Advances in Total Ankle Replacement

The ankle is one of the most complex joints in the body because it is a rotating joint with many small bones. For years, people who suffered from end-stage ankle arthritis had limited options when it came to surgical treatment.

“Total ankle replacements were rarely performed due to their high failure rate and limited range of motion,” says Penn orthopaedic surgeon, Keith Wapner, MD.

Early total ankle replacements were very invasive, and often sacrificed the integrity of the bones and soft tissue structures surrounding the ankle, thus making the joint unstable.

“Because of those reasons,” Dr. Wapner says, “ankle fusion, which joins together bones within the ankle limiting mobility, became the gold standard of care.”

The good news is that today, ankle replacement is a viable alternative to ankle fusion. Penn orthopaedic surgeons use the Scandinavian Total Ankle Replacement (STAR ™ Ankle) for the treatment of end-stage ankle arthritis.

“The STAR Ankle is unique because it’s the only three-piece, mobile-bearing device approved by the U.S. Food and Drug Administration,” says Dr. Wapner. “Because of its design, total ankle replacement patients for the first time ever can maintain range of motion for the ankle without sacrificing surrounding tissue or bone.”

The STAR Ankle system is comprised of two titanium-coated structures that cover the lower bone of the ankle joint and the bottom of the shin bone (tibia). Between the two structures sits a medical-grade plastic piece designed to move in between the metal pieces as the joint moves.

“Unlike other total ankle replacements, this type of replacement doesn’t require bone cement,” says Dr. Wapner. “We actually shape the bones to fit the replacement.”

Pennsylvania Hospital is the only hospital in the Philadelphia region to offer the STAR system for total ankle replacement. The STAR system is currently recommended for people with end-stage arthritis of the ankle.

“Pennsylvania Hospital is the only hospital in the Philadelphia region to offer the STAR system for total ankle replacement.”


For more information or to schedule an appointment with a Penn orthopaedist, call 800-789-PENN (7366) or visit PennMedicine.org/ortho.

The Art of Healing after Breast Cancer

Post breast reconstruction, patients may opt for nipple reconstruction and tattooing.

Once breast reconstruction is complete, nipple reconstruction can take place, usually several months after surgery. Patients may elect to undergo nipple reconstruction on one or both breasts using local flaps, grafts, or a combination of the two. After the nipple has healed, nipple tattooing can re-pigment the area, making it look more realistic. Nipple tattooing is a true demonstration of art’s impact on healing.

Penn Medicine welcomes Mandy Sauler, a micro-pigmentation specialist to Penn’s Plastic Surgery Division. Sauler is a skilled tattoo artist who specializes in 3-D nipple tattoos along with tattoos for other cosmetic purposes. Working for over a decade as a tattoo artist, Sauler now focuses her talents in permanent cosmetics and micro-pigmentation. She is board certified through the American Academy of Micropigmentation, and is a member of the Society of Permanent Cosmetics.

Learn more about breast reconstruction at Penn Medicine or call 800-789-PENN (7366) to schedule a consult for micro-pigmentation.

Women & Heart Disease: Reducing Your Risk

Over the past decade, great effort has been put forth to improve the recognition of heart disease in women. Despite medical advances, death from cardiovascular disease in women has not dropped in the last 30 years. Statistics show that in the United States, one woman dies every minute from cardiovascular disease.

High cholesterol and lack of exercise increases everyone’s risk of heart disease. But some risk factors such as diabetes and smoking are worse for women than men.

The rising epidemic of obesity in America is also a concern when it comes to cardiovascular disease. Women may reduce their cardiovascular risk by:

• Eating a Healthy Diet: Establish good portion control with foods low in salt, saturated fat and cholesterol. Add more vegetables, fruits, whole grains and low-fat dairy products into daily meals.
• Limiting Alcohol: Moderate alcohol consumption is related to the reduction of cardiovascular disease, but excessive drinking can harm the body.
• Not Smoking: Risk of cardiovascular disease begins to decline within months of smoking cessation. Cigarette smoking is the leading preventable cause of cardiovascular disease in women.
• Increasing Exercise: Obesity, especially in the abdomen, is an important risk factor for cardiovascular disease. An exercise routine that fits one’s lifestyle and offers moderately intense activity helps to reduce the risk for cardio-related diseases. 

Stay Educated

There are numerous educational opportunities to learn more about cardiovascular disease including online resources like PennMedicine.org/heart/resources, the American Heart Association at aha.org. Free health
screenings or seminars at local hospitals or health fairs are also available. Most importantly, women should talk to their physician about their risk for developing cardiovascular disease.

Penn Medicine has several programs designed to prevent and treat cardiovascular disease. The Preventive Cardiovascular Program and the Women’s Heart Health Program employ a multidisciplinary team of physicians, nurses and dietitians who perform comprehensive evaluations for early detection of disease. Once risk factors are established, a personalized plan is developed to prevent the onset, recurrence and progression of heart and vascular disease.  

To learn more or schedule an appointment with a Penn cardiologist, call 800-789-PENN (7366) or visit PennMedicine.org/heart.



February is Heart Month. Join Penn tomorrow, February 3rd, for National Wear Red Day.

Turning Medicine into Motherhood: The AMIGOS Study

Penn Fertility Care is investigating ways to maximize pregnancy rates, while reducing the rate of multiple gestations (twins, triplets, etc) through the National Institute of Health-funded AMIGOS study.

The study seeks to determine if the rate of multiple gestations after ovarian stimulation with medications can be reduced.

Participants must be women, age 18 to 40, who have regular ovulatory cycles. Couples who participate will come to the practice for consenting and screening visits, and receive study medications and procedures at no cost.

As one of the top-funded reproductive research programs in the nation, Penn Fertility Care has been leading breakthroughs in the treatment of infertility for over 40 years.

For more information about the AMIGOS trial, call 800-789-PENN (7366) and ask to speak with fertility research regarding clinical trials.

Find other fertility clinical trials.

Trina Salva, MD, Named Medical Director of the Helen O. Dickens Center for Women’s Health

Penn Medicine’s department of obstetrics and gynecology is pleased to announce Trina Salva, MD, as the new medical director of the Helen O. Dickens Center for Women’s Health, effective January 1, 2012. Dr. Salva is committed to the center’s goal of providing the highest level of comprehensive health care to women in the community.

Dr. Salva succeeds Bernadette Wheeler, MD, whose leadership over the past six years led to significant growth and expansion of the center. Dr. Wheeler worked to create a personal and family-centered environment and expanded the program to provide increased access to care and educational programs for women in the West Philadelphia area.

Today, the Helen O. Dickens Center offers women a variety of health services, including subspecialty care, while serving as an important site for educating and training residents, medical students and nursing students.

The Center offers the following clinics/programs:

• Prenatal
• High-risk obstetrics
• Diabetes
• Behavioral health for women
• Gynecology
• Pre-op evaluation
• Reproductive endocrinology and infertility
• Colposcopy
• Family planning

Please visit the website for more information on the Helen O. Dickens Center for Women.

New Program at Penn Health for Women at Radnor

Are you experiencing heavy menstrual bleeding?

Or a change in your monthly cycles?

Heavy and/or irregular bleeding are common problems for women in their 40s as they begin the transition to menopause. Excessive bleeding can be annoying, lead to fatigue, and can sometimes be a sign of precancerous changes in the uterus or cervix, or endometrial cancer. The two most common causes of heavy menstrual bleeding are hormonal imbalances and fibroids.  

Fibroids, non-cancerous tumors that grow in the uterus, can cause heavy bleeding, painful periods and infertility.

Penn Health for Women at Radnor offers a comprehensive evaluation and treatment plan for women suffering from irregular or heavy bleeding.

Ann Honebrink, MD, director of Penn Health for Women at Radnor says, “Our program is focused on personalizing care for each woman. We begin with a thorough medical history and a comprehensive physical exam. There are a number of tests such as ultrasonography and hysteroscopy which can be performed in the office to help identify the cause of heavy or irregular bleeding.”

Once a diagnosis is established, the care team develops an individualized treatment plan to meet the patient’s needs and lifestyle. Treatment options include hormonal and non-hormonal medication, surgery, and radiological approaches such as uterine fibroid embolization (UFE). Nearly all of the testing and procedures, including consults for UFE, can be done at the Penn Health for Women practice in Radnor.


Uterine Fibroid Embolization

Richard Shlansky-Goldberg, MD, an interventional radiologist at Penn Medicine, has partnered with Penn Health for Women gynecologists to provide fibroid patients the treatment option of uterine fibroid embolization (UFEs). UFE is a non-surgical method to shrink uterine fibroids by cutting off the blood supply. It is typically performed after medical management of fibroids has proven unsuccessful. Dr. Shlanksy-Goldberg is available to see patients for UFE consultation at Penn Medicine Radnor and Hospital of the University of Pennsylvania.

For an appointment or more information, call 800-789-PENN (7366) or request an appointment online.

A More Accurate Screening Test for Breast Cancer

It’s a revolutionary way to screen for breast cancer: Traditional mammography images combined to give a more accurate, 3-D picture of the breast.

It’s called digital breast tomosynthesis (DBT) and it's available at the Perelman Center for Advanced Medicine and will be used for women having their screening mammogram.

“DBT is more accurate – even more accurate than digital mammograms – because it uses traditional X-ray technology to capture images of the breast, while moving along a small arc around the breast to record images at different depths and angles,” says Emily Conant, MD, director of women’s breast imaging at the Hospital of the University of Pennsylvania. “In preliminary research, DBT has been shown to reduce the number of false-positives and some false-negatives, making mammography more accurate.”

Just like in a traditional mammogram, the breast is compressed for about four to five seconds while a series low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3-D image of the breast. This image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles.

“DBT offers Penn radiologists a new kind of clarity, allowing them to manipulate and see parts of the breast that we couldn’t see before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Breast images through DBT also allow radiologists to make new recommendations for follow-up screening and tests.

“DBT lets us to see the through some of the density of a breast,” says Dr. Conant. “For a woman with dense breasts, for example, we can personalize her screening, and might make different recommendations than we would for a woman who does not have dense breast tissue.”

These new imaging advantages and advances in risk assessment are part of a collaborative effort between
radiologists, medical oncologists and breast surgeons to try to improve breast cancer detection for women.

Technology continues to evolve, but collaborative research across all disciplines at Penn Medicine means
patients who come to Penn for their mammograms benefit from the latest medical breakthroughs.

“DBT is just one more step to improving breast care on an individual, personalized basis,” says Dr. Conant. “Combining personal history, genetic testing and new breast images creates a better, overall picture for breast health.”


Women’s Imaging  at the Perelman Center for Advanced Medicine
Digital breast tomosynthesis is being used for all mammogram screening at the Perelman Center for Advanced Medicine. The Center offers same-day or next-day appointments.

                    Outpatient Radiology at Perelman
                    Perelman Center for Advanced Medicine
                    3400 Civic Center Boulevard
                    Ground Floor, 300 South Pavilion
                    Philadelphia, PA 19104
                    Hours:  7 am to 5:30 pm
                    Convenient valet and self–parking are available.

For more information or to schedule a mammogram, call 800-789-PENN (7366) or visit PennMedicine.org.

In the News: Breast Cancer and Fertility Treatments

It’s a recommendation based on years of research: Beginning at the age of 40, women should have an annual mammogram to check for breast cancer.

Recent media attention about the diagnosis of breast cancer in entertainment reporter, Guliana Rancic, raises questions about a possible link between breast cancer and fertility treatment. 

Samantha Pfeifer, MD, Penn Fertility Care specialist and chair of the American Society for Reproductive Medicine’s practice committee states, “Breast cancer rates are higher among women who are older when they first get pregnant, so the disease is something fertility specialists see when
taking care of fertility patients, many of whom are in their late 30s.”

Pfeifer notes that there is no evidence that the fertility treatments themselves cause breast cancer. Addressing concerns about hormones used in some fertility treatments she states, “Although treatments can raise estrogen levels higher than in a natural menstrual cycle, these higher levels are for a short period of time and no link has been found between breast cancer risk and fertility medications.”

Pfeifer recommends that women planning fertility treatment who do not have breast cancer risk factors or symptoms should follow the usual breast-cancer screening schedule.

Read about Penn Fertility Care and fertility treatment options.