Dr. Milind Tanwar is a graduate from Post Graduate Institute of Medical Sciences(PGIMS), Rohtak and has wide experience in Arthroscopy and Sports injuries along with Complex and Neglected Fracture management. Special interest in Key Hole/ Minimally invasive surgery of Joints (arthroscopic procedures) including the knee, Shoulder, Ankle, Elbow and Wrist. He also has refined experience in Primary and Revision joint replacement surgery from Sports Injury Centre, Safdarjung Hospital and International Institute of Musculoskeletal Research (IMRI), Adelaide, Australia.
Besides clinical acumen and fine surgical experience, he possesses various publications in journals of international & national repute and is also a co-author of “Fundamentals in Orthopaedics” by Jaypee Publications. Dr. Tanwar has been an active participant in various academically enlightening events and presented research work in the same. He was also awarded the highest merit in master’s degree in orthopaedics during his post graduation.
His motive of “Healthcare for All” and continuing a legacy of a healthcare facility free of corporate pressures is the motivation behind his work and humble nature.
Informational videos and blogs which cover a wide range of topics from Sports Injuries, Arthritis, Spine related disorders, Joint replacement and Preventive/ Rehabilitative therapy and much more. Follow us on Social Media (links provided) for more Information !
Arthroscopic ACL / PCL/ MCL /PLC complex Repair
Arthroscopic Bankart/ Rotator cuff/ Biceps Repair
Arthroscopic Ankle and Elbow surgery
Arthroscopic Hip joint surgery
Knee Joint replacement
Hip Joint replacement
Shoulder Joint replacement
Elbow joint Replacement
Fracture and trauma management in acute and neglected fracture
Limb lengthening and reconstructive procedures
Injury prevention and treatment
Degenerative joint disease
Metabolic bone diseases
Inflammatory bone disease
Taping/ Needling/ Cupping
Arthroscopy literally means looking inside the Joint (“Arthros“) using a camera attached with a special Instrument (“Scope“). This minimally invasive technique lets us examine the joint – Diagnostic Arthroscopy and do surgeries after we address the cause of trouble.
Of the multiple advantages of Arthroscopy, most important ones include:
1. Smaller scars
2. Minimal Infection rates
3. Faster Rehabilitation
4. Less post surgical stiffness and pain
5. Lesser skin related complications
Indications of Arthroscopy include any Intra- Articular pathology. Intra-Articular means Inside the Joint. Any Joint related pathology can be examined and treated therapeutically with help of Arthroscopy.
Minimally Invasive Surgery is often used synonymously with Arthroscopy but they can mean differently in different cases. LASER surgery is also a common misnomer in laymen language which indicates a Minimally invasive or a Small scar Surgery. Arthroscopic surgery makes use of small stab incisions to in introduce the camera and the instruments inside the joint. The indications of an Arthroscopic surgery include:
1. Diagnostic arthroscopy
2. Osteo-Chondral Transfer
3. Ligament repair Surgery
4. Tendon repair surgery
5. Meniscal repair
6. Cartilage preservation
7. Joint preservation surgery
8. Limb Re-Alignment Surgeries
9. Kinematic Alignment surgeries
10. Arthroscopic assisted fracture surgery
Using simple surgically defined “Safe” Routes to the joint which are called PORTALS, the instruments and camera is inserted to look at the joint and treat accordingly.
The videos will take the viewers and budding surgeons into how Arthroscopy is performed in different joints. Most commonly performed arthroscopy in Knee, Shoulder, Elbow, Ankle, Wrist and the Hip. Excellent results are usually a thumbs rule when arthroscopy is performed in indicated cases.
Arthroscopic ACL reconstruction/ Augmentation Surgery in Partially ACL Tear
Arthroscopic ACL reconstruction has evolved over many years and the focus of surgery remains on Replication of biological ACL footprints. Anatomical ACL Reconstruction with preservation of ACL stump has been the most advanced form of ACL reconstruction. We believe in preserving the biological remanent of the injured ligament so as to provide maximum benefits of nature post surgery.
ACL is a major stabiliser of the knee and essentially prevents pivoting injury during sports and strenuous activities. ACL along with other ligaments like the PCL, MCL, PLC complex and MPFL stabilises the knee in performing essential sporting activities.
Most common cause of injury is due to a pivoting injury to the knee where either the leg is fixed and the body weight rotates over or vice versa. This is associated with swelling, pain and inability to perform routine activities. The most important part of the injury is diagnosis and early treatment to prevent degenerative changes in the affected knee.
There are many who suffer in silence. going through technicalities of the procedure, they fear the surgery more. The techniques of ACL reconstruction are varied and this testimonial will take you through the OT and surgical experience of a patient of ACL stump preservation surgery. These surgical procedures are technically very demanding.
1. Preservation of biology during the procedure
2. Replication of original ACL foot prints
3. Functionally double bundle like effect with single bundle preservation
4. Selected patients for best results
5. Early rehabilitation due to stump preservation
Conventional ACL reconstruction shaves off the original remanent of the ACL and creates a new ligament. The procedure robs off the knee of its biological ACL which has normal blood and nerve supply.
Our Novel technique of ACL reconstruction preserves the original bundle of the ACL and augments it using the hamstring graft with or without the use of synthetic supports (Fibre wire/Fibre tape). This procedure can be done in selected patients only where the stump is preserved post injury. This procedure has an added advantage over the usual Single Bundle ACL reconstruction as it makes it more like a natural Double Bundle Reconstruction.
Advantages of Native ACL preservation surgery :
1. Restoration of Kinematics
2. Restoration of Anatomy
3. Earlier proprioceptive rehabilitation
4. Simulates natural recovery
5. Lesser chances of failure
6. Early graft vascularisation
7. Near normal feel – Due to remodelling of Graft as per Preserved ACL
Native Single bundle ACL Preserved
Anatomical Tibial foot print preserving the Native stump
Anatomical Femoral foot print carefully preserving the Femoral Attachment of Native ACL
Parallel New Single bundle to the Native preserved stump (Knee flexed)
ACL graft with Fibre tape Augmentation.
Note: Differential tension in ACL graft and Fibre Tape
Post ACL Reconstruction Biological augmentation with Notchplasty
Do I Really have an ACL tear ?
Do I Need an ACL Surgery?
What is ACL Reconstruction?
What is ACL Repair?
Internal Brace. Yes or No ?
Best Technique of ACL Surgery?
Tentative cost of ACL Surgery?
I Am afraid of the Pain !
Is it a daycare procedure ?
All inside Vs Conventional ACL
How to prevent re-tear ?
Joint replacement surgery is a procedure where the worn out surfaces of the joint are replaced with suitable biologically compatible materials.
No ! The surgical procedure only replaces the surfaces which form the joint. It basically realigns the soft tissues and the bone so as to restore the natural kinematics (Joint Movement).
The material used in these implants is a Bio-Compatible metal and Plastic. The metals used in these implants is usually an alloy of cobalt, chromium, molybdenum and titanium. These are Bio-Inert Materials and seldom react with biology. Now metals like Gold and Oxynium have also been used to coat these implants to improve longevity. Hip replacement typically makes use of “Ceramic” which is basically a processed form of silica. This is extremely resistant to wear and tear.
Also between these two components is a layer of Ultra-Highly cross linked polyethylene. This works like cartilage and helps in fluid link movement at the joints. This insert is present in all forms of Joint Replacement surgery like Hip, Knee, Shoulder etc.
A Simple Primary Knee replacement has a survival rate of about 25 years in 83 percent of cases operated as per National Joint registry. Most primary knee replacements lasts a life time for patients who get operated around 67-70 years of age group
Most patients have a pain free average of 15-20 years post a Total Knee Replacement Surgery
If you have 4 out of 5 positive responses , you should definitely seek an Expert Joint Replacement surgeon for help.
1. Problems in maintaining Personal Hygiene (Washroom use/ Bathing)
2. Difficulty in doing daily household chores
3. Sleep disturbances due to painful knee movements
4. Visible mal-alignment with ankle arthritis
5. Regular painkiller use/ Abuse
Simple Steps to make the surgery last forever include
1. Regular Exercise
2. Diet monitoring
3. Active lifestyle
4. Avoidance of Overuse (Squats/ Lunges/ Crosslegged sitting)
5. High Flexion knees have better outcomes
6. Timely performed surgery with good muscle strength
7. Careful assisted exercises/ ADL for 2 weeks
8. Regular follow up with your primary surgeon
Knee replacement as a surgery is painless procedure. Most patients have mild pain and heaviness in the operated limb post operatively for first 7-10 days. With epidural catheter in place, and local anaesthesia infiltrated during the procedure, most patients can painlessly walk partial to full weight bearing with ambulatory support. As the patient starts walking they become quite better and independent.
The surgeon will first assess the deformities under anaesthesia and relate it with the radiological reports. With use of a standard incision and their preferred approach to the joint, the surgeon will expose the worn out joint. The worn out bones are chiseled in desired shape to set the implant in place. With help of bone cement, these implants are set into place and the wound is closed in layers.
To cut the bones in the right shape, novel technologies have come in. From CT guided navigated knee replacement, Robotic Assisted knee replacement to Robotic Knee replacement many techniques have come in for enhancing precision. In the end, the cuts are finalised only with expertise and planning of your surgeon who controls the technology. Pre operative planning plays a crucial role in these surgeries and makes them last a lifetime.
Any surgery has its own set of complications. Most of the patients do extremely well but a few might have to face challenges during the post surgical period. These include :
DVT/ Clot formation
Implant related complications
Pain/ hematoma formation
Nerve & Vessel Injury
The patient usually is discharged on day 3 of unilateral knee replacement and day 5 of bilateral replacement.
The first follow up is at 2 week when the wound is inspected and patient is allowed weight bearing without support.
At 6 weeks the patient is reviewed again for progress of muscle strength and any fresh complaints. This is followed by a 3 monthly follow up for 1st year. This is followed by an yearly review thereafter.
Most important part of the success is compliance of the patient to these precautions and instructions.
1. The patient should perform exercises regularly as instructed by the physiotherapist
2. The patient is asked to avoid any slippery surfaces while they walk for the first six weeks
3.It is imperative that the patient should not suffer any fall/slip in the first six weeks when they are most susceptible, due to lack of muscle strength, pain and loss of balance sense in the operated knee.
4. The place of residence should preferably be on the ground floor to make activities of daily living easier.
5. Arranging for a medical help/ Nurse for the first two weeks can be of great help
6. Regular follow up with the surgeon and physiotherapist is must for best results.
7. High protein diet and plenty of fluids along with high fibre content is essential for good bowel movements and gut health
With so much content flooding the internet, hearing from the patients who have got their surgery done can be very relieving and practical. Here’s what these patients have felt pre-surgery and how their lives changed after their Total Knee Replacement surgery