Senior Director, Joint Replacement Programme, BLK-Max Super Speciality Hospital, New Delhi
Series overview · 8 articles
Joint Replacement
May 12, 2024
Joint replacement has moved a long way from a last-resort, one-size-fits-all operation, and understanding when to consider it, and how it is now performed, changes both patient counselling and outcomes. Dr. Ishwar Bohra, Senior Director, Joint Replacement Programme at BLK-Max Super Speciality Hospital, New Delhi, used his Jivo Masterclass to walk through the indications for knee and hip replacement, the robotic and AI-guided technology now shaping outcomes, pre-surgical workup and infection risk, and how joint replacement is approached in children and other special cases.
What this series covers
This series works through the clinical and X-ray signs that indicate a patient needs joint replacement, how robotics, computer navigation and AI have changed hip and knee surgery, the pre-surgical screening that keeps infection risk low, the direct anterior approach and modern implant longevity, the surgical management of recurrent shoulder dislocation, joint replacement in children and other special populations, and the non-surgical alternatives and nutrition support that matter around surgery.
This article is based on a Jivo Masterclass session conducted by Dr. Ishwar Bohra, Senior Director, Joint Replacement Programme, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Ishwar Bohra taught doctors across Africa on May 12, 2024.
FROM THE LIVE Q&A
Moderator
What are the commonest indications for knee and hip replacement surgeries?
Dr. Ishwar Bohra
The most common indication is age-related osteoarthritis at stage three and above, an absolute indication for joint replacement in both hip and knee. Rheumatoid arthritis and post-traumatic malalignment of the hip or knee are also common. Other indications include autoimmune arthritis, gout and other systemic illness or coagulopathies, and avascular necrosis of the hip, which has become a bigger reason for hip replacement post-COVID.
Frequently Asked Questions
How is AI applicable to orthopaedics?▼
AI is imageless: it gives real-time information on the patient's joint alignment, the rotation needed, and the gap balancing required in arthroplasty. The history moved from patient-specific instrumentation (which only allowed a fixed cut), to computer navigation, to robotics, and now AI combined with robots. AI needs no pre-operative CT or MRI and no extra-articular pin placement - it is a pinless, imageless modern technique.
Is there much preparation before any joint replacement surgery?▼
Yes. We first screen and optimise the patient: ruling out uncontrolled medical illness (diabetes, hypertension, coronary artery disease), any potential infection source, checking haemoglobin is adequate, and ruling out autoimmune or systemic disease. After that, you need good imaging where required, trained OT staff, a clean theatre, good ICU and anaesthetic support, a standby cardiologist, and blood bank access since most cases need transfusion.
Is joint replacement possible for patients who cannot accept blood transfusion for religious reasons, such as Jehovah's Witnesses?▼
Yes. We optimise the patient's haemoglobin before surgery with hematinics or iron injections and diet, waiting a couple of weeks for it to improve. If that isn't sufficient, we use autologous transfusion: the patient's own blood is drawn and stored in advance, with no cross-matching needed, and given back to the same patient during surgery.
Which type of pre-operative templating do you use to achieve accuracy for joint replacement?▼
Templating started as physical templating, then moved to digital templating software. But since we have now shifted to more advanced techniques, we don't rely on templating anymore - intraoperative robotic-assisted guidance gives more accurate implant sizing and positioning directly.
What is the new advancement in total hip replacement, and are there any alternatives to total hip replacement?▼
Beyond computer navigation, robotics and AI, there has also been advancement in surgical approach. Older approaches like the posterior and direct lateral approach cut through muscle to enter the hip. The direct anterior approach (also called direct superior approach) avoids any muscle cut or nerve violation, with very minimal blood loss and a minimally invasive incision - patients can often go home after one day, or even as daycare.
What does this masterclass series cover?▼
Indications for joint replacement, robotic/AI surgical technology, pre-surgical workup and infection risk, implant longevity, recurrent shoulder dislocation management, paediatric joint replacement, and non-surgical alternatives.
Who is Dr. Ishwar Bohra?▼
Senior Director, Joint Replacement Programme at BLK-Max Super Speciality Hospital, New Delhi.
In This Series: Recent Advances in Joint Replacement
- 1.Joint Replacement
- 2.When Is Joint Replacement Needed? Indications for Knee and Hip Surgery
- 3.Robotics, Navigation and AI in Joint Replacement
- 4.Pre-Surgical Workup and Infection Risk in Joint Replacement
- 5.The Direct Anterior Approach and Modern Implant Longevity
- 6.Recurrent Shoulder Dislocation: Diagnosis and Surgical Management
- 7.Joint Replacement in Children and Other Special Cases
- 8.Alternatives to Joint Replacement and the Role of Nutrition in Recovery