Wockhardt Hospitals Blog

~Fortis Hospitals puts 24 year old Salsa dancer back on her dancing feet with a biological implant through a keyhole surgery~

“If you are below 55 years and have a painful or damaged knee, a conventional joint replacement might be too early for you. Simply trimming a damaged cartilage and washing the knee joint & injecting it with keyhole surgery is only a temporary solution. That is up until now” says Dr. Keyur Buch, Consultant Arthroscopic Surgeon, Fortis Hospitals.

Younger people who suffer from chronic pain in the limbs which could be a result of a trauma or arthritis at a young age, often dread to undergo surgery and leave their damaged knees untreated further leading to a condition which might at a later stage result in replacement surgery.

“Any kind of knee cartilage damage or bone defect if not treated at the appropriate time could lead to further damage of the remaining fresh cartilage and bone area and thereby increase the possibility of advancements in arthritis and further damage of the knee joint impacting the mobility. With this newly introduced keyhole surgery we are looking at treating the damaged joint and cartilage which could be because of a sporting injury or an accident” added Dr. Keyur Buch, Consultant Arthroscopic Surgeon, Fortis Hospitals who recently treated a partially damaged knee of a 24 year old young salsa dancer. This advanced arthroscopic treatment offers solution to those problems which so far were not possible to treat with conventional arthroscopic surgery.

24 year old Deepika Dubey who is working as a business analyst in a travel technology firm in Bangalore and also a professional dancer was suffering from excruciating pain in her knee that restricted her mobility and daily activities to a great extent. Deepika who has been quite active in sports and dance since her school days, had a fall during her annual sports day in her college sometime in 2005 and hurt her(right) knee. The fall was not massive at that time and she left her knee without proper treatment and continued with her physical activities. “I have been a choreographer since my school days and followed my passion for dance all throughout and joined a professional Salsa course here in Bangalore.

It was just about the time when I was finishing my course to become a trained Salsa dancer; I tripped on a wet floor one day and hurt my right knee badly again badly. That’s’ when I consulted Dr. Keyur Buch and the MRI revealed that I had a cyst in my knee which had almost eaten up an area of my bone and I needed to undergo a surgery to correct my problem and get rid of the pain. The first thing I asked Dr. Buch was "When would I be able to walk properly again and would the surgery leave a big scar on my knee? And Dr. Buch had the solution. A minimally invasive surgery which sorted my problem got me out of the pain and at the same time my knee doesn’t look ugly”

“A cyst had formed in Deepika’s knee which had taken off a part of her bone and had damaged her cartilage which was causing pain in knee and affected her mobility. The size of the cyst was almost of a one rupee coin. After investigation and keeping in mind her request of having the minimalistic scar on her knee we decided to perform this advanced nature friendly keyhole surgery to replace the damaged cartilage and bone with a biological substitute instead of using metal or plastic implant in the joint.

The conventional metal or plastic implants are not suitable for people younger than 55 years of age as it increases the possibility of a revision surgery at a later stage. Whereas this new technique gives a minimal approach to the surgery and the biological implant integrates into the body easily and takes the shape of the loss bone” added Dr. Keyur Buch. “If she had left her knee untreated she would have had to undergo a knee replacement surgery at a later date and her suffering would have continued in meantime.”

The traditional method is an open surgery where the incision is quite large and the implants used is either plastic or metal which is not long lasting and the patient might have to go for a revision surgery later or if the condition further deteriorates it may require a replacement surgery. With this new technique this can be avoided as the biological bone cartilage substitute used is almost permanent, the incision is less which means less scaring and less pain, faster recovery, lesser hospital stay and no revision surgery later. The bone and cartilage problems can be successfully treated with this technique thereby restoring the normal knee function and slowing the progression of knee arthritis. The patient can lead an improved quality of life post surgery with appropriate rehabilitation and physiotherapy.

The digestive care department performs surgeries using the Minimal Access technique so that patients enjoy faster recovery and fewer post-surgical. Minimal access surgery results in less complication, minimum surgical trauma, pain and blood loss. The patient's hospital stay is shortened and his or her post-surgery aesthetics improved.
The department aims to provide outstanding Gastroenterology care that meets the needs of the patient, referring physicians and community.

Dr Hasmukh Ravat, cardiologist said, “What makes this case rarest of rare is the introduction of IVC filter (Inferior Vena Cava) implantation. A filter was put into the Inferior Vena Cava pre-operatively so that even if the blood clot was to break off and flow towards the lung, the filter would trap it before it would compromise the lung circulation.”

After insertion of the IVC Filter, the patient was taken for the orthopedic line of treatment :
“Minimally invasive technique of per-cutaneous insertion of Proximal Femoral Nail (device) was used to fix the fracture without opening the fracture site – which meant minimal blood loss (and therefore no need for blood transfusion), minimal tissue trauma (and therefore less pain and faster recovery) and no disturbance of the fracture hematoma (which meant early fracture healing without need for bone-grafting). A high-frequency, high resolution C-arm Image Intensifier (machine) was used which gave clear images of the fracture fragments and made fracture reduction and fixation easy and accurate said Dr. Sawant.

In addition to the above, a titanium implant was used to fix the fracture, whose modulus of elasticity is closer to that of bone. The device is light but extremely strong to take the weight of this obese patient. Being an intra-medullary device it was biomechanically superior to take the stresses and strains at the fracture site till the fracture unites. This allowed early mobilization of the patient out of bed and early discharge, he said.