U doctor pioneers ankle surgery

Craig Gustafson

The University hired Dr. Chris Coetzee last August to do one thing: bring ankle- and foot-replacement surgery back to the Medical School after a 20-year absence.
During a two-hour ankle-replacement surgery on Dennis Marotz on Wednesday morning, Coetzee accomplished his task.
Ankle-replacement surgery began 30 years ago, but met dismal results. The success rate of the prosthesis after five years was around 20 percent, far below the acceptable rate of 90 percent. The technique was eventually abandoned in the late 1970s.
Roby Thompson, vice provost for clinical affairs, performed the old ankle-replacement surgery.
“The prosthesis’ components loosened with continued use,” he said. “They weren’t reliable.”
Ten years ago, an improved prosthesis was developed by Frank Alvine from Sioux Falls, S.D., using titanium and cobalt chrome with a plastic coating. So far, the prosthesis has had a five-year 93 percent success rate.
But because the new procedure is still in its infancy, it hasn’t been fully proven and isn’t widely practiced.
Full acceptance will come when ankle replacements are shown to last as long as hip and knee replacements, 10 to 15 years.
“It is a difficult joint to replace,” Coetzee said. “More so than hip and knees.”
Coetzee learned how to perform the surgery at the University of Washington under the tutelage of Dr. Ted Hanson, a nationally renowned orthopedic surgeon.
Coetzee is one of at least 20 surgeons nationwide trained to perform ankle replacements.
Wednesday’s operation was Coetzee’s fifth ankle-replacement surgery.
Rheumatoid arthritis, post-traumatic arthritis and some ankle fractures require ankle-replacement surgery.
Now 52, Dennis Marotz broke his ankle in a motorcycle accident when he was 19, but the injury’s effects have lasted a lifetime.
“I would get arthritis with change of weather and atmospheric pressure,” Marotz said. “Pain was caused by movement of the ankle; it would swell up, and the swelling caused pain.”
Numerous treatments failed to completely repair his ankle. Besides an initial surgery just after the accident, Marotz later underwent separate operations to remove three bone spurs and replace a tendon.
Doctors told him the scar tissue from his operations prevented significant reduction of swelling, which caused him constant discomfort. Before Wednesday’s surgery, Marotz’s condition limited his recreational activities.
After twisting his ankle again this summer, Marotz sought out the replacement procedure.
“My only fear was that I might reject the prosthesis,” he said, even though Coetzee said it was impossible.
Rejection occurs when living tissue is transplanted into a new body.
The University spent a year recruiting Coetzee from his private practice in Canada.
“There was a great need for a foot and ankle man at the University,” said Marc Swiontkowski, head of orthopedic surgery.
Coetzee received his medical degree and his orthopedic training in his native South Africa.

Craig Gustafson covers the Medical School and welcomes comments at [email protected] He can also be reached at (612) 627-4070 x3233.