Bone tumours, Limb salvage surgeries, Pelvic tumours, Recycling of tumour bone,tumours in children and Expandable prosthesis, Soft tissue sarcomas, Limb sarcomas, use of latest techniques including brachytherapy, Skin Cancers, Squamous carcinomas, Malignant Melanomas, General Orthopaedics, Hip fractures, Peri-articular fractures, upper limb trauma
Hindi, English, Marathi
Dr Manish Pruthi completed his Orthopedic training from PGI Chandigarh and Orthopedic oncology fellowship from Tata Memorial Hospital Mumbai. He has done his advance training in computed navigation in orthopedic oncology from Royal Orthopaedic Hospital, UK.
Musculoskeletal Onco surgeons are far and few in number and about 20 of them in active practice across the country.
Dr Manish Pruthi has performed about 350 major orthopedic surgeries in last 2.5 yrs of his tenure at Kokilaben Hospital. This includes challenging trauma cases, major tumor resections, management of bone infections and non unions. This includes international patients from Asia and Africa.
State of the art care is provided to patients with Musculoskeletal tumors with techniques like modular megaprosthesis, total bone replacements, recycling of tumor bones, brachytherapy and reconstructive surgeries.
The post operative infection rate is 0% in trauma cases and 4% in major tumour cases (international bench mark is 10%).
No. of Cases Treated
International Success Rate
KDAH Success Rate
Major orthopaedic surgeries
The post operative infection rate
Trauma cases- 0% Major tumour cases- 4%
Academics/ Researchs/ Awards
Dr Manish Pruthi has to his credit 16 publications in national and international journals. He has presented more than 40 research papers/ posters in various national and international conferences and has been invited as faculty in many national/ state conferences.
He is a section editor for the Journal of Arthroplasty and Joint Surgery and is a reviewer for many indexed journals.
Mrs. Rajeshwari Majithia, Tanzania
Dr Manish Pruthi was the doctor in charge, and I was really struck with his maturity, professionalism, and calmness, both amidst and after the surgery. The doctors humble and compassion personality really brought confidence in me and my family, and truly instilled trust in his work and capabilities.
Dr. Manish Pruthi: Total Femur Replacement for Osteosarcoma Femur
In September 2015, a middle aged man (44 years old) reported that he could not walk or stand for a day. He complained of on and off pain and swelling in his right thigh for 4 months. He was diagnosed with a femur fracture. After being diagnosed with femur fracture, he underwent an operation in the UAE, where he was employed at that time. He returned to India after the surgery.
The pain returned in a few weeks, hence he approached another hospital in India. There he was evaluated and diagnosed with a benign bone tumour. Benign tumour doesn’t spread so he didn’t have to worry much. Regular follow-ups and medication should have relieved him from pain but the problem persisted despite of undergoing suggested treatment.
Losing hope in the present treatment method, he approached Kokilaben Hospital in December 2015. Here, he was further evaluated and diagnosed with a high grade sarcoma of bone (Osteosarcoma), a type of malignant tumor with chances of spread.
Staging investigations were carried out. He received Neo adjuvant chemotherapy. He underwent Total Femur Excision in view of previous surgery and local disease contamination. The reconstruction was done with a Total Femur Prosthesis replacing both his hip and knee joints. His final pathology report showed complete excision of tumor with a good response to chemotherapy.
From the 2nd post-operative day, patient could walk carrying his complete body weight. His wound has healed, and he currently uses a stick for walking.
Dr. Manish Pruthi, Dr Ahmad Quazi, Dr Tanu Singhal: Allograft-vascularized fibula composite for infected non union femur
XDR tuberculosis in a 16 year old boy
A 16 year old boy presented with fever and cough for 1 month duration. The CT was suggestive of pulmonary tuberculosis with a pleural effusion. Culture samples confirmed the presence of mycobacterium tuberculosis, which was resistant to all first line drugs, quinolones and even 2nd line injectable agents. The child was started on a 2nd line drug regime with quinolones, aminoglycosides, QPAS, clofazimine and linezolid, coamoxiclav, clarithromycin and he improved. 4 months later he developed thrombocytopenia so linezolid was withdrawn. Three months later he developed tubercular meningitis. He was admitted to the hospital and treatment continued with the same drugs and meropenem and amoxiclav was added. He did not improve and then again linezolid was restarted. He developed peripheral neuropathy that was managed with coenzyme Q and drugs were continued. Effort was made t procure bedaquiline which failed. Injectable capreomycin was also started. After about 6 months he started to improve and 18 months later treatment was stopped. He is asymptomatic over the past 6 months. The predicted mortality of XDR tubercular meningitis is in excess of 80% and it was gratifying to save this child
Severe mycobacterium abscessus infection following liposuction
A 23 year old model developed multiple skin abscesses soon after liposuction surgery. She presented to another hospital where was advised radical debridement surgery for her entire back and thighs which would have been associated with very high mortality and morbidity. She took discharge from that hospital and presented to us. Here we sent her pus samples for analysis and detected infection due to mycobacterium abscessus. She was managed conservatively with repeated incision, drainage, and antibiotics including clarithromycin, linezolid and amikacin. She finally recovered after 6 months with very small residual scars and has resumed her modelling career. Mycobacterium abscessus is a rapidly growing mycobacteria that is associated with laparoscopic and cosmetic surgeries and can be managed conservatively with the right combination of antibiotics.
Unusual cause of Aseptic Meningitis in a 5-month-old infant
A 5-month-old infant presented with history of fever for 10 days. She was investigated on day 5 of fever and due to associated irritability a CSF analysis was done which showed around 100 cells predominantly lymphocytes. She was treated with IV ceftriaxone but her fever persisted and antibiotics were upgraded to piperacillin tazobactam. Fever persisted and the WBC and platelets kept rising and she was referred to us. At the time of presentation, she was extremely irritable but there were no other findings. In view of high WBC and platelet counts and high CRP and mild elevation of AST and ALT and also aseptic meningitis, Kawasaki disease was suspected and a 2D ECHO was done. It showed coronary artery aneurysms and the baby was treated with IVIG following which the fever subsided and the aneurysms have lessened over the past few years. Kawasaki disease a medium vessel vasculitis is an unusual cause of fever in children. Infants are unique that they may have none of the tell tale signs such as red lips and tongue and rash. If the diagnosis is delayed there is a 20% risk of coronary artery aneurysms with associated risks of myocardial infarction in later life. Use of IVIG in the first 10 days cuts down this risk to around 1%
Why babies are not small adults?
A 4-month-old infant had history of fever with no focus. A CBC showed high WBC count with predominant polymorphs. His CSR, urine routine and USG abdomen was normal. He was prescribed coamoxiclav with which the fever resolved. Three days later a repeat CBC showed a count of 36,000. The baby presented to the ER of our hospital and was admitted. On history taking, it revealed that the baby was finding it difficult to suck on the breast and lost neck control. An urgent MRI was done which showed a large retropharyngeal abscess that was impinging the airway for which urgent surgical drainage done. Retropharyngeal abscess is one of the occult sites of infection in infants and children along with brain abscess/ sinusitis, osteomyelitis etc. Diagnosis is delayed since the infant cannot localise the infection and are unable to communicate. This makes pediatric practice so challenging and different from adult medicine
Are we in Africa?
A 6-week-old baby presented from a small village near Amreli with fever for 10 days duration. A CBC was done and the PS showed trypomastigotes .This was shocking since trypanosomiasis is unheard of in India unlike Africa where it is fairly common and known as sleeping sickness. The parasite was sent for identification to a higher centre, which identified it, is Trypanosoma lewisi, an animal trypanosome. Review of literature revealed scattered cases in India due to close contact between animals and humans. The baby probably acquired it from contaminated rat excreta which is known to contain this trypanosomes. Since the baby was well and treatment is very toxic, treatment was deferred and the baby recovered spontaneously.
This was followed 1 year later by another case in an adult this time. He was a 48 year old African male residing in Lusaka, Zambia presenting with a progressive neurodegenerative disorder. He came to Kokilaben for neuro rehabilitation. Review of MRI was suggestive of trypanosomiasis. During an acute worsening event, PS for trypomastigotes was sent which was positive. Antimony based treatment was procured from Africa but the patient died. It was indeed surprising that the diagnosis of a disease endemic to Africa was not made there and made here. With increasing international travel and medical tourism it is important to be aware of world wide epidemiology of infectious diseases.
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