Case 2: Wright Medical Prophecy Total Ankle (Prophecy PSI)

This was a patient of Dr. Perler’s who works as a dentist and had suffered severe trauma to his right ankle in 1991 which required surgical reduction. He had developed post-traumatic arthritis with significant cystic changes to both the tibia and talus. In order to avoid a fusion and to delay an ankle replacement, in 2014 he underwent a partial ankle resurfacing using a fresh cadaveric specimen. This was unique as it replaced both sides of the joint. While, the bone took and the cysts were “filled” in, the cartilage portion of the graft continued to degrade. This patient’s insurance denied a request for an ankle replacement stating that they did not feel it was medically necessary.

The patient, who was a former patient of Dr. Perler’s from Indiana, opted to fly down to St. Petersburg to continue his care. After several appeals and peer to peer reviews, the patient was finally approved for a total ankle replacement. This was life altering for this patient since a more traditional ankle fusion would have likely ended his career as a dentist. This was performed in 2017 using the Wright Medical Prophecy Infinity Total Ankle (Patient Specific Instrumentation) to ensure that all cystic bone was resected and that all the planned components were a perfect fit.