A custom-made ankle prosthesis, built with 3D technology, has allowed a 33-year-old now undergoing rehabilitation to walk again. A “rare and cutting-edge” surgical operation performed by the Carlo Poma hospital in Mantua. The procedure, thanks to the three-dimensional processing of the preparatory CT images – explain the Mantuan Asst – allows the standard prosthesis of the tibia to be coupled with a ‘custom made’ prosthesis of the talus, the weight-bearing bone of the ankle, made of titanium with 3D printer. We therefore arrive at “a bone alignment with millimetric precision. A solution tailor-made for the patient and technologically ultra-modern”.
“It is a delicate operation – states Manuel Bondi, head of Foot-Ankle Surgery, author of the operation together with the director of the Orthopedics and Traumatology Structure, Andrea Pizzoli – which is performed in few Italian centers, as the talus is the keystone of the ankle and, due to the high congruence of this joint, reconstruction is not at all easy. Mantua is among the reference structures in Lombardy for ankle prosthetics. We carry out approximately 400 prosthetic operations per year , knee, ankle, big toe and shoulder)”.
“Our patient – explains Bondi – reported a walking deficit and talar necrosis as a result of bilateral clubfoot, a pathological condition which causes the affected bone to collapse. He was therefore severely limited in walking”. The conservative therapies to which he had been subjected – hyperbaric chamber, magnetotherapy, medical treatments – had not had the desired effects and we moved on to the procedure described, which avoided “a series of other reconstruction operations with a dubious functional outcome”. Bondi specifies that “the solution adopted is used only in selected cases, when a serious form of necrosis is found which causes a lot of pain and significantly limits walking, interfering with daily activities. The complete reconstruction of the damaged part is thus carried out thanks to to the study of 3D CT”. A system “more accurate than the ‘manual’ technique – the Asst points out – which does not provide for true customization of the procedure and components”. The operation and post-operative recovery times are shorter. Furthermore, the less exposure of the soft tissues allows for better pain control after the operation.
“The ankle – recalls Bondi – is a joint with particular biomechanics. It has a very small surface area, which undergoes significant stresses linked to the load that each of us produces with each step. Unlike the knee and hip joints, which are isolated, the ankle is inserted in a context of connection between the leg and the foot. This is why planning an ankle prosthesis operation is not so simple and a series of factors secondary to the position of the foot or the alignment of the ends of the tibia and fibula must be considered. “.
In ankle prosthesis, Poma already has “a good case history under its belt. After the clinical evaluation of the patient – the Asst details – we proceed with the acquisition of a three-dimensional CT scan of the ankles, to have a precise detection of the shape and dimensions of the bone to be reconstructed by a biomechanics laboratory”. Subsequently, “once the case has been carefully studied – reports Pizzoli – the laboratory engineers design the guides that will be used for the positioning of the tibial component and reconstruct the entire talar bone in titanium, which during the operation will be coupled with the prosthesis through a polyethylene meniscus. Only following approval by the orthopedic surgeon will production of the components begin.” A solution that promises “the same results obtained from modern orthopedic prosthetic surgery at the level of the other major load-bearing joints”, the hospital assures.
“The patient – concludes Bondi – can obtain good functionality of the ankle, eliminate or reduce pain significantly, have long-lasting results and especially quickly recover joint function”. The average hospital stay is 2-3 days, with physiotherapy rehabilitation starting 3-4 weeks after surgery. During this period the patient must wear an immobilization brace, which can be removed for dressings and to perform ankle mobilization exercises to be started as early as one week after the operation.
#ankle #prosthesis #rare #operation #Mantua #works