I Assist knee replacement India
Posted by on Wednesday, 31st December 2014
Tailor made knee replacement, now in Chennai
Knee replacement surgery can now give perfectly aligned knees, thanks to the new technology of movement sensors: A palm-sized electronic device, called ‘I-Assist’ is being used to personalize and support knee replacement intra-operatively. “This revolutionary device helps orthopedic experts align new knee joins more accurately and gives the best possible fit during surgery, “says orthopedic surgeon Dr.A.K.Venkatachalam, who performed this novel procedure on a fifty five year old woman in Chennai, India.
The ‘I-Assist’ is a surgical guidance system designed to improve the accuracy of a total knee replacement. It not just assists the surgeon in aligning knee implants to each person’s unique anatomy but also provides a personalized fit and truly tailor-made total knee replacement. The outcome is very predictable as perfect alignment is achieved intra operatively. The implants themselves are not custom built.
How it works:
This electronic device incorporates latest guidance technologies into a half palm sized electronic display. Some of these technologies are also inbuilt in latest smart phones. The LED lights on the display are similar to traffic signals. A green light means the position is acceptable and a red one indicates scope for improvement. Thus the surgeon can align and validate implant positioning during total knee replacement. As the device is anchored in the operating field itself, it doesn’t require shifting of the surgeon’s gaze. He doesn’t have to remove his visual focus from the operating field. Earlier navigation systems require the back and forth transfer of the surgeon’s gaze from the operating field to a computer monitor elsewhere, several times intra-operatively.
The device integrates into the operation by requiring no complex imaging equipment and additional surgical incisions. It is compatible with the company’s own product line of primary knee replacements.
History of navigation systems in total knee replacement
The goal of the surgeon during a total knee replacement is to get neutral alignment.. However, studies have shown that even experienced surgeons don’t always achieve this perfection.
Hence computer navigation systems were introduced about a decade ago to achieve perfect alignment. In this system, pins were drilled in the thigh and leg bones away from the knee. These pins were attached to sensors. The sensors relayed information to a processor located elsewhere. The monitor of the processor displayed the accuracy of the bony cuts and bony alignment. Based on these, the surgeon could intra-operatively fine tune the cuts and positioning to get perfect alignment. As mentioned previously the surgeon had to shift his gaze back and forth from the operating field to the computer monitor located elsewhere. This computer navigation system also requires intensive capital investment.
A different approach toward this goal was adopted with ‘Patient specific instruments (PSI) ’. This was pioneered by the author in Jan 2012 in Chennai. This required additional pre-operative imaging. The images were transferred electronically to engineers elsewhere. The engineers used Computer aided design to manufacture custom fit cutting tool for each patient. These patient specific instruments were shipped to the surgeon after an interval of a few weeks. Hence there is a time lag involved between the planning and execution in this process. Many patients don’t want to wait . This is where the new technology comes into picture.
The I Assist system improves on previous navigation technology.
The main component of the I-Assist knee guidance system is a disposable device that can be procured as needed. No capital equipment investment by the hospital is necessary.
Its features are
• It intuitively integrates with the surgeons’ conventional instrumentation for total knee replacement.
• No pre-operative imaging is required.
• No wait time for the patient and the hospital.
• Less invasive procedure to the patient.
Who benefits?
It benefits everybody involved :
• Surgeons’ benefit as it saves them more time unlike prior navigation technology.
• Hospitals save on additional costs by eliminating pre-operative imaging and capital investment.
• For the patient, it is less invasive and guarantees accuracy.
Which type of knee replacement patients’ benefit most from this technology?
Dr.Venkatachalam says that it is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon among other factors, the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement right. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
A sizeable number of young patients have additional complications in the leg that make a knee replacement difficult. Patients from Asia and Africa present with malunited thigh and leg fractures secondary to a previous accident. They have developed post traumatic knee arthritis as a result of these accidents. Bony deformities within the knee and outside preclude use of all previous modes of instrumentation.
• The use of conventional instruments which rely on intact straight bones is impossible.
• Conventional computer navigation is also inapplicable as it requires intact bone within the knee joint.
• PSI is also impossible to design with bone loss and extra articular deformities.
It is vital to get perfect alignment as there is a positive correlation between accuracy and long term survivorship of the implant.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.
About the author:
Dr.A.K.Venkatachalam performed this procedure on two knees in Chennai for the first time. He specializes in joint replacements and key hole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques.
For more information, visit www.kneeindia.com.
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Durable knee replacement India
Posted by on Wednesday, 31st December 2014
I-Assist guided Verilast Knee replacement- Knee replacement that lasts for 30 years
Knee replacement in young patients can now last for a long time, thanks to the novel combination of a smart device, ‘I-Assist’ and a durable implant, the ‘Verilast knee’.A procedure involving an I-assist device to implant a Verilast knee, was performed for the first time in the world on a thirty two year old woman in Chennai, India by noted orthopaedic surgeon, Dr.A.K.Venkatachalam.
Case Report-
Ms Payal, a thirty two year lady from Gujarat was suffering from a rare condition called ‘Avascular necrosis’ of the knee and had suffered extensive damage. Although, she was very young for a knee replacement, the extent of the damage left no option for Dr.A.K.Venkatachalam. He had recently introduced the I-Assist device for another patient and was working with Verilast knee technology that had shown to reduce up to 81% of wear as compared to traditional materials.
He decided to go ahead with a knee replacement procedure for Ms Payal using the Verilast CR knee and the I-Assist. It was first time in the world that the I-Assist tool was used to implant a Verilast knee. The I-Assist tool uses electronic components in a palm sized device. With this, the surgeon can align and validate implant positioning during the knee replacement.
After the procedure, the patient was very happy with the results.
About the Verilast Knee Technology
The durability of the Legion CR knee with Verilast technology is based on laboratory testing.
In a laboratory, the LEGION CR knee with VERILAST Technology was compared with a similar knee made from conventional materials (cobalt chrome and standard plastic). The results showed that after five million cycles, or simulated steps, the LEGION CR knee reduced 98 percent of the wear experienced by the other knee made of conventional materials. After 45 million cycles,it was noted with the LEGION CR knee with Verilast technology, that the wear reduced to 81% in comparison to the conventional knee implant. That's equal to around 30 years of actual use.
VERILAST technology uses advanced, low-friction surfaces on both sides of the joint, the femur bone of the thigh, and the tibia bone of the leg. It combines Smith & Nephew’s award-winning OXINIUM™ Oxidized Zirconium metal alloy and a “cross-linked” plastic component (XLPE), which together has been proved in the laboratory to double the wear of a conventional knee.
OXINIUM™, Oxidized Zirconium is a tough, smooth metal with a ceramic surface 4,900 times more abrasion resistant and 20 percent lighter than the cobalt chrome metal used in conventional implants.
• The ceramic surface is created through a manufacturing process where oxygen is naturally diffused into the zirconium metal as it is heated in air. The original metal surface is transformed into a ceramic coating which is integrated with and part of the underlying metal ; It is not an externally applied coating
• With no detectable amount of nickel, the metal most associated with allergies, OXINIUM™ is a biocompatible material for implants.
• This proprietary material has been used in more than 250,000 knee implants.
About the I-Assist Smart Tool
‘I-Assist’ is a smart tool designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person’s unique anatomy. The outcome is very predictable as perfect alignment is achieved intra operatively and raises the chances of favorable outcomes. Perfect alignment correlates positively with survivorship or durability of the implant.
Which type of knee replacement patients’ benefit most from this combined technology?
It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement perfectly aligned. There is a correlation between the alignment and survivorship of the implant. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
In addition, a sizeable number of these young patients have additional complications that make a knee replacement difficult. Mal-united thigh and leg fractures secondary to previous accidents rule out the use of traditional instruments. Bony deformities within and outside the knee preclude use of all other modes of instrumentation and navigation.
Before this novel procedure, surgeons including Dr.Venkatachalam used “Patient specific instruments’ and ‘computer navigation’ to implant the Verilast knee. These are not applicable to difficult primary knees with bone loss.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.
In summary, the I-Assist tool allows the full survivorship potential of the Verilast CR Oxinium™ knee to be harnessed in primary and difficult cases. Young patients can return to their normal lives without the fear of a redo or revision surgery later on in their lives.
About the author:
Dr. A.K. Venkatachalam specializes in joint replacements and keyhole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques. With numerous surgeries and years of experience combined with innovative and pioneering technologies, he has helped many patients to regain full mobility of knees and hips.
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Custom fit knee replacement boosts success rate
Posted by on Friday, 17th February 2012
Orthopaedic surgeon Dr. A.K. Venkatachalam, of the Madras Joint Replacement Center in Chennai, India, has introduced customized knee replacement. He is offering a concept called 'patient specific instrumentation' to help prolong the life of knee implants.
Oxinium implants are a highly rated knee replacement joint prosthetic. Oxinium joints are designed of special metal composites coated with ceramic. Then, they're fused and coated with oxygen to create very durable and long-lasting joint replacements. The latest concept to be introduced is the ‘Visionaire’, patient specific instrumentation from Smith & Nephew, an orthopedic implant company based in Warsaw, Indiana, USA. It provides the surgeon a customized device derived from the individual patient’s anatomy. This data is derived from pre-operative x rays and MRI scans of the individual patient. The images are sent online to the research and development engineers of the Smith & Nephew. Based on the scans, the design engineers fabricate a customized mould from Nylon. These are shipped to the surgeon within a gap of four weeks. Armed with these customized cutting blocks, the surgeon is confident of shaping the patient’s bone very accurately.
Dr. Venkatachalam performed the latest surgeries utilizing this customized approach at the Chettinad Health city’s super-specialty hospital.
Benefits of Oxinium Implants and Patient Specific Surgery
While Oxinium prosthetic joints are believed to last nearly 90 times longer than a traditional knee joint, Dr. Venkatachalam wants to ensure that his patients have the best experiences with joint replacements as possible. With this combined technology, the implants can be expected to last for thirty years versus the ten to fifteen years with traditional cobalt chrome implants.
The new approach to knee replacements offers a variety of patient benefits including but not limited to conservation of existing bone and added stability of the knee joint. Utilizing patient specific instrumentation during the implant process, the surgeon is able to make anatomically precise cuts of the knee bone for a much-customized fit of the Oxinium knee implant. The implant is then aligned to fit the specific patient's knee anatomy. Reduction of pain and increased mobility and range of motion are just a few of the added benefits of such stability.
In addition, the implants, designed by Smith & Nephew, are used in combination with Visionaire instruments, utilizing OXINIUM™ technology. In addition to their strengths and longevity, Oxinium implants are lightweight and hypoallergenic.
The Oxinium implant with Visionaire patient specific instruments offers minimally invasive procedures that reduce the risk of bleeding, complications, infections and postoperative pain. Patients are able to return to an active lifestyle faster than with traditional total knee replacement procedures, enhancing healing, mobility, and range of motion.
Finally, minimally invasive procedures such as the Visionaire patient specific instrument approach reduces the time a patient needs to be kept under anesthesia, again minimizing risk of complications as well as bleeding during the procedure.
The two patients who received the Oxinium total knee replacement with Visionaire patient specific instruments are both middle-aged women diagnosed with severe osteoarthritis and gross deformities.
Dr. Venkatachalam is a board certified, highly trained and experienced orthopedic surgeon in Chennai, India. He and staff members at Madras Joint Replacement Center have gained extensive experience in joint replacement surgeries throughout the United Kingdom, Belgium, the Middle East and Asia. Dr. Venkatachalam is a pioneer in minimally invasive procedures for total knee replacements.
For more information regarding Dr. Venkatachalam, the Madras Joint Replacement Center, or Oxinium implants and prosthetic knee replacements and surgeries, visit www.kneeindia.com
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Hip resurfacing- a viable alternative to hip replacement
Posted by on Wednesday, 30th September 2009
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Hip Resurfacing is Viable Alternative to Hip Replacement
Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery.
Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement, according to a study presented at the American Academy of Orthopedic Surgeons (AAOS) 2009 Annual Meeting.
The study was based on data on the outcomes of 214 total hip replacement patients and 132 hip resurfacing patients that was recorded in a joint registry maintained at a single surgeon’s practice from 2003-2006. Orthopedic surgeon Dr. Elizabeth Anne Lingard of Freeman Hospital in Newcastle Upon Tyne, England, was the study’s lead researcher.
Each patient enrolled in the study completed a questionnaire preoperatively and one year after surgery. The questionnaire included the Western Ontario and MacMaster Universities Osteoarthritis Index (referred to as WOMAC, it is a 24-item questionnaire that is completed by the patient and focuses on joint pain, stiffness and loss of function related to osteoarthritis of the knee and hip) and the SF-36, a self-report questionnaire completed by the patient that measures health-related quality of life (and generates 8 subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health; and 2 summary scores: physical component and mental component). The patients also completed a questionnaire regarding satisfaction with their procedures and outcomes one year after surgery.
The study showed that one year after surgery both groups of patients experienced significant improvements in WOMAC and SF-36. Hip-resurfacing patients, however, posted significantly higher WOMAC scores for decreased pain symptoms. When asked about patient satisfaction with the surgery, a greater number of hip-resurfacing patients said they were satisfied with their ability to perform functional activities after surgery.
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For more information:
Keywords: hip resurfacing, hip replacement, joint replacement, orthopedic surgery, minimally invasive surgery
Dr.A.K.Venkatachalam, Consultant Orthopedic surgeon at the Madras Joint Replacement center opines that hip resurfacing allows excellent range of movements with least incidence of dislocation in males younger than 60 years. While choosing female patients who demand hip resurfacing, one has to be more selective says the surgeon. Females with small femoral head circumference less than 44 mm had a higher risk of complications like femoral neck fracture. Therefore female patients with large bone size in the appropriate age group with good bone density are also suitable candidates for Hip resurfacing.
Dr.A.K.Venkatachalam, consultant Orthopedic suregeon
Madras Joint Replacement center
Chennai, India
http://www.hipsurgery.in
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New knee for Young patients introduced in India.
Posted by on Wednesday, 30th September 2009
A new knee implant that promises longevity and functional movements just like a normal knee is now the trend. The JOURNEY Knee in Oxinium was introduced in India by Dr. A.K.Venkatachalam, consultant orthopedic surgeon in Chennai recently. The first patient to receive bilateral Oxinium Journey replacements was a 38 year old lady suffering from crippling Rheumatoid arthritis.
The innovative JOURNEY anatomical knee system is designed to move and feel like a normal knee, and addresses problems still found in conventional systems such as instability and limited flexion. The JOURNEY System offers the additional durability of Smith & Nephew's proprietary alternate-bearing surface, OXINIUM* oxidized zirconium.
The system is described as "bi-cruciate stabilized" because unlike conventional knee systems, this implant design replicates the functions of both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). These ligaments provide stability and support for the knee, but are frequently removed during knee replacement surgery.
The surgical technique is similar to other knee procedures but is much more exacting and the JOURNEY system's newly designed instruments allow for both minimally invasive surgery (MIS) and computer assisted surgery (CAS). Dr.Venkatachalam received special training for this abroad.
This knee was developed after Smith & Nephew conducted in-depth analyses of natural knee kinematics and the inherent limitations in knee replacement systems. The JOURNEY knee system offers more sizing options for better fit and minimal bone resections. Smaller sizing choices that are more amenable to female anatomy make the JOURNEY system the obvious choice to achieve the best fit for all patients. Surgeons believe the JOURNEY knee will offer patients a more natural feeling knee implant and greater satisfaction.
"The JOURNEY Knee System is well suited for high demand, or young & active patients. One finds that many patients seeking a knee replacement are in their forties and fifties. This knee implant is highly recommended for this group of patients. Also more elderly patients in need of a knee replacement will also experience a near normal feeling with this knee in activities like coming downstairs. They will not feel the slight instability which is common with other knee systems.
Journey knee is the only knee replacement on the market that offers patients more natural movement and function, and provides surgeons with an answer to the challenges of current total knee systems." says Dr.A.K.Venkatachalam.
About OXINIUM* Oxidized Zirconium
OXINIUM material is a unique and advanced bearing product technology created through a proprietary manufacturing process that transforms the surface to a ceramic, resulting in a material that incorporates the best features of ceramic and metal while avoiding the limitations associated with either material. OXINIUM material is a revolutionary technology used in the production of components of knee and hip implants that exhibits superior performance characteristics due to its hardness, low-friction and resistance to roughening and abrasion.
The author Dr.Venkatachalam is a consultant Orthopedic surgeon in India and has introduced the Journey knee in India.
Visit http://www.kneeindia.com
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