Excruciating pain and stiffness in the right shoulder after an accident over a year ago prevented 20-year-old Kunal Ajit Bhide from picking up a racket. Not to allow his badminton dreams to be shattered,Kunal,who had by then reached the nationals got a shoulder implant to continue playing,a move that turned out to be a mistake as it led to further deterioration of cartilage,the tissue that binds bone to muscles.
Having tried several other treatments,a pain-free functional life seemed far from reality for Kunal,a fourth-year engineering student.
I could turn my arm 120 degrees but had to stop playing badminton, says Kunal who then met Dr Ashish Babhulkar,a Joint Replacement Surgeon at Punes Deenanath Mangeshkar Hospital.
Babhulkar recommended that the implant be removed and instead Autologous Chondrocyte Implantation (ACI),a method experts said is widely used in knee joint surgery but had never been used in India or south Asia for shoulder joints.
Babhulkar,the President of the Shoulder Society of India since September 2011,who is known for his extensive research on shoulder and joint replacements,said,ACI is the optimal treatment for cartilage defects,especially in young adults. There are certain procedures to relieve symptoms for a brief period,but they fail to address the root cause of the problem. Patients often experience a relapse within a couple of years, Babhulkar said.
ACI,a two-step minimally invasive procedure,ensures natural and permanent repair by forming a new hyaline cartilage. Thats why special instrumentation was needed for the surgery,as the shoulder is a complex joint making it difficult to approach the cartilage and implant the chondrocytes or cartilege cells cultured at a cell processing centre.
Kunal had a 6.6-mm defect on the right shoulder. A small piece of healthy cartilage was harvested and sent to the Cell Processing Centre of RMS Regrow in Lonavala for chondrocyte culture for four weeks. The cultured cells were implanted. The implantation has been successful and in six to eight weeks of post-operative rehabilitation,Kunal will regain full range of motion and function, said Babhulkar.
The progress made in ACI as a treatment for cartilage defects and joint problems has taken a couple of years now,attributed mainly to increased awareness among doctors and patients,as also reduced cost owing to availability of cell culturing within India.
However,despite being affordable and with obvious benefits,traditional modes of treatment averages about 30-40 per cent higher compared to ACI. People have comparatively higher disposable income nowadays. Add this increased spending power to insurance coverage (usually overlooked by most) and it becomes plain that regenerative medical techniques like ACI are now within reach of the middle class.
Satyen Sanghvi (chief scientific officer,RMS),said,With greater importance being given to personal healthcare,people must now start to seriously consider whether they are getting their moneys worth by investing repeatedly in temporary treatments. After all,an almost new joint is always much better than an old temporarily repaired one.