Ask the Expert Recording: William C. McGarvey, MD-Ask the Expert: William C. McGarvey, MD

Video Transcription

Video Summary

In this video, a 78-year-old woman who had a total ankle replacement 15 years ago is experiencing ankle pain bilaterally, with the left side being worse. X-rays reveal subsidence of the taylor component with erosion valgus to the tibial side, as well as destruction of the talus and possible talonevicular joint involvement. The patient is healthy and independent, and the goal is to provide a treatment plan that addresses her ankle pain while allowing her to maintain her independence. <br /><br />Dr. McGarvey suggests obtaining a CT scan for more information about the extent of the damage and bone quality. He recommends a two-stage procedure, beginning with the removal of the failed ankle replacement component and, possibly, using cement or a spacer to restore length and provide support to the lateral gutter. In the second stage, the subtalar joint could be addressed with fusion or a cement spacer, and a stem implant could be considered for the tibial side, depending on the CT scan results and remaining bone quality. Dr. McGarvey mentions the InVision prosthesis as a potential option but discloses his professional relationship with the company. The overall aim is to relieve pain and maintain stability, considering the patient's age, needs, and desire for independence.<br /><br />The video also includes a virtual interactive session where participants submit cases for discussion and guidance. In one case, a fragmented foot bone is discussed, and Dr. McGarvey suggests using 3D print companies to create a custom replacement product for stabilization. Another case involves a cystic lesion in the ankle, and treatment options like microfracture, osteoarticular transplant surgery, or joint reconstruction with biologic materials are recommended. The third case involves a patient with severe ankle pain following a fusion, and Dr. McGarvey suggests ankle fusion with bone grafting and fixation, or the use of an anterior ankle plate and leg screws. The session concludes with a discussion on various surgical approaches and techniques.<br /><br />No specific credits were mentioned in the video summary.

Asset Subtitle

Join us for our February Ask the Expert where you'll be able to tap into the expertise of AOFAS past president, Dr. William C. McGarvey. Dr. McGarvey is an Associate Professor at McGovern Medical School at The University of Texas Health Science Center (UTHealth). He also serves as the Residency Program Director for the department. His specialties include ankle joint replacement, Ilizarov methods of surgical correction, arthroscopic surgery, fracture care, orthopedic trauma and sports medicine.

Keywords

78-year-old woman

total ankle replacement

ankle pain

subsidance

taylor component

erosion

valgus

CT scan

two-stage procedure

cement spacer

subtalar joint

InVision prosthesis

pain relief

stability