Duke’s James Nunley, MD, chief of orthopaedic surgery, leads an elite team of bone, muscle, and joint specialists.

You specialize in foot and ankle surgery. Are ankle replacements common?

James Nunley: Ankle replacements are actually extremely uncommon, with less than 3,000 done per year, compared to about 250,000 hip replacements each year. Not many doctors are trained in this kind of surgery. At Duke, we have three leaders in the field, and we’ve probably done more ankle replacements in the last year than other place in the United States. We were also instrumental in developing the techniques used for ankle replacement.

Why has it taken so long for ankle replacements to take off?

James Nunley: New prostheses developed in recent years are making ankle replacements a better option. In 1975, we fused hip joints to treat arthritis. Eventually, artificial hips were developed, which are now quite effective. The same thing is happening with the ankle. We started off fusing the ankle joint, but new and better prostheses mean we can do replacements for more patients. Today, we can do things we couldn’t do three years ago.

When should a person consider an ankle replacement?

James Nunley: When the pain interferes with lifestyle, you should consider an ankle replacement to improve function and to relieve pain -- just as for the hip. Many people live with the pain because they don’t know what’s possible.

What research is happening at Duke in orthopaedic surgery?

James Nunley: In Orthopaedics one of our main research labs focused on translational medicine is studying methods of replacing cartilage through the use of stem cells. Another is studying the biomechanics of joints -- how they function, particularly the knee and ankle. And the in the lab known as the Coach K lab we’re studying problems such as stress fractures in the lower extremities, and how athletes and others can reduce injury and improve performance. All labs have a clinical focus, but come at it from different angles. All our research is focused on better patient care.

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