Hip Resurfacing Surgery India
Posted using ShareThis
Sunday, November 22, 2009
Monday, September 21, 2009
Thursday, June 11, 2009
Rare Hip Replacement in India for American citizen
Mr. Leonardo B a graphic designer from New York got a designer joint for his arthritic hip in Chennai, India. The innovative Proxima hip was implanted by Dr.A.K.Venkatachalam a British qualified orthopedic surgeon from the Madras Joint Replacement center.
Mr. Leonardo who turned 60 last December had come down with bilateral hip arthritis and was unable to enjoy life. Hailing from New York, he is settled in Spain now. He is one of several Americans expatriates who lacking medical insurance. Hospitals in New York shunned him when he sought treatment for knee and thigh pain. A diagnosis took a while to arrive as it didn’t cross the mind of the doctors that he met in a New York hospital to get hip x rays when he complained of thigh and knee pain. Often pain arising in the hip is first perceived in the knee on account of a common nerve supply.
He sought bilateral hip resurfacings in India in 2008 from Dr.Venkatachalam. This Joint replacement specialist performed a right hip resurfacing late last year. However the left hip had deteriorated to an extent to preclude a resurfacing. Mr. Leonardo was not keen to have a hip replacement as this would restrict his movements and had a risk of dislocation. His surgeon offered him a Proxima hip which has a unique design. It is not available in the United States. Moreover costs of a Hip replacement in the US are priced above $50,000.
Hip arthritis strikes middle aged and elderly Caucasians. Its treatment has been a total hip replacement in those over 70 as the prosthesis is expected to outlive its recipient. In a total hip replacement, surgeons cut the head and neck portion of the upper end of the thigh bone (femur) and implant a stemmed metal prosthesis into the bone. A cup is fixed into the socket of the pelvic bone.
However younger people afflicted by hip arthritis will outlive a conventional hip replacement and will need additional surgery later on. To skirt around these problems there are other alternatives to a total hip replacement which have better longevity.
Better materials, bone preservation, navigational aids are all used to increase the longevity of a joint replacement.
One such implant is the Proxima hip. This is a mini total hip. The stem portion of the total hip prosthesis is done away with and the prosthesis is impacted in the metaphysic of the femur. Bone in the neck of femur is not cut away as in a THR. Large diameter metal on metal (MOM) or Ceramic on metal bearings can be coupled to the stem to achieve a very durable joint. It is particularly useful when a resurfacing cant’ be done on account of advanced bone loss or presence of cavities in bone.
Designed by an Italian surgeon and launched in the international market in 2002, the hip has more than a decade’s follow up. It was introduced in South India by Dr.Venkatachalam in 2006.
This is the first time in India that this prosthesis has been used for an American patient.
Mr. B will spend a week in hospital and then recuperate in a lovely sea side resort.
Hemmed in by the recession, Americans like Mr. Leonardo are seeking treatment abroad.
The attractions of having a surgery abroad are many. No doubt will you be able to save 70 percent from your hospital bill; you will get an equivalent or better personalized service than in an American hospital. Indian surgeons like Dr. Venkatachalam of www.hipsurgery.in have been trained in the UK. The driving force in medical tourism is not only costs but availability of innovative procedures. Americans being consumerists are always looking out for best quality & value. Mr Leonardo can now boast to a friend back home that he has now got a Ferrari hip in India in comparison his Dodge hip.
Mr. Leonardo who turned 60 last December had come down with bilateral hip arthritis and was unable to enjoy life. Hailing from New York, he is settled in Spain now. He is one of several Americans expatriates who lacking medical insurance. Hospitals in New York shunned him when he sought treatment for knee and thigh pain. A diagnosis took a while to arrive as it didn’t cross the mind of the doctors that he met in a New York hospital to get hip x rays when he complained of thigh and knee pain. Often pain arising in the hip is first perceived in the knee on account of a common nerve supply.
He sought bilateral hip resurfacings in India in 2008 from Dr.Venkatachalam. This Joint replacement specialist performed a right hip resurfacing late last year. However the left hip had deteriorated to an extent to preclude a resurfacing. Mr. Leonardo was not keen to have a hip replacement as this would restrict his movements and had a risk of dislocation. His surgeon offered him a Proxima hip which has a unique design. It is not available in the United States. Moreover costs of a Hip replacement in the US are priced above $50,000.
Hip arthritis strikes middle aged and elderly Caucasians. Its treatment has been a total hip replacement in those over 70 as the prosthesis is expected to outlive its recipient. In a total hip replacement, surgeons cut the head and neck portion of the upper end of the thigh bone (femur) and implant a stemmed metal prosthesis into the bone. A cup is fixed into the socket of the pelvic bone.
However younger people afflicted by hip arthritis will outlive a conventional hip replacement and will need additional surgery later on. To skirt around these problems there are other alternatives to a total hip replacement which have better longevity.
Better materials, bone preservation, navigational aids are all used to increase the longevity of a joint replacement.
One such implant is the Proxima hip. This is a mini total hip. The stem portion of the total hip prosthesis is done away with and the prosthesis is impacted in the metaphysic of the femur. Bone in the neck of femur is not cut away as in a THR. Large diameter metal on metal (MOM) or Ceramic on metal bearings can be coupled to the stem to achieve a very durable joint. It is particularly useful when a resurfacing cant’ be done on account of advanced bone loss or presence of cavities in bone.
Designed by an Italian surgeon and launched in the international market in 2002, the hip has more than a decade’s follow up. It was introduced in South India by Dr.Venkatachalam in 2006.
This is the first time in India that this prosthesis has been used for an American patient.
Mr. B will spend a week in hospital and then recuperate in a lovely sea side resort.
Hemmed in by the recession, Americans like Mr. Leonardo are seeking treatment abroad.
The attractions of having a surgery abroad are many. No doubt will you be able to save 70 percent from your hospital bill; you will get an equivalent or better personalized service than in an American hospital. Indian surgeons like Dr. Venkatachalam of www.hipsurgery.in have been trained in the UK. The driving force in medical tourism is not only costs but availability of innovative procedures. Americans being consumerists are always looking out for best quality & value. Mr Leonardo can now boast to a friend back home that he has now got a Ferrari hip in India in comparison his Dodge hip.
Monday, June 08, 2009
Indian Orthopedic surgeon reaches out to Americans seeking Joint Replacement by SEO
http://www.free-press-release.com/news/200906/1244394825.html
Dr.Venkatachalam of the Madras Joint Replacement Center reaches out to Americans in need of high quality Joint replacements abroad. Indian surgeons are prime providers of medical tourism to Americans in need of a Hip or knee replacement. Increased awareness of the availability of orthopedic surgery abroad will no doubt help many Americans under the yoke of debt and lack of medical insurance.
Dr.Venkatachalam of the Madras Joint Replacement Center reaches out to Americans in need of high quality Joint replacements abroad. Indian surgeons are prime providers of medical tourism to Americans in need of a Hip or knee replacement. Increased awareness of the availability of orthopedic surgery abroad will no doubt help many Americans under the yoke of debt and lack of medical insurance.
Thursday, May 21, 2009
THR in Young & Active patients
More & more young & active patients world wide are in need of hip replacement surgery. In such cases, it is imperative to pay special attention to the technique to ensure a successful outcome & longevity of the operation.
Traditionally a total hip replacement was performed in the older age group.
Young patients with hip pain either had to endure pain or subject themselves to a total hip replacement with its inherent disadvantages of dislocation and life span of 10 to 15 years.
Now, recent advances in bio- materials and techniques have made it possible for young patients to get a satisfactory & successful outcome after a hip arthroplasty.
Definition of a young patient- The deciding factor is not necessarily the patient’s age, but their activity level. Even many older patients like to play Tennis, Golf or participate in physical activity. This applies also to anyone who can be expected to live for a long time, is biologically (not chronologically) young and has good bone quality. Today even septuagenarians meet these pre requisites. Surgeons have to re think their conventional strategy of putting in a total hip with a metal on poly bearing. Resurfacing also poses several un answered questions and cannot be considered as a panacea.
Causes leading to hip pain in young patients-
Avascular necrosis is the leading cause leading to hip arthritis followed by developmental dysplasia of the hip. Perthes disease, slipped upper femoral epiphyses, sickle cell disease and post traumatic arthritis are other causes leading to the common outcome of secondary osteo-arthritis. In middle and older Caucasian patients, Primary osteoarthritis is the commonest cause of hip pain.
Limitations of hip resurfacing
Off late, hip resurfacing has been vigorously promoted on the internet as a possible & preferred treatment. However there are some inherent un answered problems with hip resurfacing. Elevated metal ion levels, metal allergy, metallosis are some of the side effects of metal on metal hip resurfacing. The long term impact of raised metal ion levels is unknown. Females in all age groups are high risk candidates because of the risk of fertility curbs in young & femoral neck fracture in the older. However the attraction of a hip resurfacing drives many females to ignore these risks and choose a hip resurfacing.
Dr.Venkatchalam of www.hipsurgery.in discusses an alternate bone sparing safe approach in young & active patients. These approaches combine the advantages of a hip resurfacing and total hip replacement.
Why do you prefer the short stem?
The various short stem prostheses like the Proxima hip & METHA combine the advantages of resurfacing & THR.
On the acetabular side a full range of options is available to the surgeon.
The force transfer in the femur is more proximal and more biological. Lack of a distal stem component eliminates the incidence of thigh pain. In addition these implants open up the vast range of bio materials available.
All biomaterial combinations like metal on metal, metal on poly, ceramic on poly, ceramic on ceramic are possible. These promise excellent longevity. If a revision becomes necessary, then one can switch to a standard stem. Some of these models like the METHA hip make it possible for the surgeon to tailor the implant to the individual’s anatomy.
What other innovations can you use to ensure a proper implant positioning?
Navigation allows the surgeon to place the implant in the optimal position.
What are the special considerations in Asian patients?
Dysplasia and osteo necrosis constitute the most common indications for total hip replacement in India & Asia. Primary osteo-arthritis is rare.
Moreover these patients are younger and more active. Their social and religious habits such as sitting with crossed legs dictate to the surgeon that he must use a prosthesis which provides a large range of movement. Risk of dislocation has to be reduced. Anatomic differences also exist. All these variables require a special implant concept and very wear resistant materials with a large diameter.
To summarize, treatment of hip arthritis in the young poses a challenge to surgeons and scientists. Hip resurfacing while offering a possible solution has some draw backs. Short stem prostheses with newer bio materials promise to overcome these deficiencies and offer a long lasting surgical outcome
Traditionally a total hip replacement was performed in the older age group.
Young patients with hip pain either had to endure pain or subject themselves to a total hip replacement with its inherent disadvantages of dislocation and life span of 10 to 15 years.
Now, recent advances in bio- materials and techniques have made it possible for young patients to get a satisfactory & successful outcome after a hip arthroplasty.
Definition of a young patient- The deciding factor is not necessarily the patient’s age, but their activity level. Even many older patients like to play Tennis, Golf or participate in physical activity. This applies also to anyone who can be expected to live for a long time, is biologically (not chronologically) young and has good bone quality. Today even septuagenarians meet these pre requisites. Surgeons have to re think their conventional strategy of putting in a total hip with a metal on poly bearing. Resurfacing also poses several un answered questions and cannot be considered as a panacea.
Causes leading to hip pain in young patients-
Avascular necrosis is the leading cause leading to hip arthritis followed by developmental dysplasia of the hip. Perthes disease, slipped upper femoral epiphyses, sickle cell disease and post traumatic arthritis are other causes leading to the common outcome of secondary osteo-arthritis. In middle and older Caucasian patients, Primary osteoarthritis is the commonest cause of hip pain.
Limitations of hip resurfacing
Off late, hip resurfacing has been vigorously promoted on the internet as a possible & preferred treatment. However there are some inherent un answered problems with hip resurfacing. Elevated metal ion levels, metal allergy, metallosis are some of the side effects of metal on metal hip resurfacing. The long term impact of raised metal ion levels is unknown. Females in all age groups are high risk candidates because of the risk of fertility curbs in young & femoral neck fracture in the older. However the attraction of a hip resurfacing drives many females to ignore these risks and choose a hip resurfacing.
Dr.Venkatchalam of www.hipsurgery.in discusses an alternate bone sparing safe approach in young & active patients. These approaches combine the advantages of a hip resurfacing and total hip replacement.
Why do you prefer the short stem?
The various short stem prostheses like the Proxima hip & METHA combine the advantages of resurfacing & THR.
On the acetabular side a full range of options is available to the surgeon.
The force transfer in the femur is more proximal and more biological. Lack of a distal stem component eliminates the incidence of thigh pain. In addition these implants open up the vast range of bio materials available.
All biomaterial combinations like metal on metal, metal on poly, ceramic on poly, ceramic on ceramic are possible. These promise excellent longevity. If a revision becomes necessary, then one can switch to a standard stem. Some of these models like the METHA hip make it possible for the surgeon to tailor the implant to the individual’s anatomy.
What other innovations can you use to ensure a proper implant positioning?
Navigation allows the surgeon to place the implant in the optimal position.
What are the special considerations in Asian patients?
Dysplasia and osteo necrosis constitute the most common indications for total hip replacement in India & Asia. Primary osteo-arthritis is rare.
Moreover these patients are younger and more active. Their social and religious habits such as sitting with crossed legs dictate to the surgeon that he must use a prosthesis which provides a large range of movement. Risk of dislocation has to be reduced. Anatomic differences also exist. All these variables require a special implant concept and very wear resistant materials with a large diameter.
To summarize, treatment of hip arthritis in the young poses a challenge to surgeons and scientists. Hip resurfacing while offering a possible solution has some draw backs. Short stem prostheses with newer bio materials promise to overcome these deficiencies and offer a long lasting surgical outcome
Monday, April 13, 2009
New address for blog
This blog has now moved to http://hipsurgery.in/blog/
You can continue to see the previous posts and archives here.
Thanks
MJRC
You can continue to see the previous posts and archives here.
Thanks
MJRC
Saturday, March 21, 2009
Chettinad health city hospital
Video shows hospital facilities where Joint replacements are performed by Dr.Venkatachalam
Friday, January 16, 2009
Hip resurfacing surgery- who needs it?
Are you suffering from hip arthritis? Has your surgeon advised you a hip replacement?
Hang on! If you need a hip replacement, please read the following information on facts about the operation and a more advanced bone preserving option called hip resurfacing.
What is the hip joint? Watch video on hip joint anatomy and hip replacement operation
The hip joint is a ball and socket joint which connects the torso to your legs. It is formed by the upper end of the thigh bone ( femur) and the socket of your pelvic bone ( acetabulum). A natural shock absorber tissue called "articular cartilage" lines the ends of the bones and allows painless smooth movements.
What are the symptoms of hip arthritis?
The patient complains of pain and restriction of movement. Pain may often be felt in the knee alone with no hip symptoms. Occasionally the pain may be felt more in the buttock area rather than in front of the groin.Gradually you will loose your ability to retain a active life style through exercise and sports.
Diagnosis
Your doctor may advise x rays on which hip arthrosis is seen as a loss of joint space or narrowing of the gap. Loss of this lining shock absorber articular cartilage results in pain while you walk.
Treatment options
Initially your doctor may prescribe you pain killers and suggest you to perform exercises to retain flexibility of your joints.
When you have run out of non operative options like pain killers, physical therapy your orthopedic surgeon might advise you to seek a hip replacement.
The hip joint may need to be replaced with an artificial joint when it is irreversibly damaged and cannot be salvaged by alternate surgery. The patient complains of pain and restriction of movement.
Who needs a hip replacement?
In India, many young patients with rheumatoid arthritis, ankylosing spondylitis, avascular necrosis, post septic arthritis, post traumatic arthritis, are advised a hip replacement for disabling pain.
Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Hip replacement is a successful operation for patients above 60 years
What is a total hip replacement?
In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis.
Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the polythetheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip. It is however the best option in elderly people.
Problems with conventional total hip replacement:
A total hip replacement is an excellent & time tested operation in the elderly. However in the young problems may arise. These are
(1) Excessive bone sacrifice and loss
(2) Increased risk of dislocation
(3) Patients cannot squat or sit cross legged on the floor with out the risk of dislocation.
(4) Range of movement is less
(5) Patients cannot involve in sports
(6) Poor survival in young and active patients they require earlier revision.
(7) Revision surgery is difficult
(8) The hip feels less like a normal hip
(9) The cup wears with time and plastic from it harms bone
(10) Change in length of the leg after surgery leading to leg length discrepancy.
Why remove normal bone when only the surface of the ball is bad?
Video shows comparison of Hip replacement and hip resurfacing
This is the logic behind hip resurfacing. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.
What is Hip Resurfacing?
it is a bone preserving hip operation. In this operation only the worn out surface at the top of the femur bone is scraped and shaped into a cylindrical form from a spherical form. A metal spherical cap is glued or cemented over the cylindrical stump like a tooth crown over an old stump.
This restores the normal shape & size to the upper end of the thigh bone. Next the socket in the hip bone is scraped into a hemisphere. A metal cup is impacted after complete cartilage removal. This cup will integrate with the body’s bone on the back side as it has a layer of the same material as bone. The hip shape is thus restored to normal. Bone is preserved in the head of the thigh bone. If a hip resurfacing were to fail for some reason, it would be still possible to change this to a conventional hip replacement later on.
Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.
Advantages of hip resurfacing:
(1) Allows the patient to squat and sit cross legged on the floor safely
(2) Allows a normal range of movement.
(3) Sacrifices only the surface diseased bone and preserves normal bone
(4) Imparts a more normal sensation
(5) The joint is likely to last longer even in younger and active patients.
(6) Earlier and faster rehabilitation
(7) Less risk of dislocation
(8) Easier to revise if needed
So in conclusion although total hip replacements remain an excellent option in a specific elderly age group, Hip replacement alternatives like Hip surfacing should be strongly considered in young and middle aged patients ( less than 60 years) requiring a hip replacement in India.
Dr.A.K.Venkatachalam is a consultant Orthopaedic surgeon in Chennai.View Patient stories here-
Visit http://www.hipsurgery.in
Hang on! If you need a hip replacement, please read the following information on facts about the operation and a more advanced bone preserving option called hip resurfacing.
What is the hip joint? Watch video on hip joint anatomy and hip replacement operation
The hip joint is a ball and socket joint which connects the torso to your legs. It is formed by the upper end of the thigh bone ( femur) and the socket of your pelvic bone ( acetabulum). A natural shock absorber tissue called "articular cartilage" lines the ends of the bones and allows painless smooth movements.
What are the symptoms of hip arthritis?
The patient complains of pain and restriction of movement. Pain may often be felt in the knee alone with no hip symptoms. Occasionally the pain may be felt more in the buttock area rather than in front of the groin.Gradually you will loose your ability to retain a active life style through exercise and sports.
Diagnosis
Your doctor may advise x rays on which hip arthrosis is seen as a loss of joint space or narrowing of the gap. Loss of this lining shock absorber articular cartilage results in pain while you walk.
Treatment options
Initially your doctor may prescribe you pain killers and suggest you to perform exercises to retain flexibility of your joints.
When you have run out of non operative options like pain killers, physical therapy your orthopedic surgeon might advise you to seek a hip replacement.
The hip joint may need to be replaced with an artificial joint when it is irreversibly damaged and cannot be salvaged by alternate surgery. The patient complains of pain and restriction of movement.
Who needs a hip replacement?
In India, many young patients with rheumatoid arthritis, ankylosing spondylitis, avascular necrosis, post septic arthritis, post traumatic arthritis, are advised a hip replacement for disabling pain.
Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Hip replacement is a successful operation for patients above 60 years
What is a total hip replacement?
In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis.
Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the polythetheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip. It is however the best option in elderly people.
Problems with conventional total hip replacement:
A total hip replacement is an excellent & time tested operation in the elderly. However in the young problems may arise. These are
(1) Excessive bone sacrifice and loss
(2) Increased risk of dislocation
(3) Patients cannot squat or sit cross legged on the floor with out the risk of dislocation.
(4) Range of movement is less
(5) Patients cannot involve in sports
(6) Poor survival in young and active patients they require earlier revision.
(7) Revision surgery is difficult
(8) The hip feels less like a normal hip
(9) The cup wears with time and plastic from it harms bone
(10) Change in length of the leg after surgery leading to leg length discrepancy.
Why remove normal bone when only the surface of the ball is bad?
Video shows comparison of Hip replacement and hip resurfacing
This is the logic behind hip resurfacing. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.
What is Hip Resurfacing?
it is a bone preserving hip operation. In this operation only the worn out surface at the top of the femur bone is scraped and shaped into a cylindrical form from a spherical form. A metal spherical cap is glued or cemented over the cylindrical stump like a tooth crown over an old stump.
This restores the normal shape & size to the upper end of the thigh bone. Next the socket in the hip bone is scraped into a hemisphere. A metal cup is impacted after complete cartilage removal. This cup will integrate with the body’s bone on the back side as it has a layer of the same material as bone. The hip shape is thus restored to normal. Bone is preserved in the head of the thigh bone. If a hip resurfacing were to fail for some reason, it would be still possible to change this to a conventional hip replacement later on.
Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.
Advantages of hip resurfacing:
(1) Allows the patient to squat and sit cross legged on the floor safely
(2) Allows a normal range of movement.
(3) Sacrifices only the surface diseased bone and preserves normal bone
(4) Imparts a more normal sensation
(5) The joint is likely to last longer even in younger and active patients.
(6) Earlier and faster rehabilitation
(7) Less risk of dislocation
(8) Easier to revise if needed
So in conclusion although total hip replacements remain an excellent option in a specific elderly age group, Hip replacement alternatives like Hip surfacing should be strongly considered in young and middle aged patients ( less than 60 years) requiring a hip replacement in India.
Dr.A.K.Venkatachalam is a consultant Orthopaedic surgeon in Chennai.View Patient stories here-
Visit http://www.hipsurgery.in
Subscribe to:
Posts (Atom)