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Activity Report 2014-2015
Asian Joint Reconstruction Institute
st(1 Year)
SRM Institutes for Medical Science (SIMS) is made of 9 speciality institutes and 19 departments focusing on various specialities and sub-specialities.
The speciality institute for orthopaedics in SIMS is known as AJRI.
SRM Institutes for Medical Science
Our sincere thanks to...
...for constant support and motivation
Shri. Ravi PachamoothooChairman - SRM Group
Dr. K. SridharSr. Vice President – Medical
SIMS Hospital, Chennai
Dr. Raju SivasamyVice President - MedicalSIMS Hospital, Chennai
Message from Joint Directors
SIMS-AJRI has completed its first year of operations. The year gone by has been gratifying
with most aspects of the operations being consolidated. The Unit has performed 660
surgeries with a predominant number of complex hip and knee surgeries. The spectrum
of referrals is evidence to the growing recognition of SIMS-AJRI as a referral centre for
high performance replacements and complex revisions.
The year also saw 78 international clients from USA, Canada, Australia, ME & SE Asia and
Africa with very successful outcomes. Their feedbacks certainly ratifies to the high
standards of cares & hospitality at SIMS-AJRI. The excellent infrastructure, ambient
atmosphere and the passionate staff in all fields have made this possible.
0True to the motto of the concept of 360 comprehensive care, AJRI is in the final stages of
launching the knee and the back clinics with focus on preventive education, non operative
treatment options and techniques etc.
AJRI, on the academic front, has also been instrumental in initiating the regional group
“South Indian Arthroplasty Academy” (SIAA), involving the established high volume
centres in South India. A robust documentation programme has been developed, which
will further the academic activities and research. The fellowships offered by AJRI have
seen considerable interest with applications from across the country.
Needless to say all that has been possible over the year has been made feasible by the
excellent cooperation and support from all the institutes and support staff at SIMS. We are
indeed grateful for their efforts and we hope they continue to contribute to take the unit
higher to the next level. Team AJRI would like to place on record its sincere thanks to one
and all.
Dr. P. Suryanarayan M.S (Ortho)
Joint Director & Consultant Orthopaedic Surgeon
Dr. Vijay C. Bose M.S (Ortho), FRCS (Ortho)
Joint Director & Consultant Orthopaedic Surgeon
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AJRI Vision
AJRI Mission
To dramatically improve the lives of arthritis patients and those suffering from joint related problems, with evidence based, best possible solutions and care that are outcome oriented, yet keeping them affordable.
To dedicate ourselves to pioneering improvement in joint reconstruction, relentlessly pursue progress, and become the global benchmark of clinical excellence.
The AJRI Team
Dr. P. Suryanarayan M.S (Ortho)
Joint Director & Consultant Orthopaedic Surgeon
Dr. Vijay C. Bose M.S (Ortho), FRCS (Ortho)
Joint Director & Consultant Orthopaedic Surgeon
Dr. K. Appaji KrishnanD. Ortho., DNB (Ortho)
Consultant Spine Surgeon
Dr. Ashok Kumar PS M.S (Ortho)
Consultant Orthopaedic Surgeon
Dr. Kanniraj Marimuthu M.S (Ortho), DNB (Ortho)
Associate Consultant
Sports Medicine & Arthroscopic Surgery
Dr. K. Kalaivanan M.S (Ortho)
Associate Consultant
Dr. D. Rajeshbabu D. Ortho, DNB (Ortho)
Associate Consultant
Dr. VSV Kumar DNB (Ortho)
Associate Consultant
Dr. S. Velmurugan DNB (Ortho)
Associate Consultant
Arthroplasty & Periprosthetic Joint Infection
Dr. J. Jebaraj Resident - Orthopaedics
Spine Surgery
Trauma & Limb Reconstruction Surgery
Trauma & Arthroscopy
Our Musculo-skeletal anaesthesiologists are experts in Regional anaesthetic techniques and selective
pain blocks.
The mission of our dedicated Musculo-skeletal anaesthesiologists is to transform the universal apprehension
experienced by patients in to a cherished painless experience. They achieve this by closely interacting and
optimizing all variables of the preoperative assessment, surgical procedure and immediate postoperative
recovery period in a seamless fashion.
Musculo-skeletal anaesthesiologists’ contribution is much more than giving anaesthesia to our patients. They
function as peri-operative physicians elevating safety and patient experience to a new level that not seen before
in the city.
Periprosthetic Joint Infection Management Unit
Dr. K. KalaivananAssociate Consultant - Orthopaedic
Dr. SureshConsultant - Infectious Disease
Dr. B. Anand ShankarDr. M. Madhavan
Musculo-skeletal Anaesthesiology
AJRI draws periprosthetic joint infection (PJI) patients from all over Asia. Dealing with PJI is the Achilles' heal of
many arthroplasty units as it is associated with poor outcomes. Many surgeons are unwilling to manage these
patients due to various constraints. SIMS-AJRI has set up a specialised unit to take care of these patients to
optimise outcomes and make this treatment affordable.
The AJRI PJI management team consist of orthopaedic surgeon, infectious disease specialist, microbiologist,
pathologist, operative theatre-nursing coordinator, physiotherapist and patient coordinator who interact closely
to deliver results. The isolation of the infective organism is a vital and difficult step in the overall success in the
management of PJI. The use of Sonicator and MALDI-TOF have increased the yield rate of organism identification
to above 95% in this Unit.
The enormous success in the management of PJI has inspired this Unit to move towards one stage revision for PJI
to decrease the morbidity and reduce cost to the patient.
Dr. K. RaghavendranDirector - Institute of Anaesthesiology
& Pain Medicine
Sitting Left to Right: Ms. S. Chandravadanamba, Ms. S. Sivakamasundari, Mr. Srichandra, Ms. S. Hariveni, Ms. P. Dharani, Ms. D. Ilamathi.
Standing Left to Right: Mr. S. S. Ezhilan, Mr. G. Jegadeesan, Mr. V. Senthil Kumar, Mr. R. Srivatsan, Mr. R. Ashok, Mr. S. Naresh Kumar, Mr. S. Murugadasan, Ms. R. Devi
Rehabilitation Team
Mr. N. Mohan KumarInstitute Line Manager
Ms. N.V. PremaAsst. Manager
Patient Services
Mr. R. RajResearch & Medical
Documentation
Ms. R. SrimathiCare Coordinator
Patient Care Services
@ AJRI Office
Ms. S. Suma DeviCare Coordinator
Patient Care Services
Unicondylar Knee Replacement
Unique Surgeries @ AJRI
Correction of Complex Deformity
20 year old male with multi focal osteomyelitis during childhood with involvement of both hips, left knee and right ankle. Right hip treated with Deltamotion hip replacement. Left lower limb treated with corrective osteotomy distal femur and plating.
47 year old lady with medial joint arthritis with pain and deformity. Unicondylar replacement of the medial compartment done.
AJRI Statistics
Team Work &
Sub-specialisation
Enhanced patient experience
Consistent best possible outcomes
Out patient registration : 2996
Surgeries performed : 660
Hip Replacements : 172
Revision Hip Replacements : 30
Knee Replacements : 147
Revision Knee Replacements : 16
Hip Resurfacing / BMHR : 17
OPD Clinics @ Satellite Centres
Lions club free medical camp - Arakonam
Nellore : 10 visits (Dr. Ashok Kumar)
Tirupathi : 5 visits (Dr. Ashok Kumar)
Agartala : 2 Visits (Dr. K. Kalaivanan)
Siliguri : 2 Visits (Dr. K. Kalaivanan)
Guwahati : 7 Visits (Dr. Appaji Krishnan)
Shillong : 5 Visits (Dr. Appaji Krishnan)
Shilchar : 2 Visits (Dr. Appaji Krishnan)
One Stage Complex Total Hip Replacement in Post Infective Pelvic Support Osteotomy with Chronic Instability
Preoperative X-ray shows post pelvic support osteotomy.
Follow up X-ray at six months shows good fixation.
Failed Septic Revision Knee Replacement - Two Stage Correction
54 year old female, unable to walk and discharging sinus. She underwent Stage 1 implant removal, debridement and antibiotic cement spacer. She was treated with intraarticular antibiotics followed with intravenous and oral antibiotics for a period of 6 weeks for E.Coli. At the end of 8 weeks she underwent Stage 2 revision total knee replacement.
A 21 year old male presented with unstable left hip joint and healed sinus. He was treated with one stage complex total hip replacement and intraarticular antibiotic catheter for MRSA.
Preoperative X-rays showing bone lysis, failed revision TKR.
Perioperative images showing removed implants and antibiotic cement spacer.
X-rays show cement spacer in situ. Postoperative X-rays at 7 months showing good fixation.
Intraarticular antibiotic infusion device in situ
Unique Surgeries @ AJRI
A case of non union distal third tibia with microvascular flap
Ilizarov fixator with computer assisted 6 axis device (Ortho SUV)
Spine Surgery
The Spine Unit has developed into a separate speciality providing comprehensive care to all spine related problems both surgical and non surgical. The Unit has performed the entire gamut of spine
surgeries from disc replacement to deformity correction.
C5-C6 artificial disc replacement for disc prolapse in a 30 year old engineer.
Reduction and TLIF L5-S1 for high dysplastic spondylolisthesis in a 20 year old girl.
Posterior scoliosis correction for adolescent idiopathic scoliosis in a 17 year old girl.
All posterior total spondylectomy of D6 vertebra with reconstruction and stabilization for fibrocytic sarcoma
in a 26 year old lady.
Unique Surgeries @ AJRI
International Patients : 78
USA : 17
Bangladesh : 14
Canada : 7
Indonesia : 6
Oman : 5
Mauritius : 4
New Zealand : 4
Sri Lanka : 4
Kenya : 3
Nigeria : 2
Thailand : 2
UK : 2
Costa Rica : 1
HongKong : 1
Iraq : 1
Maldives : 1
Pakistan : 1
Singapore : 1
Russia : 1
West Indies : 1
International Patients : 78
Dr. Kartik PatelAhmedabad
Dr. Purav KansaraAhmedabad
Dr. Vivek KhakharAhmedabad
Dr. M. ManoharanPondicherry
Dr. T. RajendranTanjavur
Dr. B.S.V. PrasadVizag
Dr. Karthikeyan MaharajanPondicherry(IOA Inland Fellow)
SIMS-AJRI Fellows
SIMS-AJRI Fellowship Programs for Joint Arthroplasty
SIMS-AJRI Advanced Fellowship Program: A 3 months program in primary and revision hip & knee replacement surgeries. This fellowship is offered to surgeons who already have some experience in this field. This gives them ample opportunity to assist procedures and direct interaction with surgeons.
Surgical visitations: SIMS-AJRI being a referral centre for advanced and revision surgeries, it hosts surgeons from across the country and abroad on short-term visitations from few days to a week.
Regional Collaboration – SIAA
Video conferencing between 4 centres
Members of Team SIMS-AJRI actively interact with the other 3 high volume regional centres through video conferencing on a regular basis once in 3 weeks.
Discussion pertaining to difficult case scenarios, combined research project, guest lectures by visiting international luminaries is done on regular basis.
This facility initiated by AJRI also enables teleconferencing with patients.
SIAA Online Data Registry
Advanced online documentation of the surgeries carried out at all the centres warehoused on a cloud server.
SIAA Fellowship Programs for Arthroplasty
A 2 years fellowship program ideal for surgeons who are committed to pursuing a career in adult reconstructive surgery. This fellowship enables experience in all 4 centres. The combined data pool from the online registry gives ample opportunities for publications and clinical audits.
Dr. N. NandakumarSIAA Fellow
Presentations & Live Surgical Demonstrations
ORTHOTRENDS 2014, Ahmedabad, – Mar 2014
Dr. P. Suryanarayan
Planning revision hip surgery Removal of well-fixed implants Trabecular metal in difficult situations
Cadeveric Revision Hip Surgery Course, Ramiah Advanced Cadaveric Learning Centre, Bangalore – Apr 2014
Dr. Vijay C Bose
Cadaveric surgical demonstration of Restoration Revision stem
Implant removal and exposure in Rev THR Principles acetabular side reconstruction in Rev THR Implants for Rev THR on the femoral side
Complex Primary Hip Course held at Depuy Institute, Chennai and Ramiah Advanced Learning Centre - Apr 2014
Dr. Vijay C Bose
Fused hip takedown Post acetabular fracture THR Hip Dysplasia THR in proximal femoral deformity High performance hips THR in Protrusio
Live Surgical Course, Coimbatore, India – June 2014
Dr. P. Suryanarayan
Live surgical demonstration of Crowe 4 dysplastic hip
Lecture on Role of sleeves
Zimmer Cadaveric Course, SRMC, Chennai – June 2014
Dr. P. Suryanarayan
Surgical approach – Endofemoral Vs Transfemoral The Monoblock Wagner stem Removal of well-fixed implants
Cadeveric Knee Arthroplasty Course, Ramiah Advanced Cadaveric Learning Centre , Bangalore – July 2014
Dr. Vijay C Bose
Cadaveric surgical demo of Genesis 2 TKR
FFD correction in TKR Basic biomechanics in knee arthroplasty Avoiding mistakes in primary TKR
th8 Asia Pacific Orthopaedic Symposium, Singapore – Jul 2014
Dr. P. Suryanarayan
Hip instability Management of acetabular complications with
TMARS The Monoblock Wagner Stem – Simple time tested
option
CME, Madurai Orthopaedic Society & Madurai Medical College - July 2014
Dr. Appaji Krishnan
Anterior scoliosis correction
Advances in Orthopaedics, International Medical Education Conference, Maui, Hawaii – Aug 2014
Dr. P. Suryanarayan
Challenges in revision TKR Optimizing the function with CR slope inserts Management of severe varus knee Type 3 acetabular defects
Instruction Course in Spine, Udaipur - Aug 2014
Dr. Appaji Krishnan
Laminoplasty for compressive spondylotic myelopathy with OPLL
Meet the Masters – Live surgical course, Chennai Spine Club - Aug 2014
Dr. Appaji Krishnan
Course coordinator
Sparsh-Sunshine Live Arthroplasty Course, Sparsh Hospital, Bangalore – Sep 2014
Dr. P. Suryanarayan
Live surgical demonstration of Complex primary, Revision surgery
Dr. Vijay Bose
Live surgical demonstration of Complex hip S-Rom reconstruction with subtrochanteric shortening osteotomy for Crowe 4 hip
Changing concepts in the management of Hip dysplasia
Association for the Study and Application of the Methods of Ilizarov Conference, Goa- Sep 2014
Dr. VSV Kumar
Faculty/Instructor Ilizorov course
Combined meeting of APOA and Royal Thailand Orthopaedic Association, Pattaya, Thailand – Oct 2014
Dr. P. Suryanarayan
Revision for infected hip replacement The Monoblock Wagner Stem.
Malacca / Penang, Malaysia – Nov 2014
Dr. P. Suryanarayan
Live Surgical Demonstrations of difficult primary & revision hip
Ortho SUV Demonstration, CMC Vellore - Nov 2014
Dr. VSV Kumar
Faculty/Instructor SUV Demonstration
MOACON, Akola, India – Nov 2014
Dr. P. Suryanarayan
Infected hip revision surgery THA for protrusioacetabuli Revision THA -Femoral Side
Complex primary and revision hip replacement workshop as part of IOACON 2014. Annual meeting of the Indian Orthopaedic Association, at KIMS Hospital , Hyderabad – Nov 2014
Dr. Vijay C Bose
Changing concepts in the management of the adult hip dysplasia
De-coding ‘High -Riding Hips’
Dr. K. Kalaivanan
Poster presentation: Low gradechondro sarcoma of first metatarsal – A multimodal diagnostic approach and treatment options.
Poster presentation: Plasmacytoma of proximal femur treated with tumor prosthesis replacement (TPR) – A case report with review of literature.
IAACON 2014, Annual meeting of the Indian Arthroplasty Association, Madurai - Nov 2014
Dr. Vijay C Bose
Live surgical demo of Gen 2 Total knee Replacement.
Debate : Are large heads required in hip arthroplasty
Cadeveric Knee Arthroplasty Course, Ramiah Advanced Cadaveric Learning Centre, Bangalore – Nov 2014
Dr. Vijay C Bose
Cadaveric surgical demo of Genesis 2 TKR
Tackling varus and valgus deformity in TKR Basic Biomechanics in Knee arthroplasty Avoiding mistakes in Primary TKR
CME Programme on Increasing Survivorship of THR, Madras Orthopaedic Society, Chennai - Dec 2014
Dr. P. Suryanarayan
How to follow up patients following arthroplasty -Practical tips
THA in protrusioacetabuli
Dr. Vijay C Bose
Dysplastic hip and issues of Hip centre Getting the Limb length right and Myth of medial
offset
Presentations & Live Surgical Demonstrations
Advanced hip arthroplasty live surgery course conducted by Tanjore Medical College, Tanjore - Dec 2014
Dr. Vijay C Bose
Live surgical demo of R3 Cup and Polar stem in complex primary Hip.
Restoring Limb Length in THR Trunnionosis in Hip Arthroplasty Newer bearing options in THR
Palakad Deformity Course, Palakad - Dec 2014
Dr. VSV Kumar
Faculty/Instructor Deformity course
st1 Trichy Knee Course, under the auspices of the Trichy Orthoclub, Trichy - Jan 2015
Dr. Vijay C Bose
10 common mistakes in Primary TKR
th13 Annual Winter Ranawat ‘Advances and Techniques in Joint Replacement’ Course, ROC 2015, Mumbai – Jan 2015
Dr. P. Suryanarayan
Periprosthetic fractures around knee
Dr. Vijay C Bose
Bio-mechanical restoration in THR and limb length issues
Annual conference of Association of Spine Surgeons of India, Pune - Jan 2015
Dr. Appaji Krishnan
Treatment strategy in multilevel degenerative lumbar disc disease
JRSOA 2015, Joint Replacement State of the Art Conference, Cochin - Feb, 2015
Dr. P. Suryanarayan
Live surgical demonstration
It’s the Bearing Porous metal shell and augments Crowe 4 dysplasia-Technical tips and tricks
Dr. Vijay C Bose
Keynote lecture: Justifying hard on hard bearings 2015Lectures: Bone conserving Hip arthroplasty Guidelines for Management of periprosthetic
osteolytic lesions
TNOACON 2015, Annual meeting of the Tamil Nadu Orthopaedic Association, Salem - Feb 2015
Dr. P. Suryanarayan
Revision for infected THR Overcoming bone defects in revision knee surgery
Dr. Vijay C Bose
Workshop on Primary TKR Hip Arthroplasty in Teenagers
Dr. Ashok Kumar PS
Paper presentation: Tibial tubercle osteotomy for exposure of difficult primary and revision TKA
Dr. K. Kalaivanan
Medal paper presentation: Co Axial stitch technique for intraoperative limb length assessment in Total Hip Arthroplasty
Paper presentation: Lets get our bug named” Our Experience with an Automated Blood Culture System (BACTEC) in Diagnostic Methodology of prosthetic Joint Infection
Basic Ilizarov Course, Mumbai - Feb 2015
Dr. VSV Kumar
Faculty/Instructor Ilizarov course
CME, Indian Medical Association, Shillong- Feb 2015
Dr. Appaji Krishnan
Current advances in spine surgery Tackling spinal deformity
Cadevericcomplex primary course. Advanced Cadaveric Learning Centre, Siriraj University Hospital, Bangkok – Mar 2015
Dr. Vijay C Bose
Cadaveric surgical demonstration of S-Rom THR and pinnacle cup.
Management of dysplasia Fused hip take down THR in post acetabular fracture situation
Presentations & Live Surgical Demonstrations
Innovations
Dr. P. Suryanarayan
Associated with the conceptualization, development & clinical validation of "PREPLAN” - A CT based patient specific jig for knee arthroplasty, developed by the Stryker Technology team - New Delhi, India.
Member – Design and validation team for image based hip Navigation system – Stryker corporation.
Dr. Vijay C Bose
Member of surgeon design team for Hip Navigation for Stryker Corporation.
Designer of the 'Bose concept hip system' – instrumentation for THR with jig for intraoperative limb length restoration.
Publications
Vijay C Bose, Subramanyam Yadlapalli, Ashok Kumar PS. Uncemenented total hip arthroplasty; Basics in Hip & Knee Arthroplasty, Reed Elsevier; 2014; 138-148.
Suryanarayan P, Ashok Kumar PS. Trabecular Metal Technology in Hip, Basics in Hip & Knee Arthroplasty, Reed Elsevier; 2014; 327-340.
Suryanarayan P, Ashok Kumar PS, Subramanyam Y. Current Principles of High Tibial Osteotomy, its role in management of unicompartmental degenerative joint disease. Knee Arthroplasty and Arthroscopy 2014
Dr. P. Suryanaryan
Sectional Editor – “Trauma and Orthopedics” – Indian Journal of Surgery
Reviewer & Editorial Board – Indian journal of Orthopedics
Dr. Vijay C Bose
Member of editorial board on the JHPS – Journal of Hip preservation surgery
Member of editorial board of Indian Journal of orthoapaedics
Editorial Board
International Collaboration
Dr. Darryl D’Lima M.D., Ph.D
Director of the Orthopedic Research LaboratoriesShiley Center for Orthopedic Research and Education (SCORE)
Assistant Professor of Molecular MedicineDepartment of Molecular and Experimental MedicineThe Scripps Research Institute
SIMS-AJRI family get together at GRT Grand
The wonderful families behind team AJRI
“If you want to shine like a sun,
first burn like a sun.”
- Dr. A.P.J. Abdul Kalam