The Department for Orthopaedics treats muscle, bone and joint disorders. Areas of special emphasis include arthritis, joint replacement, spine surgery, sports medicine, physical medicine, hand, foot and ankle, orthopaedic oncology, trauma, and paediatric orthopaedics.
Our orthopaedic surgeons have diverse expertise and are committed to provide effective solutions to orthopaedic problems. Specialized services include arthroscopy, musculoskeletal tumour surgery and reconstruction, rheumatology and treatment for orthopaedic trauma.
The spine surgery program is a comprehensive interdisciplinary service incorporating orthopaedic surgeons, neurosurgeons, neurologists, physical and rehabilitation medicine and the anaesthesia pain clinic program.
In addition to conventional disc surgery of the neck and back, this service performs microscopic surgery , endoscopic spinal surgery (key hole surgery), and minimal access surgery. The surgical team is experienced in handling spinal trauma, spinal deformities, and spinal tumours as well as congenital and degenerative diseases of the spine. Spine division has done the maximum number of scoliosis surgeries (congenital, neuromuscular, idiopathic scoliosis ) in the region. Spine fusion surgeries such as TLIF, PLIF, ALIF are routinely done. High grade spondylolisthes - a condition where a vertebral body slips over another – are managed with intra operative four channel neuromonitoring device. En bloc spondylectomy (total removal of vertebra) with vertebral body cage reconstructions are carried out in patients with spinal tumours. Operative services are supported by intraoperative spinal cord monitoring (SSEP/MEP), critical care facilities, vascular embolization and excellent anaesthesia services.
Back and neck pain is evaluated and treated by a team of orthopaedic surgeons, neurosurgeons, occupational therapists, and psychiatrists in a pain clinic. Patient education and occupational rehabilitation are the prime goals of this department. This centre is a recognized AO Spine International Fellowship training in spine surgery and every year accommodates a fellow for training.
This service is offered as an interdisciplinary program involving orthopaedic hand surgeons and plastic surgeons. The Centre offers expertise in microvascular procedures to treat hand injuries, congenital deformities, arthritis and degenerative disorders, infectious diseases, and reimplantation. Joint replacement of the wrist and endoscopic hand surgery are special features of this division.
The Centre offers all types of joint replacement to restore freedom of movement and relieve the pain of degenerated and diseased joints. Surgery often provides dramatic improvement in daily functioning for people with arthritis. Medications and physical therapy services are helpful adjuncts.
Some of the latest techniques offered are cementless implants for a customised fit thus prolonging the life of the replacement. However, joint replacements do not last forever. Many people require a second replacement surgery, especially for hip joints. This replacement, or revision, can be more difficult than the initial surgery due to the difficulty in removing the adhesive material used to hold the artificial joint in place.
Knee and hip replacement surgery are the most common procedures. Orthopaedic surgeons also perform joint replacement surgery for other major joints including the elbow, ankle, shoulder, and wrist joints. In addition, our surgeons have extensive experience in using the newest clinically proven techniques to revise joint replacements that have failed. Rehabilitation following joint replacement is coordinated with other healthcare professionals on the arthritis centre team.
Our facilities to perform joint replacements are outstanding both in theatre environment and instrumentation. For all joint replacement cases we have Laminar Air Flow operation theatres, cement gun for pressurizing during cementing, vacuum mixing of the cement, pulsatile lavage, pneumatic and cordless power saw/reamer system and complete systems for primary and revision arthroplasty. A computer navigation system is also part of the joint replacement armamentarium.
This is usually undertaken in patients who have had their hip joints destroyed due to injury or diseases like osteoarthritis, rheumatoid arthritis, etc. Hip resurfacing and replacements using ceramic liners are done for relatively young active patients. Amrita is one the first South Indian Centres to use 36 diameter Delta Ceramic bearings.
Revision joint replacement is a frequent procedure and we have the entire revision instrumentation along with high speed burrs for difficult surgeries, both for the hip and knee joint. Ours is the first centre in India to use trabecular metal cone for revision knee surgery.
For knees that are severely damaged due to disease or injury, total knee replacement is the best option. The end of the thigh bone is normally replaced with a metallic component and the upper end of the leg bone with a polyethylene component with metal base plate. Most patients are ambulant from the day after surgery and are discharged the fifth day. The latest Hi-flexion fixed bearing and mobile bearing designed knee components and those specifically designed for women (gender solution knees) are routinely used.
Computer-assisted Total Knee Replacement (TKR) improves the component positioning and is routinely done in our Centre. It is predicted that the computer accuracy and the surgeon's experience together will improve the planning for implementation. The largest number of total knee replacements in Kerala using Hl- flexion, female specific designed knees with computer navigation is performed.
Joints like the elbow and shoulder, which are damaged due to diseases like rheumatoid arthritis or due to traumatic injury are treated with total joint replacement.
Tumours of the muscles and bones, while not as common as other tumours, pose a serious health challenge to people who have them. The Centre for Orthopaedics provides surgical treatment of muscle and bone tumours and works closely with the Cancer Centre to coordinate additional follow-up care for cancer patients.
In recent years, limb salvage surgery is the treatment of choice for malignant lesions of the long bones, spine and pelvis. This includes total excision, bone grafting and limb reconstruction. Custom made prosthesis for long bones around the hip and knee are commonly done in our centre. Pre and post operative chemotherapy will improve the prognosis to a large extent and is carried out with the help of the Cancer Centre. Parathyroid adenoma and osteoid osteoma can be detected in the intraoperative period using a gamma counter.
The effects of stroke, spinal cord injuries, joint replacement, amputation, and other disabling conditions can often be reduced through physician- supervised rehabilitative care. Services include treatment planning, a prescription for rehabilitative equipment, and disability determinations. Both outpatient and inpatient care for acute mobility problems are also provided.
Traditionally, many bone injuries caused by trauma were repaired using immobilisation devices placed outside the body. Our orthopaedic surgeons are leaders in using devices that are surgically placed on or in the injured bones. Those devices provide strong support and can be used in treating fractures of the pelvis, thighbone, hip, foot, and ankle.
The Centre is an ISAKOS (International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine) approved teaching centre (www.isakos.com). Keyhole surgeries of the joints are done with state-of-the-art instruments. Recovery from the surgery is much faster compared to traditional open surgery. The facilities in arthroscopy include the video arthroscope for the knee, shoulder and hip, the smaller scope for wrist elbow and ankle, complete power shaver system, pressure sensitive pump for joint distension, arthroscopic electronic power system, VAPR (radiofrequency energy delivery system), Autologous Chondrocyte Implantation and Osteochondral Autograft Transfer System (OATS).
Keyhole surgery of the knee joint is routinely done mainly for meniscal repairs, anterior and posterior cruciate ligament reconstruction, double bundle reconstructions, biopsies, knee cap dislocations for MPFL reconstruction, popliteal cyst management etc. For routine arthroscopic surgeries the patient has to stay in the hospital for only 1 or 2 days and has to continue the exercises at home. Bio-absorbable screws/implants are routinely used for ligament reconstruction.
Keyhole surgery of the shoulder and hip is done routinely for repairing joint problems in recurrent dislocations, frozen shoulder, supra scapular nerve decompression, synovectomy and rotator cuff tear repair. The hospital stay is only for a couple of days and the pain following the surgery is much less. The recovery is much faster compared to traditional open surgery. Arthroscopy of the hip is done to deal with impingemnt lesions and labral lesions.
This division offers excellent care in sports related injuries of the joints and ligaments. Arthroscopic techniques are used in cruciate ligament repair, meniscal repair , cartilage transfer, MPFL reconstruction, and multiple ligament injured knee.
We treat orthopaedic disorders as well as correction of congenital deformities like club foot, congenital rocker bottom foot and club hand on a routine basis. Expertise in management of orthopedic problems and deformities, limb length inequality, as well as sequele of fractures and infections by Ilizarov technique is available. Severed limb implantation is done with the help of experienced plastic and vascular surgeons. Management of fracture pelvis and acetabular fracture fixation are undertaken routinely.
We have a dedicated unit for treating all musculoskeletal problems in children, consisting of state-of- the-art treatment for all types of paediatric trauma, congenital malformations, metabolic diseases and genetic abnormalities (club foot, congenital dislocations, pseudarthrosis, birth injuries and other congenital deformities).
Paediatric Neuromuscular Division at the Department of Orthopaedics caters to the needs of children who are differently abled due to neuromuscular disorders like cerebral palsy, myopathies, muscular dystrophies, spina bifida, arthrogryposis, peripheral neuropathy, traumatic brain injury etc. The primary goal of this division is the orthopaedic correction of deformities in these children.
The neuromuscular unit also runs multispecialty clinics like neuromuscular management clinic including the Neurologist, Physiatrist and the Orthopaedic Surgeon and also a specialised Spina Bifida Clinic including the Neurosurgeon, Paediatric Surgeon, Orthopaedic Surgeon and Physiatrist. These clinics are designed as a one-stop referral clinic for all the needs of children with complex problems.
The orthopaedic treatment offered by this division includes multilevel surgery in cerebral palsy, deformity correction in children with neuromuscular disorders, botox clinics etc.
All facilities are available to promote daycare surgery for a variety of conditions in spinal disorders, joint problems and fractures. The system is designed taking into consideration patient comfort and convenience.
The Centre run the following speciality clinics from Monday to Saturday