Dr K Ardeshna IOSUK Fellowship report - Indian Orthopaedic ...

IOSUK Fellowship report from Dr Kashyap Ardeshana (MS orthopaedic) INDIA
I am an orthopaedic surgeon practicing at Junagadh, a district place in the Saurasthra region in
Gujarat state of India. I passed my MS in Orthopaedics 1998. After a short community service, I
started private orthopaedic practice in October 2000. I am doing general orthopaedic practice
which include trauma as main bulk of practice. I do primary joint replacements and arthroscopic
surgeries regularly. As I am away from any institutional setup, I update myself by attending
various conferences, CMES, workshops and subspecialty programmes. Recently in a knee and
shoulder arthroscopic update in Delhi Dr Radhakant Pandey from Leicester UK was a faculty, I
came to know about activities of IOSUK and the keen desire of IOSUK of helping orthopaedic
surgeons of India academically.
Fortunately I got scholarship from Asian Association of Dynamic Osteosynthesis (AADO) to
attend Edinburgh trauma course in August 2011. As I was to come for that scholarship I
recollected my chat with Dr Radahakant Panday and with all good hope I applied to IOSUK
through website. I applied for observing fellowship in area of arthroplasy and arthroscopy for
two weeks just after my Edinburgh trauma course.
I applied for fellowship on 24 th may 2011 on website. Mr Veny Kavarthapu (Secretary, IOSUK)
and Mr Amit Sinha(President, IOSUK) worked on it so quickly that on 31 st May 2011, I got
confirmation. I was picked up by Mr Kamal Deep, renowned replacement surgeon at Golden
Jubilee National Hospital, Glasgow. It was so quick a response from IOSUK that I can say that
“it is nowhere in the world”. Soon Mr Deep contacted me and guided through the rest of the
procedure.
Firstly I completed my Edinburgh trauma course which was good academic fist and a concise
revision of the orthopaedic trauma. Also Edinburgh was at its best as the summer festival was at
its peak with the tourists from around the world. Also I travelled to the Northern Scotland in
weekend to get astonishing glimpses of glens, lochs and castles and also Scottish whiskey
distillery visit. Soon after finishing that program, I headed towards Glasgow for my fellowship at
Golden Jubilee National Hospital.
The hospital is a national resource for NHS Scotland, also known as the NHS National Waiting
Times Centre in Clydebank; it is the flagship hospital for reducing waiting times in key elective
specialties like orthopaedics and heart and lung services. Hospital has ultramodern set up with
twelve specialist theatres, out of which four are dedicated for orthopaedics. I was surprised to
know that for four theatres they have about six navigations systems to do simultaneous surgeries.

They perform about 2500 arthroplasty surgery in a year. On day one on 22 August when I
reached Mrs Rose (secretary to Mr. Kamal Deep) greeted me and gave me warm welcome. She
helped me through security and photo id procedure, and then she took me to orthopaedic theatres
and introduced me to the theatre staff. Mr. Deep had programmed my short visit in such a way
that I could attend other consultant’s surgeries so that I can get maximum out of that time. Daily
I used to reach at about 8:30 am in the morning and till 4pm there used to be continuous
surgeries. As I was not scrubbing, they used to arrange a camera according to my convenience.
All the staff and registrars were very helpful to me and all the consultants were eager to answer
my smallest queries.
Mr Kamal Deep FRCS (Trauma and
Orthopaedics) is very active member of the
IOSUK. He is the organizing chairman of the
forthcoming 14 th annual meeting of the IOSUK
2012 to be held at Glasgow. He is also the key
person for the International Medical Graduate
Fellowship Joint Arthroplasty and computer
Navigation at Golden Jubilee National Hospital,
Glasgow UK. Mr Kamal Deep is General
Secretary of the British Society for Computer Aided Orthopaedic Surgery (CAOS UK) and has
given presentations on the subject across the world, including the CAOS International Annual
Conference in Germany. He is a renowned computer assisted joint replacement surgeon. He was
doing all his surgeries using navigation
only. Here I saw for the first time the
total hip replacement done using
navigation. From him I learned how to
do navigated hip replacement using
minimum invasion using acetabular
marker pin and trochanteric clamp
without wasting much time and how
accurately acetabular cup version, depth,
inclination can be positioned and on
femoral side how to do femoral
anteversion, leg length correction and
overall component positioning. He also had shown me many cases of navigated hip and knee
replacement. He explained to me about his paper on behavior of knee deformity during the whole
range of motion using the navigation which proves that in only about 13% of knees the
varus/valgus deformity remains same throughout the range, rest of the cases deformity changes
throughout the range, thus showing the use of computers in the understanding of the disease and
benefit of checking it. He told me about peculiarities of Columbus and Triathlon knee. He taught
me the technique and benefits of cruciate retaining knee replacement, which is not the common
practice in India. I also attended outdoor clinic on one day with him. When I asked him to take
photographs he happily did that and then he took me out to take photo with hospital background.

Mr. Fred Picard MD has been an Orthopaedic Consultant at the Golden Jubilee National
Hospital and has an interest in computer assisted orthopaedic surgery. He has been Secretary of
the International Society of Computer Assisted Orthopaedic Surgery since 2005. He is the person
involved in designing of the navigation system. He taught me the importance of distal femoral
cut valgus angle measurement preoperatively by long leg film or per op by navigations as there is
lot of variation in that measurement in different individuals. He also taught me how to double
check external rotation of femoral component even when using navigation. He taught me in one
case of valgus rheumatoid knee about sequential release and soft tissue management using
navigation.
Mr Martin Sarungi MD
My first day in hospital was with this very
cooperative person who warmly involved in
his discussion that my acclimatization was
very easy, I observed him doing many hip
and knee surgery. He said “enemy of good is
better”. He told me about his paper on natural
distribution of the femoral mechanical and
anatomical axis variation in osteoarthritic
population and its relevance to total knee
replacement, which was a very simple
guideline in selection of distal femoral cut and common misconceptions about it. He also taught
me fine tricks of performing anterior approach in hip replacement surgery.
Mr Alexander Siegmeth FRCS
I spent one day with Mr Alex. I observed him
doing six arthroscopic surgeries which
included meniscal and anterior cruciate
surgeries. I could see that he was doing
meniscectomies without using shaver and
how finely he could remove debris even
without it. In his ACL reconstruction I could
see many fine differences like oblique
incision for hamstring graft harvest, fibre
wire loop for graft fixation, retrobutton for
femoral side, retrodrill at femoral tunnel, 9mm screw for 8mm tibial canal and extensive use of
surface radiofrequency instead of shaver.

Mr Joseph Baines FRCS (Trauma and Orthopaedic)
Mr. Baines is a very jolly little surgeon of high caliber. He always kept smiling environment
around him. I learned many things from his case collections like acetabular defect management,
technique of impaction bone grafting and preparing dry bone, use of extended trochanteric
osteotomy, how to prevent acetabular floor damage by predrilling it and checking it by depth
gauge. I had seen him doing femoral revision. Here I had seen for the first time use of porous
coated polythelene cup (Mathys). He also explained to me in details about peculiarities of
Columbus knee replacement implant. I also observed him doing rheumatoid foot corrective
surgery in which he did hammer toe correction for toes and metatarsophalangeal fusion for
hallux valgus.
Mr Niall Munro FRCS (Trauma and
Orthopaedic)
Mr Munro is a very meticulous surgeon. I
was very impressed with the perfection,
when he was doing acetabular cementing.
Also I learned some tricks in doing anterior
approach hip replacement. He also taught
femoral pressurization technique using 20 cc
syringe. He also taught me difference
between Scorpio Triathlone and NRG
implants
What I learnt
It was avery exhaustive fellowship program. Every day was very effectively planned so that I
could get the maximum out of my short visit. Thanks to Mr Kamal Deep and theIOSUK. I could
witness more than 40 surgeries during my fellowship. There are many things I learned starting
from surgical technical tricks to patients overall management protocols, anesthetic aspects like
Caledonian protocol is very effective and aggressive pain management protocol for very early
ambulation, use of epidural wound catheter for postoperative pain medication and use of
laryngeal mask airway in anesthesia etc.
I also saw that they were not using drains in any replacement procedures. They are using
tranexamic acid extensively for blood loss prevention.
In knee replacement I had seen major differences. Almost all of them were doing posterior
cruciate retaining surgery which is totally opposite of what we are used to do here so I could see
how to do it without wasting much time and how to perform it. Patella was not replaced in most
of the cases. I also had strong emphasis of preoperative distal femoral cut measurement. I had
very much insight about using navigation in both hip and knee replacement.

How it can help me
Overall this fellowship is going to be very useful to me in the view of boosting my confidence by
knowing many new things and understanding my level of competence and comparing myself to
the highest standard surgeons and setup. I am practicing in such area, where large population of
people are suffering from knee arthritis but limited resources to the treatment and surgeons
lacking in particular training and economical aspect are major aspects. May be, I will be able to
benefit to my people around here.
My recommendation
This type of fellowship program is a very noble activity IOSUK is doing and it should be
continued as there are large number of orthopaedic surgeons in India but there are not many
centers of excellence in subspecialties that have intention of giving such fellowship and training.
So it is very useful for those who want to have exposure to many surgeries in particular
subspecialty in short duration of time.
I am again very much thankful to IOSUK, Mr Amit, Mr Venu and Mr Kamal Deep for all the
trouble they have taken for arranging my short term fellowship in very short notice of time. I see
only their noble intension of helping fellow Indian colleagues. I wish IOSUK all the success for
future activities; I wish Mr Kamal Deep all the success for his career and for next IOSUK
meeting to be held at Glasgow under his able leadership.
.