Activity Report 2014-2015

Asian Joint Reconstruction Institute

st(1 Year)

SRM Institutes for Medical Science (SIMS) is made of 9 speciality institutes and 19 departments focusing on various specialities and sub-specialities.

The speciality institute for orthopaedics in SIMS is known as AJRI.

SRM Institutes for Medical Science

Our sincere thanks to...

...for constant support and motivation

Shri. Ravi PachamoothooChairman - SRM Group

Dr. K. SridharSr. Vice President – Medical

SIMS Hospital, Chennai

Dr. Raju SivasamyVice President - MedicalSIMS Hospital, Chennai

Message from Joint Directors

SIMS-AJRI has completed its first year of operations. The year gone by has been gratifying

with most aspects of the operations being consolidated. The Unit has performed 660

surgeries with a predominant number of complex hip and knee surgeries. The spectrum

of referrals is evidence to the growing recognition of SIMS-AJRI as a referral centre for

high performance replacements and complex revisions.

The year also saw 78 international clients from USA, Canada, Australia, ME & SE Asia and

Africa with very successful outcomes. Their feedbacks certainly ratifies to the high

standards of cares & hospitality at SIMS-AJRI. The excellent infrastructure, ambient

atmosphere and the passionate staff in all fields have made this possible.

0True to the motto of the concept of 360 comprehensive care, AJRI is in the final stages of

launching the knee and the back clinics with focus on preventive education, non operative

treatment options and techniques etc.

AJRI, on the academic front, has also been instrumental in initiating the regional group

“South Indian Arthroplasty Academy” (SIAA), involving the established high volume

centres in South India. A robust documentation programme has been developed, which

will further the academic activities and research. The fellowships offered by AJRI have

seen considerable interest with applications from across the country.

Needless to say all that has been possible over the year has been made feasible by the

excellent cooperation and support from all the institutes and support staff at SIMS. We are

indeed grateful for their efforts and we hope they continue to contribute to take the unit

higher to the next level. Team AJRI would like to place on record its sincere thanks to one

and all.

Dr. P. Suryanarayan M.S (Ortho)

Joint Director & Consultant Orthopaedic Surgeon

Dr. Vijay C. Bose M.S (Ortho), FRCS (Ortho)

Joint Director & Consultant Orthopaedic Surgeon

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AJRI Vision

AJRI Mission

To dramatically improve the lives of arthritis patients and those suffering from joint related problems, with evidence based, best possible solutions and care that are outcome oriented, yet keeping them affordable.

To dedicate ourselves to pioneering improvement in joint reconstruction, relentlessly pursue progress, and become the global benchmark of clinical excellence.

The AJRI Team

Dr. P. Suryanarayan M.S (Ortho)

Joint Director & Consultant Orthopaedic Surgeon

Dr. Vijay C. Bose M.S (Ortho), FRCS (Ortho)

Joint Director & Consultant Orthopaedic Surgeon

Dr. K. Appaji KrishnanD. Ortho., DNB (Ortho)

Consultant Spine Surgeon

Dr. Ashok Kumar PS M.S (Ortho)

Consultant Orthopaedic Surgeon

Dr. Kanniraj Marimuthu M.S (Ortho), DNB (Ortho)

Associate Consultant

Sports Medicine & Arthroscopic Surgery

Dr. K. Kalaivanan M.S (Ortho)

Associate Consultant

Dr. D. Rajeshbabu D. Ortho, DNB (Ortho)

Associate Consultant

Dr. VSV Kumar DNB (Ortho)

Associate Consultant

Dr. S. Velmurugan DNB (Ortho)

Associate Consultant

Arthroplasty & Periprosthetic Joint Infection

Dr. J. Jebaraj Resident - Orthopaedics

Spine Surgery

Trauma & Limb Reconstruction Surgery

Trauma & Arthroscopy

Our Musculo-skeletal anaesthesiologists are experts in Regional anaesthetic techniques and selective

pain blocks.

The mission of our dedicated Musculo-skeletal anaesthesiologists is to transform the universal apprehension

experienced by patients in to a cherished painless experience. They achieve this by closely interacting and

optimizing all variables of the preoperative assessment, surgical procedure and immediate postoperative

recovery period in a seamless fashion.

Musculo-skeletal anaesthesiologists’ contribution is much more than giving anaesthesia to our patients. They

function as peri-operative physicians elevating safety and patient experience to a new level that not seen before

in the city.

Periprosthetic Joint Infection Management Unit

Dr. K. KalaivananAssociate Consultant - Orthopaedic

Dr. SureshConsultant - Infectious Disease

Dr. B. Anand ShankarDr. M. Madhavan

Musculo-skeletal Anaesthesiology

AJRI draws periprosthetic joint infection (PJI) patients from all over Asia. Dealing with PJI is the Achilles' heal of

many arthroplasty units as it is associated with poor outcomes. Many surgeons are unwilling to manage these

patients due to various constraints. SIMS-AJRI has set up a specialised unit to take care of these patients to

optimise outcomes and make this treatment affordable.

The AJRI PJI management team consist of orthopaedic surgeon, infectious disease specialist, microbiologist,

pathologist, operative theatre-nursing coordinator, physiotherapist and patient coordinator who interact closely

to deliver results. The isolation of the infective organism is a vital and difficult step in the overall success in the

management of PJI. The use of Sonicator and MALDI-TOF have increased the yield rate of organism identification

to above 95% in this Unit.

The enormous success in the management of PJI has inspired this Unit to move towards one stage revision for PJI

to decrease the morbidity and reduce cost to the patient.

Dr. K. RaghavendranDirector - Institute of Anaesthesiology

& Pain Medicine

Sitting Left to Right: Ms. S. Chandravadanamba, Ms. S. Sivakamasundari, Mr. Srichandra, Ms. S. Hariveni, Ms. P. Dharani, Ms. D. Ilamathi.

Standing Left to Right: Mr. S. S. Ezhilan, Mr. G. Jegadeesan, Mr. V. Senthil Kumar, Mr. R. Srivatsan, Mr. R. Ashok, Mr. S. Naresh Kumar, Mr. S. Murugadasan, Ms. R. Devi

Rehabilitation Team

Mr. N. Mohan KumarInstitute Line Manager

Ms. N.V. PremaAsst. Manager

Patient Services

Mr. R. RajResearch & Medical

Documentation

Ms. R. SrimathiCare Coordinator

Patient Care Services

@ AJRI Office

Ms. S. Suma DeviCare Coordinator

Patient Care Services

Unicondylar Knee Replacement

Unique Surgeries @ AJRI

Correction of Complex Deformity

20 year old male with multi focal osteomyelitis during childhood with involvement of both hips, left knee and right ankle. Right hip treated with Deltamotion hip replacement. Left lower limb treated with corrective osteotomy distal femur and plating.

47 year old lady with medial joint arthritis with pain and deformity. Unicondylar replacement of the medial compartment done.

AJRI Statistics

Team Work &

Sub-specialisation

Enhanced patient experience

Consistent best possible outcomes

Out patient registration : 2996

Surgeries performed : 660

Hip Replacements : 172

Revision Hip Replacements : 30

Knee Replacements : 147

Revision Knee Replacements : 16

Hip Resurfacing / BMHR : 17

OPD Clinics @ Satellite Centres

Lions club free medical camp - Arakonam

Nellore : 10 visits (Dr. Ashok Kumar)

Tirupathi : 5 visits (Dr. Ashok Kumar)

Agartala : 2 Visits (Dr. K. Kalaivanan)

Siliguri : 2 Visits (Dr. K. Kalaivanan)

Guwahati : 7 Visits (Dr. Appaji Krishnan)

Shillong : 5 Visits (Dr. Appaji Krishnan)

Shilchar : 2 Visits (Dr. Appaji Krishnan)

One Stage Complex Total Hip Replacement in Post Infective Pelvic Support Osteotomy with Chronic Instability

Preoperative X-ray shows post pelvic support osteotomy.

Follow up X-ray at six months shows good fixation.

Failed Septic Revision Knee Replacement - Two Stage Correction

54 year old female, unable to walk and discharging sinus. She underwent Stage 1 implant removal, debridement and antibiotic cement spacer. She was treated with intraarticular antibiotics followed with intravenous and oral antibiotics for a period of 6 weeks for E.Coli. At the end of 8 weeks she underwent Stage 2 revision total knee replacement.

A 21 year old male presented with unstable left hip joint and healed sinus. He was treated with one stage complex total hip replacement and intraarticular antibiotic catheter for MRSA.

Preoperative X-rays showing bone lysis, failed revision TKR.

Perioperative images showing removed implants and antibiotic cement spacer.

X-rays show cement spacer in situ. Postoperative X-rays at 7 months showing good fixation.

Intraarticular antibiotic infusion device in situ

Unique Surgeries @ AJRI

A case of non union distal third tibia with microvascular flap

Ilizarov fixator with computer assisted 6 axis device (Ortho SUV)

Spine Surgery

The Spine Unit has developed into a separate speciality providing comprehensive care to all spine related problems both surgical and non surgical. The Unit has performed the entire gamut of spine

surgeries from disc replacement to deformity correction.

C5-C6 artificial disc replacement for disc prolapse in a 30 year old engineer.

Reduction and TLIF L5-S1 for high dysplastic spondylolisthesis in a 20 year old girl.

Posterior scoliosis correction for adolescent idiopathic scoliosis in a 17 year old girl.

All posterior total spondylectomy of D6 vertebra with reconstruction and stabilization for fibrocytic sarcoma

in a 26 year old lady.

Unique Surgeries @ AJRI

International Patients : 78

USA : 17

Bangladesh : 14

Canada : 7

Indonesia : 6

Oman : 5

Mauritius : 4

New Zealand : 4

Sri Lanka : 4

Kenya : 3

Nigeria : 2

Thailand : 2

UK : 2

Costa Rica : 1

HongKong : 1

Iraq : 1

Maldives : 1

Pakistan : 1

Singapore : 1

Russia : 1

West Indies : 1

International Patients : 78

Dr. Kartik PatelAhmedabad

Dr. Purav KansaraAhmedabad

Dr. Vivek KhakharAhmedabad

Dr. M. ManoharanPondicherry

Dr. T. RajendranTanjavur

Dr. B.S.V. PrasadVizag

Dr. Karthikeyan MaharajanPondicherry(IOA Inland Fellow)

SIMS-AJRI Fellows

SIMS-AJRI Fellowship Programs for Joint Arthroplasty

SIMS-AJRI Advanced Fellowship Program: A 3 months program in primary and revision hip & knee replacement surgeries. This fellowship is offered to surgeons who already have some experience in this field. This gives them ample opportunity to assist procedures and direct interaction with surgeons.

Surgical visitations: SIMS-AJRI being a referral centre for advanced and revision surgeries, it hosts surgeons from across the country and abroad on short-term visitations from few days to a week.

Regional Collaboration – SIAA

Video conferencing between 4 centres

Members of Team SIMS-AJRI actively interact with the other 3 high volume regional centres through video conferencing on a regular basis once in 3 weeks.

Discussion pertaining to difficult case scenarios, combined research project, guest lectures by visiting international luminaries is done on regular basis.

This facility initiated by AJRI also enables teleconferencing with patients.

SIAA Online Data Registry

Advanced online documentation of the surgeries carried out at all the centres warehoused on a cloud server.

SIAA Fellowship Programs for Arthroplasty

A 2 years fellowship program ideal for surgeons who are committed to pursuing a career in adult reconstructive surgery. This fellowship enables experience in all 4 centres. The combined data pool from the online registry gives ample opportunities for publications and clinical audits.

Dr. N. NandakumarSIAA Fellow

Presentations & Live Surgical Demonstrations

ORTHOTRENDS 2014, Ahmedabad, – Mar 2014

Dr. P. Suryanarayan

Planning revision hip surgery Removal of well-fixed implants Trabecular metal in difficult situations

Cadeveric Revision Hip Surgery Course, Ramiah Advanced Cadaveric Learning Centre, Bangalore – Apr 2014

Dr. Vijay C Bose

Cadaveric surgical demonstration of Restoration Revision stem

Implant removal and exposure in Rev THR Principles acetabular side reconstruction in Rev THR Implants for Rev THR on the femoral side

Complex Primary Hip Course held at Depuy Institute, Chennai and Ramiah Advanced Learning Centre - Apr 2014

Dr. Vijay C Bose

Fused hip takedown Post acetabular fracture THR Hip Dysplasia THR in proximal femoral deformity High performance hips THR in Protrusio

Live Surgical Course, Coimbatore, India – June 2014

Dr. P. Suryanarayan

Live surgical demonstration of Crowe 4 dysplastic hip

Lecture on Role of sleeves

Zimmer Cadaveric Course, SRMC, Chennai – June 2014

Dr. P. Suryanarayan

Surgical approach – Endofemoral Vs Transfemoral The Monoblock Wagner stem Removal of well-fixed implants

Cadeveric Knee Arthroplasty Course, Ramiah Advanced Cadaveric Learning Centre , Bangalore – July 2014

Dr. Vijay C Bose

Cadaveric surgical demo of Genesis 2 TKR

FFD correction in TKR Basic biomechanics in knee arthroplasty Avoiding mistakes in primary TKR

th8 Asia Pacific Orthopaedic Symposium, Singapore – Jul 2014

Dr. P. Suryanarayan

Hip instability Management of acetabular complications with

TMARS The Monoblock Wagner Stem – Simple time tested

option

CME, Madurai Orthopaedic Society & Madurai Medical College - July 2014

Dr. Appaji Krishnan

Anterior scoliosis correction

Advances in Orthopaedics, International Medical Education Conference, Maui, Hawaii – Aug 2014

Dr. P. Suryanarayan

Challenges in revision TKR Optimizing the function with CR slope inserts Management of severe varus knee Type 3 acetabular defects

Instruction Course in Spine, Udaipur - Aug 2014

Dr. Appaji Krishnan

Laminoplasty for compressive spondylotic myelopathy with OPLL

Meet the Masters – Live surgical course, Chennai Spine Club - Aug 2014

Dr. Appaji Krishnan

Course coordinator

Sparsh-Sunshine Live Arthroplasty Course, Sparsh Hospital, Bangalore – Sep 2014

Dr. P. Suryanarayan

Live surgical demonstration of Complex primary, Revision surgery

Dr. Vijay Bose

Live surgical demonstration of Complex hip S-Rom reconstruction with subtrochanteric shortening osteotomy for Crowe 4 hip

Changing concepts in the management of Hip dysplasia

Association for the Study and Application of the Methods of Ilizarov Conference, Goa- Sep 2014

Dr. VSV Kumar

Faculty/Instructor Ilizorov course

Combined meeting of APOA and Royal Thailand Orthopaedic Association, Pattaya, Thailand – Oct 2014

Dr. P. Suryanarayan

Revision for infected hip replacement The Monoblock Wagner Stem.

Malacca / Penang, Malaysia – Nov 2014

Dr. P. Suryanarayan

Live Surgical Demonstrations of difficult primary & revision hip

Ortho SUV Demonstration, CMC Vellore - Nov 2014

Dr. VSV Kumar

Faculty/Instructor SUV Demonstration

MOACON, Akola, India – Nov 2014

Dr. P. Suryanarayan

Infected hip revision surgery THA for protrusioacetabuli Revision THA -Femoral Side

Complex primary and revision hip replacement workshop as part of IOACON 2014. Annual meeting of the Indian Orthopaedic Association, at KIMS Hospital , Hyderabad – Nov 2014

Dr. Vijay C Bose

Changing concepts in the management of the adult hip dysplasia

De-coding ‘High -Riding Hips’

Dr. K. Kalaivanan

Poster presentation: Low gradechondro sarcoma of first metatarsal – A multimodal diagnostic approach and treatment options.

Poster presentation: Plasmacytoma of proximal femur treated with tumor prosthesis replacement (TPR) – A case report with review of literature.

IAACON 2014, Annual meeting of the Indian Arthroplasty Association, Madurai - Nov 2014

Dr. Vijay C Bose

Live surgical demo of Gen 2 Total knee Replacement.

Debate : Are large heads required in hip arthroplasty

Cadeveric Knee Arthroplasty Course, Ramiah Advanced Cadaveric Learning Centre, Bangalore – Nov 2014

Dr. Vijay C Bose

Cadaveric surgical demo of Genesis 2 TKR

Tackling varus and valgus deformity in TKR Basic Biomechanics in Knee arthroplasty Avoiding mistakes in Primary TKR

CME Programme on Increasing Survivorship of THR, Madras Orthopaedic Society, Chennai - Dec 2014

Dr. P. Suryanarayan

How to follow up patients following arthroplasty -Practical tips

THA in protrusioacetabuli

Dr. Vijay C Bose

Dysplastic hip and issues of Hip centre Getting the Limb length right and Myth of medial

offset

Presentations & Live Surgical Demonstrations

Advanced hip arthroplasty live surgery course conducted by Tanjore Medical College, Tanjore - Dec 2014

Dr. Vijay C Bose

Live surgical demo of R3 Cup and Polar stem in complex primary Hip.

Restoring Limb Length in THR Trunnionosis in Hip Arthroplasty Newer bearing options in THR

Palakad Deformity Course, Palakad - Dec 2014

Dr. VSV Kumar

Faculty/Instructor Deformity course

st1 Trichy Knee Course, under the auspices of the Trichy Orthoclub, Trichy - Jan 2015

Dr. Vijay C Bose

10 common mistakes in Primary TKR

th13 Annual Winter Ranawat ‘Advances and Techniques in Joint Replacement’ Course, ROC 2015, Mumbai – Jan 2015

Dr. P. Suryanarayan

Periprosthetic fractures around knee

Dr. Vijay C Bose

Bio-mechanical restoration in THR and limb length issues

Annual conference of Association of Spine Surgeons of India, Pune - Jan 2015

Dr. Appaji Krishnan

Treatment strategy in multilevel degenerative lumbar disc disease

JRSOA 2015, Joint Replacement State of the Art Conference, Cochin - Feb, 2015

Dr. P. Suryanarayan

Live surgical demonstration

It’s the Bearing Porous metal shell and augments Crowe 4 dysplasia-Technical tips and tricks

Dr. Vijay C Bose

Keynote lecture: Justifying hard on hard bearings 2015Lectures: Bone conserving Hip arthroplasty Guidelines for Management of periprosthetic

osteolytic lesions

TNOACON 2015, Annual meeting of the Tamil Nadu Orthopaedic Association, Salem - Feb 2015

Dr. P. Suryanarayan

Revision for infected THR Overcoming bone defects in revision knee surgery

Dr. Vijay C Bose

Workshop on Primary TKR Hip Arthroplasty in Teenagers

Dr. Ashok Kumar PS

Paper presentation: Tibial tubercle osteotomy for exposure of difficult primary and revision TKA

Dr. K. Kalaivanan

Medal paper presentation: Co Axial stitch technique for intraoperative limb length assessment in Total Hip Arthroplasty

Paper presentation: Lets get our bug named” Our Experience with an Automated Blood Culture System (BACTEC) in Diagnostic Methodology of prosthetic Joint Infection

Basic Ilizarov Course, Mumbai - Feb 2015

Dr. VSV Kumar

Faculty/Instructor Ilizarov course

CME, Indian Medical Association, Shillong- Feb 2015

Dr. Appaji Krishnan

Current advances in spine surgery Tackling spinal deformity

Cadevericcomplex primary course. Advanced Cadaveric Learning Centre, Siriraj University Hospital, Bangkok – Mar 2015

Dr. Vijay C Bose

Cadaveric surgical demonstration of S-Rom THR and pinnacle cup.

Management of dysplasia Fused hip take down THR in post acetabular fracture situation

Presentations & Live Surgical Demonstrations

Innovations

Dr. P. Suryanarayan

Associated with the conceptualization, development & clinical validation of "PREPLAN” - A CT based patient specific jig for knee arthroplasty, developed by the Stryker Technology team - New Delhi, India.

Member – Design and validation team for image based hip Navigation system – Stryker corporation.

Dr. Vijay C Bose

Member of surgeon design team for Hip Navigation for Stryker Corporation.

Designer of the 'Bose concept hip system' – instrumentation for THR with jig for intraoperative limb length restoration.

Publications

Vijay C Bose, Subramanyam Yadlapalli, Ashok Kumar PS. Uncemenented total hip arthroplasty; Basics in Hip & Knee Arthroplasty, Reed Elsevier; 2014; 138-148.

Suryanarayan P, Ashok Kumar PS. Trabecular Metal Technology in Hip, Basics in Hip & Knee Arthroplasty, Reed Elsevier; 2014; 327-340.

Suryanarayan P, Ashok Kumar PS, Subramanyam Y. Current Principles of High Tibial Osteotomy, its role in management of unicompartmental degenerative joint disease. Knee Arthroplasty and Arthroscopy 2014

Dr. P. Suryanaryan

Sectional Editor – “Trauma and Orthopedics” – Indian Journal of Surgery

Reviewer & Editorial Board – Indian journal of Orthopedics

Dr. Vijay C Bose

Member of editorial board on the JHPS – Journal of Hip preservation surgery

Member of editorial board of Indian Journal of orthoapaedics

Editorial Board

International Collaboration

Dr. Darryl D’Lima M.D., Ph.D

Director of the Orthopedic Research LaboratoriesShiley Center for Orthopedic Research and Education (SCORE)

Assistant Professor of Molecular MedicineDepartment of Molecular and Experimental MedicineThe Scripps Research Institute

SIMS-AJRI family get together at GRT Grand

The wonderful families behind team AJRI

“If you want to shine like a sun,

first burn like a sun.”

- Dr. A.P.J. Abdul Kalam