Surgery

Department of Orthopaedics, joint replacement, Sports Medicine and Spine Surgery at Dr L H Hiranandani Hospital is one of the well-known Orthopaedic Centre Internationally. Orthopaedic surgeons in this hospital range from the Icons of the city to young dynamic surgeons trained for specific super specialities. Our orthopaedic surgeons not only perform excellent surgery but they are well known at international level as faculty for teaching and research. From Trauma to Joint Replacement Surgeries, from Arthroscopy to Sport injuries and from Spine surgeries to Paediatric orthopaedics, our surgeons are trained to perform to the best of their ability. They are well supported by the state of the art joint replacement operation theatre. Computer navigation and advanced arthroscopic equipment facilitates the Orthopaedic endeavour. All this is supported by digital Radiography, CT scan, MRI facilities that will make the services rendered of a very high quality.
We have a Triage process for determining the priority of patients' treatments based on the severity of their condition. Our Casualty is capable of handling all Life and limb saving procedures.

• Computer assisted Joint Replacement – Primary and Revision surgery for Hip, Knee, Shoulder & Elbow
• Arthroscopic Surgery of hip, knee, shoulder and elbow, ankle and wrist joint
• Sports Medicine
• Spine Surgery – Disc Surgery, Corrective surgery for degenerative Spine problem, Scoliosis surgery & Infection of spine
• Paediatric Orthopedics
• Platelet Rich Plasma / Autologous Platelet Concentrate Therapy
• Trauma Centre with 24hrs Emergency Casualty Services
• Regenerative Biological Orthopedic Medicine – Cartilages & Bone Implantation

Our Initiatives

HOME (Hiranandani Orthopaedic Medical Education)

Hiranandani Orthopaedic Medical Education (HOME), academic Orthopaedic division of Dr LH Hiranandani Hospital, Powai, Mumbai has been approved as an International Education Centre of SICOT (Socie'te' Internationale de Chirurgie Orthope'dique et de Traumatologie), largest International Orthopaedic Organisation.

Hiranandani Orthopaedic Medical Education (HOME) is a research unit that is dedicated to the field of Orthopaedics. The unit has submitted its first international paper to the Journal of Bone and Joint Surgery (British Volume) in March 2009. Since then there have been a number of publication. HOME boasts of a Research Fellow, a fulltime research assistant with dedicated sessions for literature search, data entry, and management of a newly developed software called SwingSmart ™.

HOME is working on a number of projects related to clinical research in Orthopaedics. A number of scientific meetings have also been planned for the future.

Two Research Fellowships are offered from HOME. The tenure is for six months initially and extendable for a year. Research Fellows are responsible for carrying out, and completing the projects. The Fellows are supervised by the three full time consultant orthopaedic surgeons. There are targets and deadlines for the projects. The Fellows are expected to present the papers in national and international conferences.

HOME also has Johnson & Johnson fellowship programme for joint replacement for 6 months. We also have one month visiting fellowship for joint replacement from Indian Orthopaedic Association MP Chapter.

HOME is a collaborative effort of the management of the Dr LH Hiranandani Hospital and the department of Orthopaedics who recognize the immense need for research in India.

The ultimate goal is to share what we are learning & orthopaedic teaching, to compare results, collaborate on promising treatments, and disseminate this important information to the orthopaedic community at large.

Joints in Motion -Arthritis Support Group
Arthritis is the world's leading cause of disability. It is the inflammation of joint cause's pain, stiffness and swelling. As per statistics of WHO (World Health Organization) there will be increase by 400% in people aged over 65 during next 30 years. As the population of the world grows older and medical advances lengthen average life expectancy, osteoarthritis will become lager public health problem. So one of the most pressing problems in the future will be need for joint replacement of arthritic disease

To spread the knowledge about the pain free management of Arthritis Department of Orthopaedics and Joint Replacement Surgery at Dr L H Hiranandani Hospital has established Arthritis Support Group in India. This is a unique Support group which provides a common platform for those suffering from arthritis. Till now we have conducted 50 support groups' meets at various locations.

Sports Medicine Clinic
With increasing interest in sports and exercise in India, sports injuries have become very common. Injuries sustained during sports or exercise can limit performance of sports person and prevent him from achieving full potential. These injuries if neglected may also lead to development of arthritis.

Sports Medicine is a branch of collaborative medicine that specializes in preventing, diagnosing and treating injuries sustained during sports or exercise. Our goal is to assist the patient in return to sports and to achieve peak performance and prevent any future problems.

Sports medicine is not only for the competitive athlete but also for a non-athlete who enjoys playing sports or exercise occasionally, the so called 'weekend warriors'

Services Offered :

• Joint consultation by sports medicine orthopaedic surgeon and physiotherapist trained in the US, UK and experienced in care of professional sports persons.
• Diagnosis & management of all injuries arising from participating in sports or exercise

• What is Joint Replacement?

  Arthritic or damaged bones surfaces are removed and resurfaced with an artificial joint know as prosthesis. Knee and hip replacements are most common, but joint replacement can be performed on other joint such as the shoulder, elbow, etc.

• Why Joint Replacement is necessary?

  When complete joint is damaged with degenerated cartilage all over then it becomes difficult for the patient to continue day to day activities of life. So total joint replacement to be considered if other options like medication, physiotherapy etc will not relieve pain and disability in such condition. The goal is to relieve the pain in the joint caused by the damage done to the cartilage. Total joint replacement which is also called as Arthroplasty is one of the most successful and innovative surgery of 19th Century.

• How is Total Joint Replacement performed?

  Under the effect of spinal or epidural or general anesthesia the damaged ends of the bones and cartilage are replaced with an artificial joint made of metal and plastic surfaces. They are shaped to restore joint movements and function.

  The materials used in a total joint replacement are designed to enable the joint to move just like your normal joint and hence resemble the normal joint closely. The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Alloys of cobalt, chrome and titanium are main metal used. The plastic used is ultra-high-molecular-weight-polyethylene. Using these advanced bio-materials and well executed surgical technique one can expect excellent results of long term durability.
  
  Total Hip Replacement Surgery
  This surgery is the most successful innovation of 19th Century. This remains gold standard procedure. In this operation socket and ball (head) of the femur bone is removed. Depending up on the bone quality new socket and stem-head made of different materials is used in. This articular surface material could be combination of plastic (ultra high molecular weight polyethylene) on Metal (cobalt chrome molibdinum), plastic on ceramic ball and ceramic on ceramic ball. Again depending up on the age and quality of bone these joints have been put in with bone cement or without bone cement. Results of this conventional hip replacement surgery are excellent only difference from hip resurfacing is that original ball is not conserved and patients are not allowed to squat.
  
  Total Knee Replacement
  When whole knee joint (all compartments) is affected then only solution to relieve pain and get back to normal routine activities is total knee replacement surgery. In this procedure thigh bone side of joint (femur) is replaced with metal prosthesis, leg side (tibia) is replaced with metal and plastic and knee cap (patella) is replaced with plastic prosthesis. Results and durability of this surgery is excellent.

  There is a breakthrough technology with high flexion –Knee designs where patient can get complete knee bending and can sit cross legged after surgery. This has been done regularly in Dr L H Hiranandani hospital. Knee replacement surgery in our hospital regularly done using computer navigation system.
  
  Unicondylar Knee Replacement
  When one compartment of knee joint is arthritic then replacing this part with metal and plastic joint through a small incision (skin cut) provides excellent quick recovery. Benefit of this operation is that patient can bend the knee fully and can perform most of the activities. Hospitalization for this surgery is just two days.

• How post-operative pain management is done?

  A very special technique patient control analgesia (PCA) is used where a catheter is kept in epidural space and through PCA pump pain relieving medicines are delivered in controlled fashion to relieve pain. If patient need more dose of medication as per pain, (extra medicine) a bolus can be adjusted by patient himself/herself through hand press button given to them in post-operative period for 2 to 3 days. There is no post-operative pain; hence this is painless joint replacement surgery.

• How long is hospital stay?

  In case of knee, hip, shoulder and elbow replacements patients have to be in the hospital for about 3 to 5 days. After unicompartmental knee replacement patient goes back home in 2 days time.

• What about physiotherapy?

  In general physiotherapy program is neither strenuous nor painful. Few simple actions of exercises are taught to the patients by physiotherapist. They have been also taught proper gait training with the use of walker and crutches or canes.

• Whether both knee replacements can be done together?

  Yes. Both knee/bilateral knee replacement can be done same day & same time. Safety of the patient is the most important criteria for this surgery. Medically fit patient having pain in both knees and willing to undergo surgery on both sides is the indication for bilateral total knee replacement. Advantages of joint replacement surgery

  Advantages of joint replacement surgery

  • Complete relieve from pain.
  • Correction of deformities.
  • Increase range of movements of the joint & stability.
  • Improvement in walking ability.
  • Better quality of life.

• What are the complications?

  • Infection : This is avoided by performing surgery in special joint replacement operation theatre having laminar air flow, use of body exhaust gown and appropriate antibiotics.
  • Loosening and Dislocation: This is avoided by proper instruction to patients, proper surgical technique and use of appropriate designs of implants.
  • Risk of clot formation: This clot formation in leg blood vessels can be avoided by proper precautions in high risk patients.

• What is Computer Assisted Joint Replacement Surgery?

  Computer-assisted joint replacement surgery is one of the most advanced treatment approaches utilized within orthopedic medicine. In the course of preparing for a knee operation, this technology allows your surgeon to complete a comprehensive assessment of the joint, including the potential creation of a 3-dimensional anatomical model. During the actual surgical procedure, these pre-op insights will be used to ensure proper joint alignment (often within fractions of a millimeter) and prosthetic placement. This means surgery could be performed with high accuracy and precision.

• How it is done?

  Computer-assisted surgery, abbreviated CAS, uses special probes attached to the body to help your surgeon ensure proper positioning of the joint replacement implants. The probes are detected by an infrared camera that is connected to a computer terminal. The computer terminal constructs an electronic model of the knee or hip based on the information gathered by sensing the position of these probes. The computer can then help guide your surgeon's placement of the knee or hip replacement implants to ensure proper positioning of the joint replacement. This also helps in proper alignment of implant, lower limb axis and ligament balancing.

• What are the advantages?

  The Advantages of Computer Guided Joint Replacement Surgery are : 

  • Restore accurate leg alignment
  • Increase the survival of the implanted joint
  • Reduce the risk of complications
  • No Radiation during Surgery
  • Constant guidance & monitoring during surgery
  • Range of motion analyses to achieve maximum function
  • Minimally invasive surgery hence decreased blood loss
  • Decreased Hospital stay

• What is arthroscopy?

  Arthroscopy is a technical term for keyhole surgery of any joint. Keyhole surgeries in joints such as knee, shoulder are well established. There are very few centers in India where Hip and small joint arthroscopy is performed. Dr L H Hiranandani Hospital is one of those distinguished few.

• What are the advantages of arthroscopic surgery?

  Until recently any approach to the joint pathologies by surgeons, involved open surgery. Open surgery means a large incision and a hospital stay of 7 days or longer, exposing the patient to potential risks such as infection, deep vein thrombosis (clots in deep veins), major nerve or vessel injury and muscle weakness. Open surgery of the joint in young adults, therefore, may expose the joint to the ravages of arthritis in later years. Arthroscopic surgery of the joints therefore, appears to be an attractive option has proved to be very successful in multiple clinical studies.

• What does the surgery involve?

  Arthroscopy is usually a day case, or overnight stay. There are multiple procedures that can be now performed with keyhole approach and use of camera and telescope, right from cleaning of arthritic debris to ligament and tendon repair and reconstructions, instability surgery and also intra-articular fracture fixation.

• Who are the potential gainers?

  Almost everyone with joint problem can be treated with arthroscopic surgery when indicated. The indications are increasingly becoming vast. Historically, athletes and active young individuals were the only targeted population but arthroscopic surgery has led to a better understanding of the mechanisms and injury patterns not known before. Hence even the elderly with knee, shoulder and other joint problems benefit significantly from arthroscopic procedures.

• What are the recent advances?

  Hip and small joint arthroscopy although a fairly new concept in India, globally has taken arthroscopic surgery by storm. Arthroscopy of the hip joint has led to a greater understanding of the nature of adolescent and adult hip pathologies, and, offers comprehensive access to an evolving series of conditions that affect the hip joint, many of which were previously unrecognized and, thus, left untreated.

• What is Plasma Rich Therapy About?

  A number of orthopaedic & sports conditions remain a major therapeutic challenge even this day and age; for example: Achilles tendon and tennis elbow. Two treatment methods that hold promise for the future of tendon disease management are injection of autologous platelet rich plasma (PRP) / Autologous Platelet concentrate (APC) and a tissue engineering approach to regenerate healthy tendon tissue.

• What are platelets?

  Platelets are small disk or plate like structures formed in blood, that are partially responsible for blood clotting (stops bleeding), and are critical in healing process. They promote more rapid healing by secreting various growth factors, which enhance recovery.

• What are platelets?

  Platelets are small disk or plate like structures formed in blood, that are partially responsible for blood clotting (stops bleeding), and are critical in healing process. They promote more rapid healing by secreting various growth factors, which enhance recovery.

• How safe is it?

  It is safe because it is the patient’s own blood that is processed and used in the therapy. Thus there is NO RISK of transmission of infectious disease.

• What are the disadvantages of this procedure?

  • The procedure is known to be associated with tolerable local pain after injections
  • The long term results are not known