Among the fastest growing fields of medicine in the world, orthopaedics has become one of the cornerstones of healthcare. At Sri Ramakrishna Hospital, the Department of Orthopaedics comprises a large team of surgeons, physicians, physiotherapists, technicians and so on. From simple fracture fixation to complex arthroscopic procedures, our orthopaedics team is equipped with both the expertise and the technology to help patients in the best way possible. Thousands of patients have benefited from knee and hip joint replacements carried out at our institution. Many who suffer from sport-related injuries have benefited from advanced surgery such as ACL (anterior cruciate ligament) surgery, PCL (posterior cruciate ligament) surgery, rotator cuff surgery and SAD (sub acromian decompression). We are also among the few institutions with expertise at polytrauma management with multiple teams working together to save patients suffering from multiple grievous injuries. Our spine surgeries have saved many a victim of a crash and our specialised team of paediatric orthopaedic doctors provide excellent care to children.
TREATMENTS & PROCEDURES
Pelvic fracture fixation:
The pelvis is composed of three major bones which are held together by ligaments. In the case of serious falls or automobile accidents, the pelvis can be seriously injured. Pelvic injuries can prove to be lethal and it is imperative that the patient received treatment as quickly as possible. In the case of fractures, surgery is often vital. The bones may be re-aligned and held in place using external or internal ‘fixations’ - systems of pins, bars, rods and screws which are meant to hold the fractured pelvis in place while it heals. Our orthopaedics team has provided critical care to number of patients suffering from pelvis fractures.
Spine fracture management:
Fractures of the spine can be terrifying, excruciatingly painful and have devastating consequences. Emergency treatment can be vital to saving and preserving movement and, therefore, a decent quality of life for the patient. Many a car or motorcycle crash victim has been saved from a life of paralysis by our experts. Our advanced trauma treatment protocols ensure that spinal trauma is properly diagnosed, well-managed and surgically treated in the least amount of time.
Polytrauma means exactly what it sounds like - injuries to multiple areas of the body. It is actually defined as injury to two body cavities or injury to one body cavity and at least two long bones. Injury to the spine and an unstable pelvis are treated as equivalent to a body cavity. In short, these are severe, frightening injuries which have a high mortality rate if not treated quickly and in the right manner. Treatment of polytrauma requires excellence in stabilisation, skill in diagnosis, speed and precision of execution and co-ordination between multiple teams. For these injuries surgeons of different specialities work together along with trauma teams and diagnosticians to provide the best results. We at Sri Ramakrishna Hospital take great pride in our orthopaedics team and their success at treating patients with polytrauma.
Complex intra-articular fracture fixation surgery:
An intra-articular fracture is far more complex and serious than the average fracture. Basically it is a fracture which somehow involves the space of a joint. While this might seem no different than any other, it takes on greater significance because of the way joints are formed and the way they function. A normal joint contains cartilage which overlays smooth surfaces of bone. This allows it to ‘articulate’ or move smoothly with comparatively little stress. When an intra-articular break heals, it may create uneven surfaces within the joint. Over the long-term this can cause enough stress to the joint for it to deteriorate. Cartilage may wear down, there may be tiny pieces which break due to abrasion and so on. This can lead to chronic pain and limited movement. The problem can become bad enough for it to require further surgery and even possibly a joint replacement. All this may be avoided if the fracture is fixed using advanced surgical techniques. Our team of orthopaedic surgeons conduct intra-articular fracture fixation surgeries with regularity, thereby ensuring a long and pain-free use of the fractured joint.
Knee replacement has brought relief from pain, mobility and a better quality of life to millions of people around the world and it is no different here in Coimbatore. Orthopaedic surgeons at Sri Ramakrishna Hospital routinely perform this surgery to great effect. While the concept of an ‘artificial knee’ might seem scary, there is nothing to be feared whatsoever.
During this surgery, the affected knee is ‘resurfaced’ using artificial parts made of high quality titanium steel and plastics. The end of the femur is capped with a metal ‘shell’ while a metal and plastic trough is placed on the tibia. Sometimes, if there is a need for it, the rear of the kneecap is resurfaced with a plastic ‘button’.
On occasion only part of the knee might be affected and so a ‘partial knee replacement’ is performed. Recovery is very quick with the patient being discharged within 3 to 5 days. Often patients who might not have walked in years, are able to ambulate comfortably in a few days. A physiotherapy regimen is prescribed in order to aid recovery and increase patient strength. Complete recovery happens in as little as 6 weeks.
The knee replacement surgery aims to help improve the patient’s flexibility, alleviate pain, allow him or her to go back to normal everyday life, correct deformities and walk normal distances. However, extreme activities, which put undue pressure on the artificial knee and joint, are best avoided.
Sports such as running and martial arts expose the knee to violent impacts, which are not advisable. The implants are not permanent insofar as to say they have a life. Most implants last patients a good 15 to 20 years but occasionally they may last ‘only’ 10 years depending on the individual. When the end of its life is nigh, the implant should be replaced, the procedure for which is called ‘revision’ surgery.
While these have become very common in the west, they are still catching on in India. Hip replacement is typically for people over the age of fifty-five who have hip function severely compromised by arthritis although sometimes it is for those suffering from trauma. This is typically an absolutely last resort when even walking with a cane and everyday activities become excruciating.
The hip joint is a ball and socket joint comprising the acetabulum (the hip socket) and the head of the femur. During the course of hip replacement surgery both these surfaces are replaced with metal and plastic implants i.e. the implants are grafted to the healthy sections of bone using what is known as ‘bone cement’. These then function as a normal hip would.
The change is almost miraculous to behold. Patients stand and walk within a day of the procedure and they get discharged within three. Physiotherapy will allow them to recover almost complete function in the hip and they can even indulge in some amount of low-impact sport. The average life of an artificial hip is well over ten years and growing with advances in technology.
Anterior Cruciate Ligament (ACL) Reconstruction and Posterior Cruciate Ligament (PCL) Reconstruction:
You would’ve probably heard of some cricketer or the other having ‘ACL’ surgery. Well, this is exactly the kind of surgery we routinely perform at Sri Ramakrishna Hospital. The anterior cruciate ligament and the posterior cruciate ligament are a pair of ligaments in the knee which form an ‘X’ shape. They basically control and stabilise the knee. If there is damage to the anterior cruciate ligament (more common) or the posterior cruciate ligament, it leads to instability in the knee.
This manifests itself by the patient’s knee just buckling even when doing things as simple as walking. It sounds familiar and you might just be thinking that you’ve experienced that before and it just sorted itself out. However, its vital that you get it checked by a good physician (we recommend one of our team of course) to ensure that its nothing serious. If it is a problem with the ACL or PCL, neglecting it for an extended period of time could lead to far greater complications in more parts of the knee. If it is indeed a problem with the ACL or PCL, reconstruction of the ligament using arthroscopic techniques is a great option, particularly in the case of young patients. During the procedure a section of bone-patella tendon or hamstring tendon is used by the surgeon to reconstruct the damaged ligament. It requires great skill, dexterity, expertise and experience. All of which our surgeons have in large quantities so you will be in the very best of hands.
The meniscus is cartilage which provides padding in the knee. It prevents the bones from rubbing against each other and acts as a shock absorbing agent. It plays a vital role in ensuring the joint doesn’t degenerate due to arthritis. The menisci however do come under a lot of stress particularly due to intensive sports. In the course of which they are prone to tearing (partially or fully). They can however be repaired using arthroscopic surgical techniques which provide long-term solutions to the condition.
Loose Body Removal:
Diseases of the synovium and injuries to cartilage can result in some loose bodies in the knee. These tend to float around the area resulting in various complications and pain. Using arthroscopic techniques they can be removed, thereby avoiding long-term damage to the joint.
In a lot of cases, complete replacement of a joint may actually be unnecessary. With advances in technology we can both diagnose and treat patients better than ever. A joint which is in early stages of deterioration can actually be saved and preserved using a variety of techniques.
Cartilage which is only partly damaged but with healthy bone below can be healed using microfracture surgery. This is performed using an arthroscope - a long thin device coupled with a small camera that allows the surgeon to see within the joint. The surgeon uses an instrument to make minuscule holes or microfractures in the sub-chondral bone. This allows an increase in the blood flow to the surface of the cartilage. Which in turn stimulates growth of new cartilage.
Similar in theory to the former, drilling uses a surgical drill to create holes in the damaged area, penetrating to the bone below. This in turn results in a healing process.
This is done using an arthroscope and the technique is similar to the previous. In this particular technique though, high speed burrs are used instead of drills or wires. These remove damaged cartilage and again penetrate to the bone allowing for faster healing.
This is an injury suffered in many sports which use a throwing motion. It is commonly experienced by bowlers in cricket, baseball pitchers, basketball players and so on. The rotator cuff comprises a bunch of muscles and tendons which surround the joint of the shoulder. Repeated stress can cause it to degenerate and tear. Typically the patient may experience pain at night and find it difficult to lift his or her arm above the height of the shoulder. When basic measures have failed to treat the condition, arthroscopic surgery can be an effective option. ‘Anchors’ are placed to repair the rotator cuff. Healing will then take a number of weeks.
Sometimes the rotator cuff tendon may get pinched between the undersurface of the acromion (a bony prominence at the top of the shoulder blade) and the humerus. To release the tendon, bone is remove arthroscopically from the acromion. Once enough is removed, the tendon is freed and this procedure is known as Subacromion Decompression or SAD.
The shoulder joint is given its mobility by the capsule which comprises thick connective tissue containing fluid. It also separates the shoulder joint from the body. Sometimes this capsule might tear or be compromised in some way. This actually results in dislocation of the shoulder. It is indeed painful but it can also seriously impact any form of activity as the shoulder is liable to repeatedly get dislocated at odd times. Using arthroscopic techniques, the capsule can be reattached to the bone. This is done using metal or bio-absorbable anchors. Recovery is speedy and patients quickly recover their full range of motion.
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