|
No time in the history of medicine has been without significant challenges
and obstacles, whether you look at healthcare in the rural, underserved
areas or in the academic centers of excellence of urban communities.
Circumstances challenge physicians to become creative and innovative in the
delivery of care. Dr. Art Reding (’32) could be considered an “innovator”
when he developed a makeshift stretcher to fit in the Reding family car,
which he utilized as an ambulance to transport critical patients to a
hospital 30-40 miles away. Other examples are found in the exam room,
operating room and laboratory, when the artistry of skillful hands and
innovative minds enable doctors to become pioneers, or partners in progress.
In this Alumni Update we would like to introduce our series on inventions
and innovations of USDSM alumni, and recognize the accomplishment of Frank
Alvine, MD (’62) in designing the Agility Ankle. Look for profiles of other
inventors and innovators in future editions of the newsletter.
In the early 1970’s Dr. Frank Alvine and his colleagues were enjoying the
successful outcomes of total joint replacements for their patients with
degenerative hip and knee joints. By comparison, total ankle implants had
relatively poor outcomes. However, interest in total ankle arthroplasty was
fueled by the somewhat encouraging results in rheumatoid patients, as well
as a desire to avoid athrodesis. The immobility associated with arthrodesis
can be particularly devastating in cases where there is bilateral ankle
involvement, making it difficult for patients to get out of a chair, off a
lavatory seat or climb stairs.¹
Since the ankle joint is not a true hinge joint, it presents its own unique
challenges in developing an ideal implant. During the 1970’s and 1980’s
approximately 23 different types of ankle prostheses were designed and
implemented, and in general, proved to be difficult to insert and adequately
secure with proper ligament tension, as well as properly sized to the
patient’s anatomy. Difficulties were also encountered in cementing
techniques, and there was a high incidence of skin complications.
Dr. Alvine’s Agility Ankle implant was designed through the use of the
Cadcam computer at DePuy Orthopedics (Warsaw, IN) based on the anatomy of
one hundred ankle x-rays. The modes of failure of other implants were
utilized in the design process before a prototype was developed in 1983. The
first implant occurred in 1984, and although the basic design persists,
multiple enhancements of the Agility ankle have been made since then,
correcting many of the post-operative complications seen with other ankle
implants. The non-adhesive implant is made of porous surface Cobalt chrome,
titanium and polyethylene, and is available in six sizes. Dr. Alvine
recommends the Agility implant for individuals older than 55 years of age
and for certain disease processes, such as rheumatoid arthritis,
particularly in those who have bilateral disease. It is FDA-approved, and
more than 1,100 Agility implants have been done thus far with Dr. Alvine
performing about half of those procedures. A 1996 review of the first one
hundred cases with a mean 4.8-year follow-up indicated an average range of
motion of 45 degrees and an overall patient satisfaction rate of 95
percent.²
Jerry Jencks of Sioux Falls got his new ankle in September 1992. At the age
of 51, he couldn’t walk, couldn’t sleep, and was having back pain due to his
altered gait. The father of three describes his quality of life as “poor”
prior to surgery, due to pain and immobility. Now at age 60, Jerry attests
the ankle to be “a magnificent invention. I have the most physically active
life and no restrictions. The difference is night and day.”
Dr. Alvine conducts training in ankle arthroplasty every eight weeks at the
Orthopedic Learning Center in Chicago for the American Academy of Orthopedic
Surgeons. Currently, there are between 400 and 500 surgeons trained in the
procedure.
Frank Alvine earned his B.A. from USD in 1960 and attained a BSMD in 1962.
He completed his M.D. at the University of Washington (Seattle) in 1964,
followed by a one-year internship at Oak Knoll Naval Hospital in Oakland,
CA, as a member of the U.S. Navy. Dr. Alvine returned to the University of
Washington to complete his residency in General/Orthopedic Surgery in 1971.
Dr. Alvine practices with his son, Greg, at Alvine Orthopedic Center in
Sioux Falls.
¹Alvine FG: Total Ankle Arthroplasty. Foot and Ankle Disorders, Vol. 2
edited by Mark S. Myerson, M.D. 2000; chap. 45:1085-1102.
²Pyevich MT, Saltzman CL, Callaghan JJ, Alvine, FG: Total Ankle Arthroplasy:
a Unique Design: Two to Twelve-Year Follow-up. The Journal of Bone and Joint
Surgery 1998; 80:1410-1420.
|
