This patient was able to walk pain-free by averting the need for an ankle replacement surgery

 A Team led by Dr. Saikat Jena conducted a two-hour-long Ankle Arthroscopy on a 58-year-old retired army man from Mumbai to address his ankle pain and cartilage damage while avoiding Ankle Replacement Surgery.

Mr Kallappa Dhule, a resident of Mumbai had pain in his ankle while walking for a year. He consulted many other doctors who tried conservative treatments with medications and exercises but there was no relief.  His pain deteriorated further and he was unable to walk. Finally, he approached Wockhardt Hospitals, Mira Road for a second opinion.

Dr Saikat Jena, Consultant Orthopaedic urgeon, Wockhardt Hospitals Mira Road said, “On arrival 3 months back, the patient was in severe pain and was unable to walk. After a detailed clinical examination, the patient was sent for X-rays which showed some abnormalities in the ankle joint. MRI scan of the ankle joint was done next, which showed loss of cartilage over the Talus bone which forms the ankle joint and it was causing the pain. These are known as Osteochondral defects which can lead to joint damage and pain.  The cartilage of the joint gets damaged spontaneously in a lot of patients in the knee due to no specific reason. However, it is believed to get damaged due to the hampered blood supply and steroid use which makes it difficult to pinpoint one causative agent.  This damage can also be seen in other joints such as the Talus bone, which is the ankle joint. The symptom that one will experience is pain while walking. Normally, cartilage is smooth, but under pressure, it can cause immense ankle pain. In this patient, damage to the bone beneath the cartilage led to joint surface damage when Arthritis occurred. That is why there is bone-to-bone grating due to friction. The lesion was largely affecting the entire medial half of the Talus. If not taken action at the right time, the joint will be completely damaged and the patient will require an ankle replacement (which in itself is a complex and fairly uncommon surgery).  Ankle replacement is not a common procedure in the country, as of now. Knee and shoulder Arthroscopy is done in many patients.  Ankle Arthroscopy is a minimally invasive surgery to treat a damaged ankle and is not performed that widely in India as compared to knee and shoulder Arthroscopy. “

Dr. Saikat Jena added, “Although Knee and Shoulder Arthroscopy are common surgeries today, Ankle Arthroscopy is uncommonly performed, despite being used to treat conditions like ligament injuries, bone impingement, and cartilage damage. The frequency of the surgery has increased over recent years due to its minimally invasive nature, shorter recovery times, and advancements in Arthroscopic technology.

An Arthroscopy (keyhole surgery) allows the surgeon to view inside your ankle using a camera inserted through small cuts on your skin. After detecting the cartilage damage, the unstable part was identified, the lesion was opened and we took grafts from the patient’s own body which is an Osteochondral graft (a tissue that replaces damaged cartilage and underlying bone in a joint) from the knee. Now, the cartilage is been taken from the patient’s knee. Later, the damaged bone was removed with special instruments, and then the harvested ones from the knee. The uneventful procedure lasted for two hours. The patient was discharged on the second post-operation day.

Mr Kallappa was advised non-weight-bearing ambulation with walker support for a month. Exercises and rehabilitation were also done.  This is how his joint was preserved, avoiding the need for replacement. Now the patient is pain-free and walking without any support.

“I found it difficult to take even a few steps because of severe pain in my ankle. Completing my everyday tasks became quite a struggle. I had to rely on my family for assistance, which I wasn’t comfortable with. As an army officer, we are trained to be independent and resilient in the face of challenges. Thanks to the prompt care provided by Dr. Saikat Jena and his team, I am now able to walk without restriction,” concluded Mr Kallappa Dhule patient.