Dr. Sadlik, you performed the first Episealer Talus procedure in Poland at a live surgery last month, what convinced you to start using the Episealer Talus implant?
As I have been dealing with ankle damage for many years, my awareness of the biomechanical requirements of this joint, which is the most heavily loaded human joint per cm2 surface, has inspired my confidence in this concept. Niek van Dijk informed me about this individually designed implant for the partial resurfacing procedure and offered to help me with the first implantation of Episealer Talus implant, which encouraged me a lot. Just like Professor Niek van Dijk, I believe that the key to success is to block leakage of the synovial fluid into the ankle bone and to perfectly recreate the shape of the support surface.
What made you suggest an Episealer Talus implant for this specific patient?
In my practice, I use technologies of biological transplants to repair cartilage defects of the ankle joint. I avoid the OATS technique because it does not perfectly recreate the shape of the articular surface and requires sacrificing the healthy cartilage surface of a healthy knee joint. I usually use the BIOR (Biological Inlay Osteochondral Reconstruction) technique, which is derived from the well-known ”Sandwich” technique developed in the 1990s. The patient qualified for this surgery was treated by me using the BIOR technique. Despite the lapse of 14 months after the surgery, the lady still felt pain that prevented her from standing and walking for longer periods. The MRI examination showed that the biological graft was partially incorporated, but about 50% of its volume was necrotized. As new subchondral cysts were forming, the Episealer implant seemed to be the perfect solution. To my surprise, 7 weeks after Episealer implantation, the patient began to walk without crutches and didn’t feel any pain in the ankle joint.
For which patients do you plan to use the Episealer Talus implant?
In my opinion, the best solution for cartilage-bone damage to joints is the regeneration of defects with the use of biological implants that can recreate living tissue at the site of damage to the joint surface or subchondral cyst. The talus has relatively little blood supply, therefore biological reconstruction is not always successful. Failures mainly affect people over 45 years of age or people with low biological potential. Also, patients with large subchondral cysts or after aggressive treatment with the Microfracture procedure do not have a good prognosis for treatment with biological implants. In these situations, Episealer seems to be the preferred choice, even though we do not know its survival rate yet.
How did you use to treat this patient’s category in the past?
These types of patients are usually treated with OATS or an ankle arthrodesis.
What benefits do you find with Episealer?
The Episealer implant allows perfect fit to the articular surface individually for each patient. The patient may put stress on the ankle relatively soon. The system of individual printed guiding devices protects the surgeon against technical errors. The implantation technique is logical and relatively simple. However, as always, we will have to wait for a reliable evaluation of the sustainable results of this promising new technology.