97-year-old regains shoulder mobility after fully-awake keyhole surgery in Chennai

CHENNAI: A 97-year-old man has regained the use of his shoulder after doctors at Rela Hospital performed what they called “India’s first fully awake keyhole surgery” using a biodegradable balloon implant, marking a significant advance in the treatment of elderly patients with complex shoulder injuries.

The patient had suffered a massive and irreparable rotator cuff tear after a fall at home. He endured persistent pain for nearly a month and was unable to lift his left arm despite conservative treatment.

Considering his advanced age and frail cardiac condition, doctors ruled out general anaesthesia and instead carried out the arthroscopic procedure under an interscalene regional nerve block, allowing him to remain conscious throughout the surgery. He was discharged within two days after routine post-operative care and physiotherapy.

The surgical team used a biodegradable balloon spacer that was inserted through tiny incisions beneath the shoulder bone. Once inflated with saline, it acts as a cushion that restores smooth movement by preventing painful bone-on-bone contact. The implant gradually dissolves over several months, leaving no permanent hardware behind.

“The rotator cuff tear was massive and conventional tendon repair was not feasible. Performing the procedure under a targeted nerve block enabled us to avoid the risks associated with general anaesthesia while ensuring a faster and safer recovery,” said Dr Ashok S Gavaskar, Clinical Lead, Orthopaedics and Head of Joint Replacement Services.

Dr Prakash Ayyadurai, Consultant in Orthopaedics, Arthroscopy and Sports Medicine, said rotator cuff tears were among the most common shoulder disorders in older adults. “It represents a growing healthcare challenge as India’s population ages. Indian studies indicate that nearly one in five adults above 40 has some degree of rotator cuff tear, while full-thickness tears affect around 10-11 per cent of the population. Age, diabetes, hypertension, smoking and repetitive overhead activities are among the key risk factors,” he added.

Mohammed Rela, chairman, Rela Hospital, said that the case was proof that advanced age and underlying cardiac illness need not be barriers to effective treatment. “Modern minimally invasive techniques, combined with tailored anaesthetic approaches, now enable even patients in their 90s to undergo surgery safely and regain meaningful function,” he said. “Elderly patients with persistent shoulder pain not to delay seeking specialist care.”