Spine Surgery Procedure at Indraprastha Apollo Hospitals Delhi, India

Geriatric Orthopedic Care:

Apollo Hospitals introduces a new implant - Zimmer Motion Loc used in operating Osteoporotic fractures, a first of its kind in South India. This implant is a revolutionary technique for Geriatric Orthopedic care that promises faster and stronger healing.

The benefits of this new implant are:

1. The Zimmer Motion Loc (as per various Asian surgeons' observations and feedback), has shown a Callus formation in as fast as 3 weeks' time.

2. The Zimmer Motion Loc screws have a reduced shaft diameter and hence act as a cantilever beam that can elastically flex within a controlled motion enveloping the near cortex. This results in axial motion at the fracture that is similar at both the cortex near the plate and the cortex opposite the plate (parallel motion).

3. As per various studies published in JOT and JBJS, the Far Cortical Locking construct can provide an 81% decrease in axial stiffness but still retain the similar or more construct strength.

4. In Motion Loc construct, all Far Cortical Locking screws equally share load and distribute loads along near and far the cortex.

5. Zimmer Motion Loc construct has a biphasic biomechanical property. As the load elevates, the cortex will provide the biomechanical support to the far cortical locking screws.

6. Under one body weight load bearing, Zimmer Motion Loc (and Far Cortical Locking Constructs) provides between 0.4mm to 0.6mm of motion at the near and far cortex. The increased working length leads to greater flexibility.

The controlled motion is within the 0.2mm-1.00mm stimulation range known to promote callus formation.

In comparison, standard locking plate constructs typically yield less than 0.1mm motion at the near cortex under one body weight.

7. One of the issues we have with the current locked system in treating Osteopenic/Osteoporotic bone is that the construct is too stiff which may lead to bone lysis and screw cut out.

A biomechanical study actually showed that the Far Cortical Locking construct demonstrated increased construct strength in an Osteoporotic bone.

FDA has already approved the use of Motion Loc in Osteopenic bones.

8. Motion Loc screw has a reverse cutting thread design which facilitates the screw removal.

9. It is recommended to back out 1/2 a turn with Motion Loc screw after reduction is achieved to prevent friction forces.

10. Lastly a distinct advantage of NCB plating system is that it provides   lag screw flexibility in addition to the locking screw stability.

The screws get locked to the plate with a locking cap at the head.

This also prevents cold welding or stripping and the Non-Contact Bridging feature further preserves the periosteum blood-flow.

 

Bone Tumor:

Apollo Hospitals India offers specific options for management of bone tumors.
Tumors of the bone can be either benign or malignant, the malignant variety being more of a challenge to treat. Further-more malignant tumors could be either primary tumor of the bone or secondary deposits from tumors elsewhere in the body. The most common bone tumors encountered are osteosarcomas, Ewing's sarcoma, etc. The most common sites of occurrence are around the knee joint - either distal femur or proximal tibia. The dramatic change of events from amputation to limb salvage surgeries has heralded a new hope to these patients who have this form of cancer.

When a person has cancer of the bone, Surgery forms a part of the treatment. Formerly if the malignant tumor was in the limbs, Surgery meant amputation of the limb. The entire limb or part of it would be removed. This led to marked disability and disfigurement. The person also had to suffer social stigma. In order to overcome the functional, psychological and social problems associated with amputation, the concept of limb salvage was evolved. Here, despite the Surgery and removal of the tumor, the limb is spared.

The aim of limb salvage Surgery in bone tumor management is to eradicate the disease, retain the integrity of the skeletal system and preserve a limb with useful function.
Successful limb sparing procedures consists of three phases namely

·         Bone resection: After making an accurate assessment of the stage and spread of the tumor the surgeon removes the affected part of the bone.

·         Reconstruction: The second phase of the procedure involves replacing the missing part of the patient's body. Prosthesis or implants are made of steel or titanium.

·         Plastic Surgery: This is performed to cover the area with muscle and soft tissues.

Then customized mega prostheses are tailor made for each patient. They conform to each and every patient and fit him or her perfectly.

The prosthesis is fitted only when the surgeon feels that the disease can be controlled by removing only one portion of the bone and not the whole limb and using an implant will give the person more comfort than removing the hand or leg and fitting with an artificial limb. A patient may or may not be able to get the full use of the limb. But surely a certain amount of functionality can be restored. The main advantage will be that the cancer would be treated without major disability.

Apollo Hospitals India specializes in management of bone tumors and there is a specialized surgical team that focuses on the management of Bone tumors.

Knee Replacement:

Apollo Hospitals, India, offers advanced treatment for conditions of the knee joint such as arthritis that can severely affect the knee and hamper routine activities.

What is Arthritis?

Arthritis is inflammation of the joints. A gradual wearing away of the tissue on the ends of bones results in reduction of joint space and friction at the exposed bone surfaces, changing regular bone movement and causing severe pain. Knee Replacement Surgery is the best solution to treat the condition and allow resumption of normal activities in the knee.

The types of arthritis are:

Osteoarthritis:

This occurs after the age of 50 in individuals with a family history of arthritis. The tissue that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid Arthritis

This is a disease in which the inner membrane of joints is thickened and inflamed. This results in excessive production of the fluid that lubricates these joints. This chronic inflammation can damage the tissue covering the ends of the bones and eventually result in loss of the tissue, pain and stiffness.

Traumatic Arthritis

It can result from a serious knee injury. A knee fracture or severe tears of the knee's connective tissue may damage the tissue covering the ends of the bones over time, causing knee pain and limiting knee function.
Symptoms

·         Severe pain in the joint that restricts everyday activities such as walking, climbing stairs and getting up from chairs.

·         Severe pain while resting.

·         Inflammation and swelling of the joint that does not improve with medication and rest.

·         Deformity in the joint.

·         Joint stiffness or inability to move the joint in a normal manner.

Treatments
some of the knee surgeries and treatments performed at Apollo Hospitals, India are:

Total Knee Replacement:

For patients suffering from severe arthritis that can cause acute pain and make even routine activities difficult, Total Knee Replacement is the best solution. The procedure involves removing all diseased portions of bone and tissue on their ends, and replacing them with metal and high density plastic components shaped to create a structure that allows normal movement of the joint. Other knee deformities will also be corrected during the Surgery.

Partial Knee Replacement

This minimally invasive procedure is an option for arthritis patients in whom only one part of the knee has been affected. In a Partial Knee Replacement the diseased portion is removed and replaced with a metal implant.

High Tibial Osteotomy

An osteotomy is Surgery that involves shaping and realigning of bones at a joint. It is usually used to treat arthritis in young patients, and is particularly recommended for those with very shallow joint sockets.In High Tibial Osteotomy the upper part of the tibia - one of the limbs forming the lower leg - is resurrected, mostly by removing a small part of bone in the area.

Minimally Invasive Knee Replacement (Resurface) Surgery (MIKRS) using OrthoGlide Medial Knee system.

OrthoGlide, a metallic, wedge-shaped device is a novel implant that replaces worn cartilage inside the knee. It offers patients a less invasive alternative to total knee replacement. This device is inserted into the knee through a 5 to 7 cm incision, which relieves pressure, restores proper joint alignment, redistributes the load more evenly and increases stability.This surgery promises a less expensive and easy path of regaining normal lifestyle functions, and it definitely offers a new ray of hope to active and young patients who are worried about major surgery and prolonged post op rehabilitation to deal with Knee Arthritis.

The Major advantages of this surgery over standard Total Knee Replacement includes its affordable cost and early rehabilitation which helps patients to return to their normal routine and life style expeditiously. It allows the patient to squat and seat cross legged, an important part of our daily lives in India and which is not possible with the conventional knee replacement surgery. Above all OrthoGlide allows delay of total knee replacement until patients are older and less likely to require a second knee replacement.

As against a Total Knee Replacement, Minimally Invasive Knee Replacement (Resurface) Surgery involves a 2 inches incision, no cutting of the natural bone, the joint is left intact, no cutting of the muscle therefore no bleeding, less painful, low infection, less complications, fast recovery, can walk the same day, the surgery can be performed as a day care surgery and therefore doesn't require hospitalization.

Minimally Invasive Subvastus Total Knee Replacement 
Minimally Invasive Subvastus Total Knee Replacement is a revolutionary procedure performed at Apollo Hospitals with great success.

This procedure promises lesser pain along with quick recovery and is performed by pushing the muscles to the side-following the Sub Vastus approach instead of cutting the muscles. This treatment is cosmetically appealing because the skin is cut only upto 8-10 cms. Also, the kneecap is not flipped as in the conventional method but it is only pushed to the side to expose the joint. Due to this, the strength of the muscles in front of the thigh extensors is preserved. The bones are not separated from each other but they are cut in place, which minimizes the stretch injury to the structures surrounding the joints. This approach can result in significantly less trauma to the leg, faster healing and more strength and mobility in the new knee.

Along with good pain control measures, minimal pain after the surgery is ensured. The patient will be able to lift the leg immediately after the surgery and can stand and walk with support the same day. The knee can be bent upto 90 degrees and the patient will be able to walk atleast 100 steps by the 3rd day-at the time of discharge. After 2 weeks time, they will be able to walk independently without any support and getting up from the sitting position becomes easy in 1 to 2 months time. Within 2 to 3 months, they will be able to stand for a long time and walk any distance without suffering from any heaviness in the thigh muscles. In other words, the patient tends to forget the knee surgery in 2-3 months and will be able to resume their day to day activities comfortably.

 

Total knee replacement using Patient specific zigs

Total knee replacement using patient specific zigs is a new cutting edge technology in this field. The customized cutting blocks are made preoperatively using CT scan images of the patient's knee and leg and then the surgery is done with the help of these blocks. This technology not only improves the accuracy of the knee prosthesis placement but also helps in less operative time, reduced blood loss, improved accuracy, enhanced surgical outcome and faster recovery with shorter hospital stay.

This first ever "Made in India-Made for India" technology has been indigenously designed and developed by a leading US based company that has its RND centre in India. This customized zig that meets quality standards will take Knee Replacements to a new level.

Correct alignment of the artificial knee replant is the key to a successful surgery. Closer the implant alignment, the better will be the surgical outcome. Traditionally achieving this alignment was based on the experience, skill and judgment of the surgeon. With the advent of the customized zig technology, the accurate alignment for the individual patient can be the calculated much more before the surgery, based on a CT-Scan. The CT-Scan and computer analysis help arrive at the most accurate alignment for the particular patient, based on which a specific zig is manufactured.

The zig which is customized for each patient is used to give the most appropriate bone cuts and positioning of the implant during the surgery. Apart from the official surgery, customized zigs also improve knee functions post-surgery and the costs are one third too.

This technology not only improves the accuracy of the knee prosthesis placement but also helps in less operative time, reduced blood loss, improved accuracy, enhanced surgical outcome and faster recovery with shorter hospital stay.