Here are some of the unique procedures carried out at the center:
Total Hip Replacement
A 31 year old lady, suffering from chronic renal failure for the past 10 years and on haemodialysis for long, developed renal osteodystrophy. Subsequently, she developed secondary degenerative arthritis of both the hip joints and had been confined to bed for the past one year. She had also developed pathologic fractures in the pelvic bones due to which she was suffering from severe low back pain, especially on sitting for long. She was treated with total hip replacement of the right hip which, was more painful. The acetabular component was cemented and the femoral component cementless. At present she is walking without any aid. The pain in the right hip has disappeared. The low back pain has also decreased considerably and she is able to sit for prolonged periods. She is coming for total hip replacement of the left hip in a few months’ time.
Curettage, bone grafting and fixation
A 7 year old boy, with complaints of pain in the right thigh for the past one month, presented with sudden increase in pain and inability to walk following a trivial fall. Radiographs of the right hip showed a pathological fracture through a simple bone cyst of the trochanteric region of the right femur. The cyst was curetted out, grafted with fibular graft taken from his right leg mixed with artificial bone and fixed with Austin- Moore pins. Post- operatively he was put on a plaster hip spica for two months. The fracture united at 4 months and the bone cyst disappeared with complete consolidation of the bone graft. He is now walking without any support and is able to sit on the floor and squat. He does not have any pain.
Cemented total knee replacement
A 76 years old lady presented 12 years ago with complaints of severe pain in the right knee with inability to walk due to severe deformity. She was diagnosed to have severe degenerative arthritis of the right knee with severe valgus deformity. She was treated with cemented total knee replacement of the right knee. The deformity was completely corrected. She was ambulating well without any support and had a good functional range of movements. She was asymptomatic till 2 years ago when she had a bad fall and sustained a dislocation of the replaced knee joint. The knee was reduced and supported in a brace, but she continued to have pain and the knee was unstable. She was treated with a revision total knee replacement 4 months ago. During the surgery, it was observed that the plastic insert was badly damaged because of the fall. She is now ambulating well without any support and is able to bend the knee to 110 degrees. She is pain- free and is leading an active life as a social worker.
Closed reduction and immobilisation in U-slab
A 6 year old girl was involved in a major road accident in which both her parents and her grand father expired. She was badly injured and was in a state of mental shock.She was initially treated at a nearby hospital. X-rays revealed fracture of the right humerus (arm bone) and the left femur (thigh bone. The right arm was splinted in a plaster slab and she was shifted to our hospital for further treatment. Further investigation revealed that an important fracture in the left hip had been missed because of inadequate x-rays. This changed the whole course of treatment. Under GA, the left femur shaft fracture was fixed with a plate and screws. The fracture neck of left femur was reduced closed and fixed with Austin- Moore pins. The left hip was then immobilized in a plaster hip spica. The right humerus fracture was reduced closed and immobilized in a U-slab. She was regularly followed- up. At the end of 10 weeks, all the fractures had united well. The hip spica and the U-slab were removed. She is now walking well without any support.
Total hip replacement
A 55 years old Bangladeshi lady was admitted with complaints of severe pain in the right hip and limping gait for the past 50 years! She had suffered from septic arthritis (infection of the joint) of the hip joint in childhood which destroyed the entire joint and left her with a permanent disability. Recently the pain had become unbearable restricting all her activities.
Her son, who resides in the UK, had shown her X-rays to several leading orthopedic surgeons in UK, US and Germany. All of them had refused to operate on her and had warned him that attempting any surgery could make matters worse. Some had offered to give it a try without giving him much hope about the outcome, but the cost was exorbitant. He finally heard of Dr. Nandkumar Sundaram and approached him with his mother’s x-rays.
On examination, it was found that the hip joint was completely destroyed and dislocated. Secondary arthritic changes were advanced. The right leg was shorter by 8 cms. She was walking with a severe lurching gait and the spine and pelvic bone were grossly deformed due to decades of abnormal walking.
The joint had been dislocated for 50 years causing the muscles to atrophy and the muscles, blood vessels and nerves to shorten. The pelvic bone and spine were deformed. The socket portion of the joint was absent. The right leg was short by about 8cms. The bones were osteoporotic due to disuse atrophy.
A new socket was created in its original position on the pelvic bone. The femur (thigh bone) was shortened by about 2.5cms to facilitate reduction of the replaced joint. Soft tissues which were under excessive tension were released. The leg length was fully corrected.
She is now completely pain-free and walking without any limp. Her leg length has been corrected fully. She is able to attend to all her needs by herself.
Fracture
A 6 year old boy was brought to the ER with a history of fall on the outstretched left hand while playing at home. He complained of severe pain and deformity of the left elbow and inability to use the left upper limb.
There was gross deformity of the left elbow and much swelling and bruising about the elbow. The left radial pulse was weak when compared to the right side. The elbow was immobilized in a plaster slab and he was taken up for surgery. Through a lateral approach, the dislocation was reduced and the fractured olecranon was fixed with two k- wires. After wound closure the elbow was immobilized in an above- elbow back slab. Post- op the radial pulse was well felt. The back- slab was removed after 3 weeks and the wires were removed. He was started on active mobilization exercises of the elbow and regained nearly full range of movements and full function.
Total Knee Replacement
A 38 year old Italian lady, who was diagnosed with Juvenile rheumatoid arthritis 20 years ago, was treated with DMARDs. She gradually developed deformity of the left hip, both knees and both ankles.
AShe underwent cementless total knee replacement of the left knee 10 years ago in Italy. At present she has a 30 o fixed flexion deformity of the left hip, 30o fixed flexion deformity of the left knee and a 30o fixed equinus deformity of the left ankle.
AShe has no pain in the operated knee but can flex the knee from 30o to 80o. She has severe pain in the right knee, aggravated on walking. She has to use a walking stick for walking and finds it extremely difficult to sit in a chair and to get up, on account of the stiffness in her knees. She underwent a total knee replacement of the right knee using cementless femoral component and cemented tibial component. (TC PLUS, PLUS ORTHOPEDICS, SWITZERLAND). At the end of 3 months, she has no pain in the right knee; she is able to straighten the right knee fully and bend it to 90o.
AWith physiotherapy, the deformity in the left hip and left knee has decreased slightly. She has now approached us for surgery on the left hip.
Knee Repair
A 19 year old boy was involved in an accident and sustained injury to the right knee. He was admitted with severe pain in the right knee, severe deformity and inability to bear weight on the right leg. There was a bleeding wound on the front of the knee.
Clinical examination revealed a fracture- dislocation of the right knee. The pulses in the right foot were absent.
A vascular surgeon’s opinion was obtained and he confirmed the presence of injury to the blood vessels behind the knee, caused by the dislocated bone fragments. He was taken up for surgery immediately. The open wound was debrided thoroughly, the fracture was opened, the dislocated fragment behind the knee was reduced and the fractures were fixed with two buttress plates and screws and wires. Once the fractures were fixed, the vascular surgeon explored the injured vessels in the popliteal fossa.
The tear in the posterior tibial vessel was repaired with a reversed vein graft. A tear in the anterior tibial vessel was directly repaired.
Post- op there was good flow in the repaired vessels and the foot pulses were well felt. The open wound in the front of the knee was debrided again after 48h and required a split- thickness skin graft cover. At 6 months, he has no pain in the knee. He is walking independently putting full weight on the right leg. He has full movement in the right knee. There were no complications.
