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Computer
Assisted Joint Replacement Surgery unit in the Hospital launched
17th Aug. 2006
Factors affecting the life span of total knee prosthesis varies.
Ones of the most important factors is the accuracy of prosthesis
placement and the restoration of surrounding muscle and ligament
balance. Computer technology has been introduced to assist in more
accurate positioning of prosthetic components, allowing the
surgeons to make informed decisions intraoperatively for precise
prosthetic placement. This allows physiologic muscle and ligament
balance which is an important factor in prolonging the prosthetic
lifespan and reducing the chances for an early revision
arthroplasty.
Research shows that malalignment of prostheses can cause the
malfunction of the knee joint with resultant knee pain. It can
also accelerate the wear of prostheses, predisposing to prosthetic
component loosening. Malalignment in the range of as little as
plus/minus 3 degrees has been shown to increase the incidence of
prosthetic loosening from 3 to 24% after 8 years.
CAS is incorporated with software to process images real time. A
digital model is produced that serves as a map for each particular
procedure. The image is then made available to surgeons to guide
them through the operation. Surgical instruments can be
incorporated into the map so that instrument position, attitude,
and progress can be monitored and controlled to within fractions
of millimeters. Surgeons can use this real-time data to correct
the procedure intraoperatively. This is much different from non-CAS
surgery as the prosthetic evaluation by X-ray is done
post-operatively. Should there is any incorrect prosthetic
alignment, there is a greater likelihood of requiring a subsequent
revision. There is a greater risk for post-operative complication
as well as increased costs. In this case of incorrect prosthetic
alignment from non-CAS surgery, the patient and physician must
accept the surgical outcome, including the likelihood of shortened
total knee arthroplasty life span.
A sensing device is attached to the patient’s knee for patient
data registry and an infrared camera will help receive the data
for processing and create each patient’s digital model. The
software contains data for various types and sizes of prostheses.
The computer will then assist the surgeon with enough information
to prepare the best bone bed surface for each particular type of
prosthesis, as well as assisting the surgeon in choosing the
optimal prosthetic size for the patient. The surgeon will then
apply the data from the CAS system to shape a fitted bone bed. CAS
also helps in monitoring the accuracy of the bone bed shape
preparation. If there is a malalignment, timely correction can be
performed right away. The latest version of the software enables
the surgeon to determine the balance of the surrounding ligament
and muscle. The ultimate goal is for optimum functionality and
durability over time.
Presently, a new procedure of Minimal Invasive Surgery (MIS) is
widely recognized as it produces minimal incision and enhances
cosmetic results. That is why CAS must be incorporated with MIS if
adequate results are expected. When CAS is applied with MIS, the
surgeon can see through the incision using a CAS monitor,
enhancing visualization and surgical accuracy. The likelihood of
prosthesis malalignment will then be reduced. It is believed that
CAS in conjunction with MIS is a promising area in orthopaedic
surgery.
Computer Assisted Joint replacement Surgery Facts
Surgeon uses his eyes and fell to achieve accuracy. Computer Image
Guided Surgery enhances these modalities for higher accuracy.
Perfection with consistency is difficult in knee replacement
surgery without computer image guided surgery. This is proven
beyond doubt and in all corners of the world.
Current methods of joint replacement are acceptable, but not
perfect. With the help of Computer Image Guided Surgery,
perfection is a reality. With perfection comes better and longer
lasting results.
Only three degree deviation leads to higher failure. An
experienced surgeon using computer assisted surgery can avoid this
consistently.
Use of computer-aided methods in joint replacement improves the
precision of implant positioning and ligament balancing, producing
better clinical results that extends the life of the implants.
With Computer Image Guided Surgery the surgeon has a greater
“vision” during surgery.
This supports decision-making and enhances the surgeon’s
flexibility to accommodate individual variation in knees of
different people.
During the surgery, the surgeon has only one chance to make a
correct cut. The Computer Image Guided Surgery System allows the
surgeon to precisely judge the accuracy before making a cut. This
is of immense value.
A 3-D infra-red camera identifies parts of knee and generates
images on computer screen to help surgeon have a ‘third eye’ to
have control over fractions of a millimeter and half a degree.
Advantages of Computer Guided and Minimal Invasive Surgery
Increased implant longevity.
Cutting bone and positioning the components with an accuracy up to
0.5 degrees and 0.5 mm
Ability to judge the bony cuts before actually making the cuts
Ability to verify the cut to very precise accuracy
3 Dimensional planning.
Constant guidance, monitoring and confirmation during surgery.
Range of motion analysis to achieve maximum function.
Minimally invasive surgery, hence
> Decreased blood loss.
> Decreased hospital stay.
> Smaller incision
> Back to feet in 2 days
> Less pain after surgery
> Early return to work
Correct implant selection and placement.
Decreased incidence of pulmonary embolism in knee surgery.
Reduced complications like
> Dislocation.
> Impingement.
> Limb length inequality
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The 1st Annual
International Trade Fair of Medical Industry in India, Meditec2006
ORBIT Expositions & Conventions and HITEX launched the1st Annual
International Trade Fair of Medical Industry in India, Meditec2006
from 19th February 2006-21st February2006 at HITEX, Hyderabad. It
was targeted at creating the only window for medical technology in
the South Asia and can boast of an active participation of
exhibitors from India, China, Taiwan, USA and Canada.
The various conferences and seminars conducted during MEDITEC2006
by MODERN MEDICARE, APOLLO Hospital and POLYCOM were the
highlights of the event, which captured the interest of many
medical professionals. Renowned doctors from all over the country
who had expressed their pragmatic views and experiences on various
topics of Medicine and Healthcare conducted the clinical lectures.
Several eminent speakers spoke on the occasion, which included,
Emergency Medicine- Dr. Bharesh Dedhia, Chief of Critical Care
Services, Dr L H Hiranandani Hospital, Mumbai.
Versatility of ‘Jess’ in Orthopaedics- Dr. Ram Prabhoo
Advancement in Cancer Treatment & Technology- Dr. Divyesh Mehta
Design Integration, Concept to Market- Prof. Munshi,IIT Mumbai
Mammography- Dr. Yojana Nalawade
Gastroenterology in India- Dr. Manu Tandon
Hospital Acquired Infection- Mr. Prabhakar
An Overview on Global regulatory requirements for Medical Devices-
Mr. Jibu Mathew
Pictures :
(Click to Enlarge)
Dr. Bharesh Dedhia taking the lecture at MediTec 2006
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Unusual ENT cases operated at
Dr L H Hiranandani Hospital
Dr. Navin Hiranandani operated several unusual cases at the
Hospital. Recently, in a case of cholesteatoma in the roof of
middle ear – Indian patient who was from England came for ear
discharge. Formerly, cholesteatoma used to have radical surgery.
The patient was however, operated with a limited approach with ear
microscope. C.T. scan showed minor erosion of the roof of middle
ear during operation, cholesteatoma was removed and erosion of the
tegmen tympani with exposure of dura mater was done. The erosion
of tegmen tympani i.e. brain covering was 1 ½ cms. However with
early surgery, minimal access was done for middle ear and mastoid
in the attic region and cholesteatoma spread was arrested. Facial
nerve canal was eroded. With a conservative approach, both tegmen
tympani and facial nerve were cleared and future complications
would be avoided. Resort to a radical procedure was also avoided
and reconstruction of the eardrum with facial graft was done at
the same time.
One case of Ranula (floor of mouth) came with history of previous
operation. He had history of swelling in both floor of the mouth
and below the oral cavity. However to avoid external scar,
especially in a young girl, the operation was done intra orally
and remnant of abnormal tissues of Ranula were removed again with
no external incision and the patient made recovery.
A case of otosclerosis (fixation of stirrup bone) with deafness
was operated. On opening the middle ear, footplate of stapes
(stirrup bone in the middle ear) was very thick. These cases carry
some risk during surgery. However, judicious use of micro drill
restored the hearing to a normal level. Advanced cases of
otosclerosis have indifferent results. However, proper use of
microdrill can bring hearing back to normal with intra canal
approach in many cases. Prosthesis as usual is used to replace the
stapes (stirrup bone) in the middle ear. Although such cases have
been done before with microburrs, the hearing improvement can
occur even in advanced cases with proper use of microburrs.
Several such cases are made all right and cured.
Limited access surgery can be done with microscope for ear surgery
appropriate to the disease and neck swelling with quicker recovery
and early mobilization of the patient.
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Hiranandani Hospital has sponsored the Auto
Rickshaw stand
18th Nov. 2005
On 18th Nov the Hiranandani Hospital has sponsored the Auto
Rickshaw stand next to Huma Adlabs for the benefit of commuters
and Autorickshaw Drivers. Mr Niranjan Hiranandani himself
inaugurated this stand. This arrangement will be helpful in
alleviating the auto woes of commuters at Kanjurmarg Station.
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Interaction with University of Technology, Sydney, Australia
The University of Technology, Sydney, Australia team visited Dr L
H Hiranandani Hospital to discuss on best nursing practices. The
UTS faculty from Sydney consisted of Prof. Christine Duffield &
Dianne Pelletier who stayed in hospital campus for the entire
period to carry out a “Gap Analysis and quality assessment” of the
nursing department.
This program included a review of nursing services, Human Resource
management, IT & use of technology, Leadership, Care Continuum &
Safe nursing practices, with special attention to evidence based
practice, nursing documentation & Nursing processes.
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After 28 yrs
he has got his smile back....
One of its kinds Dental Surgery which gives a smile to a UK
national after 28 yrs- A UK National came to the Dental OPD of
DLHHH. He selected the hospital because of its excellent
reputation, extreme cleanliness, excellent ambience and excellent
facilities. Team of Doctor from DLHHH & Mr John Victor Forstar
gave the patient a full Maxillary Implants and Ceramic Prosthesis.
The patient was so happy that he said that after 28 yrs he has got
his smile back.
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Click
here to view the Certificate......)
