A first-of-its-kind full ankle replacement surgery recently advanced orthopaedic care in Goa.
The ankle replacement was carried out on two men who suffered from ankle arthritis for 15 years. Both patients were operated on one after the other. It was a complex case as the patients’ cartilage had worn out completely.
Prof Dr Beat Hintermann (MD orthopaedics at the Clinic for Orthopaedics & Traumatology in Switzerland) and his wife Dr Roxa Ruiz Wong (foot and ankle surgeon at the same clinic) travelled to Goa from Basel in Switzerland to perform the surgery.
Dr Hintermann was also joined by orthopaedic surgeon at Healthway Hospitals in Old Goa Dr Mahendra Kudchadkar, foot and ankle surgeon at Nanavati Max Hospital in Mumbai Dr Dhrumin Sangoi ( also a former Goa Medical College doctor) with anaesthetist at Healthway Hospitals in Old Goa Dr Sanjeev Juwarkar.
Dr Hintermann said, “This surgery is a first-of-its-kind in Goa performed recently.”
Dr Kudchadkar explained that the ankle joint can get damaged even with a simple sprain or a traumatic fracture. The prolonged wear and tear of cartilage can cause arthritis and the patient has to endure pain and suffering for a long period. This leads to inability to move and even climb stairs.
Dr Kudchadkar added that the two patients who are residents of Goa were seeking solutions from all over the world and also in India. One of the patients did the surgery in 2008 when he learnt about the fracture in the ankle. But the fracture healed in the wrong position. His cartilage was so severely damaged that chronic pain persisted for most of his life. All he wanted was freedom from pain and the ability to move his ankle.
Dr Hintermann is a pioneer in ankle replacement surgery and has been performing surgeries since 1996. He installed the implant in a way that it could last for around 15 years or more.
Dr Kudchadkar said it is very important to balance the implant after its installation. “If you install the best implant but don’t balance it well then it will fail in a few weeks or months,” he said. He added, “The implant that we used is designed by Dr Hintermann who knows the functionality in and out. This case was so complex and we needed a specialised doctor as it was a challenging case.”
Dr Hintermann has handled more than 2000 ankle replacement cases overseas. The implant is designed with his wife and is approved by the United States Food and Drug Administration (FDA).
He shared his experience performing the surgery in Goa. He said, “Ankle pain is not a simple problem, especially around soft tissues and joints. This can lead to a complex issue in the form of deformity and instability in movement. This affects the social and professional life of the patients. In the case of the patients in Goa, it was treated with implants that were aligned to gain stability and balance.”
Dr Hintermann came to Mumbai last year and has performed seven replacements so far.
Dr Kudchadkar said the ankle replacement surgery conducted in Goa was successful.
“We study the case and on proper diagnosis treat patients, said Dr Wong and added, “We focus on patients who are in their final stages where their cartilage is completely worn out.”
Dr Kudchadkar said, “Implants are now available in India, but cannot be accessed the next day as theygo through licensing procedures which adds up to the high cost. This is the biggest obstacle. This was true when knee replacement surgery first began but now with the Deen Dayal Swasthya Seva Yojana scheme, it is not heavy on a patient’s pocket. We are collaborating with the government for ankle replacement as well. It will take time and will work gradually.”
“India is a huge country and once its citizens realise the benefits of this concept they will accept ankle replacement surgery more easily. In 2000, I started doing knee replacements and today I have completed 23 years. Today patients are aware and know the benefits. Similarly, in another four to five years they will accept ankle replacement surgery,” he said.
Dr Kudchadkar said the surgery restores mobility to the extent that patients can move their ankle five to 10 degrees which is not possible during their long years of suffering.
“Care is taken to conduct the surgeries in centres that carry out other joint replacements. The protocols that we follow for knee and hip replacement are followed for ankle surgeries as well,” he said.
