New technology has enhanced orthopaedic surgeries
Technology is constantly changing how we as doctors interact with and treat our patients. It is impacting every aspect of the doctor-patient interaction. One radical way technology has brought a turnaround is in the field of doctor-patient communication. In the bygone era, doctors were stereotyped as people who would hardly open their mouth while interacting with patients and even if they did only monosyllables will flow out! These days you find doctors blogging, engaging with patients through social media, handing out detailed information leaflets on procedures, so on and so forth. This has bridged the great divide between the patient and the doctor.
In terms of technicality of the procedure, modern orthopaedic technology is as cutting edge as it gets. Right from planning a surgery on a computer template to executing it through computer navigation, technology is there to help us every step of the way. This journey in a way has just begun, with newer and newer products and technologies being added on a daily basis. We have moved away from an era of joint replacement to joint preservation.
Technology allows us to dispense away with open joint surgery, instead we can these days operate upon any joint of the human body with a tiny 4 mm camera called the arthroscope. Despite being so tiny, the arthroscope gives us a magnified view of things and allows us to enter tiny nooks and corners of the joint to look at and treat any pathology. This translates into a very accurate surgery.The tiny incision allows for a very fast and a near painless recovery.
Stem cell therapy is making a grand entry into the field of joint preservation. We are able to harness the regenerative potential of our own blood and bone marrow to cure certain joint problems. The human joint has a component called cartilage, which is responsible for the frictionless movements that we experience in day to day life. The cartilage has no blood supply of its own, it derives its nutrition from the joint fluid. Once injured, cartilage does not have the ability to repair itself. Technology has enabled the use of our own platelets or bone marrow cells to help cartilage repair and regenerate itself. Improving the shock absorbing properties of joint fluid, also known by the fancy name of viscosupplementation, is another advancement to ease the pain of arthritic knees.
Why replace full when you can preserve half? Modern metallurgy aided with finite element modelling has helped create replacement of discrete areas of the knee joint. We can now replace the inner half of the knee, outer half of the knee and the knee cap separately. Selective replacement of the inner half of the knee, the so called Unicondylar knee replacement is becoming more and more fashionable. A small incision, minimal bone cutting and precise machining allows them to literally walk back out of their operation suites.
Computer navigation allows us to replicate millimetre level accuracy in our open joint surgeries. Human eyes cannot distinguish between very small change in distances and very small changes in angulations. The computer navigation equipment uses infrared cameras to read the joint landmarks and through special instruments, allows wireless transfer of data to the surgeon’s hand that enables him or her to position joint replacement implants with utmost accuracy. A few degrees or millimetres of accuracy goes a long way in improving the longevity of our joint prosthesis. Navigation has made its way in ligament reconstructions of the knee as well, wherein it allows us to put the new ligament at the exact same spot as the native ligament. For a professional sportsperson, such accuracy might mean the difference between early retirement and a comeback.
3D printing allows us to explain bone fractures better to our patients and in certain complex injuries like certain hip fractures, allows us to study the personality of the injury closely, so that appropriate surgery can be planned.
Technology in a nutshell has made us relearn our surgeries. Modern technology is focussed on how to make recovery faster, painless and more permanent for our patients. This is an exciting time to be in the field of clinical medicine. In the future we can perhaps expect to do surgeries less often and cure most ailments by appropriately targeted injections and similar minimalist interventions.
The writer is Dr Raju Easwaran, MS (Orthopaedics) Arthroscopy, Sports Injuries & Joint Preservation Surgery at Shree Meenakshi Orthopaedics & Sports Medicine Clinic.