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Soundarapandian Bone and joint Hospital – PERFIT-R KNEE SYSTEM- Personalised knee replacement

Soundarapandian Bone and joint Hospital is a leading centre in Chennai for all advanced Orthopaedic procedures. We have completed 40 years of service to our patients and continue to serve the community. We have always introduced the latest technologies to enable our patients fully recover quickly and completely and continue to lead in the field of Orthopaedic surgery.

Total Knee Replacement has been our forte and we have pioneered this surgery in Chennai. We have completed over 8000 Surgeries since the time of introduction in 1987. We are on the path of continuous innovation and improvement. We introduced the High flexion knee replacement surgery in the year 2007 and then the fast track recovery for TKR patients in 2018 which helped patients can go back home 2 days after surgery. We have now introduced the PERFIT-R system since the last 18 months.

All over the globe, TKR is one of the most successful orthopaedic procedure and is fast becoming a common operation even in India where over 250000 operation are performed each year. However a significant number of patients are dissatisfied with the outcomes of the operation due to persisting pain, instability or poor movements in the knee. This dissatisfaction is to do with the fact that traditional knee replacement believes in one alignment for all patients, namely the Mechanical alignment (MA TKR). In MA TKR the unique anatomy and individual alignment is ignored and the prosthesis is fixed in a common for all alignment . Often times important ligaments that support the knee have to released to accommodate the prosthesis in an alien alignment. This completely alters the natural gait and the axis on which the knee moves. Altering this unique alignment by traditional surgery to a one alignment for all patients has been shown to cause the dissatisfaction that many patients complain of. Many patients say ‘ my pain is now better after surgery, but this is not my knee’. Many complain of pain, instability and decreased range of movements because of this altered alignment.

Because of this growing problem of dissatisfaction rates, a new alignment technology namely the Kinematic alignment (KA TKR) was introduced a decade ago. Over the last decade surgeons have looked more closely and have found that every patients anatomy is unique and our knees are aligned differently producing a unique gait. We are born with this and it is as unique as our finger print, indeed one can recognize a person even a mile away by his gait. It was firmly believed by this group of surgeons that this unique alignment and gait should be preserved or reconstructed while performing TKR. In KA TKR the knee prosthesis is placed and alignment to the native pre-arthritic position of the bones of the knee. Because of this change in philosophy , personalising the fit has became possible. The results of knee replacement surgery using the kinematic method have vastly improved, patients now have better range of movements in the knee, less pain and have a more natural gait. In fact more and more surgeons are changing their philosophy and technique of performing TKR. However to identify the native alignment and unique bone structure, higher technology is needed and pre-operative assessment using CT scans or MRI are needed and advanced assessment are done and this is the reason we developed the PERFIT-R KNEE SYSTEM

PERFIT-R KNEE SYSTEM is a 3 dimensional [3D] surgical planning using a CT scan image of the entire leg. A thorough analysis of these 3 Dimensional images has improved our understanding and analysis of the deformities caused by arthritis . It is now possible to determine precisely the natural alignment of the knee using these 3D images. Then patient specific guides are prepared using this advanced software and a virtual operation is performed on the computer screen. These patient specific jigs and guides are prepared by advanced 3D printing for perfect execution of the operation. High precision is ensured during the execution of TKR and accurate placement of the prosthesis in the desired position is now possible. Soft tissue injury is greatly minimised and ligament releases are not performed which are very important for the stability of the knee.

PERFIT-R KNEE SYSTEM has indeed revolutionised TKR.

 The advantages of this new technology are the following

1. 3D models of the femur and tibia are created and precise measurements and alignment of the leg is studied in detail and a perfect pre-operative plan to restore the patient to the pre-arthritic level of natural kinetic alignment is planned by using the advanced 3D software.

2. A virtual operation is performed on the computer screen so there are no surprises during the planned surgery. One is prepared for abnormal sizes and also grossly altered anatomy that requires special implants.

3. These disposable Patient specific guides are autoclaved and used during the operation. This obviates the need for conventional instruments and the precision of the operation is greatly enhanced. The time taken to perform the operation is vastly reduced. Only minimal exposure of the knee is required and hence much more atraumatic. Ligament releases are usually never performed.

4. Less post-operative complications like infection as the operation time is greatly reduced.

5. Simultaneous TKR on both knees may be performed much more safely and patients with complex deformities and patients with existing bleeding tendencies will greatly benefit with the use of custom jigs

We commenced surgeries with this method in 2022 and have successfully completed 200 surgeries and the outcomes have been excellent. Patients now regain the full range of movements of the knee faster and have much less pain.

With PERFIT-R Patients can expect all the previous benefits of total knee replacement with the additional benefit of a personalised fit to enable them to walk, run and play in their own unique style!

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