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Meeting the demand: Developing endoscopic joint surgery in India
As in many other countries, Indian arthroscopic surgery first developed in the 20th century, with renowned surgeons such as Prof. Pravin Vora writing the “first words” on the subject. Around this time, another Indian orthopaedic surgeon, Dr. Danish Patel, first described the “synovial plica syndrome.” These were the first indications of a new surgical technique that requires specific learning and access to the correct instruments, as well as audio-visual and information technology systems.
As a result of these advances, the Indian Arthroscopy Society (IAS) was founded in 1983.
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Arthroscopy: a luxury or a necessity?
In 1992, Manipal University, near the city of Mangalore, hosted the first Indian meeting devoted solely to arthroscopy. Organized by Dr. Sripati Rao and his colleagues Drs. David Rajan, Nicolas Antao, Sanjay Desai, Anant Joshi, Nishit Shah and Vidyasagar Kanabar, the meeting also featured orthopaedic surgeons from France and Spain, but the number of participants did not exceed 30. During the event, participants were faced with the question: “Is arthroscopy a luxury or a necessity?”
Since then, the teaching activity and attendances have increased steadily, especially in recent years. The IAS Annual Congress – now a course approved by the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) — is held along with IAS Arthroscopy Cadaveric Courses at the Arthroscopy Learning Center in New Delhi. ISAKOS has also approved some cadaver courses at this learning center. This is extremely encouraging, because this means that the courses have international certification.
And the educational opportunities continue to multiply. There are annual study scholarships for two IAS members to gain training at the IAS-approved arthroscopy centers in New Dehli and Mumbai. Likewise, regional fundamental arthroscopic training workshops are held at the Indian towns and cities of Ludhiana, Bangalore, Patna, Hyderabad, Mumbai, Ahemadabad, Lucknow, Jaipur, Pune, Indore, Cooimbatore, Chennai, New Delhi and Nashik. Finally, the IAS has taken an active role at the recent biannual ISAKOS congress. They are truly gaining international respect and recognition.
Meeting the need
Time has resolved the question as to whether arthroscopy is a luxury or a necessity in India and, in fact, much of the world. It is a necessity. And the IAS has become a growing society with more than 1,200 life members. In addition to Indian members, it welcomes surgeons from Bangladesh, Pakistan, Mauritius, Qatar, Oman, Australia, Sri Lanka, Afghanistan and Saudi Arabia. The organization’s most pressing need is to develop training facilities and fellowship opportunities for young surgeons.
We can learn some important lessons from the experience of our colleagues in India. Arthroscopy is a vital component of what we offer as orthopaedic surgeons, and I would like to emphasize the use and need for arthroscopy across all the nations, whatever their condition and situation, as well as the need for spreading knowledge of arthroscopic techniques and procedures as widely as possible.
The summarized history of arthroscopic surgery’s development as a common technique in the Indian orthopaedic environment is similar to that in many other countries, where its use and advantages are enjoyed every day. Despite the educational demands and the need for specialized equipment, arthroscopy allows many surgical procedures to be carried out using loco-regional anesthesia.
With arthroscopy, surgical incisions are much more appealing cosmetically than those from open surgery. Likewise, the patient spends fewer days in the hospital. More outpatient surgeries are possible, the immediate postoperative period is more comfortable, and it is a technique that can be applied to the entire population affected by intra-articular pathologies.
Therefore, although we are required to make a sizeable investment in education and instruments at the beginning of the learning process for arthroscopy, our efforts are repaid many times over with the shorter hospitalization periods and a speedier return to work and physical activity. As such, we must continue to support the creation of other learning centers and opportunities in other nations.
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- Ramon Cugat, MD, PhD, is an orthopaedic surgeon at Clinica del Pilar in Barcelona and is chairman of the Orthopaedics Today International Editorial Board.