, Change in shape of dental arches
Essential changes Pelvic girdle
Changes in skull from ape to human. Arrows position of foramen magnum
July 20, 1969 Aldrin stepping
onto the surface of the Moon
Giant step to moon
A quantum leap in space
8th March, 1965.
The world is
• There is nothing like absolute truth.
• Truth is time bound.
• Truth of yesterday is not the truth
of today and truth of today will not
be the truth of tomorrow.
Change = Reality
WHAT WAS YESTERDAY
Trauma and arthritis
• Plaster of Paris
• Thomas Splint/ traction
• Open nailing/plating/ wiring
• Bone grafting
• Corrective surgery for malunion and
• Arthritis – conservative - NSAIDs
• Plaster disease? Prolonged immobilization
• Complicated fractures – high velocity
• High morbidity and mortality
• Infection – antibiotics – drug resistance –
• Arthritis crippling deformities and
uncontrolled pain and disability
What we have today
• Closed interlocking nailing/ MIS plating
• Illizarov” technique - answer to all
• Arthroscopy – diagnostic and operative
• Early mobilization and Rehabilitation
• Minimal but still infection and antibiotics
• Atleast 15 years – 25 lasting arthroplasty
for all major joints
• Good DMRDs and safe NSAIDs
Philosophy of Replacement V/s
• Disc implantation and Joint replacements
• Newer bio compatible materials like
ceramics, highly cross linked polyethylene,
better design consideration.
• MRI, Dynamic MRI, Ultrasound, Isotopes
scanning, & Multi-slicer 3D CT scanning.
• Image intensifier and key – hole surgery.
Tx Between “4 R”
Why then Change?
• Implant failure common.
• Fixing fracture is no guarantee of union.
• Who has time to wait for 6 – 12 weeks for
• Patients expectations, demands and
requirements have changed.
• Metallurgy can not replace biology.
• Arthroplasty failing in young patients
What should change?
• Any thing which-
– Guarantee Healing / union in minimal
• Minimally invasive
• Minimal risk of infection
• Biology should replace metallurgy
• Prevention – trauma and auto immune
• Philosophy of replacement than repair
Biology —> Biology
What is going on?
• Tissue engineering
• Gene therapy
• Bio-compatible material
• Early detection of diseases
• Better diagnostic techniques
• Precision (computer assisted) surgery
• Regeneration of tissue and the restoration of the
function of the organs by the implantation of cells
or tissues grown outside the body, or by the
stimulation of cells to grow into an implanted
• Articular cartilage defects.
• Large bone defects in limb salvage surgery.
• Extremely comminuted fractures with boneloss.
a quot;smartquot; implant that can sense and report on bone growth.
A titanium surface covered by carbon nanotubes for faster, better growth of
implanted bone-growing cells.The nanotubes could even self-reporting,
informing about the healing process.
• Transfer of a gene is to compensate for
genetic defects in recipients suffering from
monogenic diseases such as hemophilia.
Genes may also be transferred to individuals
who are genetically unremarkable but in
whom the product of the transferred gene
may nevertheless produce a beneficial
• In Gene therapy of rheumatoid arthritis,
the human IL-1Ra gene is transferred to
the synovial lining of the joint by an ex
vivo method utilizing a retrovirus.
Encouraging pre-clinical data have been
obtained for osteoarthritis, bone healing ,
cartilage repair, meniscus healing and the
healing of ligaments and tendon.
Year 2020 – Bone healing
• Prevention – strict traffic regulation
• Precision surgery
– Robotic telesurgery
– Computer assisted navigation surgery
– No infection – no antibiotics
• MIS / Key-hole surgery
• Bio degradable- bio-compatible, &
• Supplementation with BMP-2 and bio
absorbable cement / glue to speed up
• Supplementation by factory made
osteoprogenitor cells / stem cells and
This micro-CT image provides a detailed look at both
the vascularization and mineralization of a bone sample
• Prevention of age related chondrocyte
• Replacement of damaged cartilage by
cartilage transplantation with factory
made cartilage matrix.
• Surface resurfacing of damaged cartilage
in arthritic joints by cartilage
• Identification of genes responsible for collagen
• Correction of gene therapy
• Early detection and Immuno-regulatory drugs.
• Better understanding of triggering mechanism for
increased production of endo morphine level in
brain – for pain tolerance and no pain killer.
• Computer assisted non cemented bio-compatible
implant material for replacement arthroplasty, if
2020 and beyond
• What we want?
– Minimum accidents
– Immediate fixation and mobility in polytrauma
– NO to all preventable gene related arthritis /
musculo skeletal disorder.
– Availability of factory made spare parts in
cases of loss of limb due to injury or disease
– Regaining the natural power of tissue
regeneration in cases of tissue loss.
– NO to osteoporosis/no fracture risk in elderly
– Normal fully enjoyable life, as long as alive
Program cell death (apoptosis)
Is genetically predisposed, which can
be modified by:
Changing the environmental factors
Increase synthesis of dying cells.
All degenerative conditions including
aging can be delayed for indefinite
The best example of it:
Certain African community in spite of
highly loaded with HIV virus, do not
have any effect because of extra
production of B-Lymphocytes. Means,
there is always a surplus of B-
Lymphocytes then the number of
Lymphocytes destroyed by HIV
- osteocytes - ↓ - osteoporosis
↑ - Chondrocytes - ↓ - Osteoarthritis
Every Homo sapiens will be labeled
according to his genotype. That label will
be added with his name, making people
aware of his genotypes.
The best example will be prevention of