The Hindu Business Line : A `joint' effort

Last year, Dr Chandrashekhar Dhar, Senior Consultant Orthopaedic Surgeon at Calcutta Medical Research Institute, went to Sydney for a course on advanced joint replacement, which included computer-assisted surgery (CAS). This was followed by a week's attachment at the Sydney hospital. The exposure proved invaluable.

Today, Dr Dhar is among the 3-4 orthopaedic surgeons in Kolkata who have taken to CAS in total knee arthroplasty (TKA). The trend seems to be catching up, albeit slowly. For, the benefits of CAS in TKA are many.

What is CAS, the uninitiated would ask. CAS is an innovative method of IT deployment in orthopaedic surgery. Patient data is fed into a computer following which a three-dimensional image is created.

The software then generates a digital image of the patient's knee joint with in-depth data relating to the bones and surrounding soft tissues.

An infrared technology is applied to produce a moving digital image of the patient's knee joint as it is moved during the operation. The image is then made available to the surgeon to guide him through the operation.

Surgical instruments can also be incorporated into the map so that the position of the instrument, and progress, can be monitored and controlled to do the operation with precision. The surgeon can also use real-time data to correct the procedure intraoperatively.

This is different from traditional TKA surgery where the prosthetic evaluation is done by X-ray, post-operatively. With incorrect prosthetic alignment, the patient runs the risk of shortened TKA lifespan.

Says Dr Dhar: "Besides facilitating accurate positioning of prosthetic components, CAS allows the surgeon to make informed decisions intraoperatively for precise prosthetic placements. It also allows physiologic muscle and ligament balance, which is very crucial for prolonging prosthetic lifespan and reducing the chances of revision arthoplasty."

CAS is also helpful in doing TKA with minimal invasive surgery or smaller incisions, he says.

Dr Dhar is, however, sanguine that no surgeon wants to become machine-dependent and all want to be the master of the operation. "One has to be a master in conventional surgery even if he were to depend upon CAS. This is because the entire operation is based on the principle of conventional surgery," he says.

Dr Buddha Chatterjee, Senior Orthopaedics and Spinal Surgery Consultant at the Apollo Gleneagles Hospitals here, feels IT-dependent navigation in joint replacements is here to stay. Apollo Hospitals has opted for Brainlab software of Germany.

"The software is the same for hip and spine. In spine surgery, we fix screws and hooks. The more accurately they are fixed, the lesser the chance of neurological damage," he says.

The flip side is that CAS is a shade more expensive than conventional surgery.

Say both the doctors: "While that is true, it is less invasive and, hence, less painful. The chances of infection are reduced and the patient gets discharged from hospital faster".

After CAS, what next? Probably robotics in surgery. "In future, the bone cuts may well be robotised. While the surgeon will control the surgery, precision cutting will be done with the help of robotics."

ambar_singhroy@rediffmail.com