The Orthopedic surgeons at the Apollo Hospitals can diagnose and treat many types of bone and joint problems using minimally invasive techniques. Most minimally invasive orthopedic surgeries are done with the use of an arthroscope, a special thin tool designed for viewing and treating problems inside a joint. The arthroscope is so slim that it can be inserted into the joint through one or more tiny "keyhole" cuts through the skin, rather than longer incisions. The arthroscope is fitted with a state-of-the-art miniature camera and a specialized lighting system that enables the structures inside the joint to be viewed on a monitor. The surgeon can attach special tools to the end of the arthroscope to shave, cut, or remove tissue or bone that are causing problems. Arthroscopic or keyhole surgeries of the joints are routinely performed. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. Apollo Hospitals performs over 700 arthroscopies per year. Hip resurfacing is also done through key hole Surgery.

Meniscal Repair

Meniscus is a very important part of the Knee Joint. It mainly acts as a shock absorber for the knee.

Meniscal tears are very common and are frequently missed diagnoses for knee pains following a fall. A meniscus tear can be many types: Common tears include longitudinal, parrot - beak, flap, bucket handle and mixed/complex.

The causes of meniscus tears are sports injuries, fall and squatting and sudden twisting. Old degenerative knees will tear even by a simple movement like getting up from a chair.

Symptoms may be a pop like sound followed by

• Pain
• Stiffness and swelling
• Catching or locking of your knee
• The sensation of your knee "giving way"
• You are not able to move your knee through its full range of motion.

Treatment

Clinically it manifests as tenderness in the area of the meniscus and the diagnosis is MRI.

Small tears in the inner part of the meniscus at the white zone are trimmed. The larger tears in the white red zone and the red zone are repaired with Arthroscopic Meniscal repair anchors. Rest is for few weeks and then knee bending is commenced.

Deformity correction refers to the process of adjusting or modifying musculoskeletal deformities—most commonly a leg deformity, foot deformity or ankle deformity, though it can be used for deformities of almost any part of the body—through surgery or the use of orthotic devices. The deformities addressed by deformity correction usually stem from: congenital and developmental deformities, which are often present at birth and get progressively worse as the patient ages; physical traumas, such as sports injuries, car accidents or falls; and diseases such as diabetes, obesity, cerebral palsy and osteomyelitis.

The specific treatment will depend on the deformity being treated, but generally speaking, they either involve surgery or the use of external fixation devices. A brief description of the treatments used for certain deformities is given below.

Treatments for bow legs (genu varum deformity)

If treated early enough—before the age of four—patients may only need to wear leg braces for several weeks. For patients over the age of four, surgery is often required. The main procedures used for bow legs include: knee realignment, in which the knee bones are surgically realigned and fixed in place with pins, plates, screws or staples until they heal; and osteotomy, in which an incision is made and a small wedge is removed from the tibia (and sometimes the fibular as well), and then the leg bones are realigned and fixed using pins and an external cast or an external fixation device.

Treatments for knock-knee (genu valgum deformity)

While knock knees usually self-correct in early childhood, this isn’t always the case, and sometimes surgery is required. The surgical options for knock-knee are the same as for bow legs: knee realignment and osteotomy.

Treatments for nonunion fractures

Deformity correction for fractures that have not properly healed usually involve the use of an external fixation device that holds the bones in place to facilitate healing. The most common external fixation devices or nonunions are the Taylor spatial frame and the Ilizarov apparatus.

Treatments for limb length discrepancy

Surgeons performing a limb-length surgery will microscopically fracture the patient’s leg bone, and then apply an Ilizarov apparatus or Taylor spatial frame to keep the bone separated by a few micrometers. As the new bone grows, the external fixation device is used to readjust and widen the gap between the bones. If all goes well, the new bone will continue to grow between the gap until the correct bone length is reached. After that, the fracture is allowed to close and heal.

Treatments for dwarfism

Deformity correction is used to allow individuals with dwarfism to achieve addition skeletal growth. Most frequently, an Ilizarov apparatus or Taylor spatial frame is used, along with the same surgical technique used to address limb length discrepancy. Dwarfism often leads to other conditions that require deformity correction, including bow legs and knock-knee.

Treatments for hammertoe

Surgeons seeking to correct hammertoe, a toe that’s curled upward because of a bend in its middle joint, will most commonly use either arthroplasty or joint fusion. In arthroplasty, the surgeon will remove a small amount of bone from the affected joint and then realign it. In a joint fusion, the two bones forming the joint will be linked and combined using a pin, screw or bone graft. The bones then grow together, which straightens the toe but leaves the joint rigid and immobile.

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.

We have been treating crush injuries of hand, degloving injuries, finger tip injuries as well nail bed injuries.

Hand fractures:

At hand2shoulder clinic we are experts in treating all kinds of simple as well complex fracture on hand. In fact Dr Vikas Gupta has been one of first few surgeons in country to internally fix these fractures using locking plates. After internal fixation injured hand is mobilized early which results in faster and better overall function of hand.

Tendon injuries

At hand2shoulder clinic we have vast experience in treating different types of tendon injuries using different methods eg. Primary repair, tendon grafting, 2 stage grafting using silicone rods also pulley reconstruction whenever required.

Nerve injuries:

We have around 20 years of experience in treating treating nerve injuries. We perform primary as well as delayed nerve repairs also nerve grafting whenever required. In late cases we also perform tendon transfers in necessary.

GB Multicare Hospital offers advanced treatment for various shoulder disorders, and also houses a dedicated Shoulder Surgery Unit. Some of the shoulder surgeries undertaken at Apollo Hospitals, India are:

Total / Partial Shoulder Replacement

Total Shoulder Replacement needs to be done if both sides of the shoulder joints are severely affected by arthritis. In Total Shoulder Replacement, the damaged end of the upper arm bone is replaced by a stem with a metal head. The diseased part of the socket is replaced by a plastic shell in which the metal head sits. In case only one part is affected, partial shoulder replacement can be done.

Shoulder Resurfacing

In Shoulder Resurfacing, the surface of the bony end is made smooth and the diseased part is removed in the process. After this, a metal cap shaped to fit into the socket is fixed on the end of the bone.

Bilateral and Revision Shoulder Replacements are also done at Apollo Hospitals, India. Some shoulder surgeries can also be performed using minimally-invasive techniques.

Shoulder impingement

Shoulder impingement can be a problem with tennis players, swimmers and cricket bowlers. The repeated action of the arm going up or coming down can lead to this, especially when players do more than their usual, by trying to increase their training intensity before or during their tournaments.

The person usually complains of pain with the arm coming down, as in during a tennis serve or a bowling action. There is a tendon called the Supraspinatus tendon that gets pinched between two bony prominences at the shoulder, leading to pain and discomfort.

Precautions to be taken

• Avoid sudden increase in training level.
• Adequate in-between rest periods.
• Proper training techniques

Most of the patients benefit from judicious rest and rehabilitation. A minority will end up requiring an Arthroscopic (Key Hole) procedure for effective treatment of their symptoms and return to sport.