Movement is Life

Healthy joints are an essential part of healthy body and mind. Many diseases of the joints and aging make the joint movement stiff, painful and limbs may even get deformed. Restricted and painful mobility leads to unhappiness and affects the body as a whole. Technological advances in surgical science have allowed us to offer safe surgical treatments with reproducible results to patients with joint diseases and make mobility as painfree and as unlimited as possible.

Sports injuries, both professional and recreational, are becoming more and more common and they can spoil the career of a sportperson. Our team has been providing treatment for sports related joint injuries with minimally invasive techniques coupled with sound rehabilitation protocols individualized to patient's need and demand. Our motto is "Disability to Mobility"

Knee Replacement

  • A knee replacement is an operation to replace all or part of your knee. The knee is made up of the thigh bone (femur) and the shin bone (tibia), held in place by ligaments and covered by the knee cap (patella). The bone ends (can) glide smoothly over each other because of a covering of articular cartilage. When the cartilage is damaged by injury or worn away by arthritis, the bones can rub together painfully, making movement difficult.

  • During a knee replacement, the surgeon removes the parts of your knee that have been damaged and replaces them with new parts made of metal alloy and high density plastic.

  • Types of knee replacement

    1. Partial knee replacement
    2. Total knee replacement

How will a knee replacement help?
1. Relief/Improvement of pain
2. Restored function and mobility
3. Correction of deformities
We follow the concept of FAST TRACK KNEE REPLACEMENT. You are admitted one day prior to your surgery. You are taken up for surgery after pre-surgery testing and obtaining medical clearance for your surgery.

Surgery in most cases is done under combined spinal epidural anaesthesia. An epidural pain pump is retained post-surgery which provides excellent pain relief. Patients are orally allowed by the evening. You will be assisted to bend your knees and stand with support within few hours of surgery.

On the morning following your surgery, you will be assisted to a standing position, and using a walker, you will begin to walk on your new knee. Over the next few days, you will be walking with greater confidence, and be ready for discharge by 5th-7th day.
For the first four to six weeks following surgery, most of our patients require and receive physical therapy: either home therapy or outpatient therapy. Your physical therapist will instruct you on exercises that will help your knee regain its flexibility and strength. Your active participation in physical therapy is critical to a successful surgical outcome following total knee replacement.

Resuming your normal activities
By 6 weeks post-surgery, most knee replacement patients are able to walk independently without support and they experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living.
Be aware, however, that recovery takes time. Give yourself time to regain your strength and self-confidence. Stay active and you will notice a gradual improvement over time in your strength and endurance.

Knee Arthroscopy and Sports Injuries

What is anterior cruciate ligament (ACL)?
The ACL is an important stabilizing ligament in the knee. It connects the thighbone (femur) to the shinbone (tibia). It keeps the femur from rotating too far, and from moving too far forward over the tibia.

Why the treatment for ACL injury is necessary?
The treatment is necessary for the patient to overcome the episodes of giving way and regain confidence in his knee which should allow a return to work and sport. By stabilising the knee we can protect it from further damage to other structures in knee - such as meniscus, cartilage and possibly osteoarthritis in future.

How is the ACL injury treated?
ACL injuries are treated with surgery and post-surgical rehabilitation or a non-surgical rehabilitation program. The decision to have surgery is based upon several factors, including the person's age, level of activity, and the presence of other knee injuries.

Surgical treatment
ACL once torn does not heal and requires reconstruction. Surgery is indicated in young active patients to allow them to lead an active lifestyle.

Surgery to reconstruct the ACL is done with less invasive arthroscopy using small incisions. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times. Most patients go home the next day of the surgery.

A graft is required to reconstruct the ACL and is usually harvested from patient's own body during the surgery. (Patellar tendon graft or hamstring tendon graft).

Post-surgical Rehabilitation
No bed rest. You are able to walk with support the same day. A supervised physiotherapy program is initiated afterwards. You are able to attend your office after 1 week and driving is allowed after 2 weeks.

Majority patients who have surgical reconstruction of the ACL have an excellent outcome. Athletes can return to sports generally after 9 to 12 months, depending upon the sport and the person's dedication to the rehabilitation program.

What is posterior cruciate ligament (PCL)?
The PCL is an important stabilizing ligament in the knee. It connects the thighbone (femur) to the shinbone (tibia).It prevents backwards movement of the tibia on femur, prevents hyperextension of the knee, bending backwards on itself, and stabilises the knee on rotational movements acting as a central axis of rotation.

How is the PCL injury diagnosed?
PCL injury can be diagnosed after taking a detailed medical history and physical examination. X-rays and MRIs are helpful in confirming the diagnosis and detecting any other structures of the knee that may be injured.

How is the PCL injury treated?
Less severe isolated PCL tears (Grade 1 and 2) are usually treated with a progressive rehabilitation program. Treatment in this group consists of protected weight bearing, early range of motion and aggressive physical therapy emphasising quadriceps muscle strengthening and proprioceptive training,

Surgical Treatment
It is indicated symptomatic grade 3 PCL injury, PCL injury associated with bony avulsion and combined ligament injuries.

Surgery to reconstruct the PCL is done with less invasive arthroscopy using small incisions. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times. Most patients go home the next day of the surgery.

A graft is required to reconstruct the PCL and is usually harvested from patient's own body during the surgery. (Patellar tendon graft or hamstring tendon graft).

Post-surgical Rehabilitation
No bed rest. Toe touch weight bearing walking with crutches is recommended for 2-3 weeks for the PCL graft. Full weight bearing walking with support is allowed after 3 weeks and patient can attend his work after 3 weeks. The knee is held within a brace with a range of movement from full extension (straightening) to 90° flexion (bending) for 8-10 weeks.

Exercises are gradually stepped up in intensity and return to sports following PCL reconstruction is anticipated 9-12 months following surgery, and requires sport-specific functional training.

What is Meniscus? The meniscus is a C- shaped tough fibrous cartilage that acts as a shock absorber in the knee joint between the thigh bone (femur) and shin bone (tibia). There are two menisci in the knee, one on the inside of the knee -the medial meniscus. The other rests on the outside of the knee - the lateral meniscus.

How is the meniscal injury diagnosed?
Meniscal injury can be diagnosed on the history and physical examination of the knee. MRI scan is required to confirm the diagnosis and see other associated injuries if any.

Why is the treatment for meniscal injury necessary?
The treatment is necessary for the patient to overcome the episodes of recurrent pain and swelling in the knee joint. Also, the constant rubbing of the torn meniscus on the cartilage may cause wear and tear on the surface, leading to degeneration of the joint.

How is the meniscal injury treated?
Conservative treatment
If the tear is minor or the symptoms that are mild do not interfere with the daily activities, conservative treatment like muscle strengthening and rehabilitation exercises are required.

Surgical Treatment
Surgical treatment is warranted in cases of:
  • failed conservative management,
  • freshly injured patients in whom the knee cannot be straightened (locked knee),
  • Chronic symptomatic patients in whom symptoms interfere with occupation and/or sports.

Surgical treatment depends on the age of the patient, type of tear, the size and location of the tear. This is done by less invasive arthroscopic (keyhole) surgery. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times. Most patients go home the next day of the surgery.

Meniscal Repair
This is done in young patients with traumatic tears which are present in the outer boundary of the meniscus. In the outer region of meniscus, the blood supply is good and healing usually occurs.

Partial Removal of torn meniscus (Partial Menisectomy)
This is done in cases where a repair is not possible. The torn section of meniscus is removed and the rest is trimmed and smoothened. As much as possible normal meniscus is preserved in order to maintain the cushioning effect.

Post-op Rehabilitation
Following surgery, physiotherapy is advised to keep the knee joint active (which encourages healing) and to strengthen up the surrounding muscles to give support and strength to the knee. Patients are able to walk the next day with support of crutches and can return to work in about 4 weeks' time.

Cartilage is the “Life” of knee and other joints. Once the cartilage is damaged the joint becomes painful and stiff. Certain procedures can help in cartilage restoration.

What is articular cartilage?
Articular or hyaline cartilage is the smooth layer of tissue covering the ends of 2 bones where they touch and form a joint such as the knee or hip. The cartilage layer provides a smooth, slippery surface allowing the joint to move through frictionless range of motion during daily activities such as walking or high impact sporting activities.

How is articular cartilage defect (injury) diagnosed?
Articular cartilage injury is difficult to diagnose on clinical examination. MRI evaluation is necessary to identify the presence, location and size of the defect. MRI is also important to rule of injury to other structures (ligaments, meniscus). Arthroscopic examination is the most useful to assess the full extent of injury.

Why is articular cartilage repair necessary?
Articular cartilage does not have its blood supply and has very limited capacity to heal on its own. Left untreated this condition progresses and becomes more extensive. Patient experiences increasing pain and inability to perform regular activities of daily living without significant pain and discomfort.

What are options for treatment?
The decision to treat a cartilage lesion depends on age of the patient and desired level of activity. It is also dependent on location, size and number of defect(s) and associated injuries.

Cartilage restoration techniques require extensive periods of recovery and therapy. To ensure best outcome, patient must be committed to the rehabilitation protocol.

Typical options for treatment include:
Microfracture is an arthroscopic procedure that works best for treatment of small cartilage injuries. Microfracture involves drilling small holes into the bone at the defect site to stimulate new blood and bone marrow to enter the site and promote new cartilage formation.

Osteochondral Autograft Transplantation (OATS or MosaicPlasty) typically best for slightly larger focal lesions or those that involve cartilage and bone loss. The surgeon obtains a cartilage tissue from another location in patient’s body (autograft OATS) that is custom sized to fit into the defect to recreate a smooth joint surface.

Autologous chondrocyte implantation is an advanced tissue-engineered articular cartilage repair procedure which is done in 2 stages.

What will happen after surgery?
A post-operative rehabilitation protocol that is dependent on the exact surgical procedure performed and location of the cartilage lesion treated addressing specific range of motion and weight-bearing progressions will be started. Full recovery ranges from 2-6 months dependent on the extent of the surgery.

Knee Preservation

Knee preservation is an approach wherein patients with knee cartilage damaged are advised surgical treament to prolong the life of the natural knee joint so that the patient can retain his/her own knee till the time he/she is a suitable candidate for knee replacement. Knee preservation can, in some cases, obviate the need for joint replacement altogether.
A battery of tests in addition to clinical assessment are needed to ascertain whether you can be benefitted with knee preservation. If you are young, active and want to pursue a heavy lifestyle, you should ask your orthopedic surgeon regarding knee preservation.
A number of procedures can be done to preserve the knee joints. Some of the procedures are directed at realigning your knee joint so that the affected portion of the knee is off-loaded and mechanical alignment is corrected. Such procdure is known as Osteotomy which can be done at the thigh bone or shin bone as demanded by the situation.

Another set of procedures that are done for knee preservation are directed at the restoration of cartilage of the knee. Microfracture, mosaicplasty and autologous chondrocyte implantation (ACI) are some of these procedures that can be done to restore the cartilage in carefully selected patients.

Shoulder Arthroscopy and Replacement

Shoulder is the commonest joint in the body to dislocate. The younger and more active the patient, the more chances of recurrent dislocation. Recurrent dislocation can be safely tackled with surgical interventions that include arthroscopic (Key hole surgery) and open procedures.

After proper pre-operative evaluation a treatment plan is suggested to you that is most suited for your problem and your demands. In majority of the patients, key hole surgery suffices and the patients are operated on a day care basis. Soft tissue repair includes a Bankart’s repair with or without some additional procedures. The surgery is followed up with a dedicated shoulder rehabilitation protocol to allow you to return to normal activities as early as possible.

A subset of patients who have bony deficiency would need a bony procedure, Modified Latarjet’s Procedure. This procedure is suited for patients having more severe form of shoulder instability and is done by an open approach.
Rotator cuff problems are common amongst elderly and are a common cause of disability. Inability to use arm for day-to-day activities and pain are the common indications for intervention. Treatment of these disorders includes a phase of shoulder rehabilitation followed by a surgical procdures in carefully selected patients. The surgery is done arthroscopically (Key-hole) on a day care basis. The surgery is followed up with a supervised shoulder rehabilitation protocol for 3 months.
Treatment of painful shoulder in young people needs proper evaluation, clinical and radiologic, to arrive at a proper diagnosis and to initiate appropriate treatment. Dedicated rehabilitation protocol supervised by trained professional physiotherapists is usually helpful in tackling these complex clinical problems. Some patients, however, need key-hole surgical procedures that may include Labral Repair, SLAP repair, Biceps Tenodesis, Sub Acromial Decompression etc.
Shoulder replacement ia a very successful procedure for patients having advanced shoulder arthritis, shoulder trauma in elderly with osteoporosis, failed trauma surgeries and neglected/failed rotator cuff tears. Shoulder replacement surgeries of all varieties (Hemireplacememt, total shoulder replacment and reverse shoulder replacement) are perfromed routinely by our team.

Reverse Shoulder Replacement is the latest advancement in the field of shoulder arthroplasty. In carefully selected patients, reverse shoulder arthroplasty can provide a new lease of life.

Total Hip Replacement

Hip is the most important joint of your lower limbs. It is a “Ball and Socket” joint and gives the body much needed mobility to allow pain free movements. It has a smooth lining of cartilage on both sides that can get damaged by a number of conditions. We can have hip damage following trauma, arthritis, avascular necrosis (loss of blood supply) and some congenital conditions. Hip joint can become very painful in such conditions making day to day life difficult. Patients having pain that necessitates regular pain killers and makes activities of daily living difficult, are candidates of total hip replacement.
THR gives a reproducible outcome in terms of pain relief and restoring mobility. Many implants, however, have a tendency to wear out in the long run and may require repeat surgery later. Latest advances in the field of joint replacements have led to the introduction of materials that are very wear resistant and can provide a long lasting result and can last a patient's lifetime. Our team uses the implants that have a very good track record in terms of performance and longevity. Every patient is assessed individually and surgical solution is suggested to him/her depending upon one's need and demand. Our team performs simultaneous bilateral THR whenever indicated in suitable patients.

WHY CHOOSE US?

"Fast Track" Joint Replacements and Advanced Techniques

We use latest technology and techniques that allow us to give a better, quicker, safer and longer lasting results to our patients with joint disorders. "Fast-Track" is an approach where a patient is allowed to walk after a couple of hours of surgery that reduces the chances of complication like DVT, chest and urinary complication. It gives patients much needed confidence and morale boost that helps in a better and quicker rehabilitation. Our techniques are soft-tissue friendly and we use various blood loss reduction modalities that has reduced our patients' blood transfusion requirements to almost negligible rates. We use accelerator based navigation technology for our total knee replacement surgeries. This helps us to improve our precision and almost a zero-error alignment is achieved in all cases. It has been shown that mechnical alignment of knee prosthesis is the single most important factor in predicting the long-term success of the implant. Our pain specialists strive very hard to give you a painfree post-operative period during which you can comfortably start your day-to-day activities. At the time of discharge, the patients are able to walk with minimum support, use toilet without assistance and climb stairs.

The treatment is individualized to suit the anatomy, demands and social conditions of each patient; suitable implants and techniques are advised that give much superior functional outcome. We use latest implants and technology that allow the implants to have a long life and they usually last a lifetime.

Experienced Team

The team led by Prof. Amite Pankaj Aggarwal has nearly two decades of experience in treating joint related problems and have treated thousands of patients with crippling joint diseases. The team has collectively performed more than 4000 joint replacements and 5000 arthroscopic procedures. Complex cases of joint replacements, re-do surgeries, and failed cases are routinely referred to us for corrective surgeries. Dr. Aggarwal has performed live surgical demonstrations on joint replacments and arthroscopic surgeries at various national meetings to train young surgeons in these orthopedic sub-specialities. We have a trained team of physiotherapists and counselling personnel to help patients recover from their ailments in a comfortable environment. The team also helps in domicilliary support once the patients are discharged and are recuperating in their home environment.

"Patient Friendly" Approach

Our motto "Patient First" guides the team members throughout our interaction with the patient. We are a team of committed professionals comprising of surgeons, physiotherapists, counselors and other support staff. The patients are guided through their treatment by a compassionate, empathetic and humane approach.

Academic Track Record and Scientific Excellence

What gives the team led by Dr. (Prof) Amite Pankaj Aggarwal an edge is the fact that the team has published numerous scientific work on joint replacement and arthroscopy in various international and national journals of repute. Text books in the Orthopedic curriculum have chapters written by the team that are read across the globe by trainee students. We have published more than 70 scientific papers in journals and more than 15 chapters in books. Our surgical technique on knee surgery has been acknowledged by American Academy of Orthopedic Surgeons and is stored in their archives. Dr. Amite Pankaj Aggarwal is a regular faculty at various joint replacment and arthroscopy meetings and has delivered more than 150 CME lectures on these topics.

State of Art Infrastructure

The team led by Prof. Aggarwal performs surgical procedures at Fortis Hospital, Shalimar Bagh, New Delhi. Fortis Hospital, Shalimar Bagh, is a multi super speciality hospital offering super specializations within departments, with the mission of providing quality medical care. This is one of the largest hospitals in the Fortis Group which commenced its operations in the year 2010 and serves the residents of North, West and North-West Delhi, and the neighbouring states. The operating suites have the latest technology and infrastructure that make the surgery safe, near zero infection rates and predictable surgical outcome.

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