Medanta – The Medicity, a multi-super specialty institute located in Gurgaon, has successfully performed cement-less Total Knee Replacement (TKR) with the help of Titanium Nitride (TiNi) implant. It was the second case in India as well as at Medanta. Dr. SKS Marya, Chairman, Institute of Bone & Joint, Medanta – The Medicity planned and executed a unilateral knee replacement for the first time for a 63 year-old, Ishrat Umar, who was hypersensitive to metals and allergic to standard implants. Her treatment was successful with no adverse effects observed even two months post the surgery.
Basis the postoperative outcomes, a similar bilateral (both knees) total knee replacement has been performed on a 52 years old patient from Afghanistan, Mohd Qasim Alfaqir. The patient desired for maximum movement of knees, to be able to perform his religious rituals and daily routines with ease.
Dr. Marya, who led both the surgeries at Medanta Hospital said, “The TiNi implant provides an advantage of cement-less fixation, a coating with layers of porocoat titanium nitride ceramic, which is a structural material complementing that of a human bone. With the passage of time, the human bone grows into this surface. It also provides a mobile bearing surface which gives additional movement to the knee and reduces the rate at which the joints start wearing out. Hence, this particular implant is able to deliver a functional advantage along with an added advantage of increased longevity”.
Titanium nitride (TiN) sometimes known as tinite, is an extremely hard ceramic material, often used as a coating on titanium alloys, steel, carbide, and aluminium components to improve the substrate’s surface properties. Applied as a thin coating, TiN is used to harden and protect cutting and sliding surfaces, for decorative purposes (due to its gold appearance), and as a non-toxic exterior for medical implants. In most applications a coating of less than 5 micrometers is applied.
The major advantage of cement-less surgery is that the revision of joints which happens nearly after 20-25 years, can be done smoothly as there is no actual bone loss. Following are other advantages of this cement-less implant and are ideal for those with metal sensitivities/allergies, those who have an active lifestyle and desire a higher degree of mobility from the implants and with the passage of time, a new bone grows into the implant surface (bio-fixation).
During operation, it takes 10-15 minutes to set cement on either side. Thereby, in a cement-less knee replacement procedure, one saves a minimum of 20 minutes of operating time. The implant is mechanically fixed and not grouted using cement making revision surgeries at a later date easier. It is ideal for relatively younger patients with strong bones.
According to Dr. Marya, the principal of fixation depends on the precision of a high-quality surgery. The initial stability of implant is achieved by mechanical fixation that can be observed over the next 6-8 weeks as the bone grows over the TiNi implant and post this it provides a biological fixation.
Both these patients operated at Medanta are now able to walk and carry on with their daily routines with ease.