A 29-year-old male patient was suffering with left ankle pain. He had a history of previous surgery around left ankle for a bone-tumour called the giant cell tumour. After clinical examination and imaging, it was diagnosed to be a lapse of Recurrent giant cell tumour of left talus, the bone which forms the lower part of the ankle and distal tibia, the lower part of the long bone which connects knee with the ankle. The imaging indicated complete destruction of the talus. Giant cell tumour is a rare but aggressive non-cancerous tumour and usually develops near a bone joint. These tumours mostly occur in long bones of legs and arms in young adults after bone growth ceases. 2 – 5 % of the giant cell tumours can be malignant, however in the case of this patient it was benign. The cause for the giant cell tumours to grow is unknown yet. These tumours do relapse and as of today there is no medicine to prevent recurrence.
Specialist Doctors, led by Dr Rajeev Reddy, Consultant Orthopaedic Oncosurgeon and Sarcoma Specialist, Apollo Hospitals; salvaged a completely mutilated ankle joint by a giant cell tumour. They implanted a metal talus designed to precision using the latest state-of-the-art 3D modelling technology. The novel 3D technology enabled to recreate the exact replica of the patient’s ankle joint from the MRI scan and optimized the surgery with minimal harm to the tissue and surrounding organs.
As the tumour was present in two bones connected through the ankle joint, specialists devised a complex surgical plan. The distal tibia required extended curettage and sandwich reconstruction. Since the talus was almost completely destroyed by the tumour, a metal talus was the option to replace it and restore functionality. However, measuring the exact dimensions of the mutilated talus to design customized metal replica was a challenge. It was overcome by capturing the MRI and CT images of the talus on the patient’s right leg and later a 3D metal model was designed for the left talus.
The metal talus with precise dimensions was made by the in-house 3D printing team and group of engineers at Apollo hospital, Jubilee Hills. This advance 3D modeling technology is available at very few centres in the world and is of immense value in performing complex surgeries. The fact that every single detail is planned under one roof ensures patient’s comfort and safety, which we at Apollo hospital are very keen about, says Dr Rajeev Reddy. The patient was discharged on the 3rd day of surgery, as he had recovered. He is currently undergoing rehabilitation and is expected to have a very satisfactory function and gait, in due course. However, he needs to be cautious, as the tumour can relapse, though chances are slim and needs medical monitoring at regular frequency.
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