Total Knee Replacement

It is called TKR for short. Dr Vikram Shah began his career as dedicated TKR surgeon in 1994 despite contrary advice by his peers and seniors, as in those days TKR was not considered to be a successful surgery in India.

In the first year he did 14 TKR surgeries, but within a few years his volumes rose so high that today he and his team are doing 17% of joint replacement surgeries conducted in India.

To be able to manage about 600 TKR surgeries consistently in a month, Dr Vikram used classic industrial management principles like assembly line production, optimization, total quality management, six sigma or kaizen to maintain quality and such high levels of volume from 1994.

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’ [Zero] 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 metal alloy and 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, most surgeons took about 90 minutes for TKR surgery.

90 to 22 and sometimes 19

Dr Vikram reduced that time to about 22 minutes in 2009.

‘0’ Technique

In 2012 he further reduced the time for TKR to about 8-10 minutes using 0 technique.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, and need for long rehabilitation. Patients who have undergone TKR by ‘0’ Technique begin walking in a few hours and climb stairs on the day of surgery, if they are operated in the morning. Such mobility was achieved after 1-2 day in the early nineties.