Kalra hospital

Hi friends,

I am Dr. Sunny Chopra. Today we will discuss about knee problems. In today's era we have seen that many problem occur in the knee. In young age we having a sports injury in the knee like ACL tear, meniscal tear, ligament tear. In middle age we having a osteoarthritis, chondromalacia patella and in more elderly age group we having a severe arthritis of the knee that leads to difficulty in walking, bearing weights, squatting, sitting cross legged. We go step by step in all these cases. Next will discuss of sports injury first as I am sports injury specialist, we work even toward the minimal invasive orthopaedic surgeries and all that. So this is our knee joint. This is a ligament which is known as ACL ligament. Mostly sports injuries like cricketer, basketball player, volleyball player we having that ligament get torn and that leads to instability in the knee, instability doing sporty activity, difficulty in walking, running, climbing stairs and patient having complaint of more of knee instability rather than pain in the knee. So, we don't get to scare off these cases, we having a good ro material of knee orthoscopically. We through the orthoscopically, we reconstruct this ligament and we doesn't do many and we doesn't do so much muscle cut, we doesn't do so much of blood loss. We use the knee arthroscopy technique, minimally invasive knee technique and we reconstruct this ligament and we put the patient on rehabilitation next day, we walk the patient next day and more importantly patient within the span of 4-6 weeks start jogging and start climbing stairs and after 12-24 weeks patient can go for daily day to day activity and over a period of 6 months to 1 year, patient can resume his sporty activity and all that. In a knee, we having a one more problem is of that meniscal tear is there. We repair the meniscal, we try to preserve the meniscus and if the meniscus is unrepairable, complex tear is there, we do the meniscectomy, sub-total meniscectomy.

Basically meniscal act as a shock absorber, it basically distribute the force; dissipate the force over the tibia. So meniscal having a balancing. Definitely there are tear which are we can't handle, which has to be do the meniscectomy. In those cases we do all this technique through the arthroscopy technique. Then we having a PCL behind. We do the PCL reconstruction via the minimally invasive knee arthroscopy surgeries. Then we come to middle age patients who having osteoarthritis but not so severe arthritis in that cases in those cases if the patient having a grade 1, grade 2 osteoarthritis knee in that cases we tried to preserve the joint, we do the joint preservation surgeries, we initially put the patient on rehabilitation, knee physiotherapy. We just start the viscous supplementation also; we give the lubricants and all that. Some injection are they are time bearing, they just we apply the injection in the knee joint at the age of 45-50 years to buy the time for the joint preservation surgeries.

There are Synvisc one, there are visco-supplementation many injection, they are mostly of sodium hyaluronic acid and many patients of this grade 1 and grade 2 arthritis, they get benefits of that. Then patient who are in the Kellgren-Lawrence grade 3 and grade 4 classification who having a severe arthritis, patient can't walk even for 100 steps, patient can't bend his knees, patient having difficulty pain for that grade 3 and grade 2, we do joint inflammation surgeries, we do osteotomy of the knee joint like there is osteotomy, proximal fibular osteotomy and definitely through the knee arthroscopic debridement and lavage and then we do the proximal fibular osteotomy. In that cases we achieve many good result of grade 2 and grade 3 arthritis. Even in cases they having uni-compartment involvement, deformity not as such in that cases also we do uni-compartmental knee replacement. Only the involved compartment knee replace, for that the patient as thin lean patient and activity range of motion should be full, no deformity less than 50 degree deformity is there, for that cases we need to do the uni-compartment knee replacement. In both the compartment involved, patellofemoral joint is also involved, patient deformity also there, age is 65-70 years, then we go for total knee replacement. This is the total knee replacement. These just do the shape guard of the joint which is destructed. We remove the joint, we put a femoral component, we put a tibular component, we allow the patient to walk next day in uni-compartment.

In uni  unicondylar knee, we walk the patient next day immediately 24 hours after the surgery. We rehabilitate up 2-3 weeks and in bi compar in in both knees in both knees we allow the patient to walk 48-72 hours. We do both knees simultaneously also. We do one by one knees also. It depends on the patient, pre-anaesthesia condition, if the patient is having diabetes, patient is hypertensive or patient having a other co morbidities. We do the one stage procedure one knee and then 6 months after 2nd knee. If the patient having a no co morbidities, patient is fine, patient having more knee crippling so we can do the both knee knee replacement in the same sitting also. Don't get scared of knees treatment and all that from the Doctor Chopra spine joint solution, we having a diversity of the knee treatment from young age, from sports injury, from the middle age, from the old age. So don't get panic, don't get disheartened that we having a sports injury, we having a old age disease, we having a middle age disease, we having a complete solution from young age to old age of knee. Thanks to all listening and thanks to our God almighty.

Thank you

Hi friends, 

 I am Dr. Sunny Chopra,Orthopedist.  Today we will discuss about the shoulder. We have seen many cases of shoulder age to age. Initial young age we having impingement syndrome of shoulder and rotator cuff tear, traumatic rotator cuff tear and recurrent dislocation of shoulder. Middle age we having a rotator cuff tear, frozen shoulder, bicep tonality, slap tear and old age we having a rotator cuff arthropathy and frozen shoulder and more towards the bursitis and complete rotator cuff arthropathy.

So, we having so much myth about the shoulder where we have to go, which doctor is for shoulder because all orthopaedic doctors are not able to cure the shoulder treatment. We are continuing giving the medicines, we continue giving the injection in the shoulders and all that. Many females are come to us which having difficulty in shoulder, she can't sleep over that shoulder, belna karne me dikkat hota hai, karchi ghumane me, kapde nichodne me, even unlid the open jar, screwing and unscrewing moments; these all leads to difficulty in daily day-to-day activity and all that. And also we are going to continue physiotherapy, physiotherapy then we apply the injections also. Patient we have relief for relief for 6 weeks, 8 weeks. Now the trend gets changed. We having a good armamentarium, we having a good approach towards the shoulder, we having a minimal invasive shoulder approach via shoulder arthroscopy and shoulder rehabilitation protocol. Patients they are more towards rehabilitation, physiotherapy; even the patient having a rotator cuff tear, even the patient having a so massive tear and he can't able to play sports like many patient who having a overthrow activity, basketball player, volleyball player they having a slap tear. So that scariness of the shoulder pathology has now from onwards is getting is totally disappear. We having a many patient we dealing with shoulder pathology, like this is a shoulder joint. We having this is rotator cuff, this is a bicep tendon, this is anterior sub-scapularis the whole they form the shoulder rotator cuff. So to minimally invasive technique to shoulder arthroscopy, we repair the rotator cuff using suture anchor, using radio frequency ablation.

We decompress that subacromial area, we capsule-optimize the capsule part. We put the patient under shoulder rehabilitation, through the biceps tenotomy also the patient get relief in old age. If the bicep get tear in young age we have to do biceps tenodesis also. And we have seen the many patient who having a recurrent dislocation, recurrent dislocation more than 20-30 dislocation shoulder in a year. So there is a pathology which is known as Benkart Lesion because when the first dislocation in the shoulder, the Benkart get torn up. So we repair the Benkart lesion using a suture anchor and through the shoulder arthroscopy.

We discharge the patient next day, 24 hours. There is no any muscle cut, no blood loss, no any complication rate as seen in the shoulder. Early rehabilitation, early physiotherapy, early mobilization the shoulder joint that makes more rehabilitation protocol easier as compared to if we are going directly physiotherapy and all that. Mind you if the patient having a rotator cuff tear and we put a injection or we put a patient on rehabilitation that creates more tear vastness and we create more increase in the tear as compared to if we do arthroscopical rotator cuff repair that leads to more sound towards the rehabilitation. Physiotherapy also get some more edge after the repair.

We acclimatize or we acro-plasty the acromion process which impinge the rotator cuff. We teno tenotomy the biceps which also put a pressure over that cuff area that rotator interval area and also in some cases we do the tenodesis also. We do the Benkart also. All the patient we discharge after 24 hours. We put the patient on shoulder rehabilitation up to 4-6 weeks. 2-3mm stitch dissolvable stitch we apply that and mind you the scariness and difficulty in shoulder treatment all get resolved from the shoulder arthroscopy. We just thanks to God almighty and well wishers. We are dealing with the shoulder arthroscopy, we are dealing with shoulder pathology, we are dealing with shoulder rehabilitation. Our patients initially 4 to 6 weeks after cuff repair patient having a pain for 2 to 3 weeks but good shoulder rehabilitation the patient get relief from that area.

Thanks.

Hi friends,

Myself Dr. Sunny Chopra, Orthopedist. So, today we will discuss about spine minimal invasive spine surgery and it is mostly done by the percutaneous endoscopy. In today's era we having a quiet lifestyle dysfunction and all that and we having a common problem is back pain. Let let let I explain each and everything. This is a spine and this all the vertebrae of spine and in between the vertebrae there are the discs which are present in the spine. So in today's era while we going for forward bending and lifting heavy weights like in patients in gymnasium, young athlete or in old age patients, we having a common spine problem is there.

So, in that cases disc is protruding the nerve and that leads to pain in our legs and pain related from back to leg leads to paraesthesia, tingling, numbness and all other symptoms that leads to difficulty in doing the daily activity like walking, running and in old age the nerve get saturated and that leads to claudication in the lower limb. So we having a quiet scareness and also fear of spine surgeries and all that ki spine ke surgery ke baad pairon me lakwa maar jaega or urine or stool me koi dikkat ayegi but ab koi ghabrane vali baat ni hai.

Ab spine ke andar hmare pass vo upchar agye hai, jisse ki hum 8 ghante se 10 ghante ke baad chalna shuru kar sakte hai. Isme humko koi patient ko behosh karne ki zarurt ni hai. This happen only in local anaesthesia. Koi muscle cut ni hai, koi blood loss ni hai, koi humara cheera faadi ka kaam nahi hai. Humko sirf patient ko subah admit karna hai or 8 ghante baad hum patient ko chala dete hai or 24 ghante ke baad patient chutti hojati hai. Koi muscle cut ni hai, koi blood loss ni hai, koi anaesthesia ni hai. Patient jagta rehta hai, humse baat karta rehta hai or hum uski surgery karte hain. Basically patient humara aisa letta hai but we lie the patient in prone position and we put a endoscope over this area and we release all the material aage se disc, piche se ligaments, apka foremen ligament. We remove the ligament flavum all that.

Local anaesthesia me hum ye pura surgery karte hai. 90,95 years ke bhi old patient jinme hum surgery karne se ghabrate hai, vo patient bhi hum doorbeen dwara endoscopy dwara kar sakte hai. The motto is that ki the element which are producing the pain in the spine which are disc, posterior element, apka maspeshiya, your ligament flavum thickening, these all the structure which producing the pain. Plus jo aap ye dekh rahe hai flaccid joint, ye bhi pain produce karte hain. To we do Foraminoplasty also. Is foraminoplasty ke andar hum is foramen me jo structures hai unko hum radio frequency se ablate kardete hai. Then we do endoplasty also and simultaneously this whole procedure leads to foramano decompression, nerve decompression, neurolysis leading to fusion and we don't do any posterior stabilization and posterior fixation. We put the patient on spine rehabilitation, spine physiotherapy for atleast 2-3 weeks.

We have done at least 30-35 cases of this endoscopy spine procedure and we thanks to our God almighty and we thanks to our well wishers that we achieve a 100% success rate in these cases. We just want to give the strong message to the viewers don't get scared of spine surgery. In today's era and in previous era, in today's era we having a minimal invasive spine. We don't want to anaesthise the patient, we have to local anaesthesia, we didn't muscle cut, we didn't has scare of blood loss, we didn't get scared of neurological compromise, we walk the patient within 8 to 10 hours and we having a myth of spine surgery. So don't get scared of spine and all that.

Thank you