Cape orthopedist performs ankle replacement

Tuesday, November 19, 2013
Dr. August Ritter describes the new age of ankle replacements by using a model. (Laura Simon)

Heartened by the success of Southeast Missouri's first ankle replacement surgery of the modern era, a Cape Girardeau orthopedic surgeon plans three more such procedures by year end.

Dr. August Ritter was visited Nov. 12 by Silva, Mo., farmer Bill Hollida and his wife Shirley, who reported that results of the Aug. 28 surgery at SoutheastHEALTH were encouraging.

"I have still not had a pain pill," said Hollida, 78. "I've got a friend who had a knee replaced four weeks ago in St. Louis, and he takes them by the handful. He hasn't even gotten out of the house."

Ritter said the area's last ankle replacements were in the mid-1970s, but doctors stopped doing them "because the implants at that time did not hold up well.

"The procedure involves resurfacing the ankle joint with an artificial surface on the bottom of the shin bone, or tibia, and the top of the ankle bone, or talus," he said. "It's technically more difficult than hip and knee replacement."

Dr. August Ritter holds a model showing the new age of ankle replacements with patient Bill Hollida. (Laura Simon)

Ritter said 75 to 100 ankle replacements were done in the St. Louis region last year and that 10 to 20 will probably be performed in this area next year.

"It's a metal and plastic joint with a nice, smooth, solid surface like we use for hips and knees," he said. "We go through the bone on the outside edge of the ankle to get to the inside edge. This surgery is much less difficult than it was previously because it gives better visibility of the joint."

Ritter said Hollida needed the arthroplasty because his talus "had worn off flat and hard" and it was too difficult for him to pursue his usual activities on his grass and cattle farms.

"I haven't seen him yet today, but if he's walking in shoes in nine weeks, he's doing very well," the doctor said.

Hollida had worn a surgical boot for eight weeks but had recently begun using high-top lace-up cowboy boots. "He's been in the woods looking for deer sign," his wife said.

Also having had heart and back surgery along with the replacement of both knees, Hollida said his left ankle became arthritic while the right one stayed normal. "It just started hurting about 10 years ago," the retired auctioneer said.

"I have always been pretty active on the farm."

The Hollidas have two children, Tyler of Clubb in Wayne County and Martha Garrett of Benbrook, Texas, and five grandchildren.

Showing a model of the procedure, Ritter said, "We do it by cutting this bone and laying it down so we can see inside the ankle joint.

"We put this piece on and do the same on the other side of the tibia, then make sure the tension of the ligaments is correct."

He said the bones in Hollida's ankle were measured and the metal and plastic components milled by Zimmer Inc. of Warsaw, Ind., although SoutheastHEALTH often has the right components on hand for hip, knee and shoulder replacements.

The surgery also can be done at Saint Francis Medical Center, according to Emily Sikes, a spokeswoman for the hospital.

Ritter, a 52-year-old Cape Girardeau native, earned his undergraduate and medical degrees at the University of Missouri-Kansas City. He completed his residency at St. Louis University. In his free time, he enjoys playing polo.

Ritter said the main factor in determining if a patient needs a new ankle is if the condition is interfering with the normal course of his or her life. "If it gets a lot worse than Mr. Hollida's was, they can lose too much bone to where we can't do the operation," he said.

"If it's not that bad, they can go for a good while. We evaluate the patient and see what their goals are in life. If they're getting around OK, they may not want to have a big surgery. But when it's finally keeping them from doing the things they want and need to do, they come to me."

Pertinent address:

1701 Lacey St, Cape Girardeau, MO

211 Saint Francis Drive, Cape Girardeau, MO

48 Doctors Park, Cape Girardeau, MO

Map of pertinent addresses

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