Self Esteem: Key to a meaningful living

Many times we get confronted with low self esteem. Many definitions, many explanations yet we find that every one of us seems to get bogged down with this problem. Introspection into this complex issue made me think of the problem and an analytical view is submitted herein .Self esteem is the major challenge of our era. It lies at the heart of many of the diverse issues and challenges we face in life.
The fact is precise that low self esteem does not seem to be the problem, that it is so very insidious. Many people who suffer from low self esteem attribute their life challenges to wholly different causes and very rightfully. It does not even occur to them to relate their problems to how they regard themselves at the deepest level. You ask them to trace the origin and the answers seems to be one of the many explanations like a mean boss, racial or sexual prejudice, a talent for choosing abusive love partners and so on. We try to externalize the problem trying to source the origin out of our existence. On the contrary it stems from deep within. However, doing this merely moves a person further away from the real problem, and consequently from the solution. Thus by disguising itself as some other more immediately visible issue, low self esteem is never tackled and overcome. It remains to rear its ugly head again.
How Low Self Esteem Arises
It is very strange to believe People with no apparent self esteem problems may still be susceptible at a subtle level. For example, failing to fulfill one’s dreams when one is young, and settling for a safe route to an unchallenging existence, can damage how well one regards himself. In later life, it could manifest in short temper, cynicism when others do try to better themselves, and even physical illness. However, it is difficult and sometimes impossible pinpoint the exact problem.
In other words, self esteem issues, often inherited from your parents, appeared at this early stage. There are many causes of low self esteem. We gain our predominant world-view by the age of five. In other words, whether you consider the world to be a safe or dangerous place, and whether you will react to events in a primarily positive or negative manner, is determined by this age. Parents are the prime shapers of our young psyches at this time. However, schools, society, and more importantly our peers also play an important role. Our later experiences in life merely reinforce the core impressions we gained at this very early age. Parents play a very significant role in shaping the psyche of the future child and more or less their actions can be reflected with their children’s self esteem. People say that I have taken full care of my children, provided them with every possible needs yet my child seems to have lost his sense of direction and has become wayward in terms of confidence etc. Spiritualist and even scientists believe that this care must begin whilst the child is still in the womb! Parents are too often far too casual about how they bring up their children. They unconsciously pass on their own limitations to them as a result.
The first thing is to understand the difference between self-esteem and self-image. Self-image forms as a result of comparisons you make between yourself and those around you. It is the judgment you make of yourself - the image you have of yourself. Sadly, it is often negative as you can usually find someone better than you at almost everything. Self-image in turn affects self-esteem. An easy way to understand this difference is to look at young children. They have perfect self-esteem because they have no self-image. They are not continually judging themselves against externals and falling short. As they grow older one can note the difference .
One need not work upon self-image. There lies the key. This is what many people try to do. However, working on self-esteem is the heart of creating radical change. One important issue is the all pervading issue of self talk. The key to improving your self-esteem is to take conscious control of your self-talk. Negative self-talk is the prime cause for creating and maintaining negative self esteem. The things you say to yourself in your mind, as well as the meaning you attribute to events in your life, combine to create the reality you end up live. A study has revealed that most people’s self-talk is roughly 95% negative. They see the worst in themselves and in everything that happens. Putting a stop to such self-destructive thinking is vital. It is our thoughts and expectations that shape and produce what we become. The quality of our lives is a direct result of them.
One excellent way to combat and overcome negative self-talk is through using positive affirmations. The principle behind them is that the brain cannot entertain two contradictory notions at the same time. Eventually one of the two contradictory notions must win out and cause the other to collapse completely. The belief that finally wins out is the one that you invest with the most emotional energy and constancy of thought. Putting all your emotional energy behind them gives the affirmations the power to destroy negative self-talk and low self esteem.
Recognition of the problem is the half way to the solution. The key to success in life is to recognize the existence of the problem in the first place! Therefore, consider where self esteem issues may be lurking in your life, but manifesting as apparently external problems. The key attitude for success in life is to take total responsibility for what happens to us. We must work upon ourselves continually in order to manifest what we want. To conclude creating high self esteem is one of the best things you can ever do to totally transform every aspect of your life. The results are time tested and reproducible.

Prof GSPATNAIK is a consultant orthopedic Surgeon and a social scientist based in Bhubaneswar. He can be contacted at www.drgspatnaik.com

When I was a child, the doctor was God. Like God, in exchange for respect and obedience—”doctor’s orders”—he guided us through the valley of the shadow, held out the hope of life eternal, and came when we summoned him, yea, even through snowstorms, to sit on the edge of our bed with his empowered doctors bag and lay his hand on our fevered brow. Often we treat doctors with a higher awe. Our parents were wise by definition but he was infallible by definition; “The doctor knows best” was an incantation you could lean on. We trusted him utterly. Like God, he was the safety net forever spread under our precarious lives. Like God, he was the powerful super parent standing backup behind our mortal parents, appearing as if by magic when our mother’s remedies failed, black bag in hand: “Well, well, what seems to be the trouble? Let’s have a look.”
In the days before the all-purpose antibiotic, it was important for the doctor to figure out what ailed you, and this he did, not in the lab, but sitting on your bed. It was an art form as much as a science and a clever diagnostician were much admired. He touched your skin and lifted your eyelids and peered down your throat; he flexed your knees and elbows and thumped your back. He unbuttoned your pajamas and listened to your heart and lungs. His interest was inexpressibly comforting and most people felt better almost at once. Even if his bedside manner was brusque and his voice tired and impatient, that couldn’t disguise the love he bore us. The love was implicit in his coming; why else would he be at our side? I’m sure I wasn’t the only child who wept upon learning that he charged money for his services, but even that didn’t shake my faith in his love. Often I used to wonder and quite painfully that he is taking my father’s hard earned five rupees fees yet my parents comforted me that he has a child like me and he too needs to go to school etc.
In nineteenth-century novels the heroine’s grave condition was underlined by the number of doctor’s visits per day. It’s never clear exactly what he was doing on these visits, but visit he did, and often the languishing lady cheered up, sipped a little lemon tea, and recovered. Back then, illness was a more personal matter. It was said that those with a “strong constitution” would pull through, while the naturally sickly and patients whose constitutions had been previously undermined would turn up their toes and die of a fever like Sweet Molly Malone. Even those who believed in germs didn’t give germs much credit; violent emotional scenes or fits of passion might throw a person into a fatal fever, at least in novels. The doctor stood by, lending the constitution moral support, shoring it up with a change of air, a change of scene, an ocean voyage.
If we transcend the history for the first half of the twentieth century, the doctor cured us with aspirin, orange juice, bed rest, and the laying-on of hands. If we worsened, he put us in a hospital where we stayed, complaining about the food, until he was quite satisfied with our condition. (Then he sent us bills, or sent them to our family if we perished, and the phrase “doctor’s bills” rang ominously, and the impecunious often took years to pay them off.). Medicine has made tremendous strides since then, and by rights we should worship our doctor more fervently than ever, but somehow we don’t. He never comes to see us anymore. Sometimes he doesn’t bother to discover personally exactly what the matter is by inspecting our ailing bodies; if for some reason he needs to touch us, he first puts on latex gloves and a mask. Then he writes a prescription that should cure whatever it is, and if that fails, he orders lab tests. He makes us to fill out daunting piles of paper that look like tax forms. Rumors circulate about his income, comparable to sports stars’; sometimes we think he might be healing us as much for money as for love. He’s a quitter, too, and when we seem really sick he thrusts us away from him, sends us off to a specialist we’ve never seen before. Indeed, we may never have seen our doctor himself—now called a health-care provider—before.
Since doctors no longer talk to us by phone presumably because of multitasking and their quest of earning only money offering advice and consolation and prescriptions free of charge, some conscientious providers have now gone on-line, so we can share our ailment with our computer. (“If temperature is elevated, click here.”) .It’s lonelier to be sick now and scarier than it used to be, and millions of us have turned our backs on the new doctors and searched out Chinese women with needles, massage therapists, manipulators of joints, chanters of mantras, and purveyors of roots and barks and herbs and essential unguents. They seem friendlier. The shamans and wiccans with cures from the woods and ditches are more reassuring than the doctor himself, who has turned so cold and uncaring and who may not be God after all.
In the great yellow fever epidemic in Philadelphia, in 1793, the famous Dr. Benjamin Rush saw well over a thousand patients, bearing the cure he’d invented and believed in passionately. His treatment consisted of ripping their guts out with mercury purges and draining off most of their blood. This savage remedy should have killed them all, even if they hadn’t been already sick, but an astonishing number survived and flourished. He had tremendous confidence and courage. He strode into their evil-smelling chambers and sat on their vomit-soaked beds and smiled and said, “You have nothing but a yellow fever.” Probably they trusted him. Probably they thought he was God, and loved them, and it would be ungrateful and impious of them to die.
More of us stay alive today under the tender care of the antibiotics that replaced the doctor. We must learn to feel the same respect and trust for our bottle of pills, and smile weakly but gratefully at it when it comes to our bedside. Press it to our fevered brow, this pharmaceutical father figure squeezed into a plastic tube, with two refills and possible side effects but comforting, powerful, and wise. And probably very soon now medical science will have the bottle programmed to murmur, when we take off the lid, “Well, well, what seems to be the trouble? Let’s have a look.”

Prof GSPATNAIK is a consultant orthopedic Surgeon and a social scientist based in Bhubaneswar. He can be contacted at www.drgspatnaik.com

Heart Disease or Coronary Artery Disease is the largest single killer in our society. The changing life style and added to that the stresses and strains of life have made this disease an almost epidemic. In India it is fast growing and soon we will be the number one country with patients of Coronary Artery Disease. The WHO report is scaring and it points towards a total disaster. Keeping this in new we all need to take preventive steps to lessen the burden of this disease. First and foremost step towards this will be to have an organized lifestyle, regular exercise and diet control. But the next more important step will be to go for preventive check ups. The incidence of this disease is rising now in younger population so it will be advisable that anybody who is above 35 years should have all his investigations carried out from heart point of view at least once a year so that if there is any alarming sign it is tackled well in time. This particularly holds good in those persons who have a strong family history.
This is one scenario and the other is that someone is having coronary artery disease, which is significant enough to produce symptoms, and requires some treatment. In this second scenario one has to act immediately. Rather than have a wishful thinking that symptoms are not related to heart and may be due to gastric trouble or muscular pain one should immediately go for stress test and if it is positive then to see how much exactly the disease is, one undergoes angiography which is the only gold standard test to quantify this disease.
The real dilemma starts when one is found to be having significant coronary artery disease, which requires interventional treatment. As of now two types of interventions are available (both are invasive and require hospitalization).
Angioplasty and Bypass Surgery there can be situations where both can be offered as treatment of coronary artery disease and of course Bypass Surgery can be applied and is the solution in any type of situation. Angioplasty means that the diseased area of coronary artery is repaired by dilating the diseased porition with a balloon catheter and these days to support the weak dilated wall of the artery a stent is put in place for better long term patency rates.
Bypass Surgery is where surgically the disease part is bypassed with a new route of blood supply via a graft taken from the human body only in the form of vein or an artery. These days we used more and more of arterial grafts either the Internal Mammary Artery that runs at the beck of sternum or radial artery, which runs in the arms.
Angioplasty is less invasive than surgery in terms of that it is done under local anaesthesia and there are no major incisions. Bypass Surgery has also become less invasive in terms that it is being done on beating heart and no longer the heart is arrested to carry out these grafts. So the stressful effect of heart lung machine on the body is gone now and recovery is much faster. Bypass surgery is beyond doubt the long term, time tested solution which improves quality of life, prevents sudden heart attacks and freedom from second procedure is great.
In case of Angioplasty with stents also improves quality of life but the other two factors do not hold good. If the stent fails or blocks again it will lead to a fresh heart attack and also the chances of blockages second time are more with stents where a second procedure may be required early. The earlier stents had high re-blockage rate but the new generation of medicated or drug coated stents have better durability and patency rates but still they have above 9% re-blockage rate during the first year only. The procedure is beneficial only in short-term basis, in terms of no major incision, less or shorter stay in hospital and no general anaesthesia but at the cost of durability.
Bypass surgery is a proven durable treatment for coronary artery disease but when a patient is detected to have this disease there are certain situations where both the treatments can be applied and there the dilemma starts. If you look at human psyche anybody and everybody in the world will want a less traumatic treatment where angioplasty comes in mind but at the same time no one wants to suffer again and again and one wants a long term solution to the disease or to that effect eradication of disease (which though is not possible) but something close to that is possible with bypass surgery. As new route of blood flow is create via grafts, which are disease free, bypassing the diseased part of artery, which means in an indirect sense removing the diseased path from the route of blood supply to the heart.
Whenever a particular form of treatment is adopted it is backed by lot of research first in animal models and then in human beings as clinical trials. Then only it is offered to public en mass. Even after the procedure is accepted it is constantly evaluated by further trials and also it is compared to the already existing procedures or other newer procedure so that the best form of therapy can be chosen for the patient population. In this direction lot of trials were conducted on cardiology front about 15 major ones and some were compared with surgical arm. Even with the advent of drug eluting stents, bypass surgery scored over angioplasty with stents in terms of better long term results i.e. event free years and less chances of second procedure. Patients in the angioplasty arm had more incidence of major adverse coronary events after the first procedure.
What are the issues here lets have a look ! Agreed any patient will choose a less invasive treatment out of two available treatments. But here is a catch; these two terms of treatments have to be equally effective in terms of their results. In case of angioplasty vs surgery key issues are:
1. Is angioplasty in multi-vessel disease evidence based?
2. Are the limitations of angioplasty known to the patient?
3. Is it economical in multi-vessel disease as compared to surgery?
There is another major flaw. The trials on which we base our treatment are conducted on western population, which is genetically different than Asian or Indian population. In the sense that in western population the size of coronary arteries is much bigger than the Asian population like it is 4-6mm as compared to 2-4mm in Asians. So treatment applied there cannot hold good here.
As such if we look at Angioplasty vs CABG the two forms of treatment are not equivalent in terms of:
1. Bypass Surgery not only tackles culprit lesion but also deals with future lesions as it is done distal to the diseased part.
2. In certain situations angioplasty carries very high mortality like Left Main Disease.
3. Even the repeat revascularization or second procedure requirement is higher with angioplasty in multi-vessel disease or left main disease. As per two latest trials even in western population Arterial Revascularization Therapy Study (ARTS), Stent or Surgery (SOS) trials the incidence of second procedure in angioplasty group is 3 times higher than patients treated with surgery. Also the risk of death in both the trials with surgery is very low 1.2% in ARTS trial and 0.8% in SOS trial.
4. The trials included only simpler form of disease like single or double vessel but the results are being applied to multi-vessel group. The need for re-intervention in ARTS trial was 30% as compared to 9% in surgical group.
5. Again in diabetes the bypass surgery scores over angioplasty in terms of long term benefits as in ARTS trial it was 43% in angioplasty as compared to 10% in surgery patients.
6. Surgery offers more complete revascularization with better durability especially arterial grafts.
7. Left main disease is a very serious situation, which requires urgent intervention and bypass surgery so far has been the best form of treatment.
8. Another major disadvantage with drug coated stents is what we call “Late Stent Thrombosis” or sudden occlusion of the stent after a year or so when the blood thinners or antiplatelets are withdrawn or reduced and infact FDA in USA has issued a warning to all these companies for this dreaded complication.

Other myths about angioplasty safety have also been proven wrong.
1. Risk of heart attack during angioplasty is 10%
2. Risk of restenosis with in first year is 10% to 30%.
3. There is no reduction in neurological complications with this.
4. Even in trials including drug coated stents multi-vessel disease, small vessels, long lesions, diabetes and restenosis patients have been excluded but in practice they are applied in even these subset of patients also.

Recently a lot of studies have come in the reputed International Journals, two of which I quote here which have proven beyond doubt that CABG or Bypass Surgery is much superior to angioplasty in multi-vessel and left main disease and these subset of patients should only be treated with surgery for long term benefits and economics.
1. One paper was published in Annals of Thoracic Surgery Dec. 2006 entitled, “Coronary Artery Bypass Grafting is still the best treatment for Multivessel and Left Main Disease… But patients need to Know” by Dr. David P Taggart from John Radcliffe Hospital, University of Oxford, United Kingdom.
2. Does off pump or minimal invasive coronary artery bypass reduce mortality, morbidity and resource utilization when compared with percutaneous coronary Intervention? A Meta analysis of randomized trials. …In Journal of Thoracic and Cardiovascular Surgery March 2007 by David Bainbridge & Colleagues from Canada.
Both these papers have detailed about pros and cons of two procedures. In Lancet in Jan. 2006, the headline cover stated, “In view of the survival benefits shown for CABG the real controversy is why patients with symptoms and anatomy known to benefit from surgery are still submitted to angioplasty”.
Again the dilemma is summarized by Dr. Califf, Head of Interventional Cardiology at Duke University, “Stenting or Surgery” in Journal of American College of Cardiology”. It is likely that most people undergoing Coronary Angioplasty are not told the entire story when a decision is made about undergoing angioplasty. He attributes this to conflicts of self-referral and financial incentives and concludes, “Without Surgical Opinion the patient is in no position to have a rational input into the decision.”
The great father of interventional cardiology, Andreas Gruntizg, who died prematurely in a plane crash at age of 46 stated in 1979, “We estimate that only about 10-15% of candidates for bypass, surgery have lesions suitable for angioplasty. A perspective randomized trial will be necessary to evaluate the usefulness in comparison with surgical and medical management”.
So to conclude stent or surgery is not/should not be a physician’s choice. It should depend on what disease demands keeping in view the long term benefits and the economics. Pros and Cons of both the procedures should be made aware to patient in detail. Durability of treatment rather than short stay should be the goal and important factor for deciding treatment.
In the end I think the best way to remove this dilemma is have multidisciplinary team consisting of a physician, a cardiologist and a cardiac surgeon to decide about the treatment plan for coronary artery disease in a particular patient on individualized basis.

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Every heart attack leaves the heart muscle damaged and more the number of attacks, more the damage. After bypass surgery some part of its gets revived and some part remains damaged only. But major risk of damaged heat is whether it will be able to bear the stress of surgery and beyond a certain limit which is judged by echocardiography in terms of Ejection Fraction the risk is very high. These patients with Ejection fraction of 20% and below are generally the candidates for heart transplant which is itself is not very easy to go through because of shortage of donors especially in Indian setting and also because of life long heavy expenditure on drugs. World wide in view of this there is an effort to salvage a few patients by offering their bypass surgery though mortality for these kinds of patients is very high but otherwise also it is same if nothing is offered to them.
Beating heart surgery has proved a blessing to such patients as success rates of bypass surgery in this class of patients has improved a lot. These patients but definitely require extensive investigation to see the benefit and thorough stabilization and planning. Sometimes before surgery they are supported with intra aortic balloon pump to reduce the load on the heart as well as improve the blood supply to heart muscle to some extent so that heart improves a bit to tolerate bypass surgery.
Recently, we at Alchemist Hospital, Panchkula operated upon one such patient Mr. Tara Chand 50yrs Male. Dr. V. Sarwal, Head, Deptt. of Cardiovascular and Thoracic surgery along with his team Dr. Mubeen Mohammed, Dr. Ajay Sinha, Dr. Amit Ahuja, Dr. Dheeraj Dumir, Dr. Srinivas and Mr. Des Raj operated upon him successfully.
He came to OPD for an opinion for his heart disease and his condition was getting worse. Earlier, he had shown at many places even had angiography done at Bangalore but some how could not get operated and as per his previous record his ejection fraction was 30%. He was advised fresh angiography followed by pass surgery. On the night before his scheduled day of angiography his condition deteriorated, had chest pain, breathlessness and went into heart failure. He was admitted in the night itself and angiography showed disease had progressed and other investigations revealed a fresh heart attack. He tolerated angiography but his blood pressure was low and required drugs to support it. Echocardiography revealed further damage to heart and ejection fraction fell down to 12%. It was decided to insert IABP (Intra-aortic balloon pump) to support the heart and then stabilize him with medications for next 48-72 his before planning for surgery.
Angiography showed two arteries 100% blocked and third one was 85% in the proximal part and after that 100% blocked so all three arteries were completely blocked and he was surviving on 2-3 small branches of these main arteries.
Review of all investigations showed that he was ideally a candidate of heart transplant and bypass was quite risky but this was an option only theoretically. His Trop –I levels a marker for fresh heart attack was high so we stabilized him with drugs to take out water from lungs. Supported him on IABP for 3 days and when Trop – I level came down we decided to go for beating heart bypass surgery. Only positive thing on the whole scenario was that he was admitted with chest pain along with breathlessness which in itself on indirect indication of revivable heart muscles.
He was taken to Operation Room for surgery after 3 days and three grafts were put on him on beating heart. His vessels had quite a diffuse disease and one of the vessels had to be thoroughly cleaned (Endarterectomy) before putting up the grafts. He tolerated the procedure with moderate drug support and ventilator was removed on next day and IABP on 4th POD. Slowly his drug support was reduced, de-lined and mobilized and discharged on 12th Post op day in very stable condition.
His echocardiography showed marked improvement on his second follow-up and EF has come up to 30% now. His recovery is very good and his normal routine has started now. Beating heart bypass surgery is also quite risky in such conditions but is much better and helpful than conventional bypass surgery done on heart lung machine. This single technique has made quite a bit of difference in the outcome of such patients and our center is expert in this technique and has offered successfully this to very high risk and elderly patients even above 80yrs of age.

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Dome Osteotomy & Kodkanis Dome Stabilizer : A Knee Conserving, Reliable, Safe, Convenient & Cost-effective substitute to knee joint replacement surgery.





Osteoarthritis, or degenerative (wear & tear of joint increases as age advances) joint disease, is one of the oldest and most common types of arthritis (disease of a joint). It is characterized by the breakdown of cartilage (Insulating coating over the ends of bones within the joint) in the joint. Cartilage is the part of the joint that cushions (insulates from the nerve endings and provides a smooth surface for friction free movements of the joint) the ends of bones and its breakdown causes bones to rub against each other, resulting in pain and loss of movement. Most commonly affecting middle-aged and older people, Osteoarthritis can range from very mild to very severe. It affects hands and weight-bearing joints such as knees, hips, feet and the back.

According to the World Health Organization (WHO), around 10% of the world’s population above the age of 60 is estimated to be suffering from this condition. Moreover, an increasing number of young people, some even as young as 30, suffer from osteoarthritis.

In patients suffering from osteoarthritis of the knee, the inner sides of the knee joint gets worn off and the joint space collapses, causing ‘bowing’ (outward bending of the knee) of the knees. This ‘bowing’ leads to increased load on the inner side of the knee causing further wear and tear. In this entire process, the outer side of the knee joint is virtually intact.

The commonly opted solution to such a condition is a replacement of the knee joint, an expensive option as the cost of the artificial joint alone may be Rs. 75,000 onwards + surgical + medical +hospital cost = about Rs 1.5 lacs. Due to financial constraints a large number of patients are unable to go in for this replacement surgery. Moreover, patients lose their natural knee joint and must adjust to an artificial one.

To overcome these problems, an innovative, unique, cost-effective and less invasive (small incision of about 1 inch on front of the knee without ‘added damage’ caused to the knee) solution to deal with this condition is now available.

Dr. Pranjal Kodkani says: “Instead of knee replacement, osteotomy is now available for patients who have not reached the last stages of arthritis. This involves realigning ( straightening the ‘bowed’ knee ) the knee in such a manner that the load on the inner side of the knee is transferred to the outer side of the knee. This is done by cutting the lower bone of the knee in a particular (curved manner & not the previously followed method of removal of a wedge of bone & aligning the knee. This previous method still practised by some require postoperative plastering & immobilisation of the knee which in turn delays mobilisation and does not as good results) manner and then realigning it to make the limb straight. This osteotomy is known as the ‘dome osteotomy’ because of its shape. The surgery does not involve removal of any part of the bone or the joint and so does not shorten the leg.”

Advantages of Dome Osteotomy

* The patient is able to retain his original knee joint
* The treatment proves very cost-effective, enabling a large number of patients with modest incomes to opt for it.
* Allows all activities following surgery including squatting.
* Ideal for patients in the early stages of the disease as the original joint is saved.
* The surgery is less invasive.
* Significant amount of pain relief
* Faster mobilisation
* No artificial sensation
* Reduced risk of complications.
* Convenient, lightweight fixator facilitates faster recovery

This method also has several advantages when it comes to the recovery period. No plaster immobilization is required. Earlier, the patient would have to put up with a plaster cast, leading to immobility (since the patient cannot walk independently with a plaster. Also the plaster per se has its own disadvantages) and discomfort.

Large external ring fixators (Large metal rings applied from outside the knee to hold the bone with wires passed thro them) such as the one devised by Ilizarov in Russia allow some mobility however; their cumbersome (numerous wires are passed so the patient needs to take adequate care of all the wires and the entire apparatus to keep it clean and free of potential infection) and bulky nature may cause a certain amount of discomfort for the patient ( and difficult to socialise or even wear ones routine attire). To deal with these problems, a unique fixator, which is compact, lightweight, economical and allows early mobility is also available. It is called the ‘Kodkanis Dome Stabilizer’ (a patented and copyright product).

The surgery thus retains the original knee of the patient and results in a well-aligned (a knee straight enough so that the weight now is transmitted through the outer side of the knee rather than the inner side which is worn out and painful) leg, with significant pain relief.

Also the patient can squatt after the surgery and return to all their routine activities unlike a joint replacement where squatting which is an important activity in the Indian senario is not permitted following the surgery. Also this surgery does not burn any bridges unlike a joint replacement where a knee once cut off & lost cannot be regained.

Perhaps, the greatest advantage of Dome Osteotomy is the cost factor. The fixator is very economically priced bringing the total cost of the treatment to half the cost of joint replacement.

With incidence of young arthritics on the rise, the expectations from treatment for painful arthritic knee in this group of population are - relief of pain, rapid functional recovery for return to daily activities with the ability to squatt, not be a dependent for long, long lasting results, with least serious complications & risk of losing ones knee forever, less resurgeries, patient convenience and at an economical rate. Keeping these expectations in mind, osteoarthritis of the knee in this stage would be best treated with dome osteotomy for realignment of the knee fixed with this indigenous fixator designed to meet these requirements.

However this particular osteotomy, which is capable of providing all these advantages, is a more technically demanding procedure unlike the previously performed osteotomies and therefore not performed by all.


Older method of removing a wedge of bone and realigning the knee (High Tibial Osteotomy). Results in shortening because of removal of bone and also at times over or under correction of deformity. Also requires plastering.


‘Dome Osteotomy’ done with a curved cut in the bone & the knee is straightened by rotating the bone within the cut without removing any part of bone. The cut is fixed (stabilized) using ‘Kodkanis Dome Stabilizer’. Here ‘x’ degrees is the degree of abnormal bend in the knee which is straightened.

Advantages Of ‘Kodkanis Dome Stabilizer’ For Dome Osteotomy.

Compact & Light.
Stable fixation of dome osteotomy.
Immediate joint mobilization.
Early full weight bearing.
Early return to Activities of Daily Living.
Ability to alter correction in post-op period without anaesthesia.
No residual implants following treatment.
Better patient compliance.
Surgeon convenience.
Economical.

LINK ON INDIAN ARTHROSCOPY SOCIETY WEBSITE -

http://www.indianarthroscopy.co.in/download/current_concepts/jks_kds.pdf