91 year old back on his feet after a successful bilateral knee replacement surgery

Mr Madhukar seen above with Dr Kaushal Malhan

It’s never too late for a new beginning....

For Mr Madhukar nothing is more apt than these words.

Wockhardt Hospitals,Mumbai,Mulund has successfully performed a bilateral total knee replacement surgery in a single sitting on a 91 year old man from Mulund.In the process “Wockhardt Hospitals puts 91 year old Mr. Madhukar Nimdeo back on his feet after a successful bilateral knee replacement surgery”

Dr. Kaushal Malhan, Knee & Hip Replacement Surgeon, Wockhardt Hospitals performed the surgery on 91 year old Mr. Madhukar Nimdeo who was suffering from end-stage knee arthritis with minimal blood loss with a combination of advanced muscle sparing surgical exposure, specialized mix of navigation techniques and better patient-specific implants.

Mr. Nimdeo a retired central government employee who loves traveling and has always led an active life was suffering from knee pain for the last 8 years. Due the extreme deformity in both the knees caused by arthritis Mr. Nimdeo had to restrict his physical activities. However this couldn’t curb him from exploring adventurous sport for too long. While on his visit to New Zealand five years back he participated in bungee jumping despite his knee condition and recorded as the oldest member in New Zealand to participate in bungee jumping. But once he returned to India his condition worsened. Upon consultation with Dr. Kaushal Malhan he decided to go ahead with total knee replacement of both his knees.

“The results of the surgery are extremely encouraging and it proves that Tissue Preserving Total Knee Replacement Surgery offers good results even for very aged patients because of minimal tissue damage around the operating site. We have almost stopped the use of blood transfusions for knee replacement surgeries, even for patients who have been operated on both knees in one sitting.” said Dr. Kaushal Malhan.

Since the surgery involved minimal damage to the surrounding tissues, post operation, the nonagenarian was able to walk the same day of his surgery and also participated cheerfully in the hospital’s sporting activities held on the occasion of World Arthritis Day recently.

The Tissue Preserving Total Knee Replacement surgery goes beyond the general scope of conventional TKR surgeries that involve cutting through the quadriceps muscle during the surgery. Conventional Total Knee Replacement surgery causes trauma to the surrounding tissues that result in painful, long, recuperation periods. The patient would typically need walking aids for three to six weeks for the tissues to heal. However, in the case of Tissue Preserving TKR, the procedure involves just flipping across the muscles to reach the bone.

The specialised technique perfected by Dr Kaushal Malhan allows the advantage of satisfactory surgical exposure in all patients including the very obese with easy implantation of standard implants with standard instrumentation. Lesser tissue damage means less pain and earlier recovery.

Tissue Preserving TKR surgery aims to reduce the collateral damage which has always been part of this operation. It combines a muscle sparing exposure (which does not damage the quadriceps muscle- the front main thigh muscle) with computer assisted alignment so as to reduce the need for ligament release and appropriate implants which sacrifice less normal bone. This technique offers, among others, the ability to bend the knee almost immediately after the operation, and walk without aids much faster than conventional TKR procedures. Above all, there is no danger of any complication because there is no blood loss.

Advantages of Tissue Preserving Total Knee Replacement Surgery

• On the whole, there is less soft tissue damage and if combined with appropriate implants, one can reduce the amount of bone sacrificed during operation.

• Less post surgery pain

• Less bleeding and no need for blood transfusions.

• Faster return of knee function – muscle strength and control comes back more quickly – allows faster rehabilitation. Patients can walk on day 1 after surgery.

• Shorter hospital stay

• Less soft tissue damage and a better result

• Early return of knee motion

• After surgery recovery time is less than one third of that with conventional TKR technique.

“My painful knees were quite discouraging for me in these 8 years as I had to restrict my physical activity and mobility was also compromised to a large extent. After attending a session on tissue sparing knee replacement by Dr. Kaushal Malhan, I made up my mind to undergo surgery of both the knees and I could see the benefits from day one of my surgery. I could bend my knee on the first post operative day and with a regular physiotherapy regime I am now completely back to what I was 20 years back!” said Mr. Nimdeo.

For consultations and inquiries with Doctor Malhan,please email us at enquiries@wockhardthospitals.net

Trans Nasal Surgery Used to Remove a Woman's Tumor

For three years, a host of doctors were unable to diagnose Manju Talwar’s medical problem. The 24 year old school teacher complained of abnormal lactation, irregular menstrual cycles and was unable to conceive.

All symptoms suggested a possible gynaecological problem but despite heavy medication, Talwar’s condition did not improve. However, early this year, a MRI scan revealed a tumour in her pituitary gland.

The pea-sized gland situated at the base of the brain controls growth, metabolism and reproductive functions among others. In Talwar’s case, the tumour was pressing her optic nerve, which could lead to blindness. She was advised immediate surgery.

Talwar’s was not an easy surgery as while removing the tumour we had to ensure that the gland is preserved as she is in the child bearing age,” said Dr. Deepu Banerji, a neurosurgeon at Wockhardt Hospital,Mulund,Mumbai.

The Pituitary gland which is located at the center of the brain manufactures and secretes hormone that regulate growth ,sexual development and fluid balance in the body.

Pituitary adenomas(tumors) are abnormal growth on the pituitary glands which account for about 10% of intracranial neoplasms. They often remain undiagnosed, and small pituitary tumors have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). Tumor removal is usually done through transspheoidal approach. Endoscopic surgery is the new approach allowing a surgeon to gain maximum access within the narrow confines of the region avoiding extensive dissection.

Surgery is a common treatment for pituitary tumors. Trans-sphenoidal adenectomy surgery can often remove the tumor without affecting other parts of the brain. Endoscopic surgery has become common recently.

Dr Deepu Banerji, who operated on Talwar over three months, opted for a relatively new endoscopic trans-nasal technique for the delicate operation. This involved insertion of an endoscope through nasal cavity.

Banerji claimed that so far in Mumbai most doctors have been using microscopic transeptal technique, which involves a microscope inserted through the nasal cavity. This, he claimed has led to post-operative complications like numbness around nose and lips, nasal deformity or pain and incomplete removal of tumor.

In the new technique, an endoscope provides good view of the tumor to the doctor. Also, it makes it easier to differentiate between the tumor and the gland – leading to greater chances of complete tumour removal and preserving hormonal functions.

Talwar said she has so far not complained of any post-operative complications.For inquiries please contact us at enquiries@wockhardthospitals.net

Wockhardt Hospitals helps Chandrakant Kothere walk tall again

Chandrakanth Kothere with Dr Sachin Bhonsle

Mrs Shobha Kothere and Chandrakanth Kothere

After years of bowing down to fate, Wockhardt Hospitals helped Chandrakant Kothere walk tall again .Proving its medical one-upmanship yet again Wockhardt Hospitals performed a complicated bone deformity correction with limb lengthening surgery on 42 year old Chandrakant Kothere who was living a crippled live after a traumatic accident three years back. The Orthopedic team at Wockhardt Hospitals,Mumbai led by Dr. Sachin Bhonsle has finally made Chandrakant’s dream come true relieving him of his three year long trauma and help him walk again.

Chandrakant Kothere was 39 years old when he suffered multiple compound fractures on his right tibia, extensive soft tissue damage and skin loss following a road accident. He was advised immediate amputation of his leg in a city hospital where he had undergone initial treatment. Since he was determined not to compromise his life at such an young age, this Hindustan Petroleum employee chose to get the fractures of the leg stabilized.

The doctors in the city hospital went ahead to treat him with stabilization of the bones and subsequent plastic surgery procedures to provide a skin cover. But in a few months following the treatment, the condition worsened as the site of infection on the leg had not healed. The fracture on the leg remained un-united. Unable to bear his body weight, the broken leg bowed in disproportion and he became shortened by almost three inches on one side. The writhing pain was only worsening with time, it was almost impossible for him to walk without a pronounced limp. Having exhausted other avenues, the patient visited Wockhardt Hospital for a consultation in January this year.

According to Dr. Sachin Bhonsle, Consultant Joint Replacement and Orthopaedic Surgeon Wockhardt Hospitals, who treated Chandrakant said “Since the earlier surgery had failed the chances of failure of corrective procedures, was increased by 20 percent. So, ascertaining the nature of injuries and the inherent risk factors that would be involved in the treatment, we were confronted with three challenges

• The three year old fractures had to be healed,
• The leg had to be straightened out, and
• The leg length had to be matched to prevent the patient from limping.

All this had to be done without disturbing the microvascular skin graft in position. “And if, by chance, the corrective surgeries also failed then amputation would have been the last option. It actually took us some time to think over the treatment plan and make up our mind to go ahead,” recalls Dr. Bhonsle.

The surgery was performed in two stages. The first stage was to clear all the infected and un-united bone at fracture site; align the leg and fix the bone fragments using a ring shaped Ilizarov External Fixator. A further cut was made in the top bone fragment so that the middle bone segment could be moved to take up the left over defect to correct the leg length.

In three months following the first surgery, the middle bone segment was moved downwards -- 1mm a day to achieve complete continuity. At this stage the second surgery was performed to slip a special titanium plate from under the skin to fix all three bone fragments together to achieve a solid union. Bone grafting was done at this stage. It took further two months for these bones to heal fully and the patient finally got a straight leg with normal leg length.

“Last three years has been quite painful as I had to lead a crippled life and was under huge trauma and fear of amputation of my affected limb. Due to my condition I was unable to resume work and it became a huge liability on my family. For a last opinion I decided to visit Wockhardt Hospitals where I consulted Dr. Sachin Bhonsle and that’s when I had a ray of hope to stand back on my feet. My utmost gratitude to Dr. Bhonsle and the team at Wockhardt Hospitals for whom I am able to stand in front of you all and have a motivation to lead a healthy life ahead”, said Mr. Chandrakant Kothere.

About Wockhardt Hospitals Bone & Joint Centre:

The Wockhardt Bone and Joint Care is equipped to treat all types of musculo-skeletal problems ranging from Trauma Surgery to Minimally Invasive Arthroscopy Surgery. The hospital also specilalises in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation. Procedures performed at Wockhardt Hospitals Bone & Joint Centres are

• Arthroscopic surgery: Key hole surgery for disorders of knee and shoulder
• Minimal Access Spine surgery
• Hip Resurfacing
• Paediatric Bone & Joint Surgeries
• Fracture Treatment
• Sports Medicine
• Speciality Clinic for Arthritis
• Trauma & Pain Management
• Osteoporosis
• Lifestyle Modification Programme (Rehabilitation)
• Patient Education Programme
• Total Knee Replacement
• Unicondylar Knee Replacement
• Total Hip Replacement
• Hip Resurfacing / Surface Replacement Arthroplasty
• Shoulder Replacement
• Neck & Elbow Replacement