Articles on hip replacement

Total Hip Replacement - Learn More

Dr. A Mohan Krishna, Orthopedist
HIP JOINT: Basic AnatomyHEALTHY HIPJOINT: Hip joint is formed by head of the femur (Thigh Bone) and cup like acetabulum of the pelvis. The upper end of the thigh bone is shaped like ball which snugly fits into the socket (Acetabulum) of pelvis bone.The ball and cup of the hip joint is lined with smooth firm material cartilage, which cushions and allows smooth movement.The joint is also lined with synovial membrane which produces joint fluid.The ball of the thigh bone has a precarious blood supply, so any trivial trauma or insult can cause avascular necrosis of the femoral head.Causes of hip pain: Damaged or Arthritic HipWhen the cartilage lining of normal joint wears or gets worn out it may result in pain and stiffness in the hip.The cartilage may be damaged byAgeing: a result of natural wear and tear which is termed as Osteoarthritis of hip.Avascular necrosis of femoral head.Injury / fractures around hip joint.Diseases like Rheumatoid arthritis, Ankylosing spondylitis, etc.In some individuals genetic factors may also predispose to early damage to cartilage.OSTEOARTHRITISOF HIP JOINT (OA):Osteoarthritisis the most common type of arthritis. Primary osteoarthritis is commonly seen in elderly, above the age of 50 years. Osteoarthritis is a chronic condition characterized by wear and tear of the cartilage. As cartilage wears off the ends of bone rub against each other causing pain and stiffness. A young individual can develop secondary osteoarthritis due to trauma or diseases like Rheumatoid arthritis, Ankylosing spondylitis etc.AVASCULAR NECROSIS OF FEMORAL HEAD:Avascular necrosis is a condition in which there is loss of blood supply to the bone due to fracture or vascular damage.  Avascular necrosis of femoral head can occur following trauma, using certain medicines and some medical diseases. As a result bone cells in the head of femur dies,then collapses, the joint is destroyed and patient develops painful and stiff joint. This can take 2-8 years to develop, but can happen at an early age too.The most common causes of Avascular necrosis of femoral head are:Trauma:Fractures and dislocationsNon Traumatic causes: Alcohol abuse, Use of steroidsCertain blood disorders TREATMENT OPTIONS:When medication,physical therapy and other conservative methods of treatment fails to relieve pain, total hip replacement may be recommended by surgeon. How will Hip replacement help you?Improvementof quality of lifeSignificant pain reliefMobility is increased.Help to lead independent and comfortable lifeMost of the replaced hip joints last for 10 to 15 years and patient can have pain free lifeGetting ready for Hip replacement surgery:Medical evaluation:  Cardiac evaluation: Tests: Lab tests include Blood, urine and cardiac tests.Preparing your Hip: Surgeon examines your Hip prior to the surgery. There should be no skin infection, wounds around the Hip and skin should be clean.Others:Anaesthetic evaluation:  after getting all the blood tests and cardiologist opinion you will be examined by anaesthetist. He will evaluate you and gives you fitness for giving anaesthesia and advises different modalities of pain relief during postoperative period. SURGERY:On the day before surgery:You will be admitted in the hospital or asked to come directly to the hospital on the planned day of surgery.You need to take the medications as advised by the anaesthetist.You should have light dinner without much oil and spices and plenty of water. You should start fasting from 11PM on the day before surgery till further advice.You should give consent and sign an informed consent.Follow you anaesthetist and surgeons orders if any given to you in writing.Have a neat shower.On the day of surgery:You should be on fasting, take your regular blood pressure and thyroid medications if any with sips of water at around 6 AM.You can have a plain shower bathLimb to be operated will be marked by the surgeon.You will be shifted to operation theater half hour prior to surgery.Anaesthetist will evaluate once again and prepares you for giving you anaesthesia.Anaesthesia: Most of the Hip replacement surgeries are carried under Epidural and General anaesthesia. In rare cases when a patient is not fit for general anaesthesia, Hip replacement is performed under Spinal anaesthesia.Postoperative pain relief is achieved by continuous Lumbar epidural pump.Total hip replacement surgery:Total Hip replacement is a surgical procedure in which damaged bone and cartilage is removed and replaced with prosthetic components.There are 2 main components used in total hip replacement:The acetabular shell replaces the hip socketThe femoral stem and head replaces the worn out top of femurThere are two types of Hip replacementCemented Hip replacementUncemented Hip replacementCemented hip replacement:The damaged femoral head is removed and thigh bone medullary canal is prepared to take the femoral stem component. Bone cement is used to fix the femoral stem. A metallic ball is inserted on the top of the stem. The damaged lining of cup (acetabulum) is removed by using special reamers. A plastic cup mimicking the original anatomy is fixed using bone cement.The artificial joint is relocated and supporting tissues around the hip are sutured back.Uncemented Hip replacement:The damaged femoral head is removed and thigh bone medullary canal is prepared to take femoral component. The femoral stem is made to press fit into the boneThe artificial head is available in two materials – Metallic head                                                                                   Ceramic headThe damaged lining of cup (acetabulum) is removed by using special reamers. A metallic cup mimicking the original anatomy is fixed using press fit and sometimes augmented with screws. There are three types of liners which can be inserted into the metallic cup:Plastic linerCeramic linerMetallic linerAfter inserting appropriate liner the artificial joint is relocated and supporting tissues around the hip are sutured back.There are various combinations of head and liners to make upnew jointMetal on metalMetal on polyMetal on ceramicCeramic on ceramicRECOVERY IN HOSPITAL:  POSTOPERATIVE PERIODFirst 24 hours:Immediately after Hip surgery you would be shifted to ICU (intensive care unit) and observed for at least for 24 hours.After a day you will be shifted to ward of your choice.First postoperative day:On the bed you are advised to perform deep breathing exercises.Ankle pump and static quadriceps exercises on the bed.Gentle mobilization on bed with legs hanging down the bed and knee movement exercises.If you are strong enough you would be made to stand. Cemented hip replacement: walking with full weight on operated leg with walker.Uncemented Hip Replacement: Walking without weight on operated leg with walker.You will be shifted to ward. Second Postoperative day:To continue the exercises on bed and walking with help of walker.Drain tubes urinary catheter will be removed on the second day.You need to take plenty of fluids and regular diet.Third Postoperative day :Depending on speed of your recovery discharge would be planned.The dressing on the hip is changed to simple dressing.You are advised to continue exercises and walking, gradually increasing the pace.Fourth post operative day:Some patients with slow recovery are discharged on 4th postoperative day.Before you are discharged from the hospital, you will be helped to achieve:Getting in and out of the bed independently.Walking with the help of walker.Using toilet or commode chairDISCHARGE ADVICE:RECOVERY AT HOME You should continue to stay active when you are at home for full recovery. However remember not to overdo it. You will observe gradual improvement and increased endurance over the next 6 to 12 months.Tips to make you return home comfortable:Planning your work:You will be able to walk on crutches or a walker soon after surgery. But you will need help for many weeks with tasks like cooking, shopping, bathing and doing laundry. Make advance arrangements to have someone assist at home.Home planning:Before going for surgery, follow the steps given below to make your recovery at home easier.Fix safety bars in your shower or bathroom.Secure your stairways for support and safety.Keep a stable chair, for your early recovery period, with firm cushion, firm back, two arm, and foot stool for leg elevation.If you have low toilet seat, fix a seat raiser with arms.Walking up or down the stairs within you pain limits and depending on your recovery.DO’S AND DONT’S DURING YOUR RECOVERYDO’S Keep the wound area clean.If your wound appears red or begins to drain, inform your doctor.Check temperature regularly and inform your doctor if it exceeds above normalInform your doctor immediately if you have calf pain, chest pain, or shortness of breath.Practice / initiate regular walking using crutches or walker.Perform exercises to strengthen calf and thigh muscles.Keep pillow between the legs if you want to turn to one side.DONT’S Do not bend.Do not cross your legs.Do not squat or sit on the ground.Do not play high impact sports.Do not jog, run or jump.Avoid gaining weight as it can hasten wear and tear of the implant.Do not shower or bath until the sutures are removed.EXERCISES AFTER HIP REPLACEMENT SURGERYPhysical therapy exercise :Continue to exercise as instructed by your physiotherapist or doctor for at least 2 months after surgery.Frequent deep breathing exercises.Ankle Pumps: Move your ankle up and down to squeeze the calf muscles.Static quadriceps:  Sit with your legs straight and keep a rolled towel under your knee. Press the knee against the towel while tightening the thigh muscles. Hold this for a count of 5 to 10.Knee straightening exercises: place a small rolled towel just above your heel.Tighten your thigh. Try to fully straighten your knee such that the back of your knee touches the bed. Hold for 5 to 10 seconds.Knee bending: Sit on your bed side or chair with your thigh supported. Gradually allow your leg to fall down gently on its own weight. Now gently try to push your leg backwards till the back of the leg touches the chair or cot edge. Hold your knee in this position for 5 to 10 second. Gradually try to lift the leg upwards initially with support of other leg or physiotherapist. When the leg becomes straight maintain it for 5 to 10 seconds. Weight bearing

8 Ways To Avoid Knee Replacement

Dr. Brijbhushan Mahajan, Orthopedist
Undergoing a knee replacement for knee arthritis can be a very effective quality-of-life decision. Patients are able to get back to recreational activities and a severely reduced painful lifestyle.  Methods of avoiding the replacement with the arthritis.Weight loss – Over 65% of Americans & over 30% of Indians are either overweight or obese. The problem with this is that a lot of stress goes through the joint during ambulation. This excess weight can lead to increased pain and/or increased arthritis. Losing weight allows the patient to decrease joint pain by decreasing stress over joint, and an increased ability to perform activities of daily living, along with other substantial health benefits such as lower blood sugars and lowered blood pressure.Benign neglect – The patient is able to do most of the things that he or she wants to do, the most appropriate answer at that point may be to simply ignore the problem. One additional aspect to consider may be to modify one’s activities. This may include switching from jogging to fast walking, or shifting from skiing to an activity that is less stressful on the joints such as swimming. Physical therapy – Physical  therapy may have significant benefits. Therapy can strengthen up the muscles around the knee joint, which has  beneficial effect of unloading the pressure from the knee joint and dissipating it into the surrounding musculature. This can reduce pain.Acetaminophen and NSAIDS – These medications are predominantly available without prescription and they can be extremely beneficial for alleviating the pain. They have a low risk profile, as long as patients stick to the manufacturers dosing on the box, and don’t combine those medications that can have an additive effect and lead to a bleeding ulcer.Knee injections – Injections into arthritic knee can help substantially relieve the pain. Presently the bulk of these injections consist of cortisone, which is a hefty anti-inflammatory substance, but not one that is going to alter the course of the disease. There are some newer medications consisting of regenerative substances, which contain components such as stem cells, hyaluronic acid, and cytokines. These may in fact alter the course of the arthritis.Bracing  – Off-loading braces take pressure off of the arthritic area of the knee joint and promote pain relief. These braces are typically custom fit after seeing your doctor, and should be worn whenever the patient is up and about when the pain would typically be felt. Narcotic medications – These should not be used on a chronic basis. They should be utilized only for an acute type of situation where patients are having an exacerbation of their arthritis pain. Narcotic medication on a chronic basis has the risk of tolerance, addiction, constipation, etc. So it should be avoided. Utilizing them for exacerbations can however be very effective.Non-narcotic medications – Medications that are non-addictive such as Tramadol can be very effective for knee pain. In addition there are modulating medications such as gabapentin that can help a lot with decreasing the pain that is coming into the arthritic knee joint from the surrounding nerve endings.

How to Get a Model Backside, Perfect Waist to Hip Ratio

Ms. Swati Kapoor, Dietitian/Nutritionist
How to get a shapely butt? That’s a question many women ask. But its valid for men too. Besides vanity, its great for your health. So, besides telling you how to get a shapely butt, we’ll tell you why you should. We’re not talking size zero now…A great backside is about having shapely gluteal muscles, and having a good waist to hip ratio. The good news is that its not all genetic. The right waist to hip ratio not only make you look great in a pair of jeans (we all love those) but also helps you reduce your chances of many diseases. Studies have shown that a waist to hip ratio (WHR) is a strong determinant of your heart health. The better your WHR, the lower your risk of cardiovascular disease. Besides lowering your risk of cardiac disease an ideal WHR is also considered an indicator of fertility, in both men and women.What a good waist to hip (WHR) ratio?To calculate your waist to hip ratio, measure your waist and your hips, and divide the waist measurement by the hips. The ideal WHR for women should be less than 0.85 and that for men less than 1. Don’t measure up? Don’t worry! To get a great butt like a model, you need to do 2 things- 1.Manage your diet2.Do the right exercises. Both should help to give butt a nice athletic shape.As Indians, we are prone to belly fat, so to improve your WHR lets reduce your tummy first. Don’t waste your time on crunches. Go for a run- it’ll help you burn calories, reduce belly fat and build some leg muscles, which includes the glutes- the butt muscle :). Read some running tips and hazards especially in India. Just reducing your waist, will help you improve your health and WHR. If you’re skinny, then you need to build those glutes. Start with doing squats and lunges. Below, we’ve got a video of how to do a squat. If this is too easy for you, then do a weighted squat. Hold dumbbells on your side and perform the same movement. A lunge is basically like a giant step. Take a large step forward with the left leg and step into it till your left thigh is parallel to the floor and your right knee is right above the ground. Return to the standing position and repeat with the other leg. Similar to the squat, if its too easy, hold dumbbells in your hands, while performing the lunge.Both these muscle work the leg muscles, along with the gluteal muscles (butt muscles). Perform 3-4 sets of each exercise, with 10-15 repetitions in each set. Do this 2-3 times a week, and you should be on your way to a great butt!Along with these exercises and running, stair climbing build great leg muscles and burns fat! So, build that shapely bum and look good in pretty much anything you wear, or nothing .Get to know some easily available fat burning foods.Last but not the least, the right posture adds a lot to a make your body shapely. Slouching puts pressure on your lower back. Do these lower back exercises to improve posture.

The Major Cause of Knee Replacement and Hip Replacement Is o.a. ?

Dr. Milind Patil, Orthopedist
THE MAJOR CAUSE OF KNEE REPLACEMENT AND HIP REPLACEMENT IS O.A. ?The Total Knee Replacement (TKR ) and Total HIP Replacement ( THR), one of the prime reason is Osteoarthritis , thus it is important to understand the cause of this widely prevalent disease world over as well as in India . The Growing economy , per capita income along with drastic changes in the Life style and food habits with the less and less sun exposures on population leading to tremendous growth in this disease specially more in female population . We at REVIVAL HOSPITAL , THANE MUMBAI feel our responsibility to share the educational information with the people at large so that they can initiate PREVENTIVE measure right in time and protect themselves from these disease or can delay their prognosis . This does not any way prevent you to visit the nearest your family doctor or consultant to get more details as well as check up for timely medical intervention of your problem .What Is Osteoarthritis?Fast Facts: An Easy-to-Read Series of Publications for the PublicOsteoarthritis is a joint disease that mostly affects cartilage.Cartilage is the slippery tissue that covers the ends of bones in a joint.Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. Rheumatoid arthritis - the second most common form of arthritis - affects other parts of the body besides the joints.Osteoarthritis is the most common type of arthritis.Who Gets Osteoarthritis?Osteoarthritis occurs most often in older people. Younger people sometimes get osteoarthritis primarily from joint injuries.What Causes Osteoarthritis?Osteoarthritis usually happens gradually over time. Some risk factors that might lead to it include:How Is Osteoarthritis Diagnosed?Osteoarthritis can occur in any joint. It occurs most often in the hands, knees, hips, and spine.Warning signs of osteoarthritis are:No single test can diagnose osteoarthritis. Most doctors use several methods to diagnose the disease and rule out other problems:How Is Osteoarthritis Treated?Doctors often combine treatments to fit a patient's needs,lifestyle, and health. Osteoarthritis treatment has four main goals:Osteoarthritis treatment plans can involve:How Can Self-Care and a "Good-Health Attitude" Help?Three kinds of programs help people learn about osteoarthritis and self-care and improve their good-health attitude:These programs teach people about osteoarthritis and its treatments. They also have clear and long-lasting benefits. People in these programs learn to:People with osteoarthritis find that self-management programs help them:People with a good-health attitude:What Research Is Being Done on Osteoarthritis?Osteoarthritis is not simply a disease of "wear and tear" that happens in joints as people get older. There is more to the disease than aging alone. Researchers are studying:For More Information on Osteoarthritis and Other Related Conditions:National Institute of Arthritis and Musculo-skeletal and Skin Diseases (NIAMS) Information ClearinghouseNational Institutes of Health1 AMS CircleBethesda, MD 20892-3675Phone: 301-495-4484Toll free: 877-22-NIAMS (877-226-4267)TTY: 301-565-2966Fax: 301-718-6366Email: NIAMSinfo@mail.nih.govWebsite: http://www.niams.nih.govThe information in this fact sheet was summarized in easy-to-read format from information in a more detailed NIAMS publication. To order the Osteoarthritis: Handout on Health full-text version, please contact NIAMS using the contact information above. To view the complete text or to order online, visit Your InformationThis publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available.Occasionally, new information on medication is released.For updates and for any questions about any medications you are taking, please contactU.S. Food and Drug AdministrationToll free: 888-INFO-FDA (888-463-6332)Website: http://www.fda.govFor additional information on specific medications, visit Drugs@FDA is a searchable catalog of FDA-approved drug products.This publication is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed.Additional copies of this publication are available from:National Institute of Arthritis and Musculo-skeletal and Skin Diseases (NIAMS) Information ClearinghouseNational Institutes of Health1 AMS CircleBethesda, MD 20892-3675Phone: 301-495-4484Toll free: 877-22-NIAMS (877-226-4267)TTY: 301-565-2966Fax: 301-718-6366Email: NIAMSinfo@mail.nih.govWebsite: http://www.niams.nih.govMany of our publications are available in print. Would you like to order publications on arthritis to be mailed to you? Visit our online order form.NIH…Turning Discovery Into Health ®

How Safe Is Testosterone Replacement ?

Dr. Anish Kumar Gupta, Andrologist
Testosterone Therapy – Know the Side Effects before the Benefits.It is important to first and foremost understand that Testosterone is not a recreational or a performance enhancement drug, and is strictly something to be prescribed by someone who knows why it is being done. Als,o supplementation is of no use, it is eventually replacement, which should be the key to understand its effects and some effects.Understand the potential risks and consider alternatives before boosting your hormones indefinitely.There is a notion that Testosterone is a performance enhancer, which promise that treating “low T” this way can make men feel more alert, energetic, mentally sharp, and sexually functional. But, beware, Men should be much more mindful of the possible long-term complications.The Low - T BoomJust being tired isn’t enough to get a testosterone prescription. If a man’s testosterone looks below the normal range, there is a good chance he could end up on hormone supplements—often indefinitely. On treatment, the body stops making testosterone. And it may or may not recover to a complete extent.This wouldn’t matter so much if we were sure that long-term hormone therapy is safe, but there are small risks that could add up to harm over time. That should be a bigger concern.What are the Risks?A relatively small number of men experience immediate side effects such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also like to watch out for high red blood cell counts, which could increase the risk of clotting.The evidence for long-term risks is mixed. Cancer prostate and cardiovascular risksneed to be assessed and monitored if symptoms complex deterioration occurs.Testosterone supplementation can affect your Fertility. While testosterone supplementation increases testosterone levels, and reduces some ofthe symptoms associated with hypogonadism, it decreases the body’s productionof LH and FSH. This is because when the brain detects that testosterone levels have increased, it will cut down the production of GnRH. The result is that the pituitary gland no longer produces FSH and LH at normal levels, so sperm production also declines. A lower sperm count means that a man’s chance of impregnating his partner will be lower.Before the Jump, Assess your health globally firstHave you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?If erectile dysfunction has caused you to suspect “low T” as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.Get an Accurate AssessmentInaccurate or misinterpreted test results can either falsely diagnose or miss a case oftestosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it’s at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone,or the amount of the hormone that is able to have effects on the body. After starting therapy, follow-up with your physician periodically to have testosterone checksand other lab tests to make sure the therapy is not causing any problems withyour prostate or blood chemistry.Be Mindful of Unknown RisksApproach testosterone therapy with caution if you areat high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, ormultiple risk factors for heart problems.Ask your doctor to explain the various side effects for the different 
formulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.Have Realistic ExpectationsTestosterone therapy is not an elixir of youth. There is no proof that it will restore youto the level of physical fitness or make you live longer, prevent heart diseaseor prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with theseexpectations in mind.If erectile function has been a problem, testosterone therapy might not fix it. Infact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections. Please Remember there are only two people who can prescribe Testosterone Replacement, a Urologist-Andrologist or an Endocrinologist. A general physician or gym instructor or a friend are not people who can prescribe Testosterone Replacement.

What to Do When Planning for a Knee Replacement Surgery?

Dr. Deepak N Inamdar, Orthopedist
If you are planning to undergo a Knee Replacement Surgery, the following are some of the things that you should keep in mind:Build your muscles and range of movementsBefore the surgery, you're expected to do homework.People who strengthen the muscles around their knees have a faster, easier recovery than those who are weaker going into the surgery. If you reinforce the connections,especially of your inside quad muscle, it will be easier for them to reconnect.For the months or weeks leading up to your operation, try to get on a bicycle or work with a physical therapist to build your strength and expand your range of motion as much as possible.Build up the vital capacity of your lungsDeep breathing exercises like pranayamaIncentive spirometry - started much before surgery help your lungs/body cope and decreases chances of lung associated issues like ARDS Keep yourself clean - Infection anywhere is a strict no for replacement surgery. Treat any infections of urinary tract, skin, soft tissues and other areas .Build your endurance - Start long walks and exercise as much as you can, as ultimately it is needed post-surgery.Prepare yourself mentally to undergo the rigours of surgery and rehab, a mentally tough person is the one who does very well post-surgery.Have a buffer budget - for extras ifstay is prolonged.When to see your doctor if you are planning knee replacement?In a perfect world, I would love to see you a couple of months in advance. Then you're comfortable with the exercises, you know what you're supposed to feel, and the recovery goes more smoothly. 

10 Myths About Knee Replacement Surgery

Dr. Shreedhar Archik, Orthopedist
10 myths about knee replacement surgeryI see almost3 to 4 patients a day that desperately needs a knee replacement surgery. All these patients are grossly disabled but are reluctant to get operated. I haverealized that most of them refuse surgery because they have been scared bytheir relatives. Relatives and friends talk about the surgery very loosely i.ewithout much knowledge and most of it is hearsay. Unfortunately because ofclear cut information these patients get confused. Youngsters now days will goon the net and find out the facts but elderly generation is mostly not that techsavvy.Here are the10 0common myths I have discovered while talking to my patientsMyth 1: Iwill be in bed for a long time after the surgeryTruth: Dueto the new rapid recovery protocols the patient walks on the same day of hissurgery!Myth 2: Iwill not be able to bend my knee after the surgeryTruth: Onecan bend the knee fully after the surgery. Most of the new implants allownormal range of movement at the knee jointMyth 3:It is a foreign body inserted in my body, it will get rejected.Truth: Theseartificial joints are made up of a special metal which is compatible with ourbody and it can stay in the body forever without causing any side effects.Myth 4: Iwill need lots of physiotherapy after the surgery and recovery is very slowTruth: 99%patients do not need a physiotherapist at home. We teach patients all theexercises while they are in the hospital and all the patient needs to do ispractice the same exercises at home. 98% patients are walking without an aidafter 4 weeks.Myth 5: Doing2 knees in one sitting is very dangerousIt is theother way around. Two knees in one go has lot of advantages. You visit thehospital only once. The recovery is faster because both knees are pain freeafter the surgery. The stay is only one day extra i.e. after one knee thepatient goes home on 4th day whereas here he goes home on the 5thday. It also saves 30 to 40,000 rupees on the total cost which is another hugeadvantage.Myth 6: Iwon’t be able to sit on the floor ever again after the surgeryTruth: Mostof the patient scan squat or sit on the floor after surgery. However the kneegets extra loading while getting up and it is recommended that one sits on thefloor only in case of an emergency.Myth 7:Only joints form “A” company are good.Truth: Mostof the big companies have joints which are very similar in nature and thechoice of the company should be left to the surgeon. Every surgeon is familiarwith one a particular product which works well in his hands. Forcing a surgeonto use a certain product based on the knowledge gathered from the internet isthe worst thing to do.Myth 8:This surgery has high risk and fails most of the times.Truth: Theonly risk in the entire surgery is the risk of infection. This risk is around 2%. This risk is universally same in any center which is well equipped.Myth 9: Iam above 65 years and hence won’t be able to tolerate such a majo surgery90% ofpatients undergoing a knee replacement are above the age of 65 because this isan age related wear and tear issue. It is therefore safe surgery and all patientsare screened before they are taken up for a surgery.Myth 10:These artificial knees last only ofr 10 to 15 years therefore at age 60 I shouldnot get operated.Though it istrue that the artificial knees have a life, it is worth noting that the surgeryis offered to improve the “quality of life”. At age 60 if one cannot enjoy thedaily routine then it is not worth living that kind of painful miserable life.

Do I Need a Knee Replacement?

Dr. Mohan Puttaswamy, Orthopedist
Many patients have this question regarding their knee arthritis and ask us during their consultation. What is the right time to undergo a joint replacement surgery? The answer to this is determined by a couple of factors- age of the patient, severity of symptoms and most important how this has affected the quality of life.Each of the points mentioned have a bearing on the outcome of surgery. Total knee replacement is an excellent and cost effective way in managing knee arthritis. The satisfaction rates after knee replacement is around 80% and age at surgery has a bearing on the outcome. Generally, knee replacement in younger patients has been found to be less satisfying and has more complications. Even if though there is no cut-off age, generally knee replacement should be opted after the age of 55-60 years. In younger patients if all the options have been exhausted,then one can opt for a knee replacement. Some patients will have severe arthritis on the X-rays but clinically they are able to do their ADL (Activities of Daily Living) without much hindrance. When such a situation arises it is always the patient’s symptoms that dictate the timing of replacement and can be postponed till pain becomes severe. The pain in the knee should be continuous and not well controlled, pain should be limiting simple normal activities like stair climbing, walking or using the toilet. I am diabetic, is it OK to have a knee replacement?          The other factor to be considered during a joint replacement is the general health of the patient. If a patient has multiple medical problems-then those problems should be well controlled before undertaking a joint replacement surgery. Common medical problems like Diabetes, Hypertension, Thyroid problems, Anaemia all have a bearing on the ultimate outcome of a knee replacement. Many of our patients are obese and that can have serious repercussion regarding outcome after a replacement surgery. Weight reduction is generally difficult because patients are unable to exercise before knee replacement but when an individual’s BMI is more than 35 then the complications after a replacement increases. So, it is advisable to consult a dietician and reduce weight by dieting before going forward with a knee replacement.What pain medications are safe to treat mild arthritis?Medications like Paracetamol and Tramadol have a higher safety profile than Diclofenac or other NSAID’s (traditional pain killers). The problem with long term pain medication intake is the higher chance of kidney failure and stomach ulcer formation.  The duration of treatment necessary makes it important to take safer medications and opt for surgical treatment if pain management is not adequate.What injections are safe and effective in knee arthritis?Basically, there are 3 types of injections that are currently available in the treatment of OA knee. They are corticosteroids, Visco supplements and Platelet Rich Plasma (PRP). Corticosteroids are cheap and give good pain relief the problem with steroid injections is that they worsen the degeneration.  Visco supplements are expensive and need to be repeated and cost is a significant factor to consider when opting for Visco supplements. Visco supplements basically work by increasing the joint lubrication. Lastly, PRP is an exciting new option which is less expensive than visco supplements in some centers and is more effective than the visco supplements according to some studies. PRP reduces the inflammation in the knee joint and is patients own blood product injected into the knee joint. Please talk in detail with your surgeon regarding which is the best injection option for your knee arthritis.

Facts and Fallacies-Knee Joint Replacement Surgery

Dr. Purushottam Reddy Padala, Orthopedist
Knee Replacement Surgery- Who Needs It?Generally, but not always, joint replacement is done after the age of 50 yrs.  Having said that, no age should be exempted or delayed from surgery for want of a way out of the misery of pain from arthritis.Anybody who has end stage arthritis due to a variety of diseases-osteoarthritis, rheumatoid arthritis, joint damage due to injury etc should have joint replacement surgery.WHEN QUALITY OF LIFE IS AFFECTED TO AN EXTENT WHERE THE PATIENT IS DEPENDENT ON CRUTCHES, WHEELCHAIR OR IS UNABLE TO MOBILIZE AND ALMOST HOUSE-BOUND DUE TO PAIN, STIFFNESS AND DEFORMITY, THEN PERHAPS, JOINT REPLACEMENT IS MANDATED.What Is Available?Unless you need to squat due to religion or a job requirement, you require the usual knee- the one used for 80 % of people. The extra cost for marked knee bending provided by new knees( which is more expensive also) is possibly not required for you.Always ask your doctor to go for a reputed company. The money spent on quality is worth while in the long run.General Questions1. How long does it take after the surgery to be able to walk?Generally 2 days 2. How long before I get back to normal outdoor life?By 6 weeks you will be able to do most things like shopping, travelling etc.3. Period of stay in hospital?4-5 days.4. Do I need to do exercise?Physio is an integral part of joint surgery, to strengthen the muscles, so that normal balancing can take place. Physio for upto a month might be required.5. Can my father have surgery at the age of  seventy? No age is too old for surgery. As long as patient is fit for anaesthesia, which will be done by our anaesthetist, no age is bar from surgery.Where should I get it done?Some centres with no training are claiming 100% guarantee. Remember there is no 100 % in medical specialties. Out of the thousands that are done, a few are likely to get infected, loosen and become painful after surgery. It is recommended that you go to someone who has received advanced training abroad and practiced in Europe or the States, so that all or any eventualities are covered by that surgeon.Replace fear with confidence as joint replacement is now a well entrenched surgery, with very few complications and high success rate.Wish you all the best!Dr Purushotta Reddy