Surgery: Relentless Progress

The classic business and industrial management principles like assembly line production, optimization, total quality management, six sigma or kaizen, all were knowingly or unknowingly implements over the first two decades of Shalby Hospitals. The acid test of success was the most sought after goal.

There are literally hundreds of examples of innovations and changes that led to progress, but the most well known is perhaps the revolution that led to ‘0’ Technique in TKR surgery.

TKR or total knee replacement surgery involves cutting away the worn out parts of bones and cartilages and replacing them with synthetic alloy or polymer parts. One of the challenges of TKR that needs to be overcome at any cost is infection. One way in which the possibility of infection can be reduced is by reducing the time for which the operative wound remains open.

When Dr Vikram Shah began doing TKR surgeries in 1994 in Ahmedabad, he took on an average 90 minutes to put in the implant.

He reduced that time to about 22 minutes in 2009. In 2012 he further reduced the time for TKR to about 8-10 minutes.

The reduction of time was done without in any way avoiding the essential steps of TKR. He named this fast process the ‘0’ [zero] technique to show the minimalist approach in terms of incision, operative time, antibiotics, need for blood transfusion, need for long rehabilitation.

Thus patients who have undergone TKR by ‘0’ Technique begin walking in a few hours and climb stairs on the day of surgery. Such mobility was achieved after 1-2 day in the early nineties.


  • Bone Bank
  • Joint Inventory
  • ‘0’ Technique in TKR
  • Shalby ‘We Care’ Program
  • Friends of Shalby Foundation
  • Shalby Times, a patient centric magazine