| Orthopedic surgery for trauma and elective problems | | | | prosthesis is fitted correctly, then the incidence of |
| like joint replacement is popular amongst the urban | | | | loosening is reduced. Due to its inherent wear over a |
| and rural population. However due to supply & | | | | period of time, it cannot be everlasting as claimed in |
| demand discrepancies, advertising has a big role. The | | | | some quarters. |
| gullible public often is at risk of misinterpreting the | | | | An auto pilot in a modern aircraft makes calculations |
| reams of information brought out by hospitals. They | | | | about altitude, atmospheric turbulence etc and |
| may land up with their expectations falling short of | | | | adjusts the elevation and speed of the aircraft |
| what was promised. In this article I shall attempt to | | | | without the pilot's intervention during flight. This does |
| clarify some commonly heard terms and discuss the | | | | not happen in Orthopaedic surgery. The surgeon |
| possibilities and limitations of the procedure and | | | | cannot stand back and let the computer make the |
| thereby remove some misconceptions. | | | | surgical incisions, cut the tissues and bones. Computer |
| Key Hole surgery- is another term for Arthroscopic | | | | assisted surgery is not Robotic surgery where a |
| surgery. The arthroscope is a device introduced into | | | | Machine performs the operation without human |
| joints through key-hole incisions about 5 mm wide to | | | | assistance. |
| inspect the internal structures. The orthopedic | | | | Computer assisted surgery is traditional open surgery |
| surgeon often makes 1- 4 key holes during | | | | performed by human beings and not Robots. The |
| performance of diagnostic and therapeutic | | | | surgeons makes the incisions and during the operation |
| procedures all of the same size. Through these other | | | | gets information about remote inaccessible areas like |
| holes or portals, similar sized instruments of 5 mm | | | | the Hip and ankle joints from "Sensors" or arrays |
| width are inserted to smoothen, cut, trim or suture | | | | implanted into the leg and thigh bones. This |
| damage structures. Arthroscopic surgery is commonly | | | | information is processed by the computer to give |
| done in the Knee, Shoulder joints and rarely for the | | | | intra operative information on the correct alignment |
| elbow, ankle and hip in our country. Arthroscopic ACL | | | | and positioning of the instruments for making the |
| and other ligament reconstruction are possible in the | | | | bony cuts to get the alignment correct. The surgeon |
| knee. However a knee or any other joint | | | | makes the cuts and not the computer. The accuracy |
| replacement cannot be done by Arthroscopic or key | | | | of the cuts could be marginally improved with this |
| hole surgery. An artificial joint is made of metallic alloy | | | | procedure as compared to standard instrumentation. |
| and High density poly ethylene. In a Joint replacement | | | | However there are no long term studies to show |
| the surgeon sculpts the surfaces of the joint to | | | | that more accurate cuts produce improve results. A |
| prepare it for implantation. These prostheses should | | | | surgical operation consists of attention to the soft |
| match the dimensions of the original joint. It requires | | | | tissues like the ligaments and muscles which the |
| common sense to understand that an artificial joint | | | | computer cannot see. Nor can it give any information |
| cannot be introduced and implanted into a joint | | | | on the size of the implants. These two criteria are |
| through a tiny hole, | | | | paramount to the success of a Total knee |
| 5 mm wide. Yet large hoardings, banners and radio | | | | replacement, i.e., "Soft tissue balancing' and "Sizing" of |
| and newspaper ads would want the public to believe | | | | the implant. The computer plays no role in these two |
| so. | | | | steps. |
| Minimally invasive surgery- This differs totally from | | | | Computer assisted surgery adds on extra operating |
| Key hole surgery. This is traditional open surgery | | | | time to the tune of fifteen minutes to a total knee |
| done through full length incisions and not just | | | | replacement. This translates into increased cost to |
| punctures holes. The size of the incision is down sized | | | | the patient. The amortization of the equipment per |
| from the traditional sized large incisions. It is not | | | | case works out to nearly fifteen to twenty thousand |
| "Arthroscopic surgery" | | | | rupees. Thirdly, some of these navigational aids |
| Joint replacements can be done through minimally | | | | supplied by a particular company are compatible only |
| invasive incisions. The advantages of minimally | | | | with implants supplied by that company alone. So if |
| invasive surgery are smaller sized scars, less bleeding, | | | | better implants from another rival company are |
| less post operative pain, and faster recovery. Hospital | | | | introduced into the market, the navigational system |
| stays are shortened even for Joint replacements. | | | | and the instrumentation won't work together. So |
| Discharge from hospital requires that the patient has | | | | these hospitals are forced to make false propaganda |
| minimal or no pain is ambulant independently with or | | | | about their function provided by the implants used in |
| without aids and the wound is showing signs of | | | | their hospital despite the contrary evidence in the |
| settling down. It is therefore not the size of the skin | | | | literature. For example it has been claimed that a |
| incision alone that matters but what happens inside. | | | | "Rotating platform Knee" provides High flexion to the |
| Minimally invasive surgery is applicable to Joint | | | | tune of 155 degrees. If one were to only do an |
| replacements, Spine surgery trauma and post trauma | | | | internet search, then this claim would fall flat on its |
| reconstruction. Image intensification, computer | | | | face. |
| assistance, innovative surgical approaches, skilled | | | | Another term that is misunderstood by patients is |
| surgical assistants and newer equipment are helpful to | | | | "Knee transplant" A knee or other joint replacement |
| perform this difficult form of surgery. The whole | | | | is not a transplant. It only resurfaces the worn out |
| purpose of this approach is to make the operation | | | | portion of the joint and leaves behind the normal |
| patient friendly without compromising the results of | | | | bone. The worn out surfaces are sculpted to receive |
| the traditional operation. It should not be a mere | | | | the implant. |
| marketing Gimmick. | | | | Marketing of health services is now an aggressive |
| Computer assisted surgery- This is an area where | | | | business with complete control of the media like TV, |
| the misconceptions fall under two categories. A | | | | Radio, print and banners by large corporate hospitals |
| section of ill informed people think that the computer | | | | with huge investment on advertising. Misinformation is |
| just performs the surgery like an auto pilot and the | | | | spread easily by subtle innuendoes and inferences in |
| surgeon sits back. Another section is given to | | | | banner ads. Advertising is ethical and permissible if it |
| understand that it is the Gold standard in surgery and | | | | doesn't propagate misinformation. Spreading |
| that surgery done without computers is bound to fail. | | | | misinformation by advertisements is unethical as the |
| Both these perceptions are false. Computer assisted | | | | innocent patient reposes his trust in a Doctor and his |
| surgery is not robotic surgery, nor are the long term | | | | trust is betrayed with incorrect information. With |
| results proved. A Knee replacement done by a well | | | | nobody to bell the cat, except for some agencies like |
| trained and qualified surgeon in the right operating | | | | the advertising standards council of India, the unwary |
| theatre environment has a chance of lasting for 10 | | | | patient is at great risk of being misled. So how do |
| -15 years in 95 percent of the people in whom it is | | | | they protect themselves? What are the safeguards |
| implanted. What computer assisted or navigational | | | | from false advertisements? They need to do more |
| surgery is capable of doing is perhaps to raise the | | | | deep digging and research by referring to the |
| survivorship rate at 15 years by one to two percent | | | | manufacturer's information booklet, consulting other |
| to say 96- 97 percent. Under no circumstances can | | | | specialists, and search the internet. Only then will they |
| the prosthesis last for ever as one of the | | | | perhaps avoid falling into a trap of misinformation and |
| component polyethylenes is bound to wear. If the | | | | gain full value for their hard earned money. |