Georgene Frazier - Total Knee Replacement and Foot Reconstruction
Georgene Frazier remembers clearly the sound of a crack while she was walking on a golf course. “I actually heard the sound a couple of times over several years,” she recalls. “I found out they were the result of stress fractures in my foot but this time, I stumbled while golfing and broke an ankle.” Diagnosed in early adulthood with Charcot-Marie-Tooth (CMT) disease, an inherited disorder that causes a progressive degeneration of muscles in the legs and arms, the 70-year-old St. Louis resident had kept up an active lifestyle until her ankle healed off-center. Two surgeries later and after acquiring a severe infection, she was in constant pain in her foot, ankle, and knee and using a wheelchair, walker or a custom foot brace to get around. “I had so many problems that I needed someone to literally re-do how I had healed before,” says Frazier.
Frazier was referred to the orthopedic specialists with Washington University Orthopedics, who also noted a severe deformity in Frazier’s knee that put stress on both the knee and ankle joint.
“In Mrs. Frazier’s situation, she needed a pediatric orthopedist who treated limb alignment problems as well as a foot and knee specialist,” said Eric Gordon, MD, a WU orthopedic surgeon specializing in leg deformities. “The biggest advantage to patients coming to Washington University Orthopedics is that there are specialists in almost every aspect of medicine. In times when orthopedic problems are not classic textbook examples, we have to develop treatments that require skills that reach across the broad spectrum of orthopedics. It was the coalition of talents here that made Mrs. Frazier’s treatment possible.”
Doctors recommended both a total knee replacement and a complex foot reconstruction. “The procedures were complicated because of Mrs. Frazier’s CMT disease and the fact that she had had multiple stress fractures in her foot that didn’t heal properly,” says Jeffrey Johnson, MD, Chief of Foot and Ankle Surgery. “Her foot had tilted inward – a cavo varus foot deformity – which caused her ankle to become unstable. And she was at risk for a potential amputation because of the severity of her deformity and the nerve damage that was associated with her CMT disease.”
Dr. Johnson, Dr. Gordon, and Rick Wright, MD, co-chief of Sports Medicine, worked closely to develop a comprehensive treatment plan. First, Dr. Johnson used a special external fixation device called a Taylor Spatial Frame to stretch out Frazier’s foot deformity as much as possible. “The Taylor Spatial Frame helps to ensure that the bones are in the proper position to heal correctly because the frame can be adjusted on a regular basis,” says Dr. Johnson.
The frame is literally bolted through the skin and into bone. Its design allows for incremental adjustments to be made while the bones align and heal. Following a schedule plotted by a computer, Frazier and her husband meticulously turned the screws on the frame, adjusting its position almost every day for 14 weeks until her deformity was corrected.
Once the frame was removed and the foot deformity improved, Dr. Johnson performed a complex foot and ankle reconstruction. The bones of the foot were cut and repositioned and muscles were transferred to stabilize and straighten Mrs. Frazier’s foot and ankle. Comprehensive rehabilitation followed.
Then, after completing rehabilitation for the foot and ankle reconstruction, Dr. Wright performed a total knee replacement to complete the re-alignment of Mrs. Frazier’s leg, improving the overall function of her knee while minimizing pain.
“Mrs. Frazier’s alignment and knee osteoarthritis pain presented significant challenges, but we felt a combined surgical approach, along with her desire to become active again would overcome the challenges,” says Dr. Wright.
Now moving slowly but gracefully around her neighborhood, Frazier is back on her feet. She is often in her backyard, playing with her grandchildren. While she’s unsure whether she’ll take up golf again, she’s relieved to be without a wheelchair and walking.
“I wasn’t sure what life would bring me but it’s been great so far,” she says. “I still have to face the ongoing problems of CMT disease, but that hasn’t slowed me down. When I developed all of my fractures and complications, other doctors referred me to Drs. Johnson, Gordon, and Wright. And I’m so glad they did.”