When the painkillers stop working, arthritic joint damage in the big toe can make even the weight of a bedsheet agonising. For this 52-year-old man, even performing simple daily tasks were daunting. He had been enduring progressively worsening big-toe pain for years & could no longer wear most shoes because of pain (he was diagnosed with osteoarthritis). This week in Pune he became the first Indian to have undergone a new and revolutionary toe implant surgery performed at Sahyadri Super Speciality Hospital, Hadapsar, Pune.
The Cartiva synthetic cartilage implant was performed live during the 10th Parekh Indo-US Foot and Ankle Surgery Conference by eminent surgeon Dr. Selene Parekh, Orthopaedic Foot and Ankle Specialist, Professor – Department of Surgery, Duke University, U.S.A. and Dr. Sampat Dumbre Patil, Director – Orthopaedics, Consultant Foot and Ankle Surgeon, Sahyadri Super Speciality Hospital, Hadapsar, Pune. This 45-minute long surgery was relayed live to doctors and surgeons attending the conference at Suzlon Energy One Earth in Pune. The conference also witnessed another rare ankle replacement surgery was relayed during this very conference.
Osteoarthritis, a chronic, progressive musculoskeletal disorder is characterized by gradual loss of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement. The disease most commonly affects the joints in the knees, hips, hands, feet, and spine. It is often associated with modifiable and non-modifiable risk factors such as obesity, lack of exercise, genetic predisposition, bone density, occupational injury, trauma, and gender.
Arthritis of the big toe, or hallux rigidus, affects about one in 40 Indians over the age of 50. “We walk with a rocking motion, pushing off with the big toe with every step. Most people don’t realize how much you use your big toes and how difficult it is to do simple things, like walk, when you are in so much pain. Over time, the cushioning cartilage that stops the ends of the bones rubbing together can wear away, and the joint becomes stiff and painful. Painkillers can help and so can steroid injections. But it can get progressively worse — if all else fails; we replace the joint, or fuse the end of the foot bone to the toe bone. This means it’s rigid, and can no longer move, so the toe is no longer painful, but also restricts mobility,” explains Dr. Sampat Dumbre Patil, Director – Orthopaedics, Consultant Foot and Ankle Surgeon, Sahyadri Super Speciality Hospital, Hadapsar, Pune.
Doctors say the biggest problems with traditional implants for the big toe are the relatively high complication rates and how they often don’t last beyond seven years. Cartiva Inc’s implant – made of the same substance used in contact lenses, called hydrogel was first used in Canada and has now become a worldwide practice. The implant eliminates arthritic pain in the big toe and enables patients to regain mobility and return to a healthy, active lifestyle by providing cushioning in between the bones.
This week it was used in India for the first time as part of a non-profit activity by The Parekh Family Foundation with the support of Sahyadri Hospital and was completely free of cost. The team of doctors included some of the top surgeons from India and the U.S.A — Dr Sampat Dumbre Patil, Dr Selene Parekh, Dr Rob Holloway, Dr Bonnie Chen, Dr Danny Scott and Dr Malhar Dave.
“The Cartiva cartilage works like a bumper over the joints and is inserted into the base of the big-toe through a drilled hole. It is ideal for people in their 40s and 50s who want to continue running, using the elliptical, wearing high heels, etc.,” Dr. Selene Parekh, Orthopaedic Foot and Ankle Specialist, Professor – Department of Surgery, Duke University, U.S.A. says. “The patient was discharged on the next day itself and will be able to resume daily activities within 4 weeks. Up until now, there truly were no viable options for those who wanted to remain active. That’s why so many people in India choose to continue living with the pain. With this implant, essentially, we are changing the way we treat arthritis of the small joints.”
Additionally, during the same conference Dr. Dumbre Patil and Dr. Parekh performed a rare ankle replacement surgery for a 70-year-old man. “Having undergone a fracture decades ago, the patient was bound to get arthritis at some point of time. He was unable to bear weight on one foot. We replaced the ankle joint. He will be back on his feet within six weeks and with the help of physiotherapy, we’re sure he will be able to wear shoes within 10 weeks.”
