Latest Advances In Joint Replacement & Knee Implant

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Dr.A.K.VenkatachalamDr.A.K.VenkatachalamMS Orth, DNB Orth, FRCS, M.Ch OrthMS Orth, DNB Orth, FRCS, M.Ch Orth, , Consultant Orthopedic surgeonConsultant Orthopedic surgeon

www.kneeindia.comwww.kneeindia.comwww.hipsurgery.inwww.hipsurgery.in

www.shoulderindia.comwww.shoulderindia.com

Latest advances in Joint Latest advances in Joint replacement & Knee Implant replacement & Knee Implant

surgerysurgery

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Madras Joint Replacement CenterMadras Joint Replacement Center


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MJRC on the webMJRC on the web

• www.kneeindia.comwww.kneeindia.com

• www.shoulderindia.comwww.shoulderindia.com

• www.hipsurgery.inwww.hipsurgery.in

• www.kneereplacement.co.inwww.kneereplacement.co.in

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MJRC on the WebMJRC on the Web

‘akvenkat’

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MJRC on the webMJRC on the web

• Second live Oxinium knee Second live Oxinium knee replacement on Twitterreplacement on Twitter

• First Live knee replacement First Live knee replacement Tweetcast from India. Tweetcast from India.

• First result for ‘Knee replacement First result for ‘Knee replacement India’ inIndia’ in

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•Exclusive center for Joint replacements Exclusive center for Joint replacements and arthroscopyand arthroscopy

•Zero wait time for Joint replacementZero wait time for Joint replacement

•OR’s have Laminar air flow/ guided air OR’s have Laminar air flow/ guided air flow to eliminate infectionflow to eliminate infection

•Choice of rooms catering to all budgetsChoice of rooms catering to all budgets

•Performing Joint Replacements for more Performing Joint Replacements for more than than 15 years15 years in UK & India. in UK & India.

•Western trained team of Orthopedic Western trained team of Orthopedic Surgeons & AnesthetistsSurgeons & Anesthetists

•Pioneered several Joint replacements in Pioneered several Joint replacements in India. Short stem hip replacements, India. Short stem hip replacements, Shoulder resurfacing, Knee replacements Shoulder resurfacing, Knee replacements for young patients.for young patients.


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• Total Knee replacementsTotal Knee replacements

• Partial knee replacementsPartial knee replacements

• Hip resurfacingHip resurfacing

• Total hip replacements.Total hip replacements.

• Short stem hip replacementShort stem hip replacement

• Shoulder resurfacing & replacementShoulder resurfacing & replacement

• Elbow replacementElbow replacement

• Biological Joint replacement with cartilageBiological Joint replacement with cartilage

Latest advances in Joint Latest advances in Joint ReplacementsReplacements

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Cartilage & bone regenerative proceduresCartilage & bone regenerative procedures

• Cartilage regeneration Cartilage regeneration

• Bone regeneration for non unions, Bone regeneration for non unions, AVNAVN

• Cartilage repairCartilage repair

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• Pioneered flexible Pioneered flexible knee replacements knee replacements in South India.in South India.

• Flexible knee Flexible knee replacements allow replacements allow knee bending knee bending

• Full bending Full bending required for required for activities like activities like kneeling, gardening kneeling, gardening recreation.recreation.

Knee ReplacementsKnee Replacements

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All patients had High flex knee replacements

Patients with High flexion KneesPatients with High flexion Knees

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Minimally invasive Hip & Knee surgery - What is it?Minimally invasive Hip & Knee surgery - What is it?

• Skin incisions are smaller than Skin incisions are smaller than conventional surgeryconventional surgery

• It is not Key hole or arthroscopic It is not Key hole or arthroscopic surgerysurgery

• Inside soft tissue dissection is less.Inside soft tissue dissection is less.

• More Bone, tendons, soft tissues are More Bone, tendons, soft tissues are preservedpreserved

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• Small incisions that Small incisions that measure 4- 5 inchesmeasure 4- 5 inches

• Cause less painCause less pain

• Less blood lossLess blood loss

• Less requirement for Less requirement for analgesicsanalgesics

• Faster recoveryFaster recovery

Minimally invasive knee Minimally invasive knee replacementsreplacements

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Standard TKR incision

Minimally invasive TKR incision


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Incision for MIS knee 4 inch incision for TKR

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Advanced Regional & Local anesthesia allows painless knee Advanced Regional & Local anesthesia allows painless knee replacementsreplacements

Short VideoShort Video

Painless knee replacementsPainless knee replacements

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• Increasing number of Increasing number of patients patients < 50 years < 50 years seeking knee seeking knee replacements. replacements.

• Youngest patient so far is Youngest patient so far is 34 years. 34 years.

• Patient of 24 years is on Patient of 24 years is on waiting list for knee waiting list for knee replacement.replacement.

• Special considerations of Special considerations of material, technique material, technique needed. Oxinium knee is needed. Oxinium knee is an example of a TKR for an example of a TKR for young patients. young patients.

Knee replacements for young Knee replacements for young patientspatients

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Journey knee replacementJourney knee replacement

• High flex knee prosthesisHigh flex knee prosthesis• Only implant in market to reproduce Only implant in market to reproduce

normal knee movementsnormal knee movements• Provides excellent stabilityProvides excellent stability• Oxinium confers longevity of implantOxinium confers longevity of implant• Can be used with patient matched Can be used with patient matched

instrumentation ( PMI) allowing instrumentation ( PMI) allowing accurate implantationaccurate implantation

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Computer assisted Knee Computer assisted Knee replacementreplacement

• Used for outliersUsed for outliers

• Patients with Pre Patients with Pre existing bony existing bony deformities in the deformities in the femur or tibia.femur or tibia.

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Patient matched Patient matched instrumentation( PMI)instrumentation( PMI)

• Alternative to Computer assisted knee Alternative to Computer assisted knee replacement- Customized cutting blocks.replacement- Customized cutting blocks.

• Used for Journey knee Used for Journey knee • Reduces operating steps and time Reduces operating steps and time • In the long run will reduce the cost of the implantIn the long run will reduce the cost of the implant• Requires a standing x ray and MRI scan of the knee.Requires a standing x ray and MRI scan of the knee.• Data sent to Lab in US where cutting blocks are Data sent to Lab in US where cutting blocks are

made.made.• Cutting blocks delivered to patient in 3 weeks. Cutting blocks delivered to patient in 3 weeks. • Patients travel to India from the US/Canada Patients travel to India from the US/Canada

carrying their own customized cutting blocks. carrying their own customized cutting blocks.

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Hip ResurfacingHip Resurfacing

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Hip resurfacing- Initial considerationsHip resurfacing- Initial considerations

• Longevity of any primary THA cannot be Longevity of any primary THA cannot be predicted predicted Revision remains an issue Revision remains an issue

• Young/active patient may outlive primary Young/active patient may outlive primary THA.THA.

• Hip resurfacing extends continuum of Hip resurfacing extends continuum of care in young patients with hip disease care in young patients with hip disease as a hip replacement is still possible in as a hip replacement is still possible in future.future.

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• Young and middle aged Young and middle aged patients with hip arthritispatients with hip arthritis

• Pain is severe to need a Hip Pain is severe to need a Hip replacementreplacement

• X-rays show evidence of hip X-rays show evidence of hip arthritis arthritis

• Bone density is normalBone density is normal• Anatomy of hip is normalAnatomy of hip is normal• Limb lengths are equalLimb lengths are equal

Who is a candidate for hip Who is a candidate for hip resurfacing?resurfacing?

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• Metal on metal bearings Metal on metal bearings have longevityhave longevity

• More bone preservation More bone preservation in comparison to a total in comparison to a total hip replacementhip replacement

• Full range of movement Full range of movement & less chance of & less chance of dislocation.dislocation.

• Revision to a total hip Revision to a total hip replacement is possible replacement is possible later on. later on.

Advantages of Hip resurfacingAdvantages of Hip resurfacing

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Surgical techniqueSurgical techniqueFemoral reaming Femoral reaming

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Technique- Femoral head Technique- Femoral head cemented cemented

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Acetabular reaming & component Acetabular reaming & component insertioninsertion

• Uncemented cupUncemented cup

• Fixationby Fixationby circumferential fins circumferential fins (Durom)(Durom)

• Hydoxy apatite Hydoxy apatite coatingcoating

• Cobalt chrome Cobalt chrome molybdenummolybdenum

• High carbon contentHigh carbon content

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www.hipsurgery.in

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www.hipsurgery.in

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www.hipsurgery.in

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Birmingham Hip ResurfacingBirmingham Hip ResurfacingAmerican patient storyAmerican patient story

Short Video

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Indications for Proxima or short Indications for Proxima or short stem Hip replacementstem Hip replacement

• Any patient with Hip arthritis for whom a Any patient with Hip arthritis for whom a total hip replacement is the permanent total hip replacement is the permanent solution but Proxima will preserve more solution but Proxima will preserve more bone than a total hip replacement. Bone bone than a total hip replacement. Bone stock should be intact.stock should be intact.

• Those patients with disease in the head Those patients with disease in the head which is more extensive making “ which is more extensive making “ Resurfacing” unsuitable. For eg- Avascular Resurfacing” unsuitable. For eg- Avascular necrosis necrosis

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Short Stem Hip replacementShort Stem Hip replacement

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Proxima is a bone Proxima is a bone preserving hip replacementpreserving hip replacement

• Neck portion of Neck portion of femur is preserved femur is preserved

• Only head is Only head is removed.removed.

• The shaft of the The shaft of the femur is not femur is not entered or entered or reamed, once reamed, once again preserving again preserving bone.bone.

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• Alternative to hip resurfacing & Alternative to hip resurfacing & total hip replacement.total hip replacement.

• Head portion of the femur is not Head portion of the femur is not anatomicalanatomical

• Short stem is impacted into the Short stem is impacted into the upper portion of the femur.upper portion of the femur.

• No thigh pain vs THRNo thigh pain vs THR• Versatility- Can assemble variety Versatility- Can assemble variety

of head size and materialof head size and material• Less incidence of dislocationLess incidence of dislocation• Minimally invasive procedureMinimally invasive procedure

Mini or short stem hip Mini or short stem hip replacementreplacement

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Comparison of total hip & Comparison of total hip & ProximaProxima

• Total hip removes Total hip removes the neck portion the neck portion

• In short stem In short stem replacement neck replacement neck portion is portion is preservedpreserved

• Reaming of the Reaming of the upper femur. upper femur.

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Advantages of ProximaAdvantages of Proxima

• Less soft tissue dissectionLess soft tissue dissection• Less bony resectionLess bony resection• Large diameter Head- less chance of Large diameter Head- less chance of

dislocationdislocation• Fluid film lubrication – leads to less Fluid film lubrication – leads to less

wear of the implantwear of the implant• Metal on metal bearings- less wearMetal on metal bearings- less wear• Hence less is More Hence less is More

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Short stem or mini hip Short stem or mini hip replacement- American patient replacement- American patient storystory

Short Video

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• Shoulder resurfacing is an Shoulder resurfacing is an effective alternative to effective alternative to replacementreplacement

• Most patients with shoulder Most patients with shoulder arthritis can have a arthritis can have a resurfacing rather than a resurfacing rather than a replacementreplacement

• Resurfacing preserves more Resurfacing preserves more bone than a replacement.bone than a replacement.

• Approach is less invasive than Approach is less invasive than that for shoulder resurfacing.that for shoulder resurfacing.

Shoulder resurfacingShoulder resurfacing

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Shoulder resurfacingShoulder resurfacing

• Short videoShort video

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Cartilage & Bone renegerationCartilage & Bone renegeration

• Cartilage regeneration possible for Cartilage regeneration possible for small to medium cartilage defectssmall to medium cartilage defects

• Young patients with post traumatic Young patients with post traumatic cartilage lesions will benefit.cartilage lesions will benefit.

• 3 step procedure – Cartilage harvest 3 step procedure – Cartilage harvest from knee, culture in lab and re from knee, culture in lab and re implantationimplantation

• All steps are done in IndiaAll steps are done in India

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Cartilage regenerationCartilage regeneration

• Chondron therapy- Suited for Post Chondron therapy- Suited for Post traumatic cartilage lesions, traumatic cartilage lesions, osteochondritis dissecans, osteochondritis dissecans,

• Lesions measuring 2- 8 cm are ideally Lesions measuring 2- 8 cm are ideally treatedtreated

• Regeneration of normal cartilage Regeneration of normal cartilage occurs occurs

• May prevent progression to end stage May prevent progression to end stage osteoarthritisosteoarthritis

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Bone regenerationBone regeneration

• Bone forming cells can heal Non Bone forming cells can heal Non unions of fractures, avascular unions of fractures, avascular necrosisnecrosis

• Bone regeneration done in 3 step Bone regeneration done in 3 step procedure.procedure.

• Biological alternative to Hip Biological alternative to Hip resurfacing in early cases of resurfacing in early cases of Avascular necrosis.Avascular necrosis.

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Our Unique selling pointsOur Unique selling points

• Well Qualified & experienced surgeonWell Qualified & experienced surgeon• Direct access to Doctors instead of going Direct access to Doctors instead of going

thro marketing department- hence thro marketing department- hence personalized care.personalized care.

• Affiliated hospitals have state of the art infra Affiliated hospitals have state of the art infra structurestructure

• Fountain head of Progress in Joint Fountain head of Progress in Joint Replacements & Cartilage surgeryReplacements & Cartilage surgery

• Costs are 1/5Costs are 1/5thth to 18 to 18thth of cost in Canada/ US of cost in Canada/ US• Highly personalized care vs generic Highly personalized care vs generic

treatment in other centers. treatment in other centers.

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HospitalHospital

• Short hospital videoShort hospital video

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Health & Medicine

Latest Advances In Joint Replacement & Knee Implant