Dr. Anshu Shekhar
Education:
M.B.B.S., M.S. (Orthopaedics)
Reconstruction Surgery (F.A.R.S.), ISAKOS (USA)
OPD TIMING :
Monday to Saturday : 10.00 - 16.00 hrs
Departments Services
1. ARTHROSCOPY
2. JOINT REPLACEMENT
3. KNEE PRESERVATION
4. SPORTS MEDICINE
5. ORTHOBIOLOGICS
ARTHROSCOPY
Arthroscopy is basically ‘key hole’ surgery. The damaged tissues can be repaired using this technology without having to make large incisions and opening the whole joint. Arthroscopy involves making small cuts in the skin called ‘portals’ and inserting a camera to view the joint on a monitor. Specialized instruments and implants can be inserted into the joint through these small portals. The advantages of Arthroscopic surgery over open surgery include: 1. Lesser pain; 2. Faster recovery; 3. Lesser stiffness; 4. Early discharge from hospital; 5. Greater safety; 6. Improved accuracy. These advantages make arthroscopy a preferred option wherever possible.
View of Arthroscopic Knee Surgery
There are several conditions of the knee and shoulder joints which can be treated with arthroscopy. Some commonly performed Arthroscopy procedures by Dr. Shekhar are described below.
Knee Joint:The knee is a very important joint of the body. It is made of up 2 bones: the femur (thigh bone), tibia (shin bone) and patella (knee cap). The knee has 4 main ligaments which provide stability to the joint: 1. Anterior Cruciate Ligament (ACL); 2. Posterior Cruciate Ligament (PCL); 3. Medial Collateral Ligament (MCL); 4. Lateral Collateral Ligament (LCL). There are two cushion like structures between the bones called the meniscus. The bone inside the joint is covered by a smooth lining called the cartilage.
Anatomy of the Knee Joint
- ACL Surgery: To reconstruct or repair the torn Anterior Cruciate Ligament (ACL). This ligament is the main stabilizer of the knee joint and is important for normal knee function. It commonly gets injured during sports injuries or a road traffic accident. Due to its poor blood supply, the ACL usually does not heal by itself. Injury to the ACL causes instability, i.e., the knee wobbles and patients loses balance while walking or running. A new ligament is created using tendons from the patient’s own leg. This is fixed in the bone using metal or biodegradable implants (screws or buttons). Dr. Shekhar has performed more than 800 ACL reconstructions and even written 2 books on this subject.
Arthroscopic ACL Reconstruction
- PCL Surgery: The Posterior Cruciate Ligament (PCL) is the strongest ligament in the knee joint and is present on the back-side. It gets injured less frequently. A tear of the PCL causes pain in the front of the knee and some instability (wobbliness). When the instability is severe or there is injury to any other ligament also, surgery is required. Just like the ACL, a new PCL is created using tendons from the patient’s own leg. This is also fixed in the bone using metal or biodegradable implants (screws or buttons).
- Meniscus Surgery: The meniscus is a cartilage disc, which is present in between the bones of the knee joint. There are two menisci in each knee – a medial (inner) and a lateral (outer) meniscus. When seen from the top, they are C shaped and in the cross-section. The meniscus functions as the shock absorber in the knee and reduces wear and tear. The meniscus can tear due to an injury or as an aging related process. The meniscus has very poor blood supply and does not heal after a tear. This torn meniscus can be repaired (stitched) or sometimes removed by arthroscopy. Dr. Shekhar has extensive experience in performing all types of meniscus repairs and published several scientific papers on this topic.
Arthroscopic Meniscus Repair
- Cartilage Surgery: The smooth lining of any joint is covered with cartilage. It allows free smooth movements. The cartilage can get damaged due to a trauma, loss of blood supply or old age. Arthroscopy can be used to repair the damaged cartilage by several techniques. Dr. Shekhar has wide experience in repairing cartilage injuries.
Arthroscopic Cartilage Repair
Shoulder Joint: The Shoulder joint is a ball and socket joint. It has several muscle attachment all-around it and it a very mobile joint. The shoulder joint can be affected by several conditions but two of them which require arthroscopic surgery are:
- Labral Repair: The ‘labrum’ is a ring of cartilage that surrounds the glenoid (cup) of the shoulder joint. It gets torn when the joint dislocates i.e., the ball comes out of the cup. This happens because of trauma (sports related or road accident) or in epilepsy. The labrum must be stitched back to its original position otherwise the shoulder may keep dislocating again and again. The surgery to stich the labrum is called labral repair. It is done via arthroscopy, without having to open the whole joint. Small bio-degradable implants called suture anchors are used to repair the labrum.
Arthroscopic Labral Repair
- Rotator Cuff Repair: There are 4 muscles which comprise the rotator cuff of the shoulder joint. The cuff together allows the arm to be lifted upwards against gravity and to rotate inwards or outwards. Rotator cuff tears can occur following a trauma or more commonly, due to age-related wear and tear changes. A rotator cuff tear causes signification pain and loss of shoulder movement. It does tend to heal in some patients but may require surgery is a few patients. Like the labrum, bio-degradable implants called suture anchors are used to repair the rotator cuff tendons.
Rotator Cuff Repair
JOINT REPLACEMENT
The joint surfaces wear off due to age-related changes and this condition is broadly called arthritis. However, some conditions like Rheumatoid, Sickle cell disease, Trauma or Avascular necrosis (bone death) can also cause the joint lining to get destroyed. The end result is a very painful joint with deformity, swelling and loss of movement. Joint replacement is the operation to remove the damaged joint lining and replace it with metal parts called implants. Joint replacement is a very successful operation when done using good technique and implants. It provides complete relief from the arthritic pain, improves joint motion and corrects any deformity (get a straight leg). With modern anaesthesia and techniques, the patient can start walking on the day of surgery itself. Dr. Shekhar has an experience of having performed almost 1000 joint replacement surgeries till date.
Knee Replacement: In Total Knee Replacement (TKR), the damaged joint surfaces of the thigh bone, shin bone and knee cap are removed. This is replaced by metal implants of the same thickness which are fixed to the bone with a special chemical mix called bone cement. The joint space in between in filled using a plastic spacer called insert. The metallic implants can be of several types like cobalt-chrome, titanium alloy, oxynium or ‘gold’. The implanted jointis called a prosthesis. This usually lasts for 15-20 years when used correctly. Sometimes, when only the inner side of the knee is damaged, just that area is replaced. This is known as Partial Knee Replacement.
Stages of Knee Arthritis
Types of TKR Implants
UKR and TKR X Rays
Hip Replacement: The damaged acetabulum (cup) is prepared and a metallic titanium shell is inserted which is fixed with screws or bone cement. The shell is covered a plastic or ceramic component called liner. The damaged femoral head (ball) is removed and a metallic component called stem is inserted in the thigh bone. A ball made of metal or ceramic or oxynium is fixed at the top of the stem. The life of a total hip replacement is about 15-20 years when used correctly.
There are certain limitations of a joint replacement operation. After this surgery, the patient should not sit on the floor (padmasana), squat or use an Indian type of toilet. Some physiotherapy is also important after this surgery so that patient can regain his/her muscle strength and balance.
KNEE PRESERVATION
The knee is a very important joint of the body. It is made of up 2 bones: the femur (thigh bone), tibia (shin bone) and patella (knee cap). The knee has 4 main ligaments which provide stability to the joint: 1. Anterior Cruciate Ligament (ACL); 2. Posterior Cruciate Ligament (PCL); 3. Medial Collateral Ligament (MCL); 4. Lateral Collateral Ligament (LCL). There are two cushion like structures between the bones called the meniscus. The bone inside the joint is covered by a smooth lining called the cartilage.Injury to either the ligaments, meniscus or cartilage can cause progressive damage to the joint. This leads to mal-alignment, i.e., the knee becomes bow shaped and bends inwards(varus) or outwards (valgus). Knee preservation involves correcting the alignment to get a straight leg and also to treat the ligament, meniscus or cartilage injury by arthroscopy. The operation to straighten the leg is called an ‘osteotomy’. Dr. Shekhar has been trained in osteotomy surgery for Dr. Ronald van Heerwaarden from Netherlands, a world leader in this operation. Osteotomybasically involves making a cut in the bone to straighten the leg and fixing the bone with titanium plate and screws. It is meant for patients who are either too young for a knee replacement, or do not want a replacement but wish to have pain relief and a straight leg.
SPORTS MEDICINE
Any person who is involved in any sports is likely to get injured at some point. This is true for professional sportspersons, weekend warriors and novices. Some of the most common sports related injuries are:
a. Knee injuries – to the ligament, meniscus, cartilage or tendons
b. Shoulder injuries
c. Ankle sprain
d. Tennis or Golfer’s elbow
e. Shin splints
f. Groin strain
g. Hamstrings pull
h. Back pain due to muscle or ligament injury
i. Shin splints
All these injuries can cause substantial pain and inability to participate in the desired sporting activity. This can be frustrating for an active and motivated sports enthusiast. Dr. Shekhar specializes in the treatment of sports injuries by several modalities like medicines, Orthobiologics, Kinesiotaping and above all expert advice. He has done special training with FIFA to treat football related injuries.
ORTHOBIOLOGICS
Orthobiologics is a treatment philosophy which involves the usage of several ‘biological’ substances for the treatment of orthopaedic conditions. They are basically injectable therapies which are given to cure a condition or for pain relief. Their most important trait is that they alter or improve the biology of a person to initiate ‘healing’. The conditions which can be treated by Orthobiologics include arthritis, tendon injuries, ligament injuries, sports injuries to muscles, etc. They have application in the knee, shoulder ankle, hip, back, wrist, elbow and heel. The various Orthobiologics can either be autogenous i.e., derived from the blood of the patient or exogenous, i.e., chemical substances which exert local biological effects with no generalized side-effects. The Orthobiologics being used by Dr. Anshu Shekhar include:
- Hyaluronic Acid – exogenous inert chemical substance
- PRP – prepared from patient’s own blood
- Autologous Conditioned Serum – prepared from patient’s own blood.
- Inj. Bone Marrow Aspirate Concentrate – prepared from patient’s bone marrow
Almost all these injections are given under local anaesthesia and are painless. Their biggest advantage is their safety and absence of any general side-effects as can be seen after steroid injections.
PRP Injection in Knee