Dr Vivek Logani,
Chief of Joint Replacement Surgery,
Paras Hospitals

With special interests in knee and hip replacements and computer navigation for joint replacements, Dr Vivek Logani, Chief of Joint Replacement Surgery, Paras Hospitals, Gurgaon, shares his views on the technology-driven medical facilities with Ekta Srivastava, ENN

Tell us about your journey so far in joint replacement specialty.
I started my career in joint replacements at the prestigious All India Institute of Medical Sciences. Before Paras Hospitals, I was engaged with two high volume centres. I am one of the regular faculties for various arthroplasty courses and forums across India and abroad. At the same time, I am also involved in implant design in collaboration with a multinational organisation. I am also carrying on a CT-based pilot study to generate a sound database for knee anatomy of various sub-groups of Asian patients which will be used to guide the implant design specifically suited for Asian patients.
My team has established a Centre of Excellence for joint replacements at Paras Hospitals with special focus on computer navigation, revision arthroplasty and bone bank. I am working in arthroplasty for the last 12 years, which includes more than 2,800 primary joint replacements and about 300 revision joint replacements.
Although joint replacement surgeries alleviate pain and restore functions, they are known for associated risks. What is your take on it?
Well, its true that any surgical procedure, and not just joint replacements, is associated with its inherent risks. As an exclusive joint replacement surgeon, it is my endeavour to keep uplifting my own benchmarks everyday. These benchmarks include delivering better outcomes and minimising risks and complications. We at Paras Hospitals are able to do this since we have a very stringent process of patient selection, patient preparation for surgery, meticulous and unambiguous surgical and post-operative protocols.
Every week, I refuse three to four patients who have bad knees, but are not good candidates for surgery owing to certain other issues like severe nerve compression coming from spine, severe Parkinsonism, gait and coordination disorders, etc. If the patients choice or lifestyle itself is wrong, any surgery is doomed for failure. Moreover, good pre-operative screening and medical work up, meticulous surgical techniques and rehabilitation protocols help us to minimise the risks associated with the surgery.

What are your main focus areas?
One of my major focus areas is Computer Navigation for knee replacement with the help of which, we are able to avoid all human errors during the procedure which were hitherto unavoidable in up to five to seven percent of cases. It is an infrared-based active system in which we generate a real-time model of the patients knee during the surgery and are able to accurately align hipknee- ankle mechanical axis within zero degrees of error. This ensures accurate placement of the implant, thereby providing maximum longevity to it. In fact, ours is one of the very few centres in India and the world that are using this technology for knee replacement.
Apart from these, we get numerous cases of revision hip and knee replacements, where the first surgery was done a couple of years ago and the have worn out. In such cases we need to take the previous implants out, reconstruct the existing bone defects or complete bone loss with allograft bone from our bone bank and put new implants. Such revision joint replacement surgeries are of high magnitude and usually involve meticulous planning and a geared-up operation theatre staff.

What new technologies are being introduced in the field of joint replacement?
Apart from computer navigation for primary knee replacements, other developments have happened in terms of newer and better implants for knee and hip replacement. To enumerate a few, we have better quality of Cobalt Chromium and Oxinium Implants which have a much lower wear rate; better quality of Ultra-High Molecular Weight Polyethylene Spacers which last much longer; better implant designs which have better fit for Asian bone anatomy; implants suited for severe osteoporosis and bone defects; newer bearings like Oxinium and Ceramics for hip replacement in younger patients; hip resurfacing for select group of young patients who want to return to sports activities after surgery for hip arthritis, and so on.
Apart from these, certain concepts have become successfully utable like Unicondylar Knee Replacements, Patellofemoral Joint Replacements in which only one compartment of the knee which is most damaged is resurfaced, thereby giving long-term pain relief and preventing damage to other compartments of the knee. The life of partial knee replacements, provided they are done by a trained surgeon, is the same as that of total knee replacements. For revision joint replacements, Trabecular Metal and Modular Implants enable us to perform surgeries with more predictable and good longterm outcomes.

One of our major focus areas is Computer Navigation for knee replacement, with the help of which, we are able to avoid all human errors during the procedure

Tell us about your team here, and what are you able to achieve that wasnt possible elsewhere?
At our centre, we have developed a streamlined protocol for pre-operative assessment, intra-operative work and post-operative care. This requires collective effort of the surgeon, assistant surgeons, anesthetists, nursing staff, rehabilitation staff, housekeeping staff, counselors, physicians and many more, so that the patient has a flawless, wholesome experience not just from entry to exit, but even at home. We have a specialised and customised home-based rehabilitation programme for needy patients with a continuous follow-up and feedback system in place so that we are able to monitor closely the recovery of patients who have been operated up on by us and modify the protocols, if needed. Infrastructure wise, we have the worlds most advanced NAV3 computer navigation system for performing knee replacements, a dedicated allograft bone bank (in which we preserve human bone after meticulous screening) being run on the guidelines of American Association of Bone and Soft Tissue Banking. This bone bank is absolutely essential to be able to do justice to complex revision joint replacement surgeries which usually have bone defects.

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