As a fellowship-trained orthopedic foot and ankle surgeon Dr. Thomas A. McDonald is focusing attention on an increasingly critical area of orthopedics: ankle arthritis and replacement. In his practice with Orthopedic Associates of Hartford and his affiliation with the Bone & Joint Institute at Hartford Hospital, Dr. McDonald bridges advanced sports-medicine care with the rapidly evolving awareness of arthritis of the ankle and the science of ankle joint replacement.
Why the ankle deserves attention
Unlike hips or knees, which are the most common joint replacements, ankle replacement previously wasn’t as common or well known. That’s in part because of the complexities of the ankle anatomy itself and the difficulty of designing replacements.
The ankle bears the complexities of human motion, stability and uneven loading in a compact space, and is therefore challenging to treat. Arthritis of the ankle often stems not just from gradual wear-and-tear, but from prior trauma — fractures, sports injuries, ligament instability — that set the stage for progressive joint degeneration.
Dr. McDonald focuses on foot and ankle reconstruction as well as sports injuries of the foot and ankle. He notes that many patients endure daily pain and functional loss believing that “nothing more can be done.”
The impact of degeneration and injuries of the ankle can be profound: reduced walking ability, altered gait mechanics, secondary knee or hip stress, and loss of quality of life. While fusion surgery (ankle arthrodesis) has long been the standard for advanced ankle arthritis, it means that patients have reduced motion in the ankle. In contrast, total ankle replacement offers the possibility of pain relief and functional mobility.
The rise of 3-D custom printed implants
In recent years there’s been an exciting advance in ankle replacement that intersects with Dr. McDonald’s work: patient-specific 3-D printed instruments and implants, designed for foot and ankle reconstruction. Oxford Performance Materials, Inc. (OPM), headquartered in South Windsor, has trademarked its own 3-D printed implant called OsteoFab, which allows for precise anatomically matched implants for challenging bone defects. Other companies specialize in 3D printed instruments which are used during ankle replacement.
3-D technology, Dr. McDonald says, is revolutionizing ankle reconstruction , allowing for more precise outcomes and speedier recovery times. The technology allows orthopedic surgeons to take a CAT-scan of a patient’s ankle, and then design an exact solution based on 3-D planning and printing.
“The software is amazing. It takes a lot of the guesswork out of fine-tuning the exact alignment of the joint replacement and it allows us to customize the alignment perfectly for the patient.”
While ankle replacement surgery has been around since the 1970s, he adds, most early surgeries didn’t have long-term and acceptable outcomes. But the technological changes just in the last 10-15 years, Dr. McDonald notes, represents a sea change in his field.
“I’ve been in practice for 20 years and I’ve gone from doing 90 percent ankle fusion versus 10% replacement, to now 80-20 in favor of replacements.”
A recent article reported by the American Academy of Orthopedic Surgeons highlighted the rising use of 3D printed implants within the specialty of Orthopedics.
For McDonald’s practice, the availability of custom-fitted implants means he can tailor solutions for patients that previously might have been considered “non-candidates” for traditional joint surgery.
Sports medicine meets ankle reconstruction
In his dual role treating sports-related injuries alongside degenerative conditions, Dr. McDonald emphasizes that ankle health is central to athletic performance as well as lifelong mobility. Preserving or restoring joint motion in younger patients often mitigates the onset of arthritis in later life.
He frames his work around patient stories: the recreational athlete sidelined by persistent pain, the older adult whose limited mobility compromises independence. With motion-preserving replacement, sports-injury expertise, and cutting-edge implant technology, he aims to restore not just joints, but healthy lifestyles.
“Just over the last 5 years that has been an increasingly large part of our speciality - customized solutions for patients. The things that really excite me are being able to help patients with limited mobility and pain, helping them through ankle replacement, and working with the Bone & Joint Institute. It’s such a collaborative environment and I just love being a part of that.”
Dr. Thomas A. McDonald
Orthopedic Associates of Hartford
Phone: 860-244-8889
Email: mcdonald.team@oahct.com
Locations:
7 Elm Street, Suite 303, Enfield
345 Western Blvd., Glastonbury
31 Seymour Street, Suite 100, Hartford
150 Enterprise Drive, Rocky Hill
25 Buckland Road, Suite D, South Windsor