Nancy Shelton’s right ankle was in rough shape. Sprained several times over the decades, from her early days playing basketball in high school to later misadventures on the racquetball court, it had become severely arthritic. Shelton was forced to abandon all types of physical activity, including walking and swimming. Even getting from her car to her office was an ordeal.

Then Shelton went to see Duke’s James Nunley, MD, an orthopedic surgeon who specializes in foot and ankle surgery. Nunley was testing some new ankle replacements, and Shelton was eager to give one a try. In March 2002, she received a new artificial ankle made of cobalt chromium.

Joint replacement surgery is now the treatment of choice for nearly half a million Americans each year for joints damaged by arthritis, trauma, and other debilitating conditions. Replacing the ankle, however, has been problematic. “The ankle is incredibly technically difficult to design and to implant, and past designs have not been that good,” says Nunley. “It’s quite easy for an ankle joint implant to get out of alignment. When that happens, just like a misaligned front end of a car, it will wear out more quickly.”

Nunley and colleagues Mark Easley, MD, and James DeOrio, MD, have led the effort at Duke to bring new ankle joint designs into clinical practice. Working with two second-generation ankle prostheses over the past five years, they’ve proven that these newer designs, which more closely reproduce the anatomy of the natural joint, can yield far better results. “This work has been incredibly satisfying," says Nunley. “We’ve actually had patients come in and say, in tears, ‘You’ve changed my life.’ And that makes a physician feel very, very good.”

Shelton, for her part, has been delighted with the results. “I can do so much more now than before the surgery,” she says. “I can walk three-fourths of a mile. I can vacuum the rug and do the grocery shopping. I can make peanut butter sandwiches and French toast for my grandchildren.

“I’m still amazed by how good it feels and what I can do. I haven’t had a moment of regret.”