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.

Fortis Hospitals Mulund (formerly Wockhardt Hospitals) marks a feat in the field of pediatric cardio-thoracic surgery by performing a complex beating heart coronary artery bypass surgery on an infant. A team of cardiac experts led by Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund has successfully corrected a complicated and rare congenital deformity called ALCAPA (Anomalous Left Coronary Artery From the Pulmonary Artery) giving the baby a new lease of life.

Baby Sharon was born with normal delivery without any specific symptoms of heart defect during her birth. However after 4 months she suffered from severe cold and cough and was admitted in a city hospital as she was diagnosed of pneumonia. The baby seemed to suffer from increased breathlessness with a very high heart rate. On further investigation the baby was diagnosed of having an enlarged heart and the parents were advised to consult a pediatric cardiac surgeon.

“Baby Sharon was brought to us in a severe condition where she was suffering from severe breathlessness, excessive crying and was extremely feeble due to poor intake of feed. Upon further investigation we diagnosed her with a congenital heart defect called ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery). ALCAPA is a rare birth malformation where the positions of the arteries are switched and the left coronary artery comes out of the pulmonary artery. It occurs in approximately in 1 in 4-5 lakh live births (0.25% - 0.5% of the total birth defects) and if not treated at the appropriate time accounts for 65 % - 85 % of deaths with in 1st yr of life from congestive cardiac failure,” said Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund.

At the time of birth babies born with such deformities remain active like any normal child but as the child grow the symptoms manifests into breathlessness, inactivity and weak intake of food and they grow very weak and uncontrollable.

“ALCAPA is a serious problem and requires surgery immediately after the birth or as soon as the diagnosis is confirmed. The aim of surgery is to connect the Anomalous left coronary artery with the aorta. The precise surgery depends on the exact location of the Anomalous left coronary artery. Sometimes, it can be moved, along with a button of tissue, from the pulmonary artery and sewn into the aorta. If the Anomalous left coronary artery is located too far away from the aorta to move, a "tunnel" is made from the aorta to the Anomalous left coronary artery or by pass surgery is done by using artery of left arm.”

“Usually to perform such complex surgery heart lung machine is required which is also commonly called On-pump bypass surgery. However in the case of Baby…. we performed the surgery successfully without using heart lung machine, which means, off pump Coronary artery Bypass Graft (CABG) procedure with the self equipped instruments. Off pump bypass surgery are much common in the adult procedure group, but in neonates such procedure till date is only heard off” added Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund.

1. Grafting vessels on a moving heart which needs small compact stabilizer. Stabilizer for small neonate is not devised till date.

2. Left coronary artery was not appropriate for the graft

3. Poor functioning heart of the baby, Ejection fraction = 25%

Beating heart surgery was performed on the baby to avoid the post operation complication like fluid retention, kidney failure, lung injuries, and acute inflammatory reaction with mild to moderate heart dysfunction, hence helping the baby for the easy & early recovery. The surgery was done without using any stabilizer as such small size stabilizer for newborn babies is not manufactured by any company in the world. It is with the skill of the surgeon who has managed out the surgery without the stabilizer. Baby Sharon’s story showcases the expertise the country has in correcting the most complex congenital defects in the rarest of condition with a combination of skillful hands and technical finesse.

“The diagnosis of Sharon suffering from congenital heart problem came to us as a surprise. When Sharon was not keeping too well, we had the remotest thought of having anything to do with her heart. In fact before this I had very less awareness on congenital heart problems. In our country many kids succumb to faith due to lack of awareness on the defects and availability of expertise to correct such deformities. We need to create more and more awareness on congenital heart disease in India and the facilities provided by hospitals like Fortis Hospitals Mulund to operate upon the most complex cases. We are immensely thankful to Dr. Suresh Joshi and the entire team at Fortis Hospitals Mulund who came to us as saviors and gave a new life to our baby” says Mr. Bonni D’Souza (father of Sharon).