Orthopaedics

Orthopaedic surgery is a branch of surgery, which deals with the diseases & disorders affecting musculoskeletal system, which includes bones, joints, muscles & nerves supplying them. The orthopaedic doctors at All is Well Multispecialty Hospital treat cases surgically as well as non-surgically as per the requirement.

All Is Well Multispecialty Hospital treats musculoskeletal problem, spine diseases, sports injuries, congenital disorders, tumours and infections pertaining to musculoskeletal disorders. Being one of the best orthopaedic hospitals in town and nearby districts, All is Well Multispecialty Hospital provides and effectively manage services like Joint Replacement Surgeries, Arthroscopy, Arthroplasty, Bone Cancers, Hip Resurfacing, Knee Replacement, Fractures and Trauma.

Key features:

  • Joint replacement surgeries of hip, knee, and shoulder joint.
  • Arthroscopy of hip, knee and shoulder joint.
  • Knee replacement surgery.
  • Fractures reconstructions and trauma surgery.
  • Paediatric orthopaedic surgery.
  • Revisions of joint replacement like knee, hip etc.
  • Sports surgery
  • Rheumatology
  • Osteoporosis & Metabolic Bone Disease.
  • Orthopaedic Oncology

Special Services Offered

  • The centre offers the most comprehensive treatment for disorders of the musculoskeletal system. The centre specialises in the use of orthobiologics like:
  • Autologous chondrocytes for articular (joint) cartilage repair.
  • Autologous osteoblasts and stem cells for bone repair in avascular necrosis.
  • Platelet Rich Plasma (PRP) for musculotendinous problems.

Technology
The hospital has dedicated operation theatres supported by Computer-Aided Navigation Systems for Joint Replacement & Arthroscopic Surgery that provide accuracy and in turn superior long-term results. Our physical medicine and rehabilitation programme supports this centre and ensures that all our patients get back home faster and with greater independence.

Orthopaedic Spine Surgery
More than 2/3rd Indians experiences back pain, which affects activities of daily life. Many conditions mainly appears and occurs as part of the aging process, but the arthritis like condition also may appear in younger individuals due to changing lifestyles. Back pain takes a toll not only on the patient but also on their family and friends. Many patients find that along with the back health their personal relationships also slowly starts deteriorating.

Spine Surgery
We bring together sub specialists from multiple disciplines to provide treatment option to evaluate and treat individuals with disorders of the spine. The expertise of our orthopaedic spine surgeons combined with advanced non-surgical and surgical services; make our hospital one of the most advanced & state of the art.

Our service treats the complete range of spinal conditions, including:

  • Degenerative Spine Diseases (e.g. Herniated Discs, Stenosis and Spondylolisthesis).
  • Spinal Deformities (Scoliosis and Kyphosis).
  • Bone and Joint Infections e.g. Tuberculosis, Osteomyelitis.
  • Injuries resulting from trauma, work-related accidents, and sports injuries.
  • Tumors
  • Non-invasive management of spine disorders.
  • Acute and Chronic Pain Management.

At the Spine Clinic, we conduct a wide variety of spine surgeries, including:

  • Endoscopic spine surgery under local anaesthesia includes Discectomy, Endo-fusion, Cervical Endoscopy.
  • Minimal access surgeries like micro discectomy.
  • Out patient procedures like nerve root injections.
  • Spine Instrumentations / Fusions.
  • Cervical spine surgery.
  • Complex Anterior Spinal Reconstructive surgery.
  • Occipito-cervical Fixations.
  • Correction of spine deformity.

We are the only hospital in the city & nearby region offering day care surgery option for herniated intervertebral discs. We offer computer navigated spinal reconstructions and instrumentations by way of one of the many state of the art treatment options to choose from. Not every patient is necessarily a candidate for surgery. In fact, our physicians first consider all non-surgical options. We offer exceptional personalized care; additionally our team ensures postoperative patient safety, and outstanding rehabilitation care.

Department of Joint Replacement Surgery

Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts.

The goals of Hip Replacement Surgery are to:

  • Relieve pain.
  • Help the hip joint work well.
  • Improve walking and other movements.
  • Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts.
  • The goals of hip replacement surgery are to relieve pain, help the hip joint work better, and improve walking and other movements.
  • Risks of problems after hip replacement surgery are much lower than they used to be.
  • People usually spend 1 to 4 days in the hospital after hip replacement surgery. It takes about three to six months to be completely well.
  • An exercise program can reduce joint pain and stiffness.
  • Wearing away of the joint surface may become a problem after 15 to 20 years, and may require replacement of the joint.

Why do people need hip replacement surgery?

Common reasons for hip replacement surgery include damage to the hip joint from:

  • Arthritis.
  • Disease that causes the bone in joints to die.
  • Injuries or fractures.
  • Bone tumors that break down the hip joint.

Your doctor will likely first suggest other treatments to decrease hip pain and improve function, including:

  • Walking aids, such as a cane.
  • An exercise program.
  • Physical therapy.
  • Medications.

The knee is a complex joint made up of three bones in a hinge formation: the patella (kneecap), the end of the femur (thigh bone), and the top of the tibia (shin bone). These bones articulate with each other forming the three ‘compartments’ of the knee. In a healthy knee a highly specialised and naturally lubricated cartilage covers the surface of the bones in the joint and lets the joint surfaces glide smoothly over each other. This joint is controlled by groups of powerful muscles of the thigh and the leg.

A large number of diseases and injuries can damage the knee to the point where it becomes painful or will not function properly. Although a large number of diseases can cause knee pain, the following are the most important ones: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis: This is an age-related ‘wear and tear’ type of arthritis. It usually occurs in people 50 years of age and older.
  • Rheumatoid Arthritis: This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and bone leading to pain and deformities.
  • Post-traumatic Arthritis: This can follow major fractures of the bones surrounding the knee or tears of the knee.

In an arthritic knee the joint cartilage gets degenerated and the normally protected nerve endings in the bone gets exposed giving rise to severe pain. Also secondary effects like inflammation of synovium (soft tissue lining the joint), joint effusion, and muscle spasm are present. Ultimately the joint end up in permanently deformed and a painful state restricting not only work and recreation, but also ordinary daily activities.

The surfaces forming the joint are removed and a highly polished metal prosthesis is inserted. The metal glides smoothly on a high-grade plastic insert. The soft tissue imbalance is also corrected and any deformity is also corrected simultaneously.

Arthritic knee has four grades. In earlier grades non-surgical modalities are tried:

  • You may benefit from some gentle exercise such as walking, massage swimming, bicycle or other forms of physical therapy.
  • Weight loss can be very helpful in reducing pain from arthritic knees by reducing the stress.
  • Intraarticular cortisone injection.
  • Knee cap/braces.
  • Anti-inflammatory medications and pain medications that can help you live with arthritis. Corticosteroids, injected directly into the knee may give pain relief.
  • A cane or a crutch may be required in order to walk.

Some of the surgical options available are:

  • Ostetotomy: By surgically changing the alignment of the leg, the axis of weight is shifted to the other compartment, thus slowing down the disease progression.
  • Unicompartmental Knee Arthroplasty: When the arthritic process is in the early stages and has involved only one of the three compartments in the knee, replacing only that compartment by this minimally invasive technique will address the goals of pain relief, quick clinical recovery and early return to daily activities.

Unfortunately in spite of all these measures, the arthritis is progressive in most cases. In case of grade 4 arthritis, bone rubs against bone giving rise to severe pain, in which case, surgical management is the only option.

As already pointed out, various modalities of managing the pain and preventing disease progression are available. But in advanced stages the joint worsens and no intervention is successful. Someone who is in constant pain, wheelchair bound, not able to walk without stick and not responding to non-surgical treatment should consider the option of replacement. The ultimate aim of total knee replacement is complete pain relief and restoring joint movement.

In many ways, a total knee replacement is similar to changing a set of car tyres. How long the tyres lasts depends on how much the car is used, on what types of roads the car is driven, how heavy the car is, and whether or not the car is properly serviced and maintained. Similarly, how long a total knee lasts depends on how much it is used, what types of activities it is used for and whether you have regular follow-ups.

If you want world-class facilities, dedicated team to perform your surgery, latest technology and proven track record, then All Is Well Hospital is for you!

Following are some examples:

  • High Efficiency Particulate Air (HEPA) Filters: OT environment is strictly controlled with these filters, eliminating the minutest of particles.
  • Total Body Exhaust Suit:  OT personnel use special suits for reducing the chances of infection.
  • Cementing: The prosthesis is fixed to the bone using special, antibiotic impregnated cement. Processing the cement has a huge impact on the results, sometimes deciding the success or failure of the surgery. We are the only hospital in the city to use ‘vacuum mixing’ of the cement, in all our patients, giving it the best chance to last a lifetime.
  • Pulse Lavage: Pulse lavage has proven to be the best method for thorough irrigation of the surgical wound, which in turn is essential for preventing infection.
  • Post Operative Care: Our specialist Anaesthetist ensures a pain free postoperative recovery through use of nerve blocks and patient controlled analgesia.
  • Team: An experienced team of surgeons, technicians and nurses dedicated to perform only joint replacement surgeries.
  • High Flex Prosthesis: This highly evolved prosthesis goes beyond pain relief and aims at restoring a near normal range of movement of the knee. Sitting cross-legged is possible after 6 months.
  • Gender Specific Prosthesis: Women have different anatomy compared to men. Hence, prosthesis designed specifically for women are used.
  • Computer Assisted Navigation: Here the computer collects data regarding the morphology of the bone and guides the surgeon in performing the surgery with sub-millimetre accuracy.
  • Patient Specific Instrumentation: A pre-operative MRI scan is done to collect data and instruments customised for the patient are used.  This enables performance of surgery with very high precision.
  • Minimally Invasive Surgery (MIS): Small incisions, which causes very minimal surgical trauma are used to perform the surgery.
  • Oxinium Implants: This special material developed for joint replacement is preferred for younger patients. It is known to increase the life of the prosthesis by reducing the rate of wear.

Department of Arthroscopy & Sports Injury

Arthroscopy is a surgical procedure performed by orthopaedic surgeons to view, diagnose and treat joint problems. The term Arthroscopy comes from two Greek words, ‘arthro’ (joint) and ‘skopein’ (to look). The term simply means ‘to look inside the joint.’

Arthroscopic surgery has revolutionised the diagnosis and management of joint problems. Initially used only as a diagnostic tool prior to open surgery, the availability of better instruments and techniques has encouraged the use of arthroscopy for treating a variety of joint problems, avoiding complicated surgeries and longer recovery. In fact, except joint replacement and major intra-articular fractures, all other problems involving the hip, knee, ankle, shoulder, elbow and wrist joint can be treated with arthroscopic surgery.

The procedure is carried out under general or regional anaesthesia. The Arthroscope (telescope) is introduced into the joint through a small puncture wound. Images are sent from the Arthroscope to a television screen so that the surgeon is able to see the joint. Firstly, a detailed examination of the joint is performed, the problem identified and thereafter appropriate surgical treatment is carried out. Cartilage damage, ligament tear, etc., are treated with small instruments introduced into the joint through a second puncture wound.

Some of the advantages of an arthroscopy compared with traditional open surgery include:
•    Less postoperative pain
•    Faster recovery time
•    Quicker return to function
•    Lower risk of complications

Arthroscopy Services Offered include:

KNEE ARTHROSCOPY
•    Knee Ligament Reconstructive Surgery
o    Anatomic Arthroscopic ACL Reconstruction
o    Arthroscopic PCL Reconstruction
o    Multiple Ligament Reconstruction for dislocations
•    Meniscus Surgery
o    Meniscus repair
o    Partial menisectomy
•    Articular Cartilage Repair
o    Mosaicplasty/Osteochondral Autograft Transfer
o    Synthetic Osteochondral Implants
o    Autologous Chondrocyte Transplantation
o    Osteochondral Transplants
o    Radiofrequency/ Laser Chondroplasty
•    Patellofemoral Instability Surgery
o    MPFL Repair and Reconstruction
o    Proximal and Distal Realignment Surgery
•    Arthroscopy for Synovial Pathology
•    Arthroscopy for Painful Total Knee Replacements
•    Corrective Osteotomy for Malalignment

SHOULDER ARTHROSCOPY
o    Shoulder Instability Repair for Recurrent Dislocations
•    Arthroscopic Bankart Repair
•    Reconstructive Surgery for Bony Deficiencies
o    Shoulder problems in Throwing Athletes
•    Arthroscopic SLAP Repair
•    Arthroscopic Biceps Tenodesis
•    Arthroscopy for Acromioclavicular Joint Problems
•    Arthroscopy for Impingement Syndromes
o    Arthroscopic Rotator Cuff Repair
o    Arthroscopic Management for Frozen Shoulder
o    Shoulder Reconstructive Surgery for Fractures
o    Shoulder Replacements including Surface Arthroplasty

Why All Is Well Hospital?
•    Fellowship trained in centers of excellence
•    Skilled in advanced Arthroscopy
•    Practitioners of evidence-based advanced treatment techniques
•    Supported by excellent imaging and post-operative rehabilitation team

Dr. Subodh Borle

Spine and Orthopedics