KOCHI: In a recent case, the patient was a young man from Kochi who sustained injuries to his ankle in an accident some months back. We found it was Osteochondral Lesions of the Talus (OLT). That is the cartilage injury to the ankle joint.
OLT is characterised by damage to the articular cartilage of the talus and its underlying subchondral bone. Up to 75 per cent of OLTs occur due to injuries, such as ankle sprains and fractures. The progress in imaging and arthroscopy has drastically advanced the number of surgical treatments available as well as improved existing treatment paradigms.
If his injury was small, we could have opted for keyhole surgery. But it was a 1.5-centimetre-deep injury with damages to the talus. So, we opted for open surgery using the latest technology, with Episealer Implant imported from Episurf, Sweden. The surgery was done using a virtually created 3D model of the damaged talus. This 3D model helped identify and define the lesion.
The individualised design of the implant was customised based on MRI and CT Scan images and data. The surgery went well, and the patient is recovering fast. If the patient’s wounds heal within 45 days, then we are expecting to make him walk within that time. The virtual 3D model is created by processing data and images from MRI and CT scans with a different MRI protocol. 1mm cuts are taken for this while 4 mm cuts are done which leaves no margin for errors.
This is the first demonstrative surgery in India of its kind. But it has been almost 15 years since the surgery started in Europe. This implant has the FDA and Indian government’s approval. The surgery will improve the quality of life of the patient in a dramatic way. Severe pain and deep injury would have led to further serious cartilage damage. The surgery would help them not turn severe. The patient can get back to near-normal life after the surgery.
The future looks very bright for OLT. But we don’t have the necessary technology for making 3D implants in India. The cost is also very high. It might pick up in the future if Indian companies start producing quality products. We don’t have sufficient data to confirm the chances of a medical situation recurring as it has only been 15 years since the technology has been in use in Europe. It is completely new to India.
So, we do not know what will happen after 25-30 years. So far, we have 10-years of experience treating the ankle joint and 15 years of experience in knee joint treatments with this technology. They have worked well. However, if we need 100 per cent proof, we need 20-25 years.
The writer is the former head of the orthopaedic department at Amsterdam University Hospital, founder of the Orthopaedic Research Centre Amsterdam, Amsterdam Foot & Ankle School, and official surgeon at FIFA Medical Centre of Excellence in Madrid
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