MEDICINE-ORTHOSURGEON

​ORTHOPEDIC SURGEON

​An orthopedic surgeon is a specialized doctor, who treats our bones and muscle problems, and can perform surgery as well.

Lets imagine that you are an orthopedic surgeon at Fortis Memorial Research Institute, Gurugram.

​

A 65-year-old woman

with severe knee pain has come to you for help.

Let's look at her case!​

​Knee Scan:

​Let's examine Madhu's knee scan against a normal knee scan.

Multiple Choice

Upon examination of the 2 scans (click on the image to zoom in), what are your findings?

• The normal knee joint is bigger than the arthritic one

• There is no space between joints in the normal knee

• There is no space between joints in the arthritic knee

There is no space between joints in the arthritic knee.

​Upon examining the 2 scans it can be seen that the normal joint has space between the two bones, but the space is lost in the case of the arthritic knee.

​After discussion with your team, you have concluded that surgery is necessary for Madhu as she is at a severe stage of osteoarthritis i.e. bone-on-bone arthritis where there is no cartilage left between the two bones.

​You asked your team to find out the possible surgery options​.

​Cartilage (Normal knee)

​Loss of Cartilage (Bone-on-Bone arthritis)

​Option 1: Arthroscopy​

• Arthroscopic knee surgery involves the use of a camera to get rid of loose cartilage and bone.

• ​Pros: Recovery time is brief, and pain relief is almost immediate.

• Cons: Joint damage may continue to progress following surgery and pain may come back.

​

​

​Option 2: Arthroplasty​

• It is knee replacement surgery, where the surgeon will replace any damaged parts of your knee with artificial components.

• Pros: Provides long-lasting pain relief.

• Cons: Recovery will take several months.

​

​

Multiple Choice

Considering that your patient is 65 years old and cannot get surgery again and again for knee pain, which option would you recommend?

• Arthroscopy

• Arthroplasty

Arthroplasty.

​Considering that the patient cannot undergo multiple surgeries, it's better to go for an arthroplasty, i.e. knee replacement surgery because this type of surgery provides long-lasting pain relief as opposed to arthroscopy where damage may continue to progress and pain can come back even after the surgery.

You informed Madhu about the surgery. She is extremely stressed and doesn't want to go ahead with it. ​

Multiple Choice

Considering that stress might be harmful to the patient during surgery, what would you do under these circumstances?

• Ask Madhu's family to manage the situation

• Talk to the patient and clarify her doubts

• Go ahead with the procedure anyway

Talk to the patient and clarify her doubts.

Stress is not good for patients undergoing surgery. Many times families are unable to pacify the patients​, thus, it's important that the surgeon talks to the patients and clarify any doubts they might have and only then go ahead with the surgery.

You asked your team to find out a suitable video explaining the arthroplasty surgery procedure​ that you can show to Madhu and clear her doubts.

Let's see the video your team found!

​Well done! Madhu is relieved after talking to you and seeing the video. She has agreed to go ahead with the surgery.

​The next step is to pick an appropriate implant for Madhu. You asked your team to compare the best available implants in the market that can work as good as a natural knee.

Let's see what they found!

​Here is a comparative analysis of the 3 best knee implants available in the market:

​As per the medical records, Madhu has an insurance cover of ₹20 lacs. Both her knees need replacement and the hospital charges for the same would be around ₹3lac/knee.

Multiple Choice

Considering that the patient is 65 yrs old and requires an implant that can easily match her natural knee without much difference, which implant would you choose?

• STRYKER

• ZIMMER

• DEPUY

DEPUY.

You should choose DePuy because:

• The patient has an insurance cover of ₹20 lacs only and the hospital expenses for the two knee surgeries would be ₹6 lacs. So the amount we can spend on the implants is ₹14 lacs only, i.e. we can either pick Zimmer or DePuy.

• ​The patient wants a knee that matches the natural knee. Thus, you should go for DePuy as it can mimic the movement of the natural knee easily.

​The knee implants have arrived. Let's go ahead and decide which procedure you would use to fix the prosthesis!

​The two most commonly used procedures are as follows:

Multiple Choice

Considering that your patient is an elderly woman and cannot undergo multiple surgeries if the prosthesis becomes loose over time, which procedure would you choose?

• Cemented

• Cementless

Cementless.

Upon comparing the two procedures, it is quite evident that although the cemented procedure is quicker, it is less durable in the long term.​ Thus, you should pick a cementless procedure as your patient cannot have multiple surgeries if the prosthesis becomes loose over time.

Well done, the surgery was a success! Here are the knee scans post-surgery:

Before

After

You've monitored the patient in the hospital for a few days. Madhu can now stand and walk on her own with a support stick. So, now is the time for her discharge!

Multiple Choice

Post-discharge, what all advices would you give to the patient?

• Take medications and physical therapies

• Do knee exercises daily, but don't over exert

• Look out for any swelling or pain

• All of these

All of these.​

​Post-surgery care is very important for the patients. Thus, taking medicines timely and going for therapies is a must for the patients. The knee replacement patients should do knee exercises and movements regularly to get adapted to the new knee. But at the same time, they have to look out for any redness or swelling in the area, to avoid any infection.

Oh-no! Madhu has come back in just two weeks with severe knee pain. She cannot even walk without support. You asked your team to analyze the knee.

Multiple Choice

A deep analysis reveals that Madhu's stitches have opened up because of the heavy exercises she was doing to recover early. Considering that she overstrained her knee even after your advice, what would you do?

• Refuse to treat her as she didn't follow your advice

• Redo her stitches and put her on compulsory hospitalisation

Redo her stitches and put her on compulsory hospitalization.

​As a doctor, you are bound by the doctor's oath which states that you have to treat the patients to the best of your ability and not deny any patient treatment. Thus, you cannot refuse to treat the patient even if they are at fault. You should redo her stitches and put her on compulsory hospitalization.

​Your efforts have been successful and Madhu's condition has improvised over time. She can now walk freely without any support.

She wrote a heartfelt letter to thank you for all your help. Let's read it!​

Poll

Would you like to be an Orthopedic Surgeon in the future?

• YES

• MAYBE

• NO

Poll

On a scale of 1-5 stars (1 being the lowest and 5 highest), how much would you rate this challenge on fun and learning?

Open Ended

What changes would you suggest for this challenge?