I had a discussion on sports with Sports Officer. It is true that identifying talent, nurturing them to appropriate sports, getting them appropriate gears and facilities, supporting them through injuries and getting them back on track are all issues which need lots of effort and money.
A country which is cricket mad, gets lots of money on advertising and TV rigths alone with an appropriate sports body, should be able to streamline money and resources to cities. these should not only be first tier cities like chennai, but also cities like Trichy.
Wimbledon as far as i understand does this very well supporting so many Lawn Tennis Association across UK by not only giving tickets but also supporting them as i mentioned in my first Paragraph of this blog.
What happens to the millions and crores of money which come through sports and affilitiations and advertisements and tv rights. Is the information available through Freedom of Information one wonders!
More and More people are taking up fitness routines at slighly later age and i see lot of ladies take up gym and yoga and get injured which probably will not come under sports injuries. but as an orthopaedic surgeon practising in Trichy, i see more of these over use and sudden stretching and strengthening exercise programs in older people.
I detect more and more meniscal injuries and Anterior Cruciate Ligament ACL injuries in sports and Road Traffic Accidents in particular in India. These knee injuries need surgery and extensive rehabilitation and we are proud to have one of the best facitlities in physiotherapy in Trichy and we are able to provide arthroscopic treatment methods to the international standards.
I am also proud to have conceputalised the design and i thank the KMC Specialtiy managment for implementing the design.
Back to the title of this blog however, lots of money and efforts should be channeled from the central sports bodies of the country to places like trichy to prevent injuries in the first place by providing the expertise and facilities. Then we at KMC speciality are ready to give them the best sports medicine and surgery facilities for any ortho problems they can come up with.
Regards
Chockalingam
Monday, June 6, 2011
Thursday, June 2, 2011
Arthroscopic Surgery at Trichy, Key hole surgery to joints, cartilage tears and ligament reconstruction
Trichy as I left over seventeen years has not changed much. I can say only few major developments and it is busier with more traffic. but still i can reach from point A to Point B in less than half an hour at any point of time of the day. This is great considering that it is one of the major second tier cities in India. It also boasts an international airport and a major Railway interlink Juncion.
The people are many, mostly small business and agriculture base in earnings. BHEL is still the largest industry in the region with so many allied engineering firms nearby and linked to BHEL. Education is one of the strong points of Trichy and it has not changed as it used to be. There are more good schools and the old schools still retain their place as mine ERHS School.
The health needs of the people is still largely filled by the specialists in their own area of expertise and many private hospitals are giving good quality treatment. However health awareness has increased dramatically and people are aware of surgical methods of treatment to cure their illness.
For Example, bypass surgeries and cataract surgeries are so common for people to resort to improve their quality of life. Ortho problems are recognized as needing specialist treatment. People resort to surgical treatment of fractures without hesitation as they recognize that this can return them to normality more surely and quickly as opposed to conventional immobilization methods
So what else has changed in Trichy. Arthroscopy was introduced when i did my postgraduation in the 1990s with only the telescope without the monitor. However I am able to provide the state of the art High Definition Arthroscopic surgery to most joints in our body for treatment purposes.This is essentially key hole surgery to the joints as what a laparascopy surgery to cure gallstones etc
My patients have benefited from meniscal surgery including arthroscopic repair, ligament surgery including arthroscopic anterior and posterior cruciate ligament reconstruction, shoulder surgery including arthroscopic Bankart's repair and rotator cuff repair, arthroscopic ankle decompressions, and so on.
Compare the surgeries i was performing in UK before i left over two years ago to practice in Trichy and I am able to deliver the same to our patients and people. This is apparent in the arthroscopic techniques and joint replacement surgery,i use more than in any other sub speciality of Orthopaedics.
This is what has changed in Trichy from my point of view. Seventeen years ago, arthroscopic surgery was literally unheard of in Trichy from patients Access or awareness. Now our patients in Trichy are benefited from this state of the art treatment facility at our hospital.
Wednesday, June 1, 2011
Total Knee Replacement: India What we know and our Experience at KMC Hospitals Group
Total Knee Replacement: What we know and our Experience at KMC Hospitals Group
Dr S ChockalingamD.Ortho, FRCS [UK],FRCS [Tr & Ortho], Dr P R Ramasamy MS [Ortho], FRCS [UK]
This is an article I wrote for KMC News which is distributed to Referring and primary care doctors in Trichy Region on 14th December 2009
Total Knee Replacement is one of very successful and common Orthopaedic Operations we do at KMC Hospitals. The incidence of this surgery increasing in number reflects what is happening around the world.[Ref 1] The reason is why it is not more popular than it is at the moment is the cost of the surgery. This is obviously the point I would like to start of this brief about this surgery. The reason it is expensive at present to the reach of the common man is the technology that goes behind in the implant that is used.[ref 2]
The implant often made of strong Cobalt Chrome alloy, though titanium and ceramic are used in some designs. Any metal however polished, will have surface irregularities if one looks under the electron microscope. The surface finish and the material then become very important in reducing this irregularity and thus help in reducing the wear of the material with which this articulates.[Ref 3 and 4]
The material with this metal articulates is a specialized plastic called Ultra High Molecular Weight Polyethylene. Newer highly cross linked Polyethylene has come into use in hip replacement surgery.[ ref 5] However the quality of the Plastic used is controlled in the way this plastic insert is manufactured. This helps in the long term success of the knee replacement surgery.
The long term success of the knee replacement surgery is more important that looking at short term benefits of this surgery.[Ref 6] Any material placed between the end of the femur and tibia will relieve the arthritic pain. What is more important however is the durability of the material in staying without damaging the underlying bone!
The damage to the underlying bone is the worst scenario when faced with the failed knee replacement surgery. One fears this as the damage often starts without any warning such as pain. When one faces a failed knee replacement, the surgical challenges becomes daunting and more importantly becomes very expensive.
This brings me back to the opening paragraph of this brief, the cost of this joint replacement surgery.
A little bit more cost at the initial replacement surgery has been shown to reduce the chances of revision surgery in the long run. Revision surgery after total knee replacement is not something an ordinary individual can tackle not only as a patient but also financially. One cannot expect the Government to subsidize that cost as well as it will be impossible.
What we do at KMC Hospitals to ensure the long term success of this surgery are as follows.
We have a dedicated team involved in this surgery. The chances of infection developing after such surgery should be kept to absolute minimum and we do this by controlling the theatre environment and the personnel involved. We have only used prosthesis which has follow up data in the long run. Post operative protocols have now been developed to suit our working conditions. There are specific appropriate pain control and rehabilitation in place for these patients, both of which go hand in hand.
I have shown some examples of patients we have operated and what they look like and what they can do after such major surgery!
After total knee replacement this patient is able to sit cross legged! and riding a two wheeler at four weeks!, a patient works as a security at the age of 70 going to work by bicycle|!
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97.
Kester MA, Herrera L, Wang A, Essner A. Knee bearing technology: where is technology taking us? J Arthroplasty. 2007 Oct;22(7 Suppl 3):16-20
McEwen HM, Barnett PI, Bell CJ, Farrar R, Auger DD, Stone MH, Fisher J. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech. 2005 Feb;38(2):357-65.
Lancaster JG, Dowson D, Isaac GH, Fisher J The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement. Proc Inst Mech Eng H. 1997;211(1):17-24.
Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. J Arthroplasty. 2008 Jun;23(4):559-66. Epub 2008 Feb 13.
Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis J Bone Joint Surg Br. 2009 Jun;91(6):745-9.
.
Dr S ChockalingamD.Ortho, FRCS [UK],FRCS [Tr & Ortho], Dr P R Ramasamy MS [Ortho], FRCS [UK]
This is an article I wrote for KMC News which is distributed to Referring and primary care doctors in Trichy Region on 14th December 2009
Total Knee Replacement is one of very successful and common Orthopaedic Operations we do at KMC Hospitals. The incidence of this surgery increasing in number reflects what is happening around the world.[Ref 1] The reason is why it is not more popular than it is at the moment is the cost of the surgery. This is obviously the point I would like to start of this brief about this surgery. The reason it is expensive at present to the reach of the common man is the technology that goes behind in the implant that is used.[ref 2]
The implant often made of strong Cobalt Chrome alloy, though titanium and ceramic are used in some designs. Any metal however polished, will have surface irregularities if one looks under the electron microscope. The surface finish and the material then become very important in reducing this irregularity and thus help in reducing the wear of the material with which this articulates.[Ref 3 and 4]
The material with this metal articulates is a specialized plastic called Ultra High Molecular Weight Polyethylene. Newer highly cross linked Polyethylene has come into use in hip replacement surgery.[ ref 5] However the quality of the Plastic used is controlled in the way this plastic insert is manufactured. This helps in the long term success of the knee replacement surgery.
The long term success of the knee replacement surgery is more important that looking at short term benefits of this surgery.[Ref 6] Any material placed between the end of the femur and tibia will relieve the arthritic pain. What is more important however is the durability of the material in staying without damaging the underlying bone!
The damage to the underlying bone is the worst scenario when faced with the failed knee replacement surgery. One fears this as the damage often starts without any warning such as pain. When one faces a failed knee replacement, the surgical challenges becomes daunting and more importantly becomes very expensive.
This brings me back to the opening paragraph of this brief, the cost of this joint replacement surgery.
A little bit more cost at the initial replacement surgery has been shown to reduce the chances of revision surgery in the long run. Revision surgery after total knee replacement is not something an ordinary individual can tackle not only as a patient but also financially. One cannot expect the Government to subsidize that cost as well as it will be impossible.
What we do at KMC Hospitals to ensure the long term success of this surgery are as follows.
We have a dedicated team involved in this surgery. The chances of infection developing after such surgery should be kept to absolute minimum and we do this by controlling the theatre environment and the personnel involved. We have only used prosthesis which has follow up data in the long run. Post operative protocols have now been developed to suit our working conditions. There are specific appropriate pain control and rehabilitation in place for these patients, both of which go hand in hand.
I have shown some examples of patients we have operated and what they look like and what they can do after such major surgery!
After total knee replacement this patient is able to sit cross legged! and riding a two wheeler at four weeks!, a patient works as a security at the age of 70 going to work by bicycle|!
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97.
Kester MA, Herrera L, Wang A, Essner A. Knee bearing technology: where is technology taking us? J Arthroplasty. 2007 Oct;22(7 Suppl 3):16-20
McEwen HM, Barnett PI, Bell CJ, Farrar R, Auger DD, Stone MH, Fisher J. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech. 2005 Feb;38(2):357-65.
Lancaster JG, Dowson D, Isaac GH, Fisher J The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement. Proc Inst Mech Eng H. 1997;211(1):17-24.
Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. J Arthroplasty. 2008 Jun;23(4):559-66. Epub 2008 Feb 13.
Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis J Bone Joint Surg Br. 2009 Jun;91(6):745-9.
.
Empower with Knowledge: Ortho Problems Awareness Campaign at Puthur Trichy India
4th September 2010
Empower with Knowledge:
This is the theme we took on when we decided to meet the pensioners who have many ortho problems. Myself and Dr Aravindan decided to address the pensioners in Trichy on the current Ortho Problems. When possible i will upload my powerpoint presentation used for this talk.
The Bone And Joint Decade announced by the WHO was the basis of this talk concentrating on the arthritis, osteoporosis, back problems and road traffic accidents. We were able to highlight the problems and the treatment methods and preventive methods adopted to the World Class Standards.
I have written enough on the ortho problems already and i will stop here
Regards
Chockalingam
The Proof is in the pudding: Awareness strategy adopted for Total Knee Replacement
10th June 2010
Total Knee Replacement is one of the successful surgeries, in Orthopaedics and Surgery in General. The surgery has the benefit of relieving one's pain and improving the quality of life for an individual. This can be proved by various quantification methods such as Joint Specific Scoring Systems, and Quality of Life improvement tools.
I use these tools in my practice to the standards followed in the UK Joint Replacement Units. The quality of improvement can be quantified in other methods such as QALY. This method shows that the qualtiy of life improvement for the years ahead is comparable to Cardiac Bypass Surgery and better than cataract surgery.
Remember these two surgeries compared are done more frequently than the Knee Replacement surgery. Hence when I started my practice, we sat down with the marketing department at KMC Speciality hospital and worked on a strategy to improve the awareness.
I decided one of the ways would be to take the outcome improvement to the public directly and orgnaised the meeting called Meet Our Patients. We called on the press to interact with my patients who had knee replacement directly with no preconditions.
Patients were more than happy to narrate their quality of life improvement directly to the press who in turn took to the public through their media.
Proof is in the pudding,Right!. We are now in the process of orangising the awareness of arthroscopy in joint problems. I am calling more than 100 of my patients who had arthroscopy of knees, shoulders,ankles, elbow at KMC Speciality to come and narrate their experiences directly to the press.
We are calling this Sports Injuries and Arthroscopy Awareness meeting and organised this sunday.
I will post more on this later.
Regards
Chockalingam
Saturday, May 28, 2011
The Bone and Joint Decade 2000-2010, Ten years on........
This is an article I am writing for increasing the awareness of bone and joint disorders among the public and the medical community alike.I hope you find it useful
World Health Organisation [WHO] endorsed the launch of “Bone and Joint Decade [BJD]- 2000 to 2010” in Geneva in January 2000. The key goal is “to keep the people moving by prevention and treatment of bone and joint problems. This will in turn reduce the cost and the burden to the individuals, the carers and the society at large”.
BJD-India duly followed with National Action Network launched from Pune by eminent doctors. This was endorsed by the Government of India. As we are on the verge of this decade behind us, it is time for us to reflect and hence this article.
Arthritis affecting a joint such as knee and hips are very common in India. Every other person over the age of 65 in India is affected with arthritis. Unfortunately the treatment is not sought or often delayed.
The road traffic accidents are not only common, but also results in severely injured people. The deaths are frequent and multiple numbers of people are involved in the same accident. This is reflected in the Official statistics of the department of Road Transport and Highways, Government of India.
Unfortunately such affections of the bone and joints leave people with physical disability. The patients become dependent on the family and the society adding to the mental suffering. Some of the patients are left crippled due this pain. The true extent of their suffering is revealed in the limitation of their activities of daily living let alone their limitations in the society.
When one is not able to do even routine activities such as walking, secondary health problems arise. These include sedentary lives, increasing obesity, diabetes, high blood pressure and heart diseases. WHO recognised this growing trend in the society often leaving a financial burden.
Diet and exercise play important role in the health of our bone and joints as much as for our heart. Yet our life style had become sedentary. Increasing incidence of overweight and obesity has aggravated the bone and joint problem such as arthritis. Specific remedies for certain arthritis such as Rheumatoid are not sought. These lead to crippling deformities and disabilities. On the other hand, there is misuse of pain killers leading to other problems such as kidney failure.
Wearing a seat belt is the most effective way to prevent injuries when travelling in a car or a bus. Yet many of us remove the seat belts or consider it a hindrance to wear. Traffic rules and restrictions are rarely followed resulting in serious and disabling injuries.
“A painful advanced arthritic joint can be cured with a joint replacement” is a well known fact to many in a Western country such as UK. However people in our villages are left suffering due to the lack of awareness. This lack of awareness is present even in educated persons living in cosmopolitan cities.
With this launch of Bone and Joint Decade, WHO highlighted the need for the improvement in the diagnosis and treatment of such disorders. WHO encouraged prevention through education campaigns. Ten years on since the Bone and Joint Decade launch by the WHO, the real question had there been an any improvement at all ?
In spite of all being written early in this article, there is certainly more awareness created by this WHO initiative. The government of India through its participation in this Bone and Joint Decade has shown its commitment in prevention and treatment of these disabling conditions.
Government Welfare schemes helping them finance the treatment ensures that poor are not left alone in this treatment reach. One has to mention one such scheme for the people below the poverty line at this juncture which has benefited and continues to a huge number of financially disadvantaged section of our society.
More people are seeking treatment rather than neglecting these ailments. They are asking for the accurate diagnosis as much as the treatment itself. This is especially facilitated when they see others benefited due to the treatment options such as joint replacements. People have started to recognise the fact that “Early and appropriate treatment of injuries prevents long term disability”. Technological advances such as key hole treatment of joint problems with arthroscopy are now known.
Every year many hospitals follow the activity week to focus their year long efforts to the public in October[ 12th to 20th of October of 2010 for this year]. Many hospitals and doctors are conducting free camps to facilitate such an awareness. Their efforts should be lauded with reverence for the public service.
There is certainly a larger section of our public where the awareness has not reached as we still see a significant number of disabled people due to the bone and joint problems. Hence more concerted efforts should be done from the community in general and the medical community in particular.
Education in road traffic accident prevention should reach the “prospective road users” namely our children. Public awareness campaigns should increase in number and reach the inner villages. Medical schools should increase the training given to the doctors in dealing with bone and joint problems. There is a need for the entire community to celebrate this bone and joint week in October.
May I conclude this article saying that “Let the end of the Bone and joint Decade -2000-2010 herald a new beginning in spreading awareness of the increasing number of Bone and Joint problems. These are either preventable and when affected, many of them are certainly curable”
Dr S Chockalingam
Consultant Trauma and Orthopaedic Surgeon
KMC and KMC Speciality Hospitals,
Trichy
World Health Organisation [WHO] endorsed the launch of “Bone and Joint Decade [BJD]- 2000 to 2010” in Geneva in January 2000. The key goal is “to keep the people moving by prevention and treatment of bone and joint problems. This will in turn reduce the cost and the burden to the individuals, the carers and the society at large”.
BJD-India duly followed with National Action Network launched from Pune by eminent doctors. This was endorsed by the Government of India. As we are on the verge of this decade behind us, it is time for us to reflect and hence this article.
Arthritis affecting a joint such as knee and hips are very common in India. Every other person over the age of 65 in India is affected with arthritis. Unfortunately the treatment is not sought or often delayed.
The road traffic accidents are not only common, but also results in severely injured people. The deaths are frequent and multiple numbers of people are involved in the same accident. This is reflected in the Official statistics of the department of Road Transport and Highways, Government of India.
Unfortunately such affections of the bone and joints leave people with physical disability. The patients become dependent on the family and the society adding to the mental suffering. Some of the patients are left crippled due this pain. The true extent of their suffering is revealed in the limitation of their activities of daily living let alone their limitations in the society.
When one is not able to do even routine activities such as walking, secondary health problems arise. These include sedentary lives, increasing obesity, diabetes, high blood pressure and heart diseases. WHO recognised this growing trend in the society often leaving a financial burden.
Diet and exercise play important role in the health of our bone and joints as much as for our heart. Yet our life style had become sedentary. Increasing incidence of overweight and obesity has aggravated the bone and joint problem such as arthritis. Specific remedies for certain arthritis such as Rheumatoid are not sought. These lead to crippling deformities and disabilities. On the other hand, there is misuse of pain killers leading to other problems such as kidney failure.
Wearing a seat belt is the most effective way to prevent injuries when travelling in a car or a bus. Yet many of us remove the seat belts or consider it a hindrance to wear. Traffic rules and restrictions are rarely followed resulting in serious and disabling injuries.
“A painful advanced arthritic joint can be cured with a joint replacement” is a well known fact to many in a Western country such as UK. However people in our villages are left suffering due to the lack of awareness. This lack of awareness is present even in educated persons living in cosmopolitan cities.
With this launch of Bone and Joint Decade, WHO highlighted the need for the improvement in the diagnosis and treatment of such disorders. WHO encouraged prevention through education campaigns. Ten years on since the Bone and Joint Decade launch by the WHO, the real question had there been an any improvement at all ?
In spite of all being written early in this article, there is certainly more awareness created by this WHO initiative. The government of India through its participation in this Bone and Joint Decade has shown its commitment in prevention and treatment of these disabling conditions.
Government Welfare schemes helping them finance the treatment ensures that poor are not left alone in this treatment reach. One has to mention one such scheme for the people below the poverty line at this juncture which has benefited and continues to a huge number of financially disadvantaged section of our society.
More people are seeking treatment rather than neglecting these ailments. They are asking for the accurate diagnosis as much as the treatment itself. This is especially facilitated when they see others benefited due to the treatment options such as joint replacements. People have started to recognise the fact that “Early and appropriate treatment of injuries prevents long term disability”. Technological advances such as key hole treatment of joint problems with arthroscopy are now known.
Every year many hospitals follow the activity week to focus their year long efforts to the public in October[ 12th to 20th of October of 2010 for this year]. Many hospitals and doctors are conducting free camps to facilitate such an awareness. Their efforts should be lauded with reverence for the public service.
There is certainly a larger section of our public where the awareness has not reached as we still see a significant number of disabled people due to the bone and joint problems. Hence more concerted efforts should be done from the community in general and the medical community in particular.
Education in road traffic accident prevention should reach the “prospective road users” namely our children. Public awareness campaigns should increase in number and reach the inner villages. Medical schools should increase the training given to the doctors in dealing with bone and joint problems. There is a need for the entire community to celebrate this bone and joint week in October.
May I conclude this article saying that “Let the end of the Bone and joint Decade -2000-2010 herald a new beginning in spreading awareness of the increasing number of Bone and Joint problems. These are either preventable and when affected, many of them are certainly curable”
Dr S Chockalingam
Consultant Trauma and Orthopaedic Surgeon
KMC and KMC Speciality Hospitals,
Trichy
Friday, May 27, 2011
Health Awareness among men over forty years of age, meet by Sugam Charity
Sugam Charity Health Awareness meeting 2 on 11th of April 2010
Following the successful meet organized for women over forty on the 13th feb 2010, Sugam Charity organized the second meet for gents over the age of forty years. The aim of the meeting was to spread the awareness of life style diseases which are rife in this age group.
The format of the meet is to give awareness talk to spread the knowledge and to provide an individual assessment of these people. This is different to the master health check up though one part of it is based on the master health check up as described below.
Master Health Check up is now given as a standard to most corporate employees as part of their corporate social responsibility. The corporate bodies also take up this role to ensure they have healthy employees who in turn will take less sick leave and increase their productivity.
However this type of check up is not given to the people in the villages, one due to the lack of model of someone giving them the option of health check up as corporate bodies. but it is mainly due to the lack of awareness. sporadically the Sons and Daughters who are working in cities bring their kith and kin for these health check up, however the common man misses out.
This type of health check up can bring up the problems, hopefully at an earlier stage so that the treatment can be effective. It would also ensure people with risk factors are advised accordingly so that life style diseases do not affect them in the future.
The second part of this activity is where the charity wants to concentrate. Spreading the awareness by giving them not only their health information but also with an interactive forum at their doorstep.
This has been made very much possible by the talks given by the doctors and more importantly by the Nursing School Principal of KMC, Trichy and her Team. We at Sugam Charity cannot thank them enough as they do this on a sunday when most of us would rather spend relaxing at home. We also thank the Management of the KMC and KMC speciality hospitals for allowing us to use their team the education materials for this public exercise activity.
We at Sugam Charity hope that we have done some good to these people, only time can tell us so.
Regards
Chockalingam
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