97-Year-Old Through India’s First Fully Awake Keyhole Surgery

Rela Hospital successfully restored shoulder function and relieved pain in a 97-year-old male with a massive and irreparable rotator cuff tear by performing a keyhole (arthroscopic) procedure to implant a fully biodegradable balloon spacer. The patient had sustained the injury following a fall at home. Considering his advanced age and frail cardiac condition, the surgical team avoided general anaesthesia and performed the procedure under a regional nerve block, with the patient remaining fully awake throughout the surgery. Thanks to the minimally invasive nature of the surgery, the nanogenarian walked out of the hospital within two days of the procedure, following a routine post-operative stay in the general ward, early arm support, and a series of physiotherapy sessions. A rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, much like a cuff around the wrist. These structures keep the ball of the shoulder securely within its socket and facilitate movements such as lifting and rotating the arm. The senior citizen had sustained a tear in the rotator cuff of his left shoulder following the fall and continued to experience persistent pain for nearly a month. He was unable to lift or use his left arm, and despite rest and conservative treatment, the pain and weakness progressively worsened. The Arthroscopy and Sports Medicine specialists at the hospital performed the procedure using the InSpace™ biodegradable subacromial balloon spacer, the only minimally invasive, dissolvable spacer specifically designed for patients with massive irreparable rotator cuff tears. In this procedure, a small, deflated balloon is inserted, through tiny holes, into the space beneath the shoulder bone and gently inflated with sterile saline. The balloon acts as a smooth cushion, keeping the ball of the shoulder properly centred within its socket, thereby restoring the joint’s natural spacing and gliding mechanism. This enables the patient to lift and move the arm without the painful bone-on-bone friction. Over several months, the balloon gradually and harmlessly dissolves on its own, by which time the shoulder adapts to a more comfortable and balanced pattern of movement. No permanent implants, screws or anchors are left behind. In his comments, Dr. Ashok S. Gavaskar, Clinical Lead, Orthopaedics and Head of Joint Replacement Services, Rela Hospital, said, “In this patient, the rotator cuff tear was massive. A large portion of the tendon had torn away from the bone. Because the tear was extensive and the weakened tissues had retracted, a conventional tendon repair was not feasible. Managing such a massive tear in a 97-year-old patient is both uncommon and challenging. Shoulder arthroscopy is usually performed under general anaesthesia. But the patient's advanced age and underlying cardiac condition made this approach potentially risky. We therefore carried out the entire procedure with the patient fully awake under an interscalene nerve block, a targeted regional anaesthetic technique that completely numbs the shoulder while keeping the patient comfortable and conscious throughout the surgery. This enabled us to avoid the risks associated with general anaesthesia in a nonagenarian and facilitate a faster and safer recovery.” Dr. Prakash Ayyadurai, Consultant – Orthopaedics Arthroscopy & Sports Medicine, Rela Hospital who headed the surgical team, said, “rotator cuff tears are among the most common shoulder disorders and become increasingly prevalent with advancing age. They represent a significant and growing healthcare burden in India’s ageing population. Studies from India suggest that approximately one in five adults over the age of 40 has some degree of rotator cuff tear, with the prevalence rising sharply with each advancing decade. Full-thickness tears are seen in nearly 10-11% of this population.” “Age remains the single most important risk factor, as the tendons naturally weaken and undergo degenerative changes over time. Against this background of age-related wear and tear, even a seemingly minor fall can be sufficient to cause a major tear. Other factors that increase the risk include diabetes, hypertension, smoking and a lifetime of repetitive overhead activities,” he added. In his comments, Prof. Mohammed Rela, Chairman, Rela Hospital, said, “Performing this procedure while the patient remained fully awake at the age of 97 is a notable achievement. It exemplifies personalised, age-appropriate surgical care. This case reflects the modern, tissue-sparing direction of shoulder surgery, where an irreparable rotator cuff tear can be effectively treated using a biodegradable balloon spacer rather than major open reconstruction or joint replacement. Importantly, this case demonstrates that persistent shoulder pain and a ‘dead arm’ are not conditions that elderly patients simply have to live with. Advanced age and underlying cardiac concerns need not be barriers to effective, life-improving treatment when the right minimally invasive technique is matched to the right patient. Modern keyhole surgical techniques, combined with tailored anaesthetic approaches, now enable even patients in their 90s to undergo surgery safely and benefit significantly. We encourage patients not to delay seeking specialist advice. An early and honest assessment can help determine the most appropriate treatment options and what can realistically be achieved.”