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NCP chief Sharad Pawar undergoes hip replacement surgery

December 6, 2014, 7:15am IST | Agency: TOI

NCP chief Sharad Pawar on Friday underwent a hip replacement surgery in Breach Candy hospital after he fractured a bone close to his hip. According to doctors, he will be discharged from the hospital next week but it will take 4-6 weeks for him to recover fully.Dr Arun Mullaji, the orthopaedic surgeon who operated on Pawar, said: "The fracture was close to his hip bone. There was no option but to go for a total hip replacement. The surgery took around one and half hours."
Pawar suffered trans-cervical fracture of the thigh bone after he fell from the chair at his residence in New Delhi on Tuesday night. He was rushed to Sir Gangaram Hospital in Delhi. The political leader was later air-lifted to Breach Candy hospital for treatment.
Pawar is in the Intensive Care Unit and under observation. "Due to other medical problems, we have decided to monitor him in the ICU for a day. He will be shifted out of it on Saturday, and if all the required medical parameters are fine, we will make him walk with the help of a walker," added Dr Mullaji.

Pawar will be undergoing rigorous physiotherapy sessions and will take at least 4-6 weeks to get back to routine life, said doctors.
"Depending on his recovery, we will discharge him from hospital by middle of next week, but he will have to undergo rigorous physiotherapy to get back to routine life at the earliest," said Dr Mullaji.

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Avoid replacing total knee, just resurface it

7 December 2011 - 8:00am IST | Agency: dna

The state FDA has registered a complaint with the Mumbai Police against DePuy, a subsidiary of Johnson & Johnson that manufactured ASR implant, which is used in hip replacement surgery.
A year back, DePuy publicly recalled more than 93,000 articular surface replacement joints worldwide.
The move came after claims of metal debris from wear on the implant leading to a reaction that destroyed surrounding soft tissue and exposed patients to cobalt and chromium poisoning. In other countries, patients were compensated and re-operated. However, no such steps have been taken in India.
The FDA and Mumbai Police now want people to come forward if they have undergone a hip replacement surgery with this company's implant.
Ramrao Desai, senior inspector, Mahim police station, said, “The FDA lodged a complaint with us 15 days back. Under IPC 328, and Drugs and Cosmetics Act 17, 18 and 27, we have registered a case against the company’s director. We request people who have an ASR hip implant to contact us.”
The implant, released in 2003, used a metal cup and socket instead of a plastic or ceramic cup, to replace the hip joint. The company recalled the implants in August 2010 and admitted that 13% of those who received the device worldwide may need revision surgery. The state FDA has claimed that it doesn’t even have any data on how many patients received the implant in India.
“The police are investigating. Once the implant recipients come forward, we will know how many are affected, and accordingly take action against the company,” said an FDA official. City’s orthopaedic surgeons, however, had stopped using the implant as soon as the news broke last year.
Dr Pradeep Bhonsle, head of the department of orthopaedics, KEM hospital, said, “The moment the news broke abroad, we decided to stop using the implant, as a precaution. We have not received complaints from the patients on whom the implants were used earlier.” According to Bhonsle, Johnson & Johnson had stopped the implant’s sale even in India.Dr Arun Mullaji, president-elect of the Asia Pacific Arthroplasty Society and founder member of the Indian Society of Hip and Knee Surgeons, said, “We had asked all orthopaedic surgeons who had done the surgery using that implant to follow up with the patients. Regular x-rays and blood tests were advised. So far, we have not found any cases like those detected abroad”.
Around 4,700 implants were sold in India, out of which few are in Mumbai. Dr Ameet Pispati, consulting orthopaedic surgeon at Jaslok hospital who had performed a few surgeries using the implant said, “So far, none of my patients have needed a revision surgery. They have been regularly following up; there’s only been excessive wearing out of the implant or parts coming loose. The company has promised to fund the implant recipients’ evaluation tests, and in case it is found giving any problem, the company has agreed to pay for the next surgery too.”
The officials of DePuy in India were not available for comment.

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Have ASR hip implant? Cops want you

March 5, 2014, 10:48pm IST | Agency: TOI

MUMBAI: Not every patient with arthritis needs a total knee replacement. In fact, a majority of the patients who need surgery may only require a unicompartmental resurfacing, say doctors.
"The knee is divided into three compartments. Typically, arthritis starts in the medial compartment first. If this compartment alone is re-surfaced with artificial metal and polyethylene surfaces — called unicompartmental resurfacing — the other compartments do not develop arthritis for 10-15 years and the person does not need a knee replacement," said orthopedic surgeon Dr Arun Mullaji, who consults at Hinduja Surgical Healthcare Hospital in Khar in central Mumbai.
Knee replacement or resurfacing are needed due to arthritis, which affects 1 in 6 people. Arthritis essentially means wear and tear of the cartilage lining of the knee, leading to bones rubbing against each other.

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Indian surgeon uses iPod touch for knee replacement operation

Apr 21, 2011 at 7:26 AM

Last week when Dr. Arun Mullaji, a joint replacement surgeon at Mumbai’s Breach Candy Hospital, entered the operation theater to perform a regular knee replacement surgery on 75-year-old Gulab Singhvi, he did not have his usual array of computer-driven machinery. Instead, he had an iPod touch and a camera assembly capable of shooting infrared beams. A successful surgery later, he became the first surgeon in Asia to conduct the tricky surgery using an iPod touch! Since then he has conducted two more surgeries using the same solution. Developed by Smith & Nephew, Dr Mullaji claims the solution will bring down the number of revision surgeries patients have to undergo due to misaligned prosthetic knee joint within two years, which happens in one out of every 20 surgeries. Hit the break below to read how the surgery was conducted and a video demo by Dr Mullaji, himself. The app provides a step-by-step guide that shows where the instruments attached to the iPod touch have to be placed. The camera records the location of the instrument and sends it to a computer. Once the data is collated, it tells the surgeon how much bone needs to be removed to fit the prosthetic element.

A typical knee surgery can cost on an average up to Rs 2,50,000. “We are still determining the cost implication of this process,” said Dr Mullaji.  There are many benefits – the critical procedure of determining the hip center and positioning of the prosthetic has become more accurate. Unlike traditional knee replacement surgeries, this solution does not need any blood transfusion and patients are able to walk without any assistance within a few hours.

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All about arthritis


Dr Arun Mullaji tells us about different forms of arthritis and treatment options available. We are all living longer, but we can't increase the lifespan of our joints. With age, the thick pad of cartilage that acts as a cushion between our bones wears out. As a result, bone ends grind against each other and cause pain. The good news: this cartilage can be maintained for longer with diet and the right kind of exercise (see Yoga Rx this issue). Different people have different pain thresholds. When medicines and physiotherapy aren't enough, surgery is a viable option for people suffering from severe arthritis. However, hip and knee replacements are not a permanent solution—they last between 10 and 20 years, depending on general health and activity level. Thus, you must evaluate your condition and options carefully before opting for surgery.

DIFFERENT FORMS

Arthritis is common after the age of 50, but some forms can affect younger people as well. The elderly generally suffer from 'osteoarthritis', which affects hip and knee bones. 'Rheumatoid arthritis', which affects more than one joint, is prevalent in women between 20 and 50 years of age. The cause could either be genetic or a weak immune system. 'Avascular necrosis of the bone' is a type of inflammation caused by temporary or permanent loss of blood supply to the bones. Without blood, the bone tissue collapses. This affects the ends of long bones, especially the femur, the bone from hip to the knee. Another condition that affects our joints is 'ankylosing spondylosis'-vertebrae fusion, characterised by stiffness of backbone and hip joints. Women are more predisposed to arthritis than men. Others at risk include the obese, those who have suffered joint injury and people with a history of arthritis.

EARLY TREATMENT

There is no drug to regenerate cartilage but exercise, physiotherapy and medicines are all helpful in coping with arthritis. Walking, swimming and cycling are beneficial long-term activities. Take drugs only under medical supervision.

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Dr Arun Mullaji: Orthopaedic Surgeon WON’T GO FOR CARTILAGE REGENERATION


Regenerating cartilage in arthritic knees is futile, I think. Knee pain due to osteoarthritis affects one in six persons worldwide after the age of 55, and is three times more common among women. When the thin cartilage layer that lies over the bone wears out, raw bone surfaces grind against each another, causing pain when walking, bending the knees, getting up and sitting down, and ascending and descending stairs. There are thousands of ‘remedies’ that claim to ‘cure’ arthritis. Remember, once no cartilage is left between the bones, no remedy can ‘regenerate’ cartilage. Some of the most hyped and expensive cures include Quantitative Magnetic Resonance (QMR), Ozone therapy, hyaluronidase injections. None of these have, in valid scientific studies published in peer-review journals, been seen to be of value when there is no cartilage. They prolong suffering and deny patients the possibility of minimally invasive partial knee resurfacing. Patients then have no option but to opt for total knee replacement surgery. With modern methods of imaging cartilage through ultra-sensitive scans, we can determine accurately how much residual cartilage is present in the knee, allowing timely treatment to be institute.

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iPod Touch finds a place in the Operation Theatre


You might have heard about iPads making it’s way to Airplane cockpits and college class rooms. Our very own Rita loves the Apple App Store for the Medical Apps and has them installed on her iPod Touch.Now doctors in Breach Candy Hospital , Mumbai are using a setup involving the iPod Touch , an iOS app and a special stand to perform a knee replacement surgery.

Nullam euismod commodo

The hi-tech Doc who demoed this technology was Dr Arun Mullaji and the hospital has performed 3 successful hi-tech surgeries using the iPod touch as one of the tools.

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Mumbai doctor performs knee surgery with iPod


An aid for knee surgery, the latest in a growing array of applications for iPod, could come as music to the ears of surgeons with practice in remote places. Last week orthopaedic surgeon Dr Arun Mullaji of Mumbai's Breach Candy Hospital used an iPod Touch to perform a knee joint replacement surgery, thanks to an application called DASH, which makes the entertainment gadget useful in the operation theatre.

This one's an instance of sheer brilliance, and it has happened right here in Mumbai. A Mumbai surgeon, practicing at Breach Candy Hospital has managed to pull off an unimaginable feat. Together with orthopedic implant company, Smith & Nephew, Arun Mullaji performed knee replacement surgery on 75-year old, Prabhadevi resident Gulab Singvi using an iPod Touch. Not only was the surgery a success, the patient could walk on the same day, post the surgery.

A specialist in computer-aided knee replacement surgery, Arun Mullaji's surgery on Singvi is the first commercial non-experimental orthopedic (knee replacement) surgery in Asia to have been done using an iPod Touch. The surgery was performed using the DASH technology formulated by Smith & Nephew. The DASH system gets the iPod Touch to connect wirelessly, using Wi-Fi connection to an infrared beam emiting camera. The iPod Touch has tiny instruments attached to itself, which the surgeon can position, according to data fed on the iPod Touch. This data enables the surgeon to cut the bone with precision, and place a new joint. The exact alignments and the position of the operated portion can be viewed clearly on the iPod Touch's screen. The technology is a preferred mode because it is known to add precision to the surgery, which is key. Also, the implants done by this method are known to last longer and have better functionalities. Additionally, the surgeries done by the DASH technology are known to be more quicker, and affordable, along with it being easy for the surgeon-in charge to operate. It also accounts for being minimally non-invasive. All instructions required for the surgeon to smoothly function are fed on the iPod.

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Mumbai surgeon performs knee replacement surgery using iPod Touch

Aug 29, 2011, 04.15 PM IST | Source: Tech2.com

This one's an instance of sheer brilliance, and it has happened right here. A Mumbai surgeon, practicing at the popular Breach Candy Hospital has managed to pull off an unimaginable feat.

While several precision technologies are available for ensuring accurate removal and replacement of damaged joint parts, the novelty of the system lies in its simplicity and mobility.
DASH is being marketed as a portable navigation system that helps surgeons perform knee and hip joint replacement with greater precision. It claims to blend traditional surgical navigation with a cost-effective and easy-to-use solution. It is, however, yet to get regulatory approvals in the US.
In this device, the iPod is first attached to miniature instruments. The surgeon then positions them by reading the data on the iPod's high-resolution screen to accurately find and mark spots to cut the bone and place new components into the joint. The surgeon can thus determine,the exact alignment of the limb and the new joint on the iPod. Central to the new navigation system is the iPod Touch that links with an infrared camera to guide surgeons through each procedure. It can also aid fine-tuning of the surgical equipment and their position.
The whole instrument that comes in a strolley-like box can be assembled and dismantled easily and rapidly, as a promotional video by the developer Smith & Nephew shows.
It needs no internet connection, so it offers easy access anywhere and it works on iPod touch, iPhone, and iPad. "Accuracy in positioning the new joint is what decides how well the patient walks post-surgery, how much the knee bends, and even how long it lasts," Dr Mullaji said.
"Precision is very important," said Banglaore-based orthopaedic surgeon Dr Muralidhar Rao. "There are specialised instruments available for that." While Rao has yet to see DASH, he said doctors preferred textbook methods over those advertised on the web and media.

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Deformity Correction in Total Knee Arthroplasty Hardcover

21 May 2014 | Source: Arun B. Mullaji (Author), Gautam Shetty (Author)

With rapid advancement in technology and materials in total knee arthroplasty (TKA), long-term survival and function of the total knee is now more and more dependent on restoring accurate limb alignment, precise component position and optimum soft-tissue balance. Proper technique is key to ensuring this and is all the more crucial and challenging to achieve in arthritic knees with severe and complex deformities. Correction of such knee deformities forms an important part of TKA for orthopedic surgeons working in both emerging and developed nations.

Deformity Correction in Total Knee Arthroplasty fills the void that exists in treating severe and complex knee deformities and the use of computer-navigation in TKA. It covers the principles of deformity correction and soft-tissue balancing in primary TKA in an illustrative, step-wise and algorithmic fashion. Starting with the initial key step of preoperative planning, this book goes on to specifically describe how to deal with different types of deformities encountered in patients who undergo TKA - varus, valgus, flexion, hypertension, rotational and extra-articular deformities - as well as the stiff knee, the unstable knee, osteotomies in primary TKA and postoperative pain management and rehabilitation. This focused how-to manual includes plentiful images and clear, concise text from authors who have performed thousands of TKAs, making it a must-have reference for any surgeon unfamiliar or frequently confronted with this type of procedure.

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Deformity Correction in Total Knee Arthroplasty

Mullaji, Arun B., Shetty, Gautam
2014, XVI, 168 p. 119 illus., 78 illus. in color.

About this book:
Discusses the principles of deformity correction and soft-tissue balancing in primary TKA in an illustrative, step-wise and algorithmic fashion
Presents techniques for varus, valgus, flexion, hypertension, rotational and extra-articular deformity correction
The authors have performed over 10,000 TKAs, including over 3000 computer-assisted. With rapid advancement in technology and materials in total knee arthroplasty (TKA), long-term survival and function of the total knee is now more and more dependent on restorin accurate limb alignment, precise component position and optimum soft-tissue balance. Proper technique is key to ensuring this and is all the more crucial and challenging to achieve in arthritic knees with severe and complex deformities. Correction of such knee deformities forms an important part of TKA for orthopedic surgeons working in both emerging and developed nations.

Deformity Correction in Total Knee Arthroplasty fills the void that exists in treating severe and complex knee deformities and the use of computer-navigation in TKA. It covers the principles of deformity correction and soft-tissue balancing in primary TKA in an illustrative, step-wise and algorithmic fashion. Starting with the initial key step of preoperative planning, this book goes on to specifically describe how to deal with different types of deformities encountered in patients who undergo TKA - varus, valgus, flexion, hypertension, rotational and extra-articular deformities - as well as the stiff knee, the unstable knee, osteotomies in primary TKA and postoperative pain management and rehabilitation. This focused how-to manual includes plentiful images and clear, concise text from authors who have performed thousands of TKAs, making it a must-have reference for any surgeon unfamiliar or frequently confronted with this type of procedure.

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KEM Hospital has treated Joint bone TB for last 16 years

Mar 23, 2012 01:56 IST

In 2003, BEST bus driver, Rasool Nadaf, 51, thought he would never be able to work again after he was diagnosed with brain tuberculosis (TB). A year after completing his treatment, Nadaf had a sharp pain in his hips. In 2006, doctors at KEM diagnosed him with TB of the joints and decided to perform a surgery.
“There was a time I thought I could not work. Now I work as a peon with BEST. This was all thanks to the surgery,” said Nadaf, who walks with the help of a stick.
While most surgeons shy away from conducting a joint replacement surgery on patients suffering from joint bones tuberculosis (TB) fearing infection, the orthopaedics department of KEM Hospital has been conducting such surgeries for the past 16 years.
Experts in the field admit that most surgeons are unwilling to do this kind of surgery.
“The patient always risks the chance of re-infection which is a big financial blow. We conduct this surgery only if the patient is very insistent,” said Dr Arun Mullaji, founder member of the Indian Society of Hip and Knee Surgeons.
Dr Pradeep Bhosale, head of department, KEM Hospital, has performed surgeries on 84 patients, with both active tuberculosis and healed tuberculosis with follow-up treatment, since the past 16 years.
As recently as last month, Dr Bhosale conducted a surgery on a 45-year old man from Nagpur suffering from bone TB at Criticare Hospital.
Dr Bhosale will present a paper on this subject in the national conference of Indian Society of Hip and Knee Surgeons this April.
“We have developed a protocol of about 20 criteria that have to be fulfilled to conduct joint replacement surgeries for people with tuberculosis in the hip and knee joints. Unless the tuberculosis is detected early, the bacteria destroys bone tissues over a period of time giving rise to deformity of the bone,” said Dr Bhosale.
Most doctors conduct excision arthoplasy where the head of the joint is cut to give movement or fusing the joint together.
“Both these techniques give the patient a limp,” said Dr Bhosale.
After the joint replacement surgery, the patient has to undergo TB treatment for a minimum of six to nine months to prevent recurrence.
“We do a check-up a year after the surgery. None of my patients have got a recurrence of TB,” said Dr Bhosale.

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Your Guide to Running the Marathon

Oct 10th 2013 at 1:15PM

Orthopaedic Dr. Arun Mullaji prepares you for January's Mumbai Marathon. Running is as much about speed as it is about accurate posture, if you want to avoid injury. Running correctly is not just about putting one foot before the other and sprinting. If you wish to reduce the impact on your joints, consume energy efficiently and enjoy running for long, you need a plan.
The key to running correctly includes: strengthening your muscles, training and crosstraining, warming up and cooling down, and recovering properly.

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Kemps Corner

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 903, G Square, Jawahar Road, Above Kalyan Jewellers, Ghatkopar (E), Mumbai-400077.
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