Arup K. Bhadra, M.D.: Accelerating Recovery Through Minimally Invasive Orthopedic Treatment at Good Samaritan Regional Medical Center

Thursday, May 30, 2013

Trained in trauma surgery as well as minimally invasive, innovative joint replacement techniques, Arup K. Bhadra, M.D., handles any orthopedic issue he encounters with precision and sensitivity to patients’ needs.

The only surgeon in Rockland County fellowship-trained in joint replacement, Dr. Bhadra, orthopedic surgeon and total joint replacement specialist at Good Samaritan Regional Medical Center, is a logical choice when primary joint replacement, revision surgery or a complex orthopedic procedure is required.

Dr. Bhadra’s history is that of a renaissance man, having trained in engineering (the discipline in which he earned his Master of Science) and trauma medicine, as well as orthopedic procedures. From his early work in emergency medicine and neurosurgery in England to his fellowships in traumatology, sports medicine and adult joint reconstruction surgery in the United States, Dr. Bhadra has truly mastered his field.

Total Joint Replacements

The majority of Dr. Bhadra’s work falls in the area of total joint replacement procedures, many of which he performs through minimally invasive approaches. Well-prepared for this line of work, Dr. Bhadra trained with a surgeon who studied at the Mayo Clinic.

“My mentor was trained by world-renowned joint replacement surgeons who invented implants and the techniques around them,” Dr. Bhadra says. “That made a huge difference in his process for determining the right course of action to get the best outcome for the patient.”

Dr. Bhadra and Kenneth S. Austin, M.D.
Dr. Bhadra and Kenneth S. Austin, M.D., discuss an MRI scan of a knee and a complex patient case.

Minimally Invasive, Tissue-Sparing Approaches

Total hip replacement requires a surgeon to remove damaged cartilage from the hip socket and replace the end of the femur with a metal or ceramic head. Through an incision in the hip, the surgeon can perform this surgery as an open procedure or a minimally invasive operation.

Dr. Bhadra takes a unique and patient-friendly approach. By performing this surgery through a small incision, he minimizes blood loss and promotes quicker recovery.

Operating Room Team
The operating room team at Good Samaritan Regional Medical Center: (back row, left to right) Derek Padilla, R.N.; J.P. Ecuyer, M.D., anesthesiologist; Kareem Eltaki, M.D., anesthesiologist; (front row, left to right) Elizabeth Heim-Bell, R.N., OR nurse manager; Ramses Ayala, P.A., Rockland Orthopedics; Deborah Feit, R.N.; Mercedes Nunez, LPN; Michelle Dunne, R.N.; and Karen Stanhope, R.N., total joint replacement coordinator

Dr. Bhadra has been well-trained to perform hip surgery through both anterior and posterior approaches. In the anterior approach, a patient is placed in a supine position for optimum access. A single, tissue-sparing incision followed by blunt dissection allows the surgeon to access the hip and perform the procedure with minimal trauma. Both parts of the replacement prosthesis are placed through the same incision, with the surgeon continually checking comparative leg lengths during surgery. A surgeon can perform this procedure without detaching any muscle from the femur or pelvis, and leave the abductor tendon intact. Dr. Bhadra cautions about the risks of possible neurovascular injury during this challenging procedure. As such, all patients are thoroughly screened before he takes this approach.

“Most surgeons perform hip replacement from the back, exposing the joint and then performing the replacement,” Dr. Bhadra says. “By making the incision at a precise location without cutting any tendon and repairing the capsule or lining of the hip joint at the end of the procedure, I allow my patients to experience a fast recovery. These patients are typically well healed within five to six weeks.”

When it comes to knee replacement surgery, Dr. Bhadra offers yet another unique approach, minimizing damage and allowing patients to become mobile much sooner.

Physicians of Rockland Orthopedics
The physicians of Rockland Orthopedics & Sports Medicine (left to right): Neal H. Shuren, M.D.; Michael D. Robinson, M.D.; Arup K. Bhadra, M.D.; Cheryl J. Rubin, M.D.; and Kenneth S. Austin, M.D. Other physicians in the organization include: William L Davis Jr., M.D.; Steven A. Renzoni, M.D.; Warren K. Slaten; and Gustavo Carbone, M.D.

“For the knee, I perform a special technique, not cutting through the quadriceps tendon, but making a plane between the muscles and then pushing muscle and tendon to one side to perform the surgery,” Dr. Bhadra says. “With this method, the body doesn’t need to heal the cut tendon. There is less blood loss and better range of motion in the replaced joint. Patients love this approach.”

In fact, recovery following tendon-sparing knee replacement surgery sounds almost miraculous.

“Patients can walk first thing the morning after surgery,” Dr. Bhadra reports. “They can put weight on their feet the afternoon following a morning surgery, so they actually begin physical therapy the same day as surgery. Because they don’t have to deal with a painful cut to the tendon, they can push themselves to do more physical therapy. The result is a quicker recovery.”

Rare Complex Shoulder Replacement

When the cartilage in a joint has worn down on both sides and bones are exposed like “bare floor without carpet,” considerable friction ensues, resulting in pain and movement limitations. Deconditioning, as a result of self-imposed movement restriction, may further weaken the joint. These factors often complicate replacement surgeries, especially those of the shoulder.

Bhadra Shoulder Replacement
Dr. Bhadra examines a patient who underwent right reverse total shoulder replacement for osteoarthritis and complete tear of rotator cuff. Within two months, the patient had excellent range of motion.

Dr. Bhadra describes the shoulder ball-and-socket joint as resembling a golf ball and a tee, in that the tee does not completely encircle the ball. In a total replacement, both must be replaced. Dr. Bhadra relies on a metal ball combined with a titanium-and-metal stem for the ball portion of the joint. He uses a highly porous, metal-backed plastic prosthetic for the socket.

“For traditional shoulder replacement to work, the patient must have a healthy, fully functional rotator cuff muscle,” Dr. Bhadra explains. “Supposing the patient has significant arthritis, he or she may also have significant tearing to the rotator cuff. A new joint would not perform any better than the original one because part of the problem is the musculature surrounding the joint. There is still no muscle to lift the arm.”

In such cases, Dr. Bhadra reverses the procedure. This way, the deltoid muscle can again be leveraged to lift the arm. This procedure is especially indicated for people who have rotator cuff damage and concomitant arthritis in the shoulder joint such that they cannot raise their arms.

“When I put the ball part on the socket side and create a functional socket on the original ball/arm side, other muscle groups get involved to lift the arm,” Dr. Bhadra says. “The result is that these patients can achieve excellent pain relief and functional recovery, along with improved range of motion. For patients who could not previously lift their arms, this is a life-changing difference.”

Revision Surgeries

Dr. Bhadra says joint replacement surgery has evolved considerably during his career, especially in the realm of revision surgeries.

Bhadra Hip Replacement
Dr. Bhadra examines a patient who underwent right total hip replacement six months ago. The patient was able to get back to Zumba after just two weeks.

“In total hip replacement, for example, most U.S. surgeons have moved away from using cement. We are not introducing binding material because those joints last a long time. If, God forbid, you need to have a hip replacement redone, because the prosthesis is loose or has experienced wear and tear, it is easier if cement was not used during the first surgery,” Dr. Bhadra says. “Instead of cement, we now use a specially designed implant that bonds with the bone. This is especially useful for young patients who still lead a fairly active lifestyle. It helps them in the long term if we have to take the joint out and do it again.”

Dr. Bhadra also performs partial joint replacement surgery when only one portion of the joint requires attention. When possible, he applies the same minimally invasive principles to protect surrounding ligaments and tendons and promote the best possible recovery and function for patients.

Coherent Care Team for Complex Conditions

With his experience in sports medicine, Dr. Bhadra enjoys the team approach to orthopedic medicine at Good Samaritan Regional Medical Center and at Rockland Orthopedics & Sports Medicine, P.C. Staff at the Total Joint Replacement Center at Good Samaritan Regional Medical Center, under the direction of Kenneth Austin, M.D., pride themselves in their ability to work together to best serve the community.

Dr. Bhadra and Dr. Austin
Dr. Bhadra and Dr. Austin discuss recent updates and articles in joint replacement surgeries.

“A big advantage of the Total Joint Program at Good Samaritan Regional Medical Center is that this is a local program served by local physicians and nurses. You get the warm, one-on-one approach you’re used to in a community hospital, rather than a large academic facility where you can lose that personal touch,” says Dr. Austin.

Rockland Orthopedics & Sports Medicine is a multispecialty group comprised of nine physicians, including six orthopedic surgeons, two physiatrists and a rheumatologist. All physicians are fellowship-trained in a variety of subspecialties, including total joint replacement, arthroscopy, sports medicine, shoulder and knee surgery, traumatology, hand and upper extremity surgery, and spine. All physiatrists are triple-board-certified in physical medicine and rehabilitation, pain medicine, and electrodiagnostic medicine. Rockland Orthopedics & Sports Medicine has three office locations throughout the Hudson Valley: Airmont, Stony Point and Monroe. All offices offer physical therapy, with occupational therapy and hand therapy also available at the Airmont office.

“Many of our patients suffer from complex conditions with a spectrum of comorbidities ranging from other joint diseases to degenerative processes in the body,” Dr. Bhadra says. “Often, they have lower back issues as well. Our physical therapists do excellent work with these patients.

Team of Medical Assistants
The team of medical assistants and secretaries at Rockland Orthopedics & Sports Medicine

“The advantage of a team approach is that if a patient comes in with multiple, interrelated complaints, I can care for him or her in one place. The patient does not have to visit multiple providers for what are essentially connected issues. Also, as patients get to know us as a team, we are able to leverage that unity to push them a little harder to achieve the best possible outcome.”

Location is another benefit to Dr. Bhadra’s practice. Although close to New York City, Good Samaritan Regional Medical Center provides many advantages over traveling to the big city for care. Physicians and staff are accessible, taking a one-on-one approach to patient care. Furthermore, Dr. Bhadra’s practices all offer quick access to providers.

“Any patient can walk in the door and get access to assessment or intervention,” Dr. Bhadra says. “Patients do not have to wait for a phone call or get lost in the halls of a large unit. Having a personalized experience and knowing that your surgeon is approachable and likable is something patients appreciate.”

A Good Neighbor

With office hours at all three Rockland Orthopedic & Sports Medicine locations, Dr. Bhadra is readily available to patients — and physicians — in many neighborhoods. Often, he is called in to trauma cases involving multiple, crushing or open bone injuries. His experience at the Trauma Center at University of Louisville Hospital, where he completed a fellowship, serves him well in these instances. And, he welcomes consultations on nonemergent cases, as well.

“My doors are open,” Dr. Bhadra says. “When it is necessary to have a consultation about a medically complex patient case or a new technique, I am happy to have a discussion about how to best serve that patient and deliver the best-quality care through the most appropriate, minimally invasive techniques.”

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