Articles on knee

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.

7 Basic Queries About Total Knee Replacement

Dr Dewangan Ssunil Kumar
 Total Knee Replacement: The knee comprises the joint between the femur and the tibia but also the joint between the patella and the front of the femur. Either or all of these parts of the knee may be affected by arthritis to various degrees. The procedure of joint replacement includes removing the affected joint surfaces and replacing them with metal components with a high-density polyethylene-bearing surface between the metal components What is Total Knee Replacement? A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients which ranges from 2-3 weeks to 2-3 months. Correct rehabilitation following surgery significantly improves outcomes.In the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface. The femoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits. The patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.Advantages of Total Knee ReplacementThe most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around 2-3 weeks or a month's time. The patient regains a normal lifestyle and mobility with significant improvement in quality of life.Frequently Asked Questions about Knee Replacement SurgeryWho is the candidate for a total Knee replacement? What are the risks of Total Knee Replacement? Should I have a total knee replacement? Who develops a more severe or an earlier arthritis? When can I return home? What measures should be taken after the surgery/operation (post operative instruction)? What activities should I avoid after knee replacement?Q 1 who is a candidate for a total replacement?Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure can be performed in younger people if joint is already damaged. So criteria for surgery based on age is non dependent. The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:You have daily pain which affects your ADL (Activities of Daily Living).Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.You have significant stiffness of your knee.You have significant instability (constant giving way) of your knee.You have significant deformity (knock-knees or bowlegs).Q 2 what are the risks of total knee replacement?Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung. Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:some residual knee painloosening of the prosthesisstiffnessinfection in the knee jointA few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.Q 3 Should I have a total knee replacement?Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you the (Patient). All your questions should be answered before you decide to have the operation. If you have any questions, please feel free to write to us.Q 4 who develops a more severe or an earlier arthritis?One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, and local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding. Another form of Arthritis is inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD's), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist. Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.Q 5 When can I return home?You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.Q 6 What measures should be taken after the surgery/operation (Post operative instruction)The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery. Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings. Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery. Your activity program should include:A graduated walking program to slowly increase your mobility, initially in your home and later outside.Resuming other normal household activities, such as sitting and standing and walking up and down stairs.Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about two to four weeks after surgery.Q 7 What activities should I Avoid after Knee Replacement?Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics. You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.

Treatment of Arthritic Knee Pain

Dr. Samarjit S. Bansal, Orthopedist
Knee pain can be due to many reasons. The most common cause in elderly patient is arthritis (specifically osteoarthritis). It is very disabling and can be cause of severe agony and misery in elderly population. Patient will have difficulty in getting up from bed or chair, difficulty in sitting and squatting and climbing stairs . Few patients may hear crackling sound on bending the knees. Treatment depends upon the stage of the disease. Stage is decided by the x-rays predominantly and clinical examination.Various treatment methods are:EXERCISES:   Exercises help strengthen your muscles and improve/maintain the range of motion of the joint. It is very effective in the early stage of arthritis. There are specific exercises for muscle groups around the knees. These exercises decrease pain also. This can delay/prevent the need of surgery and also reduces the quantity of pain killers required. Proper exercises reduces the risk of injury. In case surgery is required, exercises before and after surgery helps in early recovery.MEDICINES: There are various medicines available for treatment of knee pain. These are important part of treatment of knee pain. NSAID's are commonly used in acute conditions . But these should be avoided for long term use as they have side effects also. There are few analgesics which are relatively safe and can be taken for longer period under the guidance of doctor. Treatment specific medicines are available for Gout , Rheumatoid arthritis. Steroids also sometimes used to decrease acute pain.OTHER MEDICINES: Glucosamine and chondroitin have shown to be effective in moderate to severe arthritis. But study results are mixed for these supplements. Newer products like rosehip extracts with collagen are also showing good results.KNEE INJECTIONS:  When oral medicines are not giving relief than knee injections can be taken before going for surgery. There are three types which can be injected into joint.HYALURONIC ACID: A thick fluid, similar to the fluid that naturally lubricates joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Although study results have been mixed about the effectiveness of this treatment, relief from one or a series of shots may last as long as six months. These are given weekly for period of 3-5 weeks depending upon the product.CORTICOSTEROIDS:  Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. While the injections bring targeted relief to the joint and lack many of the side effects of oral corticosteroid medications, they are not without risks.PLATELET RICH PLASMA (PRP): PRP contains a concentration of many different growth factors that appear to reduce inflammation and promote healing. These types of injections tend to work better in younger people and in people with mild arthritis.SURGERY: Surgery is the last option when all other treatments have failed and knee pain is very terrible and affecting the patient in activities of daily living.TOTAL KNEE REPLACEMENT:The most common knee surgery is total knee replacement, a procedure in which the damaged knee joint is removed and replaced with prosthesis of metal, high grade polymers and plastics. Healthy patients are made to walk the next day after surgery. Few patients take slightly longer time. ARTHROSCOPY: Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage (especially if it is causing your knee to lock), and reconstruct torn ligaments.OSTEOTOMY: If the damage to your knee is mostly limited to one section, your doctor may recommend a surgery called osteotomy. In an osteotomy, the surgeon reshapes the bones and repositions them to take the weight off of the damaged part of the knee. In doing so it can help relieve pain and improve function, particularly for someone who is not ready to have a total knee replacement.NOTE: This article for information purpose. Kindly consult your doctor for appropriate treatment.

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.

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 Old Are Your Knees?

Dr. Vishwas Virmani, Physiotherapist
The knee is the largest joint in the human body, and it requires a lot of care, especially as it plays an essential role in walking and other daily activities. Problems associated with the knees including chronic knee pain and osteoarthritis are usually associated with the elderly. However, in recent times it has become an issue that affects a younger age group as well. Some of the common causes of knee pain in the young are: Chondromalacia patellaeA softening of the cartilage under the knee cap that causes deep knee pain and stiffness especially after prolonged sitting and climbing stairs. Chondromalacia patellae Bursitis around the knee jointIt is caused by inflammation of various bursae around the knee joint. It can be related to posture and overuse.Early osteoarthritis is a common cause of knee pain. Osteoarthritis is a disease that causes the degeneration of the knee cartilage. It is common in the elderly, but the following causes have seen its prevalence among young people rise. Causes-of-knee-pain If you experience constant knee pain for more than 3 weeks, you must visit an orthopaedic doctor, and also take an X-ray or an MRI to enable prompt diagnosis. Medication and physiotherapy usually help. Muscle strengthening of the quadriceps and the hamstrings is advised to reduce stress on the joints and prevent overuse or injury. However, in some cases surgery may be required. In most cases a laparoscopic surgery is advisable and the procedure is usually completed within less than a day. Prevention of Knee Pain Knee pain is a difficult chronic condition to have; however, most causes of knee pain are treatable if diagnosed early on. If you experience knee pain for more than three weeks, get it checked, and ensure that you maintain a healthy lifestyle to prevent further aggravation of the condition.

Knee Sports Injuries

Dr. Rajat Jangir, Orthopedist
Problems in the knee are extremely common. These injuries range from sprains and anterior knee pain, to meniscus and ligament tears, to arthritis. With the current increase in activity that we are seeing in today’s population, knee injuries will only become more common. Fortunately, as knee injuries become more common our understanding of these injuries and ability to treat them successfully continues to improve. From improved understanding of how musculoskeletal dynamics affect knee injury, risk, and prevention; to using the latest minimally invasive techniques to treat surgical knee problems; our knowledge and techniques for treatment of the knee continues to evolve and improve.ACL InjuriesThe anterior cruciate ligament (ACL) is one of the four major ligaments of the knee. Ligaments are strong, dense structures made of connective tissues that help stabilize a joint. In this case, the ACL connects the femur to the tibia and helps provide stability to the knee and minimize stress across the knee joint. Twisting or pivoting movements can often cause the ACL to strain or tear.ACL tears occur in athletes participating in cutting and pivoting sports such as basketball, football, soccer, and skiing. At the time of an ACL injury the athlete typically feels a “pop” or a tearing sensation. This is followed by swelling within the first six hours of the injury. The most common injury associated with ACL tears is a meniscus tear.It is well recognized that ACL injuries are much more common in females. There are multiple reasons for this including bone anatomy, hormonal differences, muscular balance, and the way they perform certain sports. Of these factors, the ones we can potentially change are muscular balance and the way sporting moves are completed. Females tend to cut and jump with their knees only slightly bent, which can predispose them to ACL injury. The hamstring to quadriceps strength ratio is also different from males. Studies have shown that strengthening exercises and plyometric programs aimed at changing these factors can prevent ACL injuries.ACL strains can sometimes be treated with physical therapy and muscle strengthening. However, most complete tears require surgery in active patients. Modern ACL surgery involves completely removing the torn ligament and reconstructing the torn ACL. The most common grafts used to reconstruct a torn ACL are the patella tendon, hamstring tendons, or cadaver tissue (allograft). Each graft offers specific advantages and disadvantages, so it is important to understand the differences.Meniscus InjuriesThe meniscus is a pad of specialized cartilage that is located between the femur and tibia bones in the knee joint. There are two menisci in the knee – one on the inside of the knee (medial meniscus) and one on the outside of the knee (lateral meniscus). The meniscus has several functions including: acting as a shock absorber or cushion, distributing load across the knee, decreasing friction, and adding to stability of the knee.Meniscus tears typically occur as a result of twisting injuries to the knee. They can be caused by traumatic injury, often seen in athletes, or they can be degenerative in nature, tearing from minor trauma as the meniscus becomes more brittle with age. The symptoms of a meniscus tear include pain, swelling, locking, and inability to completely straighten the knee joint. An MRI is frequently obtained to diagnose a meniscus tear.Treatment of meniscal tears depends on several factors including the type of tear, the location of the tear, and the activity level of the patient. Some patients can be treated nonoperatively. If surgery is necessary, minimally invasive arthroscopic techniques are used to either trim out the torn portion of the meniscus (partial meniscectomy) or to repair the meniscus.The PCL InjuriesThe posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. The PCL, along with the ACL, is located in the center of knee. Its primary function is to prevent posterior translation of the tibia on the femur. The PCL also plays a role in the side-to-side stability of the knee.The PCL is injured less commonly than the ACL. The most common mechanism of injury involves a blow to the front of the tibia (shin bone) when the knee is bent. PCL tears can occur as isolated injuries or can be associated with other knee injuries.The symptoms of a PCL injury are usually less dramatic than those of an ACL tear. Swelling is often only mild. The pain from a PCL injury is usually resolved within 2-4 weeks. However, a sense of instability may persist, especially when changing directions.Treatment for isolated PCL injuries initially focuses on rehabilitation and strengthening after the pain and swelling subside. Partial tears of the PCL do not usually require surgical treatment; even isolated complete tears of the PCL do not always need surgical treatment.If symptoms of instability persist after rehabilitation, surgical reconstruction of the PCL is recommended. Modern PCL surgery involves completely removing the torn ligament and reconstructing the torn PCL using a minimally invasive arthroscopic technique. The new PCL is made using a tendon graft, obtained from either the patient or cadaver (allograft). Furthermore, PCL reconstruction surgery is typically performed as an outpatient procedure.Cartilage InjuriesCartilage is a type of specialized connective tissue. There are three main types of cartilage: hyaline (articular) cartilage, fibrocartilage, and elastic cartilage. Hyaline (articular) cartilage provides a smooth, white, glistening layer covering the femur, tibia, and undersurface of the patella. The main functions of the hyaline cartilage is to provide shock-absorbing properties and allow for a frictionless smooth surface. Articular cartilage lacks blood supply and therefore has a limited capacity for healing. It can be injured by trauma or repetitive injury.Cartilage injuries may cause pain, swelling, and/or locking if the fragment has separated into the joint. The surgical treatment options for cartilage damage are: debridement (cleanup), microfracture, cartilage (osteochondral) transplant, allograft, and chondrocyte transplantation. These cartilage restoration procedures can be done using minimally invasive arthroscopic techniques.MicrofractureThe microfracture technique is used for full thickness cartilage defects with exposed bone. Articular cartilage has a limited capacity to regenerate itself due to its lack of blood supply. Therefore, the microfracture technique was designed to stimulate a biologic repair for this type of cartilage. A minimally invasive arthroscopic technique is used to place microfracture holes into the exposed bone, which allows the release of blood and bone marrow contents into the cartilage defect. This activates a healing response and stimulates the production of the fibrocartilage layer, which forms over the exposed bone. This technique is very effective for cartilage restoration.Transplant (OATS)Osteochondral (cartilage) transplantation (OATS) procedures are designed for full thickness chondral defects. Small chondral defects are treated by removing an osteochondral cylinder (plug) from a specific area within the knee joint that does not require cartilage to function properly. This osteochondral cylinder (plug) is then transplanted to the affected area in order to repair the chondral defect.Large chondral defects can be treated using an allograft (cadaver) osteochondral graft. The typical patient considered for this procedure is a young, active individual with a traumatic isolated chondral injury. The advantage of this procedure is that it allows placement of hyaline (articular) cartilage into the chondral defect. This technique is performed through a minimally invasive arthroscopic procedure, or through an open technique depending on the size and location of the lesion.AllograftSome cartilage lesions are too large for microfracture or autograft OATS to work successfully. Thus, an allograft OATS surgery may be required in some of these cases. In this surgery a cylindrical area of bone is removed where the cartilage lesion is located. A similar sized bone plug with overlying articular cartilage is then removed from a matched cadaver. This cylindrical area of bone is then placed in the defected area in order to repair the cartilage lesion.Chondrocyte TransplantationChondrocyte transplantation is used for relatively large cartilage defects in the knee, where the underlying bone is normal. This procedure is usually done in one of two ways. Cartilage cells can be harvested from the patient, sent to a lab, grown, and then later implanted into the patient via a second surgery. The other option is to use fetal chondrocyte cells, which requires only one surgery. In either case the lesion is cleaned of any residual cartilage. A tissue patch is then sewn into the lesion and cartilage cells are injected into the area. These cells then grow into hyaline (articular) cartilage.SummaryMicrosoft PowerPoint - IOC Diploma presentation [Compatibility Mode]Knee injury extremely commonHistory will direct the examination and helpwith diagnosisPhysical examination directed to the history– Keep in mind the rules of thumbTreat based on the injury and also the patientMost knee injuries can be treated withoutsurgery– Need to rehabilitate the athlete

Things You Must Follow After Knee Replacement

Dr. Hrushikesh R.Saraf, Orthopedist
Knee replacement surgery is one of the specialised surgeries. For better results, after this procedure certain things patient must follow religiously.We can divide it in four categories: 1. Preoperative - Some changes at home like arrangement of commode/western toilet is must. If western toilet is not available then fold-able commode chair can be arranged. Also ,during immediate post operative period patient needs walker followed by  stick support for walking. So do arrange these things prior you get admitted for surgery. Medicines like clopitab /ecosprin must be stopped before one week of surgery or as per advised by your surgeon/physician .2. During admission and post operative period - Follow all instructions given by your doctor. Do exercise and physiotherapy as per schedule. Eat lots of water and keep yourself hydrated. Take soft diet and small feeds after 3-4 hrs. If you are diabetic then keep a watch on sugar levels. If you have fever then immediately contact your surgeon and follow their guidelines.3.Post operative at home - Physiotherapy exercises are important during post operative period to regain strength of thigh muscle. Also they help you to become independent from support of the walker. It trains you to climb chair and perform all your day to day activity at your own. Three months of physiotherapy after surgery not only makes you independent but help to regain maximum range of movement of your new joint.4.Follow up - Regular follow up with surgeon every month for first 6 months and then every year is mandatory. Excessive activity ,over-activity, jogging ,trekking, must be avoided after surgery. Swimming cycling can be started with instructions of your surgeon. Walking is good exercise and that is more than enough for all the patients of this age group. Sitting cross-leg and squatting must be avoided. Patients with high flexion joints can sit cross leg  with consent of their surgeon. 

Build Strong Bones and Eliminate Knee Inflammation

Dr. Vishwas Virmani, Physiotherapist
There’s no doubt that remaining active is crucial for building and strengthening your bones. But if any part of your body is in pain – especially weight-bearing joints such as your knees – it’s pretty hard to keep moving.That’s why today we’re going to discuss the importance of avoiding knee problems, and easy ways to prevent and relieve knee pain, including a simple exercise you can do at home.Not All Exercise is the SameIf you’re a “Saver,” you know that not just any exercise will do when it comes to increasing bone density and strength. As I explained in the Save Our Bones Program, to really build bone, you need to engage in weight-bearing exercise that utilizes the effects of gravity on bones and muscles.When your knees hurt, though, doing such exercises is certainly difficult, if not impossible. Even getting in and out of a car or climbing a short flight of stairs becomes a painfully challenging task.The Importance of Healthy Knees for Your Bone HealthAll of your joints and bones are important, of course. But knees have a particular role in bone health because they are so central to weight-bearing exercise.Your thigh muscles are pivotal in maintaining the integrity of your knee joints. Walking, for example, is an excellent overall bone-strengthening activity, but it doesn’t target the specific muscle groups that stabilize the knee.A study from the University of Iowa showed a 50% decrease in knee pain in women who had the strongest thigh muscles in the study. Other muscle groups play a role in maintaining the knee joints as well.General Care of the KneesKnee pain does not have to be an inevitable part of ageing. I want to talk about some general tips for keeping your knees healthy, and then we’ll move on to a special knee-strengthening exercise that you can do right in your home.Keeping your hip and bottom muscles (the “glutes”) strong helps keep the pelvis at the proper angle. Strong bottom muscles align the hips and thigh bones (femurs), which in turn keeps the knee joints in proper alignment.Stretching is also important, because it keeps muscles limber and flexible. Muscles that are rigid can pull joints out of alignment, but supple muscles hold your skeleton in proper form and help absorb shocks.In our modern world, excessive sitting has become quite a health hazard. With regard to the knees, sitting weakens the outer hip and leg muscles while tightening up the inner thighs and groin muscles, creating imbalance. The knee, of course, is one of the main joints that suffer when this happens. Stretching the inner thighs and groin muscles helps even out the imbalance, especially when combined with strengthening the outer hip and leg muscles.Strengthening your core muscles also improves your knees’ integrity. It may seem odd that abdominal muscles would affect your knees, but they do. You see, when your abs are weak, your pelvis tends to tilt forward, creating a “sway back.” Strong abs “tuck” your tummy in and pull the bottom of your pelvis forward. Once again, it’s all about alignment; you can’t have healthy knee joints if the rest of your body knocks them off-balance.And now, I want to share with you an easy exercise to prevent knee aches and pains:The Knee CurlStand and hold onto the back of a chair.Lift your right leg straight out behind you, without pointing your toes.Bring your heel toward your buttocks as far as you can by bending your knee. Don’t move your hips, and keep the leg you’re standing onSlightly bent. Hold for one second, then lower to the floor.Repeat the movement 10 to 15 times.Switch legs and do 10 to 15 curls with the left leg. Then perform another 10 to 15 curls with your right leg. Finish by doing 10 to 15 curls with your left leg.
I chose this exercise not only because it is geared toward the knees, but also because it is typical of the moves you’ll find in the Densercise™ eBook System. You see, Densercise™ is designed with knee pain prevention in mind. You’ll find exercises that strengthen the thighs, core muscles, and knees without hard impact, such as:Step UpSide LungeChair DipsWall SquatsHeel LiftChair Knee LiftMountain Pose to Chair Pose and many more!You can do all these exercises right in your home – no special equipment necessary!