A small introduction
About Us
Modern Ortho Clinic for Minimally invasive techniques achieve almost 100% success in Diagnosis and many times accuracy in operative goals than traditional procedures.
Let us introduce ourselves
About Modern Ortho Clinic
Dr. P.C. Dey is the pioneer of Arthroscopic surgery in Odisha and has the credit of operating more than 5000 knee and over 1000 shoulder arthroscopic surgeries.
Knee Arthroscopy: Meniscus is the cushion between two bones femur and tibia. Cruciate ligament is a rope like structure connecting two bones of the knee i.e that is thigh and leg bones and plays important role in knee motion and stabilizes the joint.
How A.C.L. is injured: A.C.L is commonly injured during sports and road accidents; but it may also tear during trivial injuries sustained in day to day activities like dancing, jumping and running. A person may hear a pop sound during an A.C.L. tear and this is usually accompanied by immediate swelling of knee. Most often we tend to pass this off as a simple knee sprain and is only later that we realize its seriousness.
A.C.L is commonly injured during sports and road accidents; but it may also tear during trivial injuries sustained in day to day activities like dancing, jumping and running. A person may hear a pop sound during an A.C.L. tear and this is usually accompanied by immediate swelling of knee. Most often we tend to pass this off as a simple knee sprain and is only later that we realize its seriousness.
What happens once A.C.L. is torn: After an A.C.L. tear knee becomes unstable, it buckles or gives way when you take a sudden turn or even a small jump. One feels insecure while walking on uneven ground and slopes and experiences a lot of apprehension during such activities. Over a period of time the knee might give way even during normal walking. After an A.C.L. injury your leg bone slides easily over the thigh bone. The abnormal movement causes progressive damage to other structures inside the knee, like meniscus and articular cartilage and eventually leads to early wearing off (arthritis) of the knee. There may a small tear or large bucket handle tear of meniscus or cruciate ligament rupture or simple synovitis, loose body, osteochondral fragment, synovial chondromatosis.
Loose bodies can be removed arthroscopically. In synovial diseases punch biopsy is taken. Tear in the peripheral part of the meniscus can be repaired with suture but if injured in the central part where blood supply is less and union is difficult, we have to balance that with RF (Radiofrequency) and shaver.
Surgical Reconstruction of ACL: For Cruciate ligament we need to reconstruct with middle 1/3 of patellar ligament or semitendinosus tendon with or without gracilis tendon.
The surgery is performed under regional anaesthesia; the knee is first inspected with arthroscope to confirm the diagnosis.
For removal of semitendinosous tendon, we need 2-3cm cut in upper medial aspect of leg, Tendon stripper is used to remove the tendon. Length of tendon is about 34-32cm. We need to make it 4 fold & come out 60-80mm. Both ends will be sutured with ethibond suture. One end is tied with endobutton which is fixed on femoral side. Other end is fixed with suture disc which is fixed on tibial side.
How A.C.L. is injured:
With help of zig and drill bit tibial and femoral tunnels are made as per tendon size. Graft is then introduced into the joint in both tibia and femur with suture disc and endobutton respectively. These fixation devices normally need not be removed. 1-3 stitches are necessary. Brace is applied. No plaster, 2-4 days hospitalization in ligament injury. Same day discharge in meniscus injury. Normal activities after 6 weeks in ligament construction after 7 days in meniscus surgery.
Shoulder Arthroscopy: Within this decade the treatment of shoulder joint is totally changed due to advent of new techniques, instruments like arthroscope and newer diagnostic tools like M.R.I. The shoulder problems are basically divided into 3 categories.
1. Recurrent dislocation of shoulder.
2. Rotator cuff tear.
3. Subacromian bursitis.
Recurrent dislocation of shoulder: Recurrent dislocation of shoulder means shoulder joint dislocated more than twice. Most of the time it starts with trauma which is either sports related accident or fall during household work. If not treated with adequate rest which is almost 6 weeks in the 1st incident then the muscles & capsule around the shoulder joint lies loose and it leads to recurrent dislocation, sometime during sports or during taking out goods from higher shelf; it dislocates, during removing the baggage from aeroplane, train, bus it slips. When it happens more than twice the patient is not able to sleep comfortably at night with the fear that hand may go up over the head and may dislocate. Any work in overhead position of arm is a regular tension for the patient like during wearing a shirt or dress.
Surgical correction: Arthroscopic Bankarts repair is a telescopic surgery just like laparoscopy with 2 to 3 small hole, 5 to 10ml blood loss and no stitches with immediate comfort after surgery almost without physiotherapy. Needs 4-6 weeks for full recovery.
* Shoulder is a ball & socket joint, the socket is formed by the glenoid of scapula bone and the ball is the head of arm bone.
* Shoulder usually dislocate to front.
* Front part of the labrum is torn from the glenoid and slipped from its position due to dislocation.
* 2-4 anchors is usually drilled to glenoid and the thread coming out from the anchors eye is fixed to torn labrum.
* Which is then pulled back to its original position on glenoid border to make a hood to the humeral head and prevent it from dislocation.
* Immediate post- op physiotherapy and arm pouch & no plaster
* It is apermanent solution.
* Patient can go back to his normal duty 4-6 weeks and sports after 6 months.
Rotator cuff tear: There are 4 muscles around the shoulder that controls all the movements of the shoulder. They are very heavy muscles, never tear with minor trauma, it only tears with accident or during sport. But due to the ageing process the muscles become thin & weak, so torn with trivial trauma or regular work. The diagnosis, is very easy as the patient is not able to lift his hand and if the doctor or anybody lift it & leave in the elevated position, the arm drops like a dead piece which is called Drop arm sign.
Arthroscopy is the best treatment or solution to get back the arm function, it need only 2 to 3 holes and 1 to 2 anchors by which the torn part of the muscles can be pulled back to its original position & implanted to the bone.
Needs only 3 weeks rest & then some exercises to get full range of movement & function
DR PC DEY CLINIC FOR MINIMALLY INVASIVE JOINT & SPINE SURGERY
(ARTHROSCOPY & ENDOSPINE)
Operated more than 2000 cases (which is the 3rd highest in the world) by this technique successfully at a very affordable cost.
At regular interval we are arranging training programmes and national, international conferences on Endospine, WESS (World Endoscopic Spine Society) Congress, to train the Ortho & Neurosurgeons of India and other countries.
Dr Dey visits different parts of India & other Countries to train the Neuro and Ortho Surgeons frequently.
Dr. P.C. Dey is the pioneer in Endospine surgery in Odisha and one of the pioneer in India, learned this noble technique directly from the pioneer Dr. Jean Destandau of France.
The other one is Spinal canal stenosos or Sciatica in which the diameter of the spinal canal is decreased due to aging process. When age advances the canal dimension decreases due to weakness of the bone and side projection, ligamentum flavum hypertrophy and disc degenaration. In both slipped disc and sciatica, spinal cord or nerve roots are compressed. The pain radiates from back to legs and toes. Tingling and numbness starts in legs and toes. During walking person feels tightness in legs and the walking distance reduces. Sometimes control over urine lost, is also called sciatica syndrome. At times negligence of petty symptoms leads to complete loss of sensation of toes and foot and loss of power of foot which is otherwise called footdrop.
What is Endospic Spine Surgery?
The Endospic Surgery is the most advanced and successful technique for treatment of Slipped disc and Sciatica. A special localizing device is used to localize the disease site with the help of image intensifier. The operating tube is placed on the laminae through a small 16 to 18mm incision. The surgeon’s eye is focused right inside the body close to the problem. The working insert mounted in the tube of having 4 channels, for 4mm telescope, 4mm suction tube, 8mm operating instruments channel and the last one for nerve root retractor.
The entire procedure is performed under video-endospic monitor through high definition camera and the nerve is guarded by nerve root retractor, so almost nil chance of injuring the nerve. There will be minimal blood loss and no stitches required. It can move from left to right below the spinous process and very easily decompress bilateral nerve roots at multiple levels. Endospine minimizes post operative discomfort and allow for rapid resumption of normal physical activities including sports.
FAQs
Is Physiotherapy Required?
In general not required
But in some special condition it may be considered.
Do I have to wear Brace?
Generally no, only for those who has associated bony problems like Osteoposis, Fracture, Spondilitis or Spondylolosthesis.
Will it Recur?
Almost nil to remote chances in comparison to Open and Microspic technique.
What are percentage of nerve root injury or any other complication?
We have most advanced high end facilities to treat the patients with Endospine technique with almost nil complications.
