East Lyme surgeon implants 3D-printed ankle joint in pioneering procedure at UConn Health
Aug. 25—FARMINGTON — If not for her orthopedic surgeon's creativity, Lori Cannon might be saddled with the equivalent of a cement boot.
Instead, seven months after undergoing a left ankle replacement using an implant fashioned with a 3D printer, Cannon, a 65-year-old great-grandmother, displayed no more than an almost-imperceptible limp as she walked toward an elevator earlier this week.
She goes up and down stairs, she said, and rarely needs a Tylenol for pain. If her ankle's stiff in the morning, she just stretches it.
To say she's pleased with her current state would be a major understatement.
Cannon attributes her mobility to the success of the procedure performed by East Lyme's Dr. Lauren Geaney, a foot and ankle specialist and assistant professor of orthopedic surgery at the UConn Health Center's Musculoskeletal Institute in Farmington. Geaney, a 2000 graduate of East Lyme High School, operated Jan. 10, performing what might have been the first 3D ankle replacement in Connecticut and one of the first in the Northeast.
"She's doing better than I expected," Geaney said of her patient. "It's never going to be normal ― she's not going to start running. But she'll be able to keep up with the grandkids."
To appreciate how far Cannon's come, consider her injury.
On June 17, 2021, she was helping a Durham neighbor paint his garage when she fell from a ladder. Crumpled on the ground, she started screaming when she realized what she first thought was a piece of wood was actually bone sticking out of the inside of her left leg.
"I had never seen bones sticking out before," Cannon, a longtime registered nurse, said. "It was quite shocking."
When EMTs arrived, they initially mistook for blood the red paint covering Cannon, who recalled thinking the scene must have look like something out of a horror movie. At Yale New Haven Hospital, doctors reset the bones and operated the next day, inserting three stabilizer bars and a plate with 14 screws in it.
By late 2021, Cannon, wracked with pain, could barely walk. She asked a colleague at UConn Health, where she works as a trainer in the IT department, for a recommendation. The colleague got her an appointment with Geaney in January 2022.
Geaney first removed the hardware that had been placed in Cannon's leg, and began treating an infection that was the cause of Geaney's discomfort. X-rays revealed considerable bone loss that would rule out a standard ankle replacement. At the same time, Cannon feared fusion surgery, an option in which the ankle bones would be fused together, likely curtailing the ankle's range of motion.
"That's a great option for pain relief," Geaney said. "But mobility, limiting the loss of motion, was the goal. ... We discussed that I was going to this (orthopedics) conference and I said, 'Let me brainstorm this. If a replacement fails, it could be catastrophic.'"
Geaney brought Cannon's case to a medical conference in Denver in the spring of 2022, intending to pick the brains of the other attendees. A 3D-printed implant that would be custom made by Paragon 28, an Englewood, Colo.-based company focused on orthopedic foot and ankle repairs, emerged as a possible solution.
(The "28" of the company's name represents the number of bones in the foot.)
"I really think this could work ― if you're willing to take that gamble," Geaney told Cannon.
While 3D-printed implants had been used before, what made Cannon's unique was that it would have to be designed to address the substantial bone loss she'd sustained as well as the fracture. Little or no data existed to indicate how well it would hold up over the next five to 10 years.
Made of titanium, a strong, corrosion-resistant metal, and polyethylene, a plastic, and coated with titanium nitride, a hard ceramic material, the implant would require a $35,000 investment on UConn Health's part.
"Lori said, 'I really want my motion,'" Geaney said. "I told her I couldn't guarantee this was going to work. I can't make promises."
In a well-rehearsed, five-hour operation, Geaney led a UConn Health surgical team that placed the implant in Cannon's leg while the patient was under general anesthesia and numbed by a nerve block. Cannon went home the next day. During the procedure, Geaney also inserted a small plate with seven screws. In time, bone will grow into the implant, providing ever greater support.
"It's rare to find a doctor like Dr. Geaney who's willing to think outside the box, to be creative," Cannon said. "Fusion surgery would have left me with a peg leg, like I had a cement boot."
Over Mother's Day weekend this year, Cannon hiked for an hour in the woods of Maine with some of her grandchildren.
"Not too much slows me down," she said.
