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Mini P Thomas
Mini P Thomas


Bone set

88LizaMohan No healing touch: Liza Mohan can barely walk without a walker after her hip surgery went wrong.

Orthopaedics goes hip with computer navigation, 3D printing and more

Liza Mohan’s world turned upside down after she underwent a hip surgery.

“My bones were cut carelessly and the implants were not placed properly,” says the 57-year-old from Malappuram, Kerala. Later she had a metal rod and wires inserted in her leg that led to a severe infection. She underwent surgeries again and again to fix it, but nothing worked. Finally, the wires and the rod were removed. Mohan can now barely walk without a walker.

“The more we invade a bone, the higher are the chances of infection, bone loss and dislodging of fat from bone marrow,” says Dr Yash Gulati, senior consultant, joint replacement, and spine surgeon, Indraprastha Apollo Hospitals, Delhi. “Now we use gyroscope [a navigation-based technology used in the aircraft industry and smartphones] for orthopaedic surgeries. The idea is more accuracy and less invasion of the bone,” he says. The technology, which uses WiFi, helps surgeons position the implants exactly the way they should be. “Gyroscope-based I-Assist computer navigation helps the surgeon locate the centre of the hip, knee and ankle joint in real time on the operation table. He then places the implants at 90 degrees to the line joining these three joints, thus avoiding any shear stress at bone implant interface,” says Gulati.

The new technology has many advantages. “Better navigation not only helps in perfect placement of implants, but also reduces risk of serious complications like bone marrow particles or blood clots travelling to lung and brain, causing problems of embolisation and stoppage of blood supply to those parts. Also with this technique, blood loss is significantly reduced and single knee replacement can be done without any blood transfusion,” says Gulati. The implants placed using this technology tend to last longer, as they are placed properly and there aren't any artificial stretches on the joints. “Precise positioning of the implant is critical for short-term as well as long-term success to achieve pain-free movements with normal gait pattern. The technology gives good results in terms of knee joint function, and the recovery after surgery is much quicker,” he says.

Not just the technology but also the newer implants have significantly improved the quality of patients' life. Implants made of ceramics and Vitamin E integrated polyethlene last longer. “Now we also have implants designed specifically for the Asian population,” says Gulati. Earlier, Indian patients had to make do with implants designed for the Caucasian population.

Dr J.V. Srinivas, senior consultant, orthopaedics, Fortis hospital, Bengaluru, is confident of doing hip replacement or knee surgeries even on nonagenarians. One of the major factors that made it possible is the advancement in anaesthesia techniques. His elderly patients, says Srinivas, are able to lead a pain-free life.

Dr Sharan Patil of Sparsh hospital in Bengaluru says the advancements in orthopaedics have tremendously boosted the confidence of surgeons. “The CT scans and MRI scans are being replaced by 3D printing technology in specific challenging situations. In the 3D model, we can see the bones and joints in all their dimensions. We can rehearse the entire surgical procedure on this model even before we do them on the patient. We see what is the size of the metal implants and prosthesis to be put inside the human body, where we need to position it and where we will get a good hold of the bone. This gives extraordinary amount of precision to the surgeries. During the surgery, there is nothing that is unexpected,” says Patil, with a smile.

The 3D printing technology has brought in innovations that appear like science fiction. One of the advantages of this technology is that it can provide “patient specific and problem specific solutions”, says Patil. “Now we can reproduce the whole pelvic bone in just 12 hours. The material used to reproduce these bones costs less than Rs 15,000 only,” he says.

At Sparsh Hospital, the next exciting thing on the horizon is 3D printed customised prosthetics.

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