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Apollo Institute of Orthopaedics introduces for the first time in India - the revolutionary Hip Arthroscopy The frequency of Hip Arthroscopies has been increasing explosively over the past years, leading to a hugely improved technique and greater understanding of the arthroscopic anatomy of the hip joint. Arthroscopic hip procedures can successfully treat conditions previously unrecognized or only treatable by open procedures. Improvements in technology have made the procedure accessible and reproducible. Arthroscopy for intra-articular conditions and endoscopy for periarticular pathologies continue to evolve. With the increased understanding of hip pathology and the onset of new concepts such as femoroacetabular impingement, the need for an arthroscopic access not only to the central compartment of the hip but also to the periphery became evident.

Hip Arthroscopy is one of the most rapidly evolving arthroscopy techniques. It combines the benefits of a Minimally Invasive procedure and a short rehabilitation period. Improved instrumentation and technical skills have advanced our ability to accurately diagnose and treat various conditions. The role of this procedure continues to evolve with new indications that might change the outcome of degenerative joint disease of the hip joint.

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Apollo Gleneagles Hospitals, kolkata offers advanced treatment for various hip disorders, including arthritis. Apollo has the distinction of pioneering the Birmingham Hip Resurfacing procedure in India. The procedure has a success rate of 99% and has proved extremely beneficial for relatively young patients suffering from secondary arthritis.

Birmingham Hip Resurfacing

Birmingham Hip Resurfacing has been considered a breakthrough medical technique. Apollo Gleneagles Hospitals, kolkata, is the pioneer of the Birmingham Hip Replacement procedure in the Asian region. Thousands of medical tourists from across the globe come to Apollo Gleneagles Hospitals, kolkata, to undergo BHR - not just for the cost factor, but also for the expertise. BHR has come as a boon for younger patients, as it results in very little bone loss and almost normal unrestricted movements and functions. The success rate of BHR is over 99%.

What is Birmingham Hip Replacement or resurfacing (BHR)?

BHR is primarily intended for use in people who are in need of a hip replacement at a younger age and therefore are likely to be more active. In Birmingham Hip Resurfacing a very small part of bone on the top of the thighbone is resurfaced. A metal head is fixed on the thighbone. It fits into a metal socket placed in the joint.

For people needing a replacement under the age of 55, regular consideration is given for this procedure. People aged between 55 and 65 who are very active and otherwise fit may also be suitable and this will be determined by their bone quality and activity level.

The BHR advantage

Traditional Total Hip Replacements (THR) invariably have a 'metal on plastic' bearing. These are reasonably successful in elderly relatively inactive patients, but offer unacceptably poor long term outcomes for young, active patients often with unavoidable multiple revision surgeries and associated complications. It is to avoid this unfortunate sequence of events that Birmingham Hip Resurfacing (BHR) was developed.

Who Needs Hip Resurfacing?

    Conventional Hip Replacement
  • Suitable for Elderly Patients
  • Head of femur (thigh bone) removed
  • Articulation is metal with plastic Wears out rapidly in young and active patients
  • Revision Surgery invariably necessary in younger patients
  • Activity restriction required after Surgery for fear of dislocation
  • Sport not advised as the usage is inversely proportional the life of the hip replacement
    Birmingham Hip Replacement
  • Suitable for Younger Patients
  • Bone not removed
  • Articulation is metal with metal
    'Everlasting' - based on 35 year history in Birmingham of Metal on Metal Articulation
  • Revision Surgery not required for younger patients
  • Activity restriction not required after Surgery as there is hardly any risk of dislocation (can sit on floor ,squat, use Indian toilet, etc)
  • Sport and High demand activities encouraged as usage is not related to life of resurfacing implant

Total Hip Replacement

The end portion of the thighbone affected by arthritis is replaced with a metal head that can be cemented with special glue to the stem of the thighbone (or) can be uncemented (in younger patients). The socket is replaced with a metallic cup and high density plastic is used as an insert into it. The socket is usually left uncemented (screws are used to connect to the thighbone). The Total Hip Replacement procedure enables restoration of the natural gliding motion of the joint.

Proxima Hip Replacement

The Proxima Hip Replacement is also ideal for young patients. In this minimally-invasive procedure, the part of thighbone at the point where it begins is shaped and replaced by a metal head. This sits in a metal cup that is fitted into the socket.

Bilateral and Revision Hip Replacements are also done at Apollo Gleneagles Hospitals, kolkata. Some hip surgeries can also be performed using minimally-invasive techniques.

Apollo Gleneagles Hospitals, kolkata offers advanced treatment for various shoulder disorders, and also houses a dedicated Shoulder Surgery Unit. Some of the shoulder surgeries undertaken at Apollo Gleneagles Hospitals, kolkata are:

Total / Partial Shoulder Replacement

Total Shoulder Replacement needs to be done if both sides of the shoulder joints are severely affected by arthritis. In Total Shoulder Replacement, the damaged end of the upper arm bone is replaced by a stem with a metal head. The diseased part of the socket is replaced by a plastic shell in which the metal head sits. In case only one part is affected, partial shoulder replacement can be done.

Shoulder Resurfacing

In Shoulder Resurfacing, the surface of the bony end is made smooth and the diseased part is removed in the process. After this, a metal cap shaped to fit into the socket is fixed on the end of the bone.

Bilateral and Revision Shoulder Replacements are also done at Apollo Gleneagles Hospitals, kolkata. Some shoulder surgeries can also be performed using minimally-invasive techniques.

Shoulder impingement

Shoulder impingement can be a problem with tennis players, swimmers and cricket bowlers. The repeated action of the arm going up or coming down can lead to this, especially when players do more than their usual, by trying to increase their training intensity before or during their tournaments.

The person usually complains of pain with the arm coming down, as in during a tennis serve or a bowling action. There is a tendon called the Supraspinatus tendon that gets pinched between two bony prominences at the shoulder, leading to pain and discomfort.

Precautions to be taken

  • Avoid sudden increase in training level.
  • Adequate in-between rest periods.
  • Proper training techniques
  • Most of the patients benefit from judicious rest and rehabilitation. A minority will end up requiring an Arthroscopic (Key Hole) procedure for effective treatment of their symptoms and return to sport.

Apollo Gleneagles Hospitals, kolkata offers advanced treatment for conditions of the knee joint such as arthritis that can severely affect the knee and hamper routine activities.

What is Arthritis?

Arthritis is inflammation of the joints. A gradual wearing away of the tissue on the ends of bones results in reduction of joint space and friction at the exposed bone surfaces, changing regular bone movement and causing severe pain.Knee Replacement Surgery is the best solution to treat the condition and allow resumption of normal activities in the knee.

The types of arthritis are:

Osteoarthritis

This occurs after the age of 50 in individuals with a family history of arthritis. The tissue that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid Arthritis

This is a disease in which the inner membrane of joints is thickened and inflamed. This results in excessive production of the fluid that lubricates these joints. This chronic inflammation can damage the tissue covering the ends of the bones and eventually result in loss of the tissue, pain and stiffness.

Traumatic Arthritis

It can result from a serious knee injury. A knee fracture or severe tears of the knee's connective tissue may damage the tissue covering the ends of the bones over time, causing knee pain and limiting knee function.

Symptoms

  • Severe pain in the joint that restricts everyday activities such as walking, climbing stairs and getting up from chairs.
  • Severe pain while resting.
  • Inflammation and swelling of the joint that does not improve with medication and rest.
  • Deformity in the joint.
  • Joint stiffness or inability to move the joint in a normal manner.

Treatments

Some of the knee surgeries and treatments performed at Apollo Gleneagles Hospitals, kolkata are:

  • Total Knee Replacement
  • Partial Knee Replacement
  • High Tibial Osteotomy
  • Minimally Invasive Knee Replacement (Resurface) Surgery (MIKRS) using OrthoGlide Medial Knee system.
  • Total knee replacement using Patient specific zigs
  • The Ideal Knee

The Orthopedic surgeons at the Apollo Gleneagles Hospitals, kolkata can diagnose and treat many types of bone and joint problems using minimally invasive techniques. Most minimally invasive orthopedic surgeries are done with the use of an arthroscope, a special thin tool designed for viewing and treating problems inside a joint. The arthroscope is so slim that it can be inserted into the joint through one or more tiny "keyhole" cuts through the skin, rather than longer incisions. The arthroscope is fitted with a state-of-the-art miniature camera and a specialized lighting system that enables the structures inside the joint to be viewed on a monitor. The surgeon can attach special tools to the end of the arthroscope to shave, cut, or remove tissue or bone that are causing problems.Arthroscopic or keyhole surgeries of the joints are routinely performed. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. Apollo Gleneagles Hospitals, kolkata performs over 700 arthroscopies per year. Hip resurfacing is also done through key hole Surgery.

Meniscal Repair

Meniscus is a very important part of the Knee Joint. It mainly acts as a shock absorber for the knee.

Meniscal tears are very common and are frequently missed diagnoses for knee pains following a fall. A meniscus tear can be many types: Common tears include longitudinal, parrot - beak, flap, bucket handle and mixed/complex.

Causes and Symptoms

The causes of meniscus tears are sports injuries, fall and squatting and sudden twisting. Old degenerative knees will tear even by a simple movement like getting up from a chair.

Symptoms may be a pop like sound followed by

  • Pain
  • Stiffness and swelling
  • Catching or locking of your knee
  • The sensation of your knee "giving way"
  • You are not able to move your knee through its full range of motion.

Treatment

Clinically it manifests as tenderness in the area of the meniscus and the diagnosis is MRI.

Small tears in the inner part of the meniscus at the white zone are trimmed. The larger tears in the white red zone and the red zone are repaired with Arthroscopic Meniscal repair anchors. Rest is for few weeks and then knee bending is commenced.

Apollo Gleneagles Hospitals, kolkata offers specific options for management of bone tumors.

Tumors of the bone can be either benign or malignant, the malignant variety being more of a challenge to treat. Further more malignant tumors could be either primary tumor of the bone or secondary deposits from tumors elsewhere in the body. The most common bone tumors encountered are osteosarcomas, Ewing's sarcoma, etc. The most common sites of occurrence are around the knee joint - either distal femur or proximal tibia. The dramatic change of events from amputation to limb salvage surgeries has heralded a new hope to these patients who have this form of cancer.

When a person has cancer of the bone, Surgery forms a part of the treatment. Formerly if the malignant tumor was in the limbs, Surgery meant amputation of the limb. The entire limb or part of it would be removed. This led to marked disability and disfigurement. The person also had to suffer social stigma. In order to overcome the functional, psychological and social problems associated with amputation, the concept of limb salvage was evolved. Here, despite the Surgery and removal of the tumor, the limb is spared.

The aim of limb salvage Surgery in bone tumor management is to eradicate the disease, retain the integrity of the skeletal system and preserve a limb with useful function.

Successful limb sparing procedures consists of three phases namely

  • Bone resection: After making an accurate assessment of the stage and spread of the tumor the surgeon removes the affected part of the bone.
  • Reconstruction: The second phase of the procedure involves replacing the missing part of the patient's body. Prosthesis or implants are made of steel or titanium.
  • Plastic Surgery: This is performed to cover the area with muscle and soft tissues.

Then customized mega prostheses are tailor made for each patient. They conform to each and every patient and fit him or her perfectly.

The prosthesis is fitted only when the surgeon feels that the disease can be controlled by removing only one portion of the bone and not the whole limb and using an implant will give the person more comfort than removing the hand or leg and fitting with an artificial limb. A patient may or may not be able to get the full use of the limb. But surely a certain amount of functionality can be restored. The main advantage will be that the cancer would be treated without major disability.

Apollo Gleneagles Hospitals, kolkata specializes in management of bone tumors and there is a specialized surgical team that focuses on the management of Bone tumors.

Apollo Gleneagles Hospitals, Kolkata introduces a new implant - Zimmer Motion Loc used in operating Osteoporotic fractures, a first of its kind in South India. This implant is a revolutionary technique for Geriatric Orthopedic care that promises faster and stronger healing.

The benefits of this new implant are:

1. The Zimmer Motion Loc (as per various Asian surgeons' observations and feedback), has shown a Callus formation in as fast as 3 weeks' time.

2. The Zimmer Motion Loc screws have a reduced shaft diameter and hence act as a cantilever beam that can elastically flex within a controlled motion enveloping the near cortex. This results in axial motion at the fracture that is similar at both the cortex near the plate and the cortex opposite the plate (parallel motion).

3. As per various studies published in JOT and JBJS, the Far Cortical Locking construct can provide an 81% decrease in axial stiffness but still retain the similar or more construct strength

4. In Motion Loc construct, all Far Cortical Locking screws equally share load and distribute loads along near and far the cortex

5. Zimmer Motion Loc construct has a biphasic biomechanical property. As the load elevates, the cortex will provide the biomechanical support to the far cortical locking screws.

6. Under one body weight load bearing, Zimmer Motion Loc (and Far Cortical Locking Constructs) provides between 0.4mm to 0.6mm of motion at the near and far cortex. The increased working length leads to greater flexibility.

The controlled motion is within the 0.2mm-1.00mm stimulation range known to promote callus formation.

In comparison, standard locking plate constructs typically yield less than 0.1mm motion at the near cortex under one body weight.

7. One of the issues we have with the current locked system in treating Osteopenic/Osteoporotic bone is that the construct is too stiff which may lead to bone lysis and screw cut out. 

A biomechanical study actually showed that the Far Cortical Locking construct demonstrated increased construct strength in an Osteoporotic bone. 

FDA has already approved the use of Motion Loc in Osteopenic bones

8. Motion Loc screw has a reverse cutting thread design which facilitates the screw removal.

9. It is recommended to back out 1/2 a turn with Motion Loc screw after reduction is achieved to prevent friction forces.

10. Lastly a distinct advantage of NCB plating system is that it provides lag screw flexibility in addition to the locking screw stability. The screws get locked to the plate with a locking cap at the head. This also prevents cold welding or stripping and the Non Contact Bridging feature further preserves the periosteum bloodflow.

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