By: 11 June 2024
Surgeon in Focus Q&A with Senthil Kumar

Mr Senthil Kumar is a senior orthopaedic foot and ankle surgeon in Scotland based at Glasgow Royal Infirmary, a large University teaching hospital. He undertakes all aspects of foot and ankle related problems; his special interests include sports injuries of foot and ankle and ankle replacements. He has treated elite athletes and players from a variety of sport at club and national level in Scotland. He also treats dancers from Scottish Ballet and Glasgow Dance School. He has published on various aspects of foot and ankle surgery and plays an active role in teaching and training. He heads the Foot and Ankle Fellowship programme at Glasgow Royal Infirmary, where also served as a Clinical Lead and Clinical Director for 5 years. He was an examiner for both the FRCS and MRCS examinations of Royal Colleges of Surgeons in United Kingdom and Ireland from 2009-2019.


OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?

SK: From a very early stage, I liked the hands-on nature of surgical procedures and the immediate improvement the intervention often resulted for the patient. Anatomy has always been my favourite subject in medical school, naturally I was attracted to surgery and dissection. Orthopaedics was becoming more popular as a career choice for many young surgeons at that time and I was very much guided by my teachers in the medical school. Orthopaedic trauma surgery is one of the most rewarding experience for a surgeon, this and the ability to provide effective and durable pain relief for disabling conditions like arthritis made orthopaedics an obvious choice for me.


OPN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within the orthopaedic industry? How has work changed over the past 4 years?

SK: The capacity to provide scheduled care has been hugely reduced in the post-pandemic period, currently the health service in the UK is predominantly focused on catering for the emergency and cancer related work. Fortunately, bone and soft tissue cancers are rare, our work has therefore been disproportionately affected by the changed priorities. The waiting times for orthopaedic elective operations have therefore grown significantly. It looks as though this is going to continue for the next several years.


OPN: What’s the best part of your job?

SK: The satisfaction one gets when everything goes well with a surgical procedure and the patient returns to the clinic after a few months and says how much they have improved, particularly the pain relief they have achieved, is immeasurable and very satisfying indeed!


OPN: … and the worst?

SK: The repeated failures one sees after some operations can be demoralising and you really feel for the patient who has undergone many months of recovery and disruption only to see yet another complication.


OPN: What has been the highlight of your career so far?

SK: I was fortunate enough to be one of the first surgeons to undertake foot and ankle surgery as a full time elective commitment within our job plans. Little did I know at the time that this subspecialty within orthopaedics is growing to grow so quickly and I was lucky enough to see its full development in Scotland in particular, and the whole of the UK.


OPN: Are you currently involved in any research or work with emerging technologies?

SK: Yes, we have 2 projects ongoing currently looking at the long term results of ankle fracture fixation and also ankle replacement surgery.


OPN: Please can you tell us more about the research and what it could mean to patient experience and outcomes?

SK: I have always had a healthy dose of scepticism when I am asked to try a new implant or technique. I firmly believe that as surgeons, we have a great responsibility to make sure that any new and emerging techniques have been fully audited before they are widely adopted. Sadly we have seen this again and again over the years. One example which comes to my mind immediately is the treatment for arthritis of the big toe joint, especially joint replacement surgery. Many replacements have come and gone, we reviewed and published one such replacement many years ago and showed widespread concerns in our patients, we decided not to continue to implant that device in our patients based on that research.


OPN: You recently helped organise a cadaver course in Barcelona. How did it go and what were the outcomes of the event?

SK: Ankle joint has always fascinated me, although one of the most commonly injured joints in the lower limb, this joint very rarely develops arthritis as one gets older. This natural resilience gets broken by severe injuries and other conditions which result in arthritis. Ankle replacement surgery is undergoing a renaissance at the moment and the UK based foot and ankle surgeons are leading the field in terms of doing the most number of ankle replacements in Europe, proportionate to the population. It is my belief, that in the right patient, this procedure can be as successful as the hip or knee replacement and the Barcelona course is focused on teaching the principles and selection of patients for this surgery and we also trained the young surgeons in 2 different types of ankle replacements. The course was well received by all the delegates and the feedback was excellent.


OPN: Do you have any more events lined up?

SK: Yes, we have just finalised the programme for the next cadaver course in Barcelona which will be held on 23 and 24 January 2025.


OPN: Are you planning to attend any other orthopaedic events in 2024?

SK: Yes, I have been invited to be on the faculty for the scientific sessions of the Annual Congress of the European Foot and Ankle Society (EFAS) to be held in Brussels and also our own Foot and Ankle Scotland (FASt) annual meeting, both in October this year. I look forward to attending both of these meetings.


OPN: If you weren’t a foot and ankle surgeon, what would you be?

SK: Within medicine, I really liked urology as a specialty, if I hadn’t managed to get an orthopaedic junior job, I would have become an urologist.


OPN: What would you tell your 21-year-old self?

SK: Maybe more concentration on the studies rather than other distractions!!


OPN: If you were Health Minister for the day, what changes would you implement?

SK: I will abolish the differences between primary and secondary care, make it a singular and unified structure. Reduce the level of political interference in running the health service, give more powers to the medical director and the nurse matrons who should be in charge of running the hospitals.


OPN: Away from the clinic and operating theatre – what do you do to relax?

SK: I have recently taken up baking, this is not too dissimilar to surgery! I find it very relaxing and therapeutic at times. I also enjoy going to the gym and catching up with friends there. I have plans to learn golf and a musical instrument in the next few years, too.


OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2024 and the next decade?

SK: Orthopaedic surgeons are going to be very busy for the foreseeable future. For the next few years, more and more work will be done to catch up with the waiting lists and even in the long run, this specialty is going to become even bigger and even more specialised. I can see a future time where even within my own subspecialty of foot and ankle surgery, there will be surgeons doing only forefoot surgery, only ankle arthritis related surgery and so on….