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Latest Advances In Joint Replacement & Knee Implant


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Latest advances in Joint replacements higlkights rane of procedures currently performed by Dr. Venkatachalam. This list is not exhaustive and newer procedures are introduced frequently. Patients seeking value medical care abroad will benefit from this knowledge

Published in: Health & Medicine
  • Primus Super Speciality Hospital provides patients with the region’s best Orthopaedic specialists, offering diagnosis,treatment, surgical services and rehabilitation of the highest level. Our state-of-the-art treatment, including educational, support and rehabilitation services, leads to faster recovery and better prognosis. Primus Super Speciality Hospital 2, chandragupt Marg Chanakyapuri New Delhi- 110021, India 011 - 66206620, 9953722892
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Latest Advances In Joint Replacement & Knee Implant

  1. 1. Dr.A.K.Venkatachalam MS Orth, DNB Orth, FRCS, M.Ch Orth , Consultant Orthopedic surgeon Latest advances in Joint replacement & Knee Implant surgery
  2. 2. Madras Joint Replacement Center Restoring Mobility & flexibility
  3. 3. MJRC on the web <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
  4. 4. MJRC on the Web ‘ akvenkat ’
  5. 5. MJRC on the web <ul><li>Second live Oxinium knee replacement on Twitter </li></ul><ul><li>First Live knee replacement Tweetcast from India. </li></ul><ul><li>First result for ‘Knee replacement India’ in </li></ul>
  6. 6. Madras Joint Replacement Center <ul><li>Exclusive center for Joint replacements and arthroscopy </li></ul><ul><li>Zero wait time for Joint replacement </li></ul><ul><li>OR’s have Laminar air flow/ guided air flow to eliminate infection </li></ul><ul><li>Choice of rooms catering to all budgets </li></ul><ul><li>Performing Joint Replacements for more than 15 years in UK & India. </li></ul><ul><li>Western trained team of Orthopedic Surgeons & Anesthetists </li></ul><ul><li>Pioneered several Joint replacements in India. Short stem hip replacements, Shoulder resurfacing, Knee replacements for young patients. </li></ul>
  7. 7. <ul><li>Total Knee replacements </li></ul><ul><li>Partial knee replacements </li></ul><ul><li>Hip resurfacing </li></ul><ul><li>Total hip replacements. </li></ul><ul><li>Short stem hip replacement </li></ul><ul><li>Shoulder resurfacing & replacement </li></ul><ul><li>Elbow replacement </li></ul><ul><li>Biological Joint replacement with cartilage </li></ul>Latest advances in Joint Replacements
  8. 8. Cartilage & bone regenerative procedures <ul><li>Cartilage regeneration </li></ul><ul><li>Bone regeneration for non unions, AVN </li></ul><ul><li>Cartilage repair </li></ul>
  9. 9. <ul><li>Pioneered flexible knee replacements in South India. </li></ul><ul><li>Flexible knee replacements allow knee bending </li></ul><ul><li>Full bending required for activities like kneeling, gardening recreation. </li></ul>Knee Replacements
  10. 10. Patients with High flexion Knees All patients had High flex knee replacements
  11. 11. Minimally invasive Hip & Knee surgery - What is it? <ul><li>Skin incisions are smaller than conventional surgery </li></ul><ul><li>It is not Key hole or arthroscopic surgery </li></ul><ul><li>Inside soft tissue dissection is less. </li></ul><ul><li>More Bone, tendons, soft tissues are preserved </li></ul>
  12. 12. <ul><li>Small incisions that measure 4- 5 inches </li></ul><ul><li>Cause less pain </li></ul><ul><li>Less blood loss </li></ul><ul><li>Less requirement for analgesics </li></ul><ul><li>Faster recovery </li></ul>Minimally invasive knee replacements
  13. 13. Minimally invasive knee replacements Standard TKR incision Minimally invasive TKR incision
  14. 14. Minimally invasive knee replacements Incision for MIS knee 4 inch incision for TKR
  15. 15. <ul><li>Advanced Regional & Local anesthesia allows painless knee replacements </li></ul><ul><li>Short Video </li></ul>Painless knee replacements
  16. 16. <ul><li>Increasing number of patients < 50 years seeking knee replacements. </li></ul><ul><li>Youngest patient so far is 34 years. </li></ul><ul><li>Patient of 24 years is on waiting list for knee replacement. </li></ul><ul><li>Special considerations of material, technique needed. Oxinium knee is an example of a TKR for young patients. </li></ul>Knee replacements for young patients
  17. 17. Journey knee replacement <ul><li>High flex knee prosthesis </li></ul><ul><li>Only implant in market to reproduce normal knee movements </li></ul><ul><li>Provides excellent stability </li></ul><ul><li>Oxinium confers longevity of implant </li></ul><ul><li>Can be used with patient matched instrumentation ( PMI) allowing accurate implantation </li></ul>
  18. 18. Computer assisted Knee replacement <ul><li>Used for outliers </li></ul><ul><li>Patients with Pre existing bony deformities in the femur or tibia. </li></ul>
  19. 19. Patient matched instrumentation( PMI) <ul><li>Alternative to Computer assisted knee replacement- Customized cutting blocks. </li></ul><ul><li>Used for Journey knee </li></ul><ul><li>Reduces operating steps and time </li></ul><ul><li>In the long run will reduce the cost of the implant </li></ul><ul><li>Requires a standing x ray and MRI scan of the knee. </li></ul><ul><li>Data sent to Lab in US where cutting blocks are made. </li></ul><ul><li>Cutting blocks delivered to patient in 3 weeks. </li></ul><ul><li>Patients travel to India from the US/Canada carrying their own customized cutting blocks. </li></ul>
  20. 20. Hip Resurfacing
  21. 21. Hip resurfacing- Initial considerations <ul><li>Longevity of any primary THA cannot be predicted Revision remains an issue </li></ul><ul><li>Young/active patient may outlive primary THA. </li></ul><ul><li>Hip resurfacing extends continuum of care in young patients with hip disease as a hip replacement is still possible in future. </li></ul>
  22. 22. <ul><li>Young and middle aged patients with hip arthritis </li></ul><ul><li>Pain is severe to need a Hip replacement </li></ul><ul><li>X-rays show evidence of hip arthritis </li></ul><ul><li>Bone density is normal </li></ul><ul><li>Anatomy of hip is normal </li></ul><ul><li>Limb lengths are equal </li></ul>Who is a candidate for hip resurfacing?
  23. 23. <ul><li>Metal on metal bearings have longevity </li></ul><ul><li>More bone preservation in comparison to a total hip replacement </li></ul><ul><li>Full range of movement & less chance of dislocation. </li></ul><ul><li>Revision to a total hip replacement is possible later on. </li></ul>Advantages of Hip resurfacing
  24. 24. Surgical technique Femoral reaming
  25. 25. Technique- Femoral head cemented
  26. 26. Acetabular reaming & component insertion <ul><li>Uncemented cup </li></ul><ul><li>Fixationby circumferential fins (Durom) </li></ul><ul><li>Hydoxy apatite coating </li></ul><ul><li>Cobalt chrome molybdenum </li></ul><ul><li>High carbon content </li></ul>
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  30. 31. Birmingham Hip Resurfacing American patient story Short Video
  31. 32. Indications for Proxima or short stem Hip replacement <ul><li>Any patient with Hip arthritis for whom a total hip replacement is the permanent solution but Proxima will preserve more bone than a total hip replacement. Bone stock should be intact. </li></ul><ul><li>Those patients with disease in the head which is more extensive making “ Resurfacing” unsuitable. For eg- Avascular necrosis </li></ul>
  32. 33. Short Stem Hip replacement
  33. 35. Proxima is a bone preserving hip replacement <ul><li>Neck portion of femur is preserved </li></ul><ul><li>Only head is removed. </li></ul><ul><li>The shaft of the femur is not entered or reamed, once again preserving bone. </li></ul>
  34. 36. <ul><li>Alternative to hip resurfacing & total hip replacement. </li></ul><ul><li>Head portion of the femur is not anatomical </li></ul><ul><li>Short stem is impacted into the upper portion of the femur. </li></ul><ul><li>No thigh pain vs THR </li></ul><ul><li>Versatility- Can assemble variety of head size and material </li></ul><ul><li>Less incidence of dislocation </li></ul><ul><li>Minimally invasive procedure </li></ul>Mini or short stem hip replacement
  35. 37. Comparison of total hip & Proxima <ul><li>Total hip removes the neck portion </li></ul><ul><li>In short stem replacement neck portion is preserved </li></ul><ul><li>Reaming of the upper femur. </li></ul>
  36. 38. Advantages of Proxima <ul><li>Less soft tissue dissection </li></ul><ul><li>Less bony resection </li></ul><ul><li>Large diameter Head- less chance of dislocation </li></ul><ul><li>Fluid film lubrication – leads to less wear of the implant </li></ul><ul><li>Metal on metal bearings- less wear </li></ul><ul><li>Hence less is More </li></ul>
  37. 39. Short stem or mini hip replacement- American patient story Short Video
  38. 40. <ul><li>Shoulder resurfacing is an effective alternative to replacement </li></ul><ul><li>Most patients with shoulder arthritis can have a resurfacing rather than a replacement </li></ul><ul><li>Resurfacing preserves more bone than a replacement. </li></ul><ul><li>Approach is less invasive than that for shoulder resurfacing. </li></ul>Shoulder resurfacing
  39. 41. Shoulder resurfacing <ul><li>Short video </li></ul>
  40. 42. Cartilage & Bone renegeration <ul><li>Cartilage regeneration possible for small to medium cartilage defects </li></ul><ul><li>Young patients with post traumatic cartilage lesions will benefit. </li></ul><ul><li>3 step procedure – Cartilage harvest from knee, culture in lab and re implantation </li></ul><ul><li>All steps are done in India </li></ul>
  41. 43. Cartilage regeneration <ul><li>Chondron therapy- Suited for Post traumatic cartilage lesions, osteochondritis dissecans, </li></ul><ul><li>Lesions measuring 2- 8 cm are ideally treated </li></ul><ul><li>Regeneration of normal cartilage occurs </li></ul><ul><li>May prevent progression to end stage osteoarthritis </li></ul>
  42. 44. Bone regeneration <ul><li>Bone forming cells can heal Non unions of fractures, avascular necrosis </li></ul><ul><li>Bone regeneration done in 3 step procedure. </li></ul><ul><li>Biological alternative to Hip resurfacing in early cases of Avascular necrosis. </li></ul>
  43. 45. Our Unique selling points <ul><li>Well Qualified & experienced surgeon </li></ul><ul><li>Direct access to Doctors instead of going thro marketing department- hence personalized care. </li></ul><ul><li>Affiliated hospitals have state of the art infra structure </li></ul><ul><li>Fountain head of Progress in Joint Replacements & Cartilage surgery </li></ul><ul><li>Costs are 1/5 th to 18 th of cost in Canada/ US </li></ul><ul><li>Highly personalized care vs generic treatment in other centers. </li></ul>
  44. 46. Hospital <ul><li>Short hospital video </li></ul>
  45. 47. Thank you