Dr. Jeffrey Holmes

Mesa resident Elliott Munro, right, almost lost a leg from cancer treatments because an ankle bone had died. But with the help of Banner CORE Center surgeon Dr. Jeffrey Holmes, left, Murro became the first Arizonan recently to have a new ankle that came from a 3D printer. 

The implementation of 3D printing is changing the future of orthopedic surgery, and a Mesa man has been at the forefront of beneficiaries in Arizona.

The 35-year-old man earlier this year became the first person in the state to undergo 3D-printed ankle replacement surgery.

Elliott Munro, a two-time leukemia and bone marrow transplant survivor, underwent the surgery in March at Banner Boswell Medical Center in Sun City following months of severe ankle pain.

Munro was previously diagnosed with avascular necrosis, which caused bones to die as a result of his cancer treatments.

Because traditional solutions, like ankle fusion or replacement, weren’t options due to the condition of his bones, the 3D printed implant was considered as a list-ditch effort to save his foot from amputation.

“I couldn’t do normal fusion or replacement because a lot of my bones were so dead and deteriorated — you can’t attach dead bone to dead bone,” said Munro. “Basically, my next option was amputation.”

The artificial ankle was carved from titanium using a 3D printer and was coated with a special titanium nitride coating.

Fewer than 50 of these surgeries have been done in the United States.

Banner CORE Center for Orthopedics Surgeon Jeffrey Holmes, who performed Munro’s surgery, told the East Valley Tribune that although the surgery is still very new, it’s not much more technical than a standard ankle replacement.

“The process of doing this is almost identical to doing an ankle replacement,” said Holmes. “There was really no extra expertise that needed to be on this.”

“It wasn’t harder than the standard ankle replacement,” he continued. “It was just a little bit scarier and nerve-wracking since it was the first one in Arizona.”

The surgeon replaced Munro’s damaged talus bone with the 3D-printed implant, much like with a bone replacement.

As far as complications go, Holmes explained that the risk factors were similar to other types of surgeries, such as infection.

“It could get infected, and there are other wound complications from the incision itself,” said the surgeon. “With Elliot going through all of the chemotherapy and radiation, his skin wasn’t the best skin for healing purposes so that was a factor.” 

While there aren’t many studies that determine how this kind of replacement will hold up long-term, Munro said he is doing just fine.

The father of four just finished his last round of physical therapy and is currently walking without a boot.

“I’m doing stuff that three-to-four months ago I never imagined being able to do,” said Munro. “I’m still in the recovery process, but I feel like I’m almost back to normal.” 

Munro was first diagnosed with leukemia at age 11 and then again at 16.

After having two bone marrow transplants, he was given steroids to help “sustain” him through the treatments.

At 24, his joints began to give him severe, intolerable pain — which was a side effect from the steroids.

Munro was then diagnosed with osteonecrosis, a serious condition caused by his bone tissue being starved of blood.

Because the lack of blood causes bones to break down at a faster rate than the body can replace them, the condition went on to affect his hips, knees and ankles.

Munro was hospitalized in October 2018 for severe pain in his right ankle due to a deteriorating talus bone. 

The bone connects the heel to the lower leg and is crucial for ankle mobility. 

Munro’s former doctor told him that traditional remedies, such as ankle fusion or replacement, were not options and that he should consider amputation. 

But the young father was determined to seek a second opinion.

“The doctor I had been seeing for over 10 years was out of options,” said Munro. “That’s when I finally found Dr. Holmes and I’m so grateful I did.”  

Having known about 3D surgeries for a while, Holmes carefully analyzed his new patient’s situation. 

The surgeon eventually came to the conclusion that Munro was a perfect candidate. 

“There have been a few conferences [about 3D printing] that I’ve gone to and everything else, I just hadn’t had a patient who would do well with it present themselves yet,” said Holmes, adding: 

“For me, it was a no brainer with Elliot. He was the ideal patient. If it didn’t work, he ends up with amputation, but if he didn’t do it it, he still ends up with amputation.”

Once the pair decided to go through with the surgery, they faced another obstacle — trying to convince the hospital to allow it.

“It was a lot of meetings and a lot of denials,” said Holmes. “I had to back it up with research and evidence, and that was the problem — there is no evidence.”

“For them [the hospital], they’re looking at this as being a costly and high-risk procedure,” he added. “So it was me trying to do a lot of persuading.” 

The hospital finally approved the surgery and Holmes went to work on collaborating with a New Jersey company about the design of the implant.  

“It’s a process,” said the surgeon. “You have to do a CT scan that has to meet certain parameters and then send it to the company. Then they are able to construct on a screen what the implant would look like.” 

Holmes worked with engineers for several weeks to fine-tune the implant structure to meet Munro’s needs. 

While Munro couldn’t quite coax his insurance to cover the surgery, he still went through with it on March 19. 

Now, he is walking in normal shoes again and is pain free most of the day. 

He is also able to continue traveling for work at an educational technology company based in Scottsdale, where he is an account manager. 

Munro is now focusing his efforts on raising awareness about this type of technology in the hopes that more insurance companies will start to cover it. 

“I feel blessed I was able to find a doctor that was not only willing to do it, but able to fight for it,” said Munro. “I’m hoping that people will hear about it and start asking their doctors about it.”

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