Friday, June 20, 2008

Total Hip Replacement

Minimal invasive surgery (MIS) is a word frequently uttered in the seminars and conferences. Big versus small incision surgery is a never ending debate. Of course it is of cosmetic value for patient but struggling for surgeons.

Even orthopaedicians are running after MIS. Spine, joint replacement, fracture, or complex trauma, MIS stands front line. Being done with knee replacement thesis I was always fascinated with replacement surgery.

Mr.... your joint is burnt up and needs replacement. Sounds so amazing for the patient. They have hundred queries, but since there is no option for painless mobile life ultimately give their consent. Worth for exhausted joint and painful arthritis.

Don’t know the exact number of cases I assisted for joint replacement. I was lured to incise, cut the neck of femur, prepare acetabulum, put the metal inside it, and close it. Show the x ray to the patient he takes a long breath and imagine half of his thigh and hip area must have been cut like anything to put that big metal implant. But the small scar in the back of thigh and hip really build up the confidence to his surgeon.

I had done most of the part of surgery many times. But was always waiting for my turn right from A-Z of the hip replacement surgery. And today was my day. My seriousness toward work, interest to it, optimal knowledge to the subject, and faith of my boss and in fact his hang up to the next case made my dream come true. Boss said you start the case, expose and I will join after that. But after a long time I was a master of the surgical blade, why should I miss the opportunity of proceeding smooth till I wish. With in no time I exposed the joint, dislocated it, marked the neck cut and prepared the neck. Started the acetabulum preparation. In between I keep informing my boss. Boss was confident enough so he bothered not. The moment boss came to see my progress, I was almost through. I was about to put the acetabulum component. My boss was so kind that he did not want me to interrupt. Said sail smoothly. In between he told you are fast just because your exposure was fantastic. Exposure was with small incision, well prepared, and with utmost tissue respect. Boss was happy to see it. I thought it’s my progress towards perfection. I did not that I wanted appreciation but to master my skill. Shortly I finished. Must have taken one and half hour for the entire procedure, very smoothly and as expected and predicted beforehand. Everybody came and see and commented as they like. I mind them for their praise only. Only thing I objected in my mind is party again. Party means 1000 rs minimum. Oh god I gave party last week only for latissimus dorsi. But I don’t mind it, because it’s a tradition. Of all those I have started the new tradition, a new event and possibly a history of being a junior resident, replacing hip joint, though I am over with my MS degree.

Till now the post operative progress is fine and encouraging. Let’s see the post operative x ray and will be able to review the faults if there are any.

Thanks for all, my boss, my senior colleague who assisted me, nurse, and the anesthetist mam, who had doubt that I can do it and asked for the consultant to join to finish it quickly. Thanks for your anaesthesia mam because of which I could do in time frame and smoothly.

( will update with photograph soon)

Monday, June 16, 2008


Life is change. Every time when new thing is expected you feel happy. I was floating with similar ideas in mind. The new octopus hip replacement system was being planned for next day.

Each of us entered theatre with best possible preparation. Some slept less, some read more, some imagined high and some expected less as this was being tried for first time. Most of the time such first ever surgeries are either best or worst.

Is life a change or change is life? I can’t and don’t want to understand. Whatever, I accept it easily. Theater opened and the anesthetist was about to bring the patient into deep coma. A state of reversible death which modern medicine gained victory over life.

In no time every schedule was changed. The entry of boss swept the theatre list and everybody got confused and silent as if there was a massive destruction following Tsunami. I was told to join next theatre for another case which I was not aware of. I cried. Surgery is not a science of cutting by boss, retracting by junior and suturing by the junior most, and the most ignored is the post operative review. Bloody you need to prepare for it, study for it, plan and perform for the best. If not so, its like butchery and you are a legalized butcher granted a permission to dig knife upon human. My day took a U turn from hip replacement surgery to tumor resection around neck and shoulder with soft tissue reconstruction. My inclination towards plastic surgery and few experiences with basic bottom line knowledge of soft tissue reconstruction didn’t allow me to spoil my mood. Boss summarized me the plan “tumor excision and coverage with lattisimus dorsi flap” since he had not seen the flap earlier he took permission from boss to involve me in his team.

In no time with bounding pulse, sweating forehead, swollen and shaky limbs we all were prepared to start, a team of 3 – boss, me and my junior. I love this team not because all are young blood, but also we all participate equally in surgery, feel free to comment and put our views, all prefer to listen songs during surgery and the taste of songs is similar.

We started and within 2 hour we could resect the tumor. It was a soft tissue tumor including the base of neck anteriorly, extending upto shoulder and a 10 * 10 cm aggressive looking mass which also needed extensive deep tissue and skin excision.

After tumor excision I was about to leave theatre for 15 minutes for a consultation from another boss in OPD. I informed them, not that I asked for permission. Any way I was sure to leave. My boss replied “I will speak to the consultant in the OPD over phone but do one thing tell the name of patient” I thought I was trapped in between. I had already informed to boss in OPD and friend that I will come. I told boss that I will be more comfortable in surgery after I am through with the OPD work.
When I came after break everybody was ready for second stage surgery. Boss gave me a marking pen and knife “ jo bhi karma hai tume karma hai.” I felt happy and thought there are lot many things to learn at any stage of life. It’s better to say I don’t know rather guessing it and show eagerness to learn it. It keeps your emotion balance, self esteem and confidence high. I took one and half hour to complete the surgery. Raised and freed lattisimus dorsi muscle through post axillary line skin incision. Made a subcutaneous tunnel and retrived the muscle next end to cover the defect. On top of it grafted the skin. Interesting part was it spread like a fire in the rest of the theatre and all came to see it. I was happy that given a chance we can perform. How can my juniors and seniors leave me with out offering them a party?

I am in constant follow up with the wound. Its healing well. Graft uptake is 100%. I must say thank to my boss for his faith upon me, my junior who constantly kept my confidence high during surgery and anesthetist without whom patient won't allow me to operate. Thank you all. (Will update with photographs soon)