Arthroscopy surgery at Trichy to cure joint problems of knee, shoulder and other joints

Sports Injury Service and Advanced Arthorscopic Surgery Service At KMC Speciality Hospital

Sports is becoming more of a passion as much as a hobby in our Country. Winning World level events has attracted more of our young boys and girls to partake in sports and even take this as their profession. As each profession carries its risks, sports poses us the biggest risk to these young generation in the form of injuries.

Injuries in sports mostly affect the musculoskeletal system. The muscles, tendons, bones and the joints are the components of this system. The joints are complex structures having cartilage, ligaments attached to the bone through soft tissues.

Most sports injuries are managed initially with the following fundamental principles. Remember the mnemonic RICE whenever one gets injured. Rest the injured part, apply Ice, apply Compression and Elevate the injured part. The practice of applying warmth in the form of hot water pack/bottle to the injured part is not recommended.

Physiotherapists either at the sports arena or at the hospital can treat majority of minor injuries to the muscles and tendons. The spasm associated with the muscle and tendon injuries can be treated with stretching and local treatment as described above. Some of these injuries especially the minor ligament injuries need rehabilitation by attending a dedicated physiotherapy department.

KMC Speciality Hospital has a dedicated Physiotherapy department to treat these injuries. The devices available in the department cover all areas of the body. They are designed to treat with mobilisation, stabilisation and retraining.
Though the initial pain and suffering improve with these simple measures and physiotherapy treatment, the long term recovery depends on detection and treatment of major injuries. These major injuries often feel like minor injuries after rehabilitation. However the key to return to sports and normality relies on recognising these as needing further treatment.

Hence we need experts who can diagnose and be able to treat them with the modern treatment methods. At KMC Speciality Hospital, we have surgeons trained and practiced abroad in treating these injuries. Treating them with modern treatment methods practiced in western countries is the key for getting back to normality.

Modern methods of treatment of the sports injuries often involve keyhole surgery to the joints. This is called Arthroscopic Surgery. Arthroscopy started as far as back in 1910s, though the treatment with this technique was possible after 1970s in Japan.

The Advanced Ortho Care at KMC Speciality Hospital has a dedicated state of the art High Definition Arthroscope with HD monitor for excellent visualisation and treatment of the injured part. The supportive power instruments, electronically controlled pump system and Radiofrequency Ablation techniques are at par with the most advanced hospitals in the world.

The problems, which can be treated with these Arthroscopic techniques, are many and can only be listed as a guide as follows.
1. Cartilage injuries of the knee: Meniscus Injuries in the knee and Wrist cartilage injuries
2. Ligament Injuries: Anterior and Posterior Cruciate Ligament Injuries in the knee
3. Tendon injuries of the muscles in the shoulder: Rotator Cuff Injuries and SLAP lesions
4. Recurrent Dislocations: Dislocations of the shoulder and kneecap, which often recur in young sports people
5. Recurrent and persistent pain in joints: Impingement of the joints, which affect mostly shoulders, ankles and elbow
6. Post trauma stiffness of the joints
7. Instabilities of the joints: shoulders and ankles
8. Infections of joints
9. Arthroscopic fusions of joints especially ankle


Some of the other Advanced Ortho treatment Methods provided at KMC Speciality Hospital are as follows
1. Joint Replacements of Knee, Hip, Shoulder, Elbow and Ankle using imported implants with international standards [Swedish, UK and Australian Standard]
2. Partial joint replacements with implants originating from Oxford,UK.
3. World Class treatment methods of simple and major Trauma using principles of international Swiss [AO] and American Standards [ATLS]
4. Treatment of deformities in Children with Ponseti Method [Canada]
5. Treatment of complex trauma and deformities using Russian Technique [Ilizarov technique]
6. Treatment of Fractures in Children using French Technique [Nancy]

Doctors Day India: Modern Technology of Arthroscopic Surgery for joint problems in Trichy

Pain Relief with Modern Technology at our doorstep: Key hole surgery to the Joints [Arthroscopy]
Dr S Chockalingam
Pain is highly unpleasant physical sensation caused by illness or injury, according to Oxford Dictionary. Joint pain not only causes this unpleasant sensation, but also disables a patient. Inability to do walk, sit, squat or wash ourselves without pain is quite common among us; often we do not like to talk about them.
We attribute lot of these inabilities to our age, illness such as diabetes or arthritis. Yet most of these problems are mechanical problems of our joints and the surrounding tissues. Tendonitis, ligament injuries and cartilage problems which affect so much of our sports stars, do not leave the rest of us from causing pain and disability.
These mechanical problems causing disabilities to our knees and shoulders are very common. Technology comes to our rescue in recognizing and correctly solving these problems. Arthroscopy of the joints help us to bring the benefits of key hole treatment like laparoscopy.
Arthroscopy is the key hole surgery to most joints in our body to provide treatment with advanced equipment. This treatment reduces discomfort to the patients, increases the accuracy of surgical technique and hence often relieves a patient’s disability to return them to normality.
The technical expertise in providing such a specialized treatment is more important than the equipment itself

. The message I would like to leave on this Doctors’ Day is to “commend the efforts by the doctors who strive to provide the best to our patients by bringing the modern technology right to our doorsteps to alleviate our pain and disability”.

Chest Injuries in trauma: The major killer in India after road traffic accidents: Seat belt should be worn in cars and buses

Breathing and Chest Trauma

Dr S Chockalingam

One of the major killer injuries is Chest Trauma. In fact the chest trauma is the commonest killer for a driver behind a steering wheel especially when not wearing a seat belt. Chest trauma is one of the injuries, which is treatable in a patient who can reach a hospital alive. Appropriate treatment can save many lives if recognised promptly. This appropriate treatment is often a simple intervention as opposed to a thoracotomy. Any doctor irrespective of their specialist interest should safely perform these simple interventions.

The following content focuses briefly on the essential anatomy, physiology of the chest. The main focus is then on recognising these injuries and acting swiftly to save one’s life. Early recognition of these injuries will also help in preventing late deaths.


Essential Anatomy:

The Chest is comprised of the lungs and pleural cavity, heart and pericardium, mediastinum and its contents, chest wall with the ribs and the muscles, diaphragm.

Essential Physiology:

The function of the chest is mainly two fold, gas exchange chamber and a safe haven for the heart and major vessels.

1.The lungs with the bronchial tree and alveoli function as gas exchange chamber. Oxygen gets in to the circulation and CO2 is excreted. The Chest Wall with the pleural cavity and the diaphragm acts as the motor behind to facilitate the gas exchange.

2. A safe place to keep the important organ, the heart and the main blood vessels.

Recognition and treatment of the chest injuries:

In our Medical School, we are taught the art of clinical Medicine. These would be taking a detailed history, thorough examination and ordering appropriate investigations before instituting treatment. The management of trauma is a clear exception to this approach. Hence we have to recognise the injuries and treatment the life threatening injuries before proceeding to the next step. This is most appropriate in chest trauma.



Recognition of Chest Injuries:


A patient who had trauma should always have the primary survey starting with

Ensuring a patent Airway with Cervical Spine Protection before moving on to the chest injuries. The injuries to the airway presents with similar features to the chest injuries. Airway obstruction with
1. Strider
2. Inability to talk
3. Broken tooth
4. Secretions in the pharynx
5. Gross swelling of the neck

Should be managed before moving on to the chest injuries.

The recognition of the chest injuries is essentially two fold.

1. Assess the breathing
2. Assess the cardiac function

These are done by

1. Look
2. Feel
3. Percuss
4. Auscultate
5. Use adjuncts

Look:

1. Equal chest wall movements
2. Engorged veins in the neck
3. For open wounds
4. Abnormal chest wall movements

Feel:

1. Tenderness
2. Crepitus
3. For equal chest wall movements
4. Pulse rate
5. Tracheal position, midline or deviated



Percuss:

1. Hyper resonance
2. Dull note on percussion

Auscultate:

1. Air entry on both sides
2. Heart sounds
3. Abnormal sounds suggesting obstruction
4. Blood pressure

Adjuncts:

1. Pulse oximetry, Pulse, Blood Pressure assessments
2. Chest X ray
3. ECG

Serious Injuries to be recognised promptly:

1. Conditions which affect mainly breathing
a. Massive air collection around the lungs: massive pneumothorax
b. Massive blood collection around the lungs: massive hemothorax
c. Chest wall injuries leading to flail chest
d. Open chest wound with pneumothorax

2. Conditions which affect the heart and circulation

a. Massive blood collection around the heart: Cardiac Tamponade
b. Massive blood collection around the lungs: massive hemothorax


Treatment as you recognise these serious injuries

1. Needle decompression and chest drain for massive pneumothorax
2. Cover open wounds with air tight dressings immediately
3. Resuscitate with oxygen and blood prior to
4. Chest Drain for massive hemothorax
5. Ventilate with oxygen, ambo bag for flail chest before intubation
6. Needle decompression of pericardium in rare instances

The rest of the chest injuries can wait until we complete the primary survey and management of other major injuries.
Other Injuries, which will become life threatening in due course and hence should be recognised and treatment started. These are

1. Pneumothorax which is not massive
2. Hemothorax which is not massive
3. Major airway injury of tracheobronchial tree
4. Blunt injury to the heart
5. Major vessel injury such as aorta
6. Mediastinal often open injury
7. Injury to the diaphragm
8. Multiple rib fractures

Please remember the power cable for chest wall function is “the intercostals nerves and the phrenic nerve and the brain” ultimately. Hence any injury to the spinal cord, brain and the phrenic nerve will affect breathing even when the chest wall is not injured.

Summary

We have to be familiar with understanding of the following features associated with major chest injuries

When observing the patient

1. Chest pain and air hunger
2. Distress in breathing
3. Sucking open, but often-small wounds in the chest wall.
4. Flail chest

When eliciting the signs

5. Absent breath sounds
6. Engorged neck veins
7. Subcutaneous emphysema
8. Tachycardia and Hypotension
9. Deviated trachea
10. Muffled heart sounds
11. Cyanosis

When assessing with
12. Abnormal saturation with Pulse oximetry
13. Chest x ray abnormalities in trauma
14. ECG changes of blunt cardiac injury

The key message of this review on Chest Trauma is never underestimate these injuries as often these injuries kill a patient within few hours of injury and if not will adversely affect the outcome in the first few days of admission to the hospital

Innovation in Orthopaedics and at KMC Speciality Hospitals: 1. Epsom to Trichy: Chockalingam

This is a custom spica table for applying hip spicas in children. There are so many different methods to attach a support for the child when applying hip spicas. The best one i have used is one introduced by my predecessor and former Colleague Mr[Dr] Philip Cheong Leen. We worked at Epsom General Hospital,Epsom, Surrey, UK. This was simply a miniature iron board made of metal.

So the concept was not mine but to bring to my hospital, i felt it was necessary. I have done hip spicas for femoral fractures, DDH and so on. I gave the measurements and idea to our Theatre senior ODP Mr Jayaraj and he executed very well. What you then see is what the output of the carpenter at our hospital and painting was done aptly in a pink colour.

Regards


Chockalingam

Academic Input from chockalingam

This is the work output of nearly five years of working on knee replacements at Royal London Hospital, London on Freeman Samuelson Knees. I always treasure the time I spent with Mike Freeman and Gareth Scott

This is the work output of my association with Mike Bell, Senior Consultant Paediatric Orthopaedics at Sheffield. I will always cherish the training given by him in this area along with other consultants in UK

This is the work output of a case report on skin burns in Orthopaedics

5th June 2011: Sports Injuries and Advanced Arthroscopy Awareness meet Trichy

Since 2009 January, We have done more than 150 thereupatic Arthroscopic Surgeries. These include Knee Meniscal Surgery, meniscal repairs, Anterior and Posterior Cruciate Ligament Surgery, Shoulder Decompressions, Rotator Cuff repair and Stabilisation, Ankle , elbow and wrist thereupatic arthroscopies. the indications even included rare conditions such as arthroscopic treatment of intra articular hemangioma and removal of bomb shrapnels arthroscopically.

When such work is being done in a hospital in a city like Trichy, you feel for the people who are not aware of the facilities being available and hence this year we took Arthroscopic Surgery , in other words the key hole surgery to joints for awareness program.

Sports being increasingly taken up by the younger generation and road traffic accidents constantly presenting with joint injuries, we decided that this would be the time for us to promote the awareness.

Please go through the picture attached with the details of the awareness program and i will post few pictures as well

Regards

Chockalingam

Part 2:Doing a job vs completing a job: concept of professionalism and sincerity and how money clouds both.

When I went to pay the Electricity Bill in Trichy, there were four queues. I joined the first outer queue without giving any thought. Then I noticed the queue on the inner two queues moved swiftly and the outer queues did not move as fast as one would expect. The obvious inference anyone would make is that the persons at the desk serving the public are efficient in some counters and may be we joined the wrong queue.

But why should only the outer queues move slowly whereas the inner queues were otherwise. Chances! May be and they were not in this instance. The outer queues had constant disturbances with people getting in front by pushing themselves in. And also many people would simply give their cards and money to someone in the queue already to pay for them. Hence the person at the counter was doing as fast as the other counters but had too many transactions per person to handle.

Why I am elaborating this story so much? This is part two of my previous blog and completing a job. You can complete this job of paying the EB bill in many ways.

1. By properly standing in the queue: Be Sincere

2. You can squeeze in and pay the bill and be efficient in comparison to the one who is following the option 1. : Be Efficient

3. You can find ways to avoid the queue altogether, for example pay someone to pay for you and stand for you or log on to your account online and pay without a sweat, Be Professional.

Be efficient sounds good in option 2 but it is not acceptable to someone who stands in the queue sincerely. But be Professional sounds the best option since you find better way to do a job and acceptable and sounds right as well.

This brings me to the concept of Professionalism and Sincerity.

Though Sincerity sounds right in any thing you do, it may not be the efficient approach in competing a job. That is why Professionalism is much needed to combine sincerity and efficiency. This is why professionals score more and earn more for a given job. But you have to find professionals who show professionalism as opposed to efficiency by short cuts just like our example.

It can be difficult for anyone to differentiate the people who can complete the job efficiently as opposed to completing professionally. The latter approach may sometimes appear to take longer and costlier. I see more people who can complete a job without professionalism but efficently. In fact lots of jobs completed are done efficiently.

The efficient methods of following shortcuts are good if the outcome is for one off use or has a definite end point. For example paying an EB bill as above. But where it really hurts if the outcome has long term use. For example a building or a bridge. Here Efficiency has to give way for Professionalism. Because if you do not follow professionalism, then the lack of quality would show in the long run.

But you have to remember that everyone of us is a professional in what we do if we show professionalism.


Regards Chockalingam

Our Trichy: Status of Sanitation and Hygeine, the Conundrum of Free Lunch and one that is paid for.

State Welfare Schemes and Government Welfare schemes are addressed to take off some of the inequalities in the population of the state or the nation. This to my understanding is that taking off some of the inequalities would give the underprivileged a head start in the race to achieving a reasonable or good standard of living.

If the population themselves are expected to achieve these comforts or essentials, it might take a very long time and that person may never see the benefit in his life time. This is why the State or the Government Free Benefits should continue.

Then the state or the Government has to decide which are the essentials and in what priority they should be given. Throughout the World , the countries have been doing this free benefits in different models. We will take Health Care for Example.

In UK, the Government vows to provide good health care for its population by beefing up the government hospitals with facilities, technical expertise and so on. Hence if you have an emergency then you feel safer in a Government Hospital even if you are the Prime Minister of that Country. You can walk in to any Government Hospital in UK expecting a good standard of health care for free funded by the Government.

Whereas in USA, the private providers take up the majority of health care provision just like our country. However the Government does not want the underprivileged to be left with a bad deal. They provide health insurance for those who cannot afford themselves. So you can walk in to any hospital who accepts Government health insurance to get your health care for free, funded by the government.

When the Government decides to give health Insurance for people who cannot afford themselves, or cannot buy health insurance for themselves and their loved ones, then it is commendable act. When it decides to give more free benefits like an item like a Television or a Fan or a Grinder which they can use in day to day life, one starts questioning them.

But I feel the issue is not the free item which is given at present. Because to me and you who is reading the blog, a fan may be a comfort which we can acquire easily but not to everyone. What is more important however is "what is not given which is more urgent to the needy".

I had the opportunity to see Trichy from a different point of view. Point of View is quite true in its meaning in that i observed Trichy by foot as opposed to going in a AC car.

Working in a hospital in India, I was alarmed in the number of Gram negative infections in my patients. These are not just wound infections after surgery for example, but in chest infections where these organisms are found.

Where do these bugs come from? From the community outside and the air we breathe in. If the sanitation is so bad outside and you are going to get infected with these bugs, then what is the benefit of all the comforts you acquire either by earning for it or by the State Benefits.

What is the point of having a toilet built for public use and charging for the same. If I am one of those underprivileged, I would rather go and do my duties outside for free and avoid paying to do so in a public toilet.

If you do not get my point by now, then this is it. There is an urgent need for addressing the Sanitation and the Hygeine for the environment as a whole to improve the quality of everyone's life. If the Government decides to build free and many public toilets for example, then it could be the best initiative ever.

Then I am told this had been done before and not used in the villages nor in the towns commonly. But having walked for nearly three hours in Trichy where the so called underprivileged live, i noticed only on public toilet.

What the Government should do is

1.to ensure that there are these facilities everywhere and make them free.

2. There should be clear directions in every part of the city and the villages.

3. These facilities should be brought under the vigilance of the Health Department. The contractors who are maintaining these can be independent, but their annual quota of money allocated can be linked to the health department vigilance report on their status.

4. The Government should then advertise the facilities so heavily that anyone not using such a free facility will be frowned upon.

If you then find a member of public not using these free facilities, available everywhere,maintained to high standard but funded by the government, then one can start fining the public to ensure that the sanitation standards do not fall.

You cannot blame the common man for passing urine outside in India yet until the above facilities are in place. Until then the India which we know lives as two halves.

One where people can afford and pay for it and maintain good standards and enjoy comforts they want. The second would be the one where people not only do not have the essentials and do not have a choice in spoiling the environment for the first half as well as themselves.

This is exactly the reason why the first half should worry about the second half and not just walk over them. The second half do not need the pity but essentials in life to be provided to them until they can move up in the social ladder.

The most essential of all is the Sanitation and Hygeine and the so called underprivileged people will find ways to earn the rest. So back to Health care Provision for free, I hope to go to any city or village and able to do our essential morning duties for free, funded by our Government.

or will it be a John Lennon Song Imagine Scenario! Time only can tell us, Oh No, We do not have time, Remember time gone is already time lost. Read my previous blog on time and money.

Regards

Chockalingam

Doing a job vs completing a job: concept of professionalism and sincerity and how money clouds both.

Doing a job is standard practice in almost all our life. Not doing a job is not uncommon in some employed areas. In other words, we do see some people who get paid but actually not doing the job they are meant to do. It can be upsetting to people who do work well and get paid the same money or salary.

But the above scenario is not as frustrating as when someone does not do the job to completeness. It is like trying to fix a broken hinge by a repair man. We do across some scenarios where someone comes to the job but finds that he does not have the necessary tools. he leaves the site without completing the job at hand saying that he would come another day to complete the job.

The above scenario happened at our house when we recently fitted a new air conditioner unit. When the unit was delivered and the installation team came to our house, the installation team asked me to get the electrical wiring sorted out and they will complete the job in one hour after the wiring is sorted. They had inspected the site of the fitting and marked where the holes had to be drilled.

We duly called our trusted electrician who finished the wiring straightaway and no sweats!. We called the AC team back again. They started making the hole, they realised that a more powerful drill is needed as the wall is too thick. We asked them to sort it out. Oops!! there is a problem. they do not know how to get a more powerful drill.

We asked them to contact their office. Oops they do not know either. Then we spent next two days making phone calls to our carpenter and other friends who have done AC installation in their house. At the end we called our electrician back again, he did the hole straightaway and no sweats!

But the AC installation team have wasted our time for good two days. Remember the time is our precious commodity if you have read my previous blog.

Now you begin to understand that doing a job is different to completing a job. But wait, not completing a job is not the worst thing and wastage of our time.

Because completing a job can be achieved with different methods.

Take the above domestic scenario for example. The electrician who helped us for the AC installation not only had to complete the hole which was started by the AC team, but also had to correct the errors the AC team had made when they attempted the job. Now we bring the concept of Professionalism and sincerity.

Please wait for my next blog when it all makes sense.

"Time is our best gift to someone", use it in your life or lose it!!! . "Money and Time the Conundrum"

You work and spend your time to get money. One gets money to get the essentials in life and the comforts one can get. We also need money to gift someone you love. This can be in the form of food, clothes, education, assets as the gift to the someone you love. this can be your parent, child, wife and so on. But you spend time to get the money to gift that someone in any form as i detailed.

Then the time of yours is the gift to them and not the actual gift. The time is then the most precious part of all. Just like the time you invest in health as i explained in my previous blogs, you also invest in time to get the money which in turn is used for your loved ones. Then what you are actually giving your loved ones as the gift is your time.

Now if time of yours is the gift to someone, then even if that time does not yield in material benefits (with money and the associated gifts), it is still the gift. for example, you spend time with your loved ones, then it is your gift to them. in fact the loved ones with which you are spending the time are also gifting their time to you

This is something you can use in your work life as well. If you are able to give time at work to someone or something important then you are gifting your time. This is something you have to remember in a job you love doing where you are happy to gift your time for that job.

More importantly you should not be wasting your time in jobs you do not like or enjoy. When the people who do not do their job properly for example, are wasting their precious time in a job where they do not enjoy or like.

You also have to remember if someone is incompetent, or complascent in what they should be doing, then they are not only wasting their precious time of life but also your precious time of life if you are involved in the outcome of their job.

Which brings me to the concept of finite gift concept in everyone's life. Finite means that there is definite end point and it is measurable. Our life has a finite end point though we ourselves cannot measure it.

In other words, our life and the time you spend has a finite end point and that is all the gift we can give to anyone and ourselves. Hence one should choose how we would like to gift that precious time we have and not waste it.

Remember our time is finite and hence the gift of time we can give is precious. Remember the person who is receiving that gift should also be able to appreciate this and make them understand so.

I hope that you have got what i wanted to convey as Time is My Best Gift to you and not the actual gift. Now if someone moans that they did not get what they wanted from someone they love, make them understand this point. The time that individual spent to get that particular item is the gift
.

This is especially important if one is not well off to give an expensive gift but labours his time to get that gift

Back to the second part of title of the blog, "Use it or lose it". This is written for the good use of the time we have got and if we do not use it well, sorry it is too late, we have already lost it.

Now go on and use your time well and i shall try to do as well

Regards

Chockalingam

Invest your health For the sake of your loved ones!!!!!!!!!!!!

I spoke of health, money and the importance of time in our life in the earlier blogs. I also wrote on investing Health for your loved ones. If you invest on your health, it would be not only for yourselves but also for your loved ones.

I spoke mainly of exercises in the context of investing in health for your loved ones. This means that you exercise and the amount of exercise can be quantified and counted as your investment for your loved ones. Just like saving account you do for your child for example.

You can also extrapolate the same on your diet for example. If you make sure you eat healthy diet with vegetables and fruits, then you can count towards the same. If you did not eat healthily today, then you have not saved for health on diet.

Now imagine if you are the main person who cooks for the household or someone who serves food, you have then the responsibility of getting the right food on the table. If you do not, then you are not investing on your loved ones health.

In India, often you are asked to eat more than you can chew in the name of love or Virunthombal. This would then negatively affect your health and the person who insists on eating may be then drawing on your health savings account. You just have to make sure they understand that!


Happiness and rest and sleep or also important for your health. Hence if you take adequate rests, sleep well, then you are investing on your health. If you acaquire happiness by being with your friends and families, you would like to be with or go on holidays you wanted, then indirectly you do invest in your health and for your loved ones.

Now the calculation of how much investment you have for your health becomes interesting. if you have regular exercise, eat good food, be happy and take adequate rest and sleep well, your investment account of health is going to be looking good.

But what if you start off now with obesity or overweight. Then you have to start your health savings account now. Think of your body weight as an account and this is your credit card account.

I say this to my patients. Your body weight is opposite to that of a savings account. In a savings account you want to save more by putting in more money and taking less out. But in your body weight credit card account, you put less in and take more out if you want ot lose weight.

How to put this all into a measurable method. We thought of one method of really putting money when you exercise ,and you can do so if you have healthy food and sleep well and take adequate rest and so on.

I will let you know of a formula in my next blog.

My patient is ready they say and i have to go now

Regards

Chockalingam

How Sports Should Develop in India. learn from Wimbledon Lawn Tennis Association. Sports Medicine in Trichy including arthroscopy.

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

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.

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.
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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