cover any area that may have been missed. From there, nurses and physical therapists get patients moving sooner to help them manage pain after surgery.”
Mike can attest to the effectiveness of these advances, as he is now pain-free and eager for many more years of physical activity. “I know my surgery was a huge success when I wake up every morning and take 20 steps before I even think about my ankle — and then notice I have no pain,” he says.
If You Heal Them, They Will Come
Drs. Kim and Haskell take a team approach to their work, always consulting on complex cases and often operating together. “The breadth of our cases has grown in the last 10 years,” Dr. Haskell says. “Analysis of at least 150 cases proves there is no difference in the complication rate between total ankle replacement and replacement with additional incisions to fix foot deformities or misalignments in the foot and ankle.”
The surgeons have even published research papers detailing their ability to correct a wide array of ankle deformities while also fixing the arthritic pain. “We’ve become very good at replacing a nice, straight ankle,” Dr. Kim adds. “And now with newer techniques, we can repair some crookedness in the ankle as well — straightening the foot and replacing the ankle. It’s very exciting.”
This excitement is one reason why Drs. Kim and Haskell help train future orthopedic surgeons. Dr. Haskell teaches at the San Francisco VA Medical Center, and the two recently ran a joint fellowship program that had trainees splitting time between Mills-Peninsula and Stanford University.
Because of their experience and expertise, Drs. Kim and Haskell serve a wide catchment area of loyal patients. One even chose to return to Mills-Peninsula for her surgery after she’d moved to Europe. Plus, the surgeons receive a steady stream of referrals from all over the Bay Area, the Central Valley and Nevada, and these patients are more than willing to travel to Burlingame for their procedures.
“Mike’s outcome — walking normally with no pain — is very common and what makes it fun to be an orthopedic surgeon,” Dr. Kim says. “We hope more patients and orthopedic specialists will realize how reliable ankle replacement surgeries have become.”