‘Life is motion’ is the credo we all believe in. In order to succeed in today’s fast paced life one needs to be shipshape and achievers know the price of not being able to move. Occupations today demand a person to be mobile and the quality of mobility is important. As long as age is on a person’s side nothing seems to go wrong but when you start to develop the inevitable signs of aging you start to look around for remedies.

An extremely common affliction of degenerative nature that is bothersome and occasionally crippling is arthritis of load bearing joints like knee and hip. Literature is replete with the various measures to be adopted to prevent or retard the progression of this condition and even alternative medical practitioners keep on coming out with this brace or that churan for arthritis. The bottom-line is there comes a stage when nothing but a surgery will do.

Joint replacement surgery has been around for some time now and like in all other fields where a lot of R&D is involved, there are newer and better products available now. The dream of the developer remains an implant which is universal in application and will last a lifetime. Taking cue from hardcore industrial practices, one of the most versatile bearing surface available for a hip replacement is Ceramic (aluminum or zirconium based). It has excellent wear properties, is hard and if properly used will last a lifetime giving the receiver patient a new lease of life.

Technological advancements

On the other side is the issue of fixation of these implants inside the body so that these implants don’t come loose and need to be revised. Technological strides have given concepts like plasma spraying of minute beads of metal, grit blasting of minute beads of metal or using metals like Tantalum with amazing scratch and spatial properties.

All of these allow living bone to grow- in or grow- on these implants  up to several micrometers thereby almost internalising them. In hip replacement these two factors- improvement in bearings ( the actual interface where movement occurs) and the better fixation of implants to bone;  have transformed the indications and outcomes of hip replacements. Today younger and younger patients can be given replacements, a near normal activity can be ensured and lasting implants can be offered. Couple this with advances in surgical techniques and sometimes minimally invasive methods , it becomes music for a patient crippled with a bad hip.

Knee replacements: touching a new high

The other major joint that is replaced is the knee. Estimates are that last year about 50,000 knees were replaced in India. This figure is bound to go north as awareness and affordability increases in patients. Again it’s the developers and the doctors dream to offer a system that will last a lifetime and allow all activities. On that front today we have the good fortune of offering highly cross linked high density polys at the bearing which has extremely low wear rate and can last for very long. Also there is the concept of meniscal or mobile bearing polys which derive their durability from the simple principle of reduced constraint at the base plate which translates into lesser stresses at implant bone interface thereby improving longevity.

As in hips uncemented knees are also available which have more biologic interface at implant and bone. Besides there has been a revolution as regards options available for revision of old replacement surgeries which have outlived their usefulness for one reason or the other.

Suffice it to say that advances in joint replacement surgery are no less than in other technologically driven fields and today we can safely offer it to younger, more demanding patients and ensure that it lasts for long.

Spine surgery: sea of changes

Another field that has seen a welcome sea- change is spine surgery. There was a time when surgery for spine was often referred to as a passport to being a cripple. People were wary of getting surgery on the spine even in conditions like trauma, tumors and infections. A lot has changed in the past few decades and now spine surgery is accepted much readily and the reason is simple. Better understanding – of the disease processes, of the way spine exists spatially and how it functions in vivo.

Things were really made easier by the development of newer imaging modalities especially MRI. These allowed a surgeon to target the actual region of affliction and gave that vital clue as to the proper approach to the pathology. For decades surgeons were attempting to access the anterior part of the spine and advances in surgical techniques provided them the leverage to do just that. Better scans also helped in planning surgeries for deformity correction like scoliosis.

Another aspect of revolution in spine surgery was the development of implants used to stabilize segments of spine weakened by disease and/ or surgery itself. Judicious use of implants ensured that patients spine would not just collapse and jeopardize the spinal cord and the patients could be mobilized more confidently and early too. Developments in metallurgy brought the role of titanium to the forefront as MRI’s could be done after surgery too! Advances in biologics too have kept pace and now we have things like BMP (bone morphogenic protein) and TCP (tricalcium phosphate) which enhance new bone formation where it is desirable.

Like in the major joints, there is also a lot of work on the disc replacement surgery especially in the neck, less commonly in the lower back. Minimally invasive techniques have ensured that bigger surgeries are performed with minimal tissue damage. Patients are more informed today and surgeons are more armed today to lessen the burden of disease and infirmity caused by afflictions of the back.