Arthroscopic Surgery at our KMC Speciality Hospital, Trichy, India: Key hole surgery

This is the article published in KMC News 2010

Arthroscopic surgery [Key hole Surgery] at our KMC Specialty hospital
Dr S Chockalingam FRCS, FRCS [Trauma and Ortho]

Joint replacements have now become the standard of care for advanced arthritis. These joint replacement surgeries for arthritis of knee, hip and shoulder have become common at our hospitals. The less known treatment method for joint pain in younger individuals will be discussed in this article.

This less known treatment method namely arthroscopic treatment for joint pain is now increasingly used in our city as in the Western world. An arthroscope is a telescope,[ type of endoscope] the size of a pen when introduced into the joint, helps us to evaluate the joint and introduce instruments to repair or remove the injured structures

Professor Kenji Takagi in Tokyo used a cystoscope back in 1919 to look inside the joint. Eugen Bircher a Swiss Politician/Army Physician is considered as the father of arthroscope where he used a thoracolaparascope to view the joint. Japanese surgeon Masaki Watanabe gets the credit for using arthroscopes for interventional procedures rather than for merely diagnosing the problems.

Advances in the fiber optics in the 1970s and 1980s have now helped to the current design of these arthroscopes which come in various small sizes for various joints. We now have this facility to treat joint problems and I have shown the use of this surgical technique in managing joint problems at KMC Speciality hospital

The following conditions are some of the patients who have been treated at KMC Speciality hospital with our state of the art instruments using this technique.
1. Diagnosis of unexplained knee pain where Tuberculous synovitis, synovial chondromatosis and other conditions and treatment of septic arthritis of all joints.
2. Meniscal tears:This is one of the commonest indication for this procedure. Even though sports injury is a common mechanism of these meniscal tears, it is fairly common in middle aged women and men in India.
3. Cruciate ligament tears. Ligament reconstruction of the anterior cruciate ligament done through this minimally invasive technique has perfected this reconstruction
4. Shoulder pathologies. The shoulder is only second to the knee in the numbers where this technique is being used here at our hospital. Decompression of the subacromial space and Shoulders that dislocate repeatedly are common indications
5. Ankle and other joint pathologies. So far we have treated variety of pathologies with this minimally invasive technique at KMC


Regards

Chockalingam

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”.

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.