national institute of joint surgery

26 Jan
Orthopedics, Diabetic Foot Surgery, Arthritis, Sports Injuries, Musculo Skeletal Disorders, Hip Surgery, Cervical Spondylosis, Knee Surgery, Orthopedic Surgery, Osteo Arthritis Knee, Osteoporosis, Osteopathic Medicine, Orthopedic Oncology, Orthopedics & Traumatology, Pediatric Orthopedics, Physiotherapy, Spondylolisthesis, Rheumatic Disorders, Rheumatology, Spine Surgery, Spine and Joint Replacement ,flat foot, plantar fasciitis, neck pain , backpain, knee pain , foot pain, ankle pain, ankle arthroscopy , rheumatoid arthritis

Orthopedics, Diabetic Foot Surgery, Arthritis, Sports Injuries, Musculo Skeletal Disorders, Hip Surgery, Cervical Spondylosis, Knee Surgery, Orthopedic Surgery, Osteo Arthritis Knee, Osteoporosis, Osteopathic Medicine, Orthopedic Oncology, Orthopedics & Traumatology, Pediatric Orthopedics, Physiotherapy, Spondylolisthesis, Rheumatic Disorders, Rheumatology, Spine Surgery, Spine and Joint Replacement ,flat foot, plantar fasciitis, neck pain , backpain, knee pain , foot pain, ankle pain, ankle arthroscopy , rheumatoid arthritis



24 Mar

About The Author

Dr Manoj R. kandoi is the founder president of “Institute of Arthritis Care & Prevention”

an NGO involved in the field of patient education regarding arthritis. Besides providing

literature to patient & conducting symposiums, the institute is also engaged in creating

patients “Self Help Group” at every district level. The institute also conducts a certificate

course for healthcare professionals & provide fellowship to experts in the field of arthritis.

The author has many publications to his credit in various journals. He has also written a

 book “ The Basics Of Arthritis” for healthcare professionals.

The author can be contacted at:

Dr manoj R. kandoi

C-202/203 Navare Arcade

Shiv Mandir Road, Opposite Dena Bank

Shiv mandir Road, Opposite Dena bank

Shivaji Chawk, Ambarnath(E) Dist: Thane Pin:421501

State: Maharashtra Ph: (0251)2602404 Country: India

Membership Application forms of the IACR for patients & healthcare professionals

can be obtained from.


Institute of Arthritis Care & Prevention

C/o AshirwadHospital

Almas mension, SVP Road, New Colony,

Ambarnath(W) Pin:421501 Dist: Thane

State: Maharashtra Country: India

Ph:  (0251) 2681457 Fax: (0251)2680020

Mobile ;9822031683




Studies have shown that people who are well informed & participate actively in

their own care experience less pain & make fewer visits to the doctor than do other

 people with arthritis. Unfortunately in India & many third world countries we do not have patient education & arthritis self management programs as well as support groups. This is an attempt to give a brief account of various arthritis, their prevention & self management methods which can serve as useful guide to the patients of arthritis.

It would be gratifying if the sufferers of the disease knew most of what is given in the book.



I am thankful to Dr (Mrs) Sangita Kandoi for her immense help in proofreading & for her invaluable suggestions. The help rendered by  Nisha Jaiswal is  probably unrivalled. Thanks also to vidya, sheetal and  parvati for their continous support throughout the making of the book. The author is grateful to his family for the constant inspiration they offered. The author alone is responsible for the shortcoming in this piece of work. He welcomes suggestions for improvement from the readers.


Neuropathic Arthritis:



Arthritis caused by repeated minor injuries to the joint which is insensitive to pain leading to its disorganisation is known as neuropathic arthritis. It is named after Jeon-Martin Charcot (1825-1893) who first described it in association with tabes dorsalis.


Disorders associated with charcot’s joint:

– Diabetes mellitus                  – Syringomyelia

– Syphilic                                 – Spine bifida

– Chronic alcoholism               – Meningomyelocele

– Hansens disease                    – Congenital insensitivity to pain

– Peripheral nerve injuries        – Amyloid neuropathy

                                                – Charcot -marie -tooth disease



Reduction in joint sensibility


Protective function of pain is lost


Loss of protective muscle reflex


Harmful joint strain go unprevented


Cumulative strains leading to severe degenerative changes


Articular cartilage and subchondral bone worn away.

ligament laxity and joint instability.


Types of charcots joints:

  1. Atrophic: “Pencil -in -cup” deformation, resorption of bone end, usually affects upper extremities.
  2. Hypertrophic: Joint space narrowing, with bony sclerosis, new periosteal bone formation, articular

      surface fragmentation and joint subluxation can be seen.


Stages in formation of charcots joint:

Stage I:             Joint subluxation, osteoporosis, cortical defects.

Stage II:            Osteolysis, fracture, periosteal elevation or new subperiosteal bone formation.

Stage III:          Healing stage, reconstructive, decrease swelling and bony ankylosis.


Clinical features:

  • Knee, ankle and subtalar joints are most commonly affected in the lower limb and elbow in upper limits.
  • Joints in the spine may also be affected.


Symptoms: Common presenting complaint is painless swelling and instability of joint.


  • Irregular hypertrophy at the bone ends
  • Moderate restriction of movements ~
  • Ligament laxity with excessive side to side movements
  • Localized erythema, swelling and increased skin temperature can also be noted.



Associated findings in charcot’s joints:

In tabes dorsalis, the lower extremities and spine are commonly involved. Other signs include ataxia, argyll robertson pupils, absent knee reflexes and, absent deep position, vibration and pain sense.

In Syringomyelia upper extremities are commonly involved. Clinically features of sensory dissociation, loss of pain and temperature, and preservation of touch is noted. Deep sensation is undisturbed. Progressive muscle atrophy in the arms and fibrillation and trophic changes in the fingers may also be noted.


Radiographic changes:

  • Exaggerated changes of degenerative arthritis seen such as loss of cartilage space, absorption of bone ends, hypertrophy of bone at the joints margins etc.
  • Subluxation or dislocation may be noted.









             Conservative                                                                 Surgicals

          – Supportive and protective                                          – Surgical fusion in corrective

             bracing                                                                          position can be obtained.

           – Role of biphosphate pamidronate

              under investigation.


Criteria for surgical intervenation:

  • Instability of the foot or ankle
  • Deformity
  • Chronic ulceration
  • Progressive joint destruction (despite conservative care)
  • Adequate circulation
  • No active infection
  • Systemic factor: Patient should be medically stable and compliant and have the potential for returning to an active lifestyle




Surgical methods used:




















Timing of surgical reconstruction / management:

It should be done when stage of reconstruction begins i.e. when acute inflammatory condition has subsided & there is radiographic evidence of healing.


Patterns of bone & joint involvement in neuropathic diabetes:

  1. Forefoot: Radiographic findings are often atrophic & destructive mimicking osteomyelitis. Plantar ulceration is an associated findings.
  2. Tarsometatarsal joints: Characterized by disruption of the TMT joints often with collapse of the midfoot. Plantar ulceration frequently develops at the apex of the collapsed cuneiform or cuboid.
  3. Naviculocuneiform, talonavicular & calcaneocuboid joints: There is usually dislocation of the navicular or disintigeration of naviculocuneiform joints.
  4. Ankle joint: Infrequent but associated with severe deformity & instability. It may also be associated with involvement of subtalar joint.
  5. Calcaneus: It is characterized by rare avulsion fracture of the posterior process of the calcaneus.


Factors responsible for noninfective bone & joint destruction in diabetic foot:

  • Peripheral neuropathy with loss of protective sensation
  • Autonomic neuropathy with increased peripheral blood flow
  • Mechanical stress of weight bearing ,
  • Repititive trauma
  • Nonenzymatic glycosylation of collagen
  • Decrease cartilage growth activity
  • Corticosteroid -induced osteoporosis



























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NAME                                                                  :    Dr Manoj R.kandoi

SEX                                                                       :     Male

DATE OF BIRTH                                               :     01/07/1971

ADDRESS                                                            :    C-201, 202,203 Navare arcade,

Opposite Dena  bank, Shivaji Chawk Ambernath(E)     

421501,   Dist: Thane State: Maharashtra  Country:India             





ADDRESS FOR CORRESSPONDENCE         :     Dr. Kandoi’s Ashirwad Hospital,New Colony,SV.P.

Road, Ambernath (W) Tel No: 680020,681457


                                                                                    Fax No.: 0251-680020           

PHONE:                                                                     Residence: 602404, Mobile No: 9822031683




M.B.B.S.                               Bachelors of medicine and bachelor of surgery passed in October 1992 from university of Bombay

D. (Orth)                             Diploma in orthopedics surgery passed in November 1996 from the college of physicians and surgeons, Parel, Bombay.

M.S. (Orth):                        Master in orthopedics surgery passed in January 1997 from the university of Bombay.

F.C.P.S. (Orth):                  Fellowship of college of physicians & surgeon passed in March 1997 from the college of physicians & surgeon, Parel, Bombay.

D.N.B.E. (Orth):                 Diplomat qualification degree awarded by National Board of Examination, New Delhi in January 1998.





  1. A.    Dr. Kandoi’s ashirwad Hospitals:
  • Almas Mension, S.V.P. Road, New Colony Ambernath (w) 421501 Tel No: 2680020, 2681457
  • Ganesh Ashish Apartment Vadavli Section, Ambarnath(E) 421501 Tel No.: 2606766


B)Ankur nursing home:

      Mohan plaja, O.T.. section, Ulhasnagar – 4. PH. 2581324


C)Honorary Consultant:

  • Kevalram Chanrali Hospital – Ulhasnagar-3 (affiliated to Jaslok Hospital)
  • India red Cross Society, Ulhasnagar-2
  • Chayya Hospital Ambarnath(W)





  1. Treatment modalities for bone defects using Ilizarov Technique: Dissertation submitted for M.S. Examination of Bombay University.
  2. Management of supracondylar and Intraaricular fracture of femur: Dissertation submitted for the fellowship of college of physician & Surgeon of Bombay.
  3. Treatment modality of Bone defects using Ilizarov technique: Orthopaedic Update (India) Journal (Indexed) as a first author.
  4. ‘Intermetacarpal transverse k wiring for treatment of fractures of metacarpals’ poster presented in IOCON 2009 A CONFERENCE OF INDIAN ORTHOPEDIC SOCIETY AT ORISSA IN NOVEMBER 2009
  5. Tuberculosis of C.V. Junction: Bombay Hospital Journal as a co-author (Vol. 39, No. 4, 1997)
  6. A typical presentation of spinal tuberculosis a case report: Indian practitioner as a first author (June-97, VOL.50, No.2).
  7. Leptomeningeal primary melanomas, causing compressive Myelopathy:Indian Journal of Orthopedics Jan 98 as a first author
  8. Acute disseminated Eosinphilic granuma involving spine: A case report & review of literature: Indian Journal of medical Sciences as a first author (Vol. 52, No.1, Jan. 1998)
  9. Intradural Extramedullary Tuberculoma causing Cord compression: A case report & Review of Literature: Journal of Indian medical Association as a first author (Vol. 96 No. 8, Aug. 1998)
  10. Multiple Ipsilateral fracture of lower limb: A study of problems & Management: Indian Journal of surgery as first author.
  11. Sonographic assessment of bone at distraction site in ilizarov procedure (Vol. 7, No.2, Dec 97).
  12. “Thoracic outlet syndrome : A mystery probed “ An article published in synapse Vol2 Issue 1 June 2004.
  13. Current concepts in osteoporosis an article published in Synapse Volume 1 Issue 1 March 2004.
  14. Tennis Elbow: A review of Literature Article in ‘Doctor Mitra’ in January ’04.
  15. Therapies in prevention and treatment of osteoporosis: A current concept review in Dr. Mitra No. 70 15th Aug, 2004.
  16. ‘Coccygodynia : A review’ published in Pure Health Oct-04
  17. Editor of Synapse journal of Ambernath medical Association.
  18. ‘Intermetacarpal transverse k wiring for treatment of fractures of metacarpals’ article published in journal of maharashtra orthopedic association Dec. 2007
  19. .‘Intermetacarpal transverse k wiring for treatment of fractures of metacarpals’ poster presented in traumacon 2009 of Indian trauma society in Mumbai
  20. Supracondylar osteotomy for correction of developmental genu valgum” , A paper presented in British Orthopaedic Association Annual Meeting in Manchester on 16th September 2004,.
  21. .‘Intermetacarpal transverse k wiring for treatment of fractures of metacarpals’ poster presented in IOCON 2009 in  ORISSA






















  •        OBSERVORSHIP AT   Univarsity of         Washington, foot and ankle department,U.S.A






  • Observorship at Hissingpark foot and ankle clinic October 2008, Augsberg, Germany
  • Clinical Fellow, University of Washington
  • Observorship at policlinico multimedica at Milano, Italy in October 2009
  • Centro Mano Studo fellow ,Univarsity of Milan, Italy
  • Fellow Of International College of Surgeons, Chicago.
  • Fellow of Royal Society of Medicine.
  • Fellow of Royal Society of Tropical Medicine.
  • International affiliate Member, National Osteoporosis Foundation,california.
  • Awarded INOR Fellowship of British Orthopedic society the year 2004 by Indian Orthopedic Association to attend British Orthopedics meet at Manchester.
  • Awarded “Chikitshak Ratan”  of the year Oct 6,2004,

by Global Society for Health and Educational Growth. In New Delhi.

  •  Aits-Ircad fellowship in wrist arthroscopy in Taiwan in year 2009
  • Aits – ircad fellowship in knee arthroscopy in tripod in nov 2010
  • Ankle arthroscopy at academic medical centre,Amsterdam,Netherland in 2011











1.  The basics of Arthritis: A guide for students and practitioners

Published  by:

The National Book Depot

Parel, Mumbai – 400 012

ISBN: 81-87540-25-7

First Edition 2003

2nd Edition 2006


2.  Living With Arthritis

Published by :

Institute of arthritis care and prevention

Ambernath (W) Dist : Thane 421 501


3. Clinical cases in orthopaedics

Published by

The National Book Depot

Parel, Mumbai – 400 012

First edition 2006

ISBN NO.81-87540-58-3



4.  Clinical aspects in osteoporosis

Published by

Jaypee publishers Pvt. Ltd

New Delhi India

First edition 2005

ISBN NO.81-8061-451-4


OTHER CONTRIBUTIONS: A comprehensive web based resource for patients and health professionals A comprehensive web based resource for patients and health professionals.




  1. Basic fracture fixation course organized by department of Orthopedics and Traumatology L.T.M.G.
  2. Hospital Sion in April-94.
  3. Bombay Orthopedics Society western India regional Orthopedics conference (WIROC) held in Bombay 16th –17th Dec 1995
  4. Advanced fracture fixation course organized by department of Orthopedics and Traumatology L.T.M.G.
  5. Hospital Sion in Oct 97.
  6. Diploma of the National Board for the practice of Orthopaedic Surgery in December 1997.
  7. “INTERLOCKING NAIL FEMUR & HUMERUS” Organised by  Thane Orthopaedic Society in 11th January 1998.
  8. Hands on workshop on interlocking nail system organized by Thane Orthopedics Society in January 98.
  9. Attended POSI 2000 conference (6th annual conference of pediatric Orthopedics society of India)
  10. Workshop on Osteotomies around the hip during ‘POSI’ 2000.
  11. Pediatric fracture course during ‘POSI’ 2000
  12. Western India Regional Orthopedics conference ‘WIROC-2000’ held in Mumbai 16th-17th Dec 2001

       4th February 2001

  1. ‘BASIC ARTHROSCOPY WORKSHOP’ Organized by B.O.S> on 17th, 18th August 2001.
  2. Attended and actively JESS FIXALOR WORKSHOP Organised by Bombay Orthopaedic Society from 3rd Sep to 8th Sep 2001.
  3. Attended Jess course’2001 held by B.O.S. at V.N.Desai Municipal in Sept’ 2001
  4. Attended ‘IMPLANT UP DATE 2001’Conducted by B.O.S. on 9/09/01
  5. Attended ‘MOACON-2001’ at Mahabaleshwar 8/11/01
  6. Attended ORTHOPAEDIC ON COLOGY UP DATE 19/10/01 organized By BOS.
  7. Attended ‘ISSH-2001 CONFERENCE’ organized by ISSH
  8. Attended ‘Advanced course in hand surgery’ organized by BOS on January 2002.
  9. Shoulder & Knee Imaging for Radiology Education Foundation (REF) on 16 march 2002.
  10. Attended ‘Uma Symposium-2002’ on 22nd December 2002.
  11. Attended “FRACTURE IN CHILDREN” at the Holy Family Hospital, Bandra in 19th January 2003.
  12. Attended Flap dissection course organized by BOS in August 2003.
  13. Attended Trauma management course organized by Indian Trauma Society in April 2003 at  


  1. Attended 17th National seminar on “Individual Achievements & National Development” On 06 Oct 2004 at New Delhi.
  2. Advanced Hand Surgery ll Instructional Course Indian Orthopaedic association in 24th & 25th January 2004.
  3. Attended Workshop on basic illizaron Instructional Course Leactures, CMS, Conference at the Golden Jubilee Conference of The Indian Orthopaedic Association held in Mumbai in 25th to 30th December 2005 by IOACON 2005.  
  4. Attended & Actively Participated in the Implants Update 2006.
  5.  Attended “One Small Step” A CME on GAIT & Motion Analysis on 16th & 17th September 2006 at Holy Family Hospital, Bandra (W).
  6. Attended CME Programme of Diabetic Foot Society of India held on 13th October 2006 at Tata Memorial Hospital, Mumbai.
  7. Attended & Actively Participated in CME & Video Show On Ingrown Toe Nail in 7th January 2007.
  8. Attended & Actively Participated in Symposium on Dentistry & Chickengunia on 28 January 2007.
  9. Attended & Actively Participated in Paediatric CME on in 11th March 2007. 
  10. Attended Orthopaedic Surgeon & Enhanced Productivity in 21st December 2007 at the Nanavati Hospital, Vile Parle (W) by WiROC.
  11. Attended 41st Western India Regional Orthopaedic Conference in 22nd & 23rd December 2007 at the J.W. Marriott, Juhu by WiROC.
  13.  Attended “Ponseti Training Course 2008” on 1st March 2008.
  14. Attended INDO-US Conference on foot and amkle surgery at Mumbai in jan;2010



  • Attended APOA (ASIA PACIFIC ORTHOPEDIC ASSOCIATION) conference in April 2003 at Coimbatore.
  • Attended annual conference of International College of surgeons in Chennai in July 2003.
  • Attended “National Trauma Management Course” by Academy of Traumatology (India), IATSIC, Asia Pacific Orthopaedic Association. in 23rd & 24th April 2003.
  • Attended 1st Conference on Truma of Asia Pacific Orthopaedic Association in 25th – 27th April 2003 at Coimbatore, India.
  • Attended International Convention Centre & G-Max, Manchester by British Orthopaedic Association in 15th- & 17th September 2004 & ‘Indian Summer’ on 14th September 2004.
  • Attended Seminar & Hands-on-Workshop on Locking Compression Plate (LCP) in 3rd June 2005 by SYNTHES INTERNATION at Miraj.
  • Attended APLAR  Conference in Kualalumpur, Malaysia  in 2006
  • Attended “Intramedullary Nailing in Tibial Diaphyseal & Metaphyseal “ Organized by AO International in 24th September 2006 at Mumbai.
  • Attended joint annual conference of Indian Foot and Ankle Society with British Orthopaedic Foot and Ankle Society ‘IFASCON 2008’ in 3rd August 2008.





52 Weeks of rotations in Department of Internal Medicine, General Surgery, Orthopaedics, Gynaecology & Obstetrics, Paediatrics, Otolaryngology, Ophthalmology, Preventive & Social Medicinc, Casuality Ward management, Intensive Critical Care, Rural Health Posting and Immunization programmes.



Was part of medical relief team from Grant Medical & J. J. Group of Hospitals for disaster management during earthquake which occurred in Latur in 1993.


Handle Primry Health Care Centre for Solegaon, Ratnagiri District, Maharashtra, India as a sole health officer for 2 months.




  1. Represented B. N. Bandodkar College in Cricket in the University level.
  2. Represented Sports team of J. J. Group of Hospitals at PULSE’90 AIIMS, New Delhi.
  3. Represented Grant Medical College in Cricket & Hocky at Intern-collegiate festivals.




  1. Dr. K. R. Patel prize for the highest aggregate marks in P.S.M. amongst students from Grant Medical College in 3rd M. B. B. S. examinations of Bombay University in 1992.
  2. Was selected to represent the ‘ELITE BATCH’ of Department of Pharmacology, Grant Medical College Competitions.
  3. Certificate of Excellence from Department of Pharmacology. Grant Medical College for excellent performance throughout the academic year in 2nd M.B.B.S.





Year            Period                 Hospital                            Teacher                     Speciality

FIRST        1.2.94 to    King Edward Memorial       Dr. V. J. Lahiri          Spine Surgery

                   31.7.94      Hospital, Parel, Bombay.


                  1.8.94 to    King Edward Memorial        Dr. P. B. Bhosale      Sports Clinic &

                  31.1.95      Hospital, Parel, Bombay                                         Ilizarov Surgery

SECOND  1.2.95 to    King Edward Memorial        Dr. B. R. Patel          Tumour Surgery &

                  30.7.95      Hospital, Parel, Bombay.                                        Arthroplasty


                  1.8.95 to    R. N. Cooper Hospital          Dr. R. N. Katre.        Elbow Surgery

                  31.1.96      Juhu, Bombay.                                                       General Orthopaedics

THIRD     1.2.96 to    King Edward Memorial        Dr. P. B. Bhosale      Sports Clinic &

                 31.1.97      Hospital, Parel, Bombay.                                        Ilizarov Surgery







K. E. M. Hospital is the largest hospital in Asia with over 1800 beds. Department of Ortopaedics has six units & a total of about 300 beds. This hospital handles a very large volume of outdoor & indoor patients. The theatre have a laminar airflow and are well equipped. There is a separate spinal surgery operating theatre and a separate emergency trauma theatre along with the routine orthopaedic theatre.


Cooper hospital is the largest peripheral hospital in Bombay with about 100 beds in Orthopaedics handling all types of orthopaedic work including spine, Arthroscopy & Paediatric Orthopaedics.




International organizations:

  • National osteoporosis foundation (Washington, DC 20037-1292)
  • World Orthopedics Concern (461/2002)
  • International Club for Bones & Joints Disease (Year 2002)

      National organizations:

  • Indian Orthopaedics Association (LM – 4335) 
  • Bombay Orthopedics Society.
  • Indian medical association (MAH-6875/78/1003/61340/97-98/L)
  • Association of medical consultants of Bombay.
  • Kalyan Orthopedics society.
  • Maharashtra orthopedics Society.
  • Indian society for surgery of hand
  • Ambernath Medical Association.
  • Ulhasnagar Medical Association.
  • Indian Foot Society (LM NO.: 159)
  • Indian Arthroscopy Society.
  • Indian Rheumatology Association.
  • Geriatric society of India (No. L-687)(Year 2002)
  • Trauma Society of India (No.: 176)




Institute of Arthritis Care and Prevention: A registered charitable trust act registered under Mumbai Trust Act working for the spread of arthritis awareness in the general population and General practitioners.  The institute is conducting a certificate course for doctors on arthritis. 

Medicare charitable hospital trust:  A registered charitable trust act registered under Mumbai Trust Act working for the poor and underprivileged people residing in remote towns of Thane district by conducting free medical camps.  The trust is presently engaged in construction of the largest super specialty charitable hospital in Thane district.

Ashirwad group of hospitals:  First ISO 9001 certified private group of hospital in Thane district, actively funding the charitable goals of the above mentioned trusts.

API College of Allied Health Sciences: Mumbai’ leading paramedical college of studies in Physiotherapy, Optometry, Occupational Therapy, Radio imaging Technology, Medical Laboratory Technology (Bachelor













17 Dec