Conditions & Procedures

Hip Surgery

Total Hip Replacement

Hip Replacement involves removing the arthritic parts of the joint (cartilage and bone), replacing the "ball and socket" part of the joint with artificial components made from metal alloys, and placing high - performance bearing surface between the metal parts. The metallic artificial ball and stem are referred to as the "prosthesis". Upon inserting the prosthesis into the central core of the femur, it is fixed with the bony cement called methyl methalcrylate. Alternatively, a "cementless" prosthesis is used which has microscopic pores that allow bony in growth from the normal femur into the prosthesis stem. The "cementless" hip is felt to have a longer duration and is considered especially for younger patients. There are many different shapes, sizes and designs of artificial components of the hip joint. For the most bearing service is made from a durable part composed of chrome, cobalt, titanium, or ceramic materials. The newer artificial joints are highly sophisticated and it mimics the movement of the normal hip. Along with the newer designs available and the advanced techinical skills we have acquired, we carefully assess your hip and your needs and replace it with the suitable prosthetic joint.

Osteo Arthritis - Right Hip

After Total Hip Replacement

Newer materials in Hip Replacement

There has been a lot of research going on to find out an ideal material with which the artificial joint can be made, which will last forever. Researchers started using a material called ceramic in the mid, late 90’s and this has become a boon to younger patients needing total hip replacement. Ceramic is very hard and scratch resistant. The wear property of this material compared to the traditionally used metal on poly ethylene is about 1400 times superior. Therefore a well performed hip replacement with this material should last any one’s life time. In the traditional metal on plastic, the plastic wears slowly over time, and as the plastic wears out small particles of plastic debris develop. This triggers response by the body which can lead to loosening of the joint implant over time. This causes pain and leads on to revision surgery. In ceramic hips the amounts of wear is negligible. Another new material which has recently been introduced is oxinium, which also has superior wear properties compared to traditional metal alloys.

Knee Surgery

Total Knee Replacement

This is the commonest joint replaced in India. Here the diseased ends of the thigh and leg bones and sometimes the surface of the knee cap are replaced. The components are made of cobalt chrome alloys and poly ethylene. Recently implants made of titanium and oxinium have also been introduced.

Osteoarthritis Knee

After Total Knee Replacement

 

High tibial osteotomy (HTO)

HTO is a procedure performed for realigning the knee joint in patients with osteoarthritis. This is usually done in younger patients with osteoarthritis. This allows the affected cartilage to recover and alleviate the symptoms

This shifts weight from bad side of joint to good side.

Arthritis in young patient

After HTO

 

Unicondylar/Partial knee replacement

If only one half of the knee joint is badly worn out, that half alone can be replaced. This is called unicondylar knee replacement.

 

Shoulder Surgery

Total Shoulder Replacement

Shoulder replacement is becoming more and more popular as a remedy for arthritis and fractures of the shoulder. Shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. In a total or hemi shoulder replacement, the worn head of the upper arm bone or humerus is replaced with a metal ball mounted onto a stem. The socket or glenoid bone of the scapula may also be resurfaced with a polyethylene (plastic) component.

Reverse Shoulder Replacement

This is a different type of shoulder replacement, where the ball and socket components are reversed, that is the socket is on top of the arm bone and the ball where normally the socket will be in the shoulder blade. This type of joint is used in cuff tear arthropathy.

Cuff tear arthropathy

After Reverse Shoulder Replacement

Latarjet Procedure.

This is a procedure done for recurrent dislocation of the shoulder in high demand patients like athletes. This procedure is mainly performed when there is some bone loss from the front of the glenoid (as a result of a bony bankart lesion or repeated dislocations wearing away the front of the glenoid. The procedure involves transfer of a bone called 'Coracoid' with its attached muscles to the deficient area over the front of the glenoid. This replaces the missing bone and the transferred muscle also acts as an additional muscular strut preventing further dislocations. This procedure has a high success rate (Recurrence rate of less than 1-4%)

Laterjet Procedure

Laterjet Procedure

 

Elbow Replacement

Elbow can also be affected by osteo or rheumatoid arthritis. Elbow joint replacement can effectively treat the problems caused by arthritis of the elbow. The procedure is also becoming more widely used in aging adults to replace joints damaged by fractures. In elbow replacement surgery, the painful surfaces of the damaged elbow are replaced with artificial elbow parts. One part fits into humerus (arm bone) and other part fits into ulna (strongest bone in the forearm).The two parts are then connected and held together by a pin. The resulting hinge allows the elbow to bend.

Arthritis with stiff elbow

After Elbow Replacement

Elbow Movements After Replacement

Total elbow replacement

Total elbow replacement

 

Revision Surgery

Revision hip and knee replacement

When an already replaced joint fails either due to wear and tear after many years, infection, injury or some other problem, the joint needs to be replaced. This is known as revision joint replacement. This is much more difficult and complex compared to a primary joint replacement. These procedures require careful planning and preparation, specialized tools and implants (Prosthesis).These specialized implants are expensive and the procedures are done only by surgeons who have considerable experience in joint replacement surgery. I have been regularly performing primary and revision joint replacement procedures for the past 15 years.

Failed knee replacement

After revision knee replacement

Failed hip replacement

After revision hip replacement

Paediatric Orthopaedics

One of my special interest is Paediatric orthopaedics. The following are some of the common orthopaedic problems which I deal with.

Club Foot

Also known as CTEV, this is the commonest congenital deformity requiring treatment. The current method of treatment is known as Ponseti’s technique of serial plastering. Neglected cases are treated with open surgery or correction using external frames.

Bilateral Club Feet

After Ponseti Treatment

Developmental Dysplasia of Hip

Previously known as congenital dislocation of hip, this condition has to be diagnosed early to be treated with a brace. If diagnosed late, surgery is invariably required. Many of these patients need to undergo complex pelvic osteotomies to reconstruct the socket. I specialize in reconstructive hip surgeries for patients who have had delayed diagnosis or failed surgeries for DDH.

Developmental Dysplasia of Right Hip

After Surgical Treatment

Cerebral Palsy

This condition is caused due to an irreversible damage to the brain, which occurs before, during or after birth. This results in tightness of muscles in the limbs and occasionally in the trunk as well. These children are commonly referred to as ‘spastic’ children. The orthopaedic treatment involves physiotherapy, using certain medications like Botox injections to reduce the tightness and surgeries like correction of contractures, tendon transfer to balance muscles and bony surgeries to correct deformities and stabilize joints. These include pelvic osteotomies to stabilize hip and foot stabilization procedures.

Cerebral Palsy Before Treatment

Cerebral Palsy After Treatment

Obstetric Brachial Plexus Palsy

Obstetric Brachial Plexus Palsy is one among the severe types of birth injuries. The Incidence of OBPP in new born babies is 1.5/1000 birth. The child with shoulder dystocia has 100 times greater risk and large babies have 14 times greater risk, whereas twin or multiple pregnancy and caesarian section have protective effect. I have been treating children with this condition and routinely perform reconstructive procedures like contracture release, corrective osteotomies and modified quads procedure.

Obstetric Brachial
Plexus Palsy - Right Arm

After Corrective Osteotomy

OBPP Mods quad procedure pre op

OBPP Mods quad procedure post op

 

Limb Lengthening and Deformity Correction

Shortening or deformity of the limb due to congenital conditions, infections, trauma or any other cause can be corrected using special frames known as fixators which are available in a variety of designs.

Congenital Pseudarthrosis of Tibia

Congenital Pseudarthrosis
of Tibia - After Treatment

 

Muscular Dystrophy

Muscular dystrophy is a hereditary condition where there will be progressive weakness of upper and lower limbs due to a defect in the muscle. The problem may start at a very young age or during adolescence depending on the type of problem. The common types are Duchenne and Becker muscular dystrophies. These children require surgeries to correct limb or spine deformities or to stabilize the hip joints.