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Local surgeon performs ankle joint replacements

Dr. Alejandro Miranda, a surgeon on the team at Steamboat Orthopaedic & Spine Institute, shows the ankle joint replacement implant. Miranda has completed two total ankle replacement surgeries locally. (Photo by John F. Russell)

A serious climbing accident, including a forceful twisting and smashing spiral fracture to her right ankle, put Joan Allison Weiss in pain and limited her mobility for almost 20 years.

After the fall from a cliff while rappelling, Weiss looked down to see her right foot twisted 180 degrees backward. Then 42-year-old Weiss and friends had been training for a multi-day adventure race, and fortunately, the group included an emergency room doctor and several EMS workers who provided immediate care.

But after two initial surgeries and then three additional surgeries within the next few years, including 21 pieces of metal put in and then taken out of her ankle, various doctors thought Weiss’ eventual choice was to have her ankle fused. She utilized conservative treatments, as the pain gradually got worse. In 2015, she started using a cane to walk and two canes at night when she was tired.



Weiss waited until April of this year when she was selected for a total ankle joint replacement, or ankle arthroplasty, performed by Dr. Alejandro Miranda, a surgeon on the team at Steamboat Orthopaedic & Spine Institute.

“There’s a renewed interest in ankle replacements among foot and ankle orthopedists since modern implants have proven to be durable with clinical results that are similar to alternative treatments,” said Miranda, who has performed two of the artificial ankle joint replacement surgeries locally so far, including for a man from South Routt County.

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Total ankle joint replacements are becoming more common as improvements in implants and techniques increase patient outcomes. (Photo by John F. Russell)

The doctor said results of early ankle replacements performed in the 1970s and 1980s were discouraging, so ankle fusion was considered the gold standard treatment for end stage arthritis.

“With the development of modern implants and improved techniques, the latest studies now show that outcomes after total ankle replacement mirror that of an ankle fusion while preserving ankle range of motion,” Miranda said. “An important key is selecting the appropriate patient.”

The procedure requires a very specific patient, with a preference for those who are older and prefer lower impact activities. The ankle must have minimal deformity and healthy bones, as well as not too much tilt or instability in the joint, Miranda said. Typically, the patient has experienced a prior serious ankle injury that led to long-term pain and post-traumatic osteoarthritis.

“Basically, people have degenerative problems with pain significant enough that daily activities are limited and have exhausted all conservative treatments,” Miranda said. “The biggest goal for patients is to have improved functional ability and get back to doing more that they want to do without pain.”

The doctor currently uses the Infinity Prophecy total ankle system implant from Memphis-based Wright Medical Group. The company creates a personalized cutting guide for each patient based on CAT scans of the ankle.

Before being considered for ankle joint replacement, patients often try a range of nonsurgical treatments, such as footwear and activity modifications, custom braces or injections of steroids or platelet rich plasma.

Just three months beyond surgery and still healing from soreness and stiffness, Weiss, now 62, is very happy with the results.

“They basically told me I was going to be in pain the rest of my life, and now I’m not in pain 24/7,” said Weiss, who lives in Grand Lake. “I’m glad I live alone because I could cry. I’m not crying now. I’m thrilled with the results even after three months. The pain is already a million times better than the pain I was having before. I walk faster and go up and down steps faster.”

Before surgery, simple things, such as taking her dog, Biggle, for a walk, were “really hard and slow,” she said, and her work helping at a veterinarian clinic was laborious. Now that she is more mobile, she can complete tasks in half the time.

Grand County resident Joan Allison Weiss and her dog Biggle — in a selfie photo from last week — are both happy they are able to go on long walks now. (Courtesy photo)

Miranda completed a year-long foot and ankle fellowship at the University of Pennsylvania in Philadelphia, where he performed ankle joint replacements alongside noted Dr. Keith Wapner, who was a member of the team that performed the initial controlled trials evaluating the efficacy and safety of the STAR, or Scandinavian Total Ankle Replacement, in 2009. The local surgeon’s background also includes a fellowship in sports medicine at Cedars-Sinai Kerlan-Jobe Institute, care of professional soccer teams and physician for the U.S. Snowboardcross team during international competitions. Miranda moved to Steamboat Springs in fall 2018.

Weiss said she is planning to take a long car trip this fall to hike in Canada.

“There is a lot more I can look forward, too,” Weiss said last week. “Now my ankle actually bends. I can totally move it around in circles, and it doesn’t hurt.”


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