Dr. Khera's Wellness Clinic

Different methods to treat Disc problems

Hello friends, I am Dr. Gaurav Khera. I am an orthopaedic surgeon, doing joint replacements and spine surgeries at the Access healthcare. Now today I will be talking about the lumbar degenerative disc disease. Now it sounds very big, but it is not as complicated as it sounds. It basically is what you people commonly know as disc disease. So it is a fairly common problem that is seen in our population today. In fact, about 30 or 40% of the patients who come to our OPD have lower back pains, some have other disc problems and very commonly seen after 40 years of age and this incidence gradually increases up to 60-70 years of age. The other environmental factors which are associated with this are, first of all, smoking, secondly it is, mild to moderate trauma, thirdly its seen in people who lift heavy weights, fourth is obesity, especially central obesity, that is if you have a very heavy waistline.

Now, what is Lumbar degenerative disc disease? Now, our spine is composed of multiple bones, which are starting from your neck and they come all the way down to your hip, divided into the cervical, dorsal, lumbar and sacral spine. And between these bones, there are these small pieces of discs, which act as cushions. When your body walks, these act as shock absorbers between your body’s bones. Now, these discs, when these come out of their normal place, it gives or presses against the nerves which are passing through these areas and it causes pain. This is what happens in the disc disease. Basically, in the patient, it will come as lower back pain, and this pain will be traveling down to the hip, and it will also be coming down to the legs. Some people complain that as they walk, the pain increases.

They also complain of tingling numbness. They complain that sometimes their fingers or their toes are feeling numb. These are some of the very common symptoms which are being seen. Few people may have only lower back pain, and these are the people who do not have very significant disc disease. Now there are two main causes of the disc disease. First is an inflammatory reaction that occurs in the disc, and second is the micro-motion instabilities that occur. Inflammatory reactions may occur as a result of some small traumas which may occur such as when you may injure your back. Such inflammatory reactions occur in the form of small swellings in the body. And micro motion instabilities are when the body ages, the disc which has an outer fibrous thick layer, that degenerates, and as it degenerates, the pulp which is there at the centre, of the discs, tends to degenerate. What I mean is it comes out of its normal space. And as it comes out of the normal place, it comes and tends to press on the nerves and these are the two most common causes.

All disc patients are not to be operated. When we get these patients, the first and foremost investigation that we do is an X-Ray. And if required, we go in for an MRI. Frankly MRI is the known standard to diagnose the disc disease. The findings of an MRI are always coordinated with the clinical findings. Once we have diagnosed that it is a disc problem, we have to establish that what the compression on the nerves is. If the nerve compression is a lot, and if we think that we cannot do anything other than surgery, then we take the patient for surgery.

If not, we take the patient fro physiotherapy, lifestyle changes and few medications. These medications may carry on for a few weeks to a few months. And a lot of exercises has to be carried on regularly. Lifestyle changes such as weight loss, stoppage of smoking are very important. And if you can achieve this, then your problems are very easily solved. If you have any queries regarding your disc problems or back pains, then you can get in touch with me for the same.

You can reach me in my clinic, which is there in Indrapuri, by the name of Dr. Khera’s Wellness Clinic or you can also contact me through Lybrate for the same. Thank You. In case you have a concern or query you can always consult Orthopedic Doctor in Ludhiana & get answers to your questions!  

Benefits of Knee Replacement

Hello, friends, I am Dr. Gaurav Khera I am a consultant orthopedic surgeon joint replacements and spine. Today I will be talking to you about total knee replacement. Knee replacement is the most common surgery which is being done these days it is also a surgery which has got a lot of bad name to it because of a few complications that are associated a few myths which are associated. I'd like to clear all those out today.

Before I start talking about knee replacements I would like to tell you something about the anatomy of the knee joint. (Displaying knee model) now this is the knee joint knee joint is a type of a hinge joint, a modified hinge joint, it has three compartments, it has the middle or the inner compartment the lateral or the outer compartment and the patella femoral compartment. now what basically happens in osteoarthritis that is the reason why we do a total knee replacement is that the joint it starts to age or it starts to degenerate, and as the joint degenerates this blue coloured cartilage cover it starts to go away, as the cartilage cover goes the joint tries to recover from this degeneration process and in doing so in the repetitive process these osteophytes which are like bony specules they are formed, now these bony spicules as they are getting formed they start pinching into the surrounding tissues, surrounding tissue means the ligaments, basically 4 ligaments are in the joint 2 of which are inside and 2 of which are outside. the outside ones are the lateral and the middle collateral ligament and the inner other anterior and posterior cruciate ligament now the first ligament to get involved is the medial collateral ligament which is on the inner aspect of the knee joint and there is tightening of this ligament which takes place as the recommend gets tightened this middle compartment it starts to tighten up and there is further rubbing of these bones as these bones are out this blue cartilage it goes away and the bone gets exposed and the raw bone Easter surfaces they rub against each other causing severe excruciating pain.

The patients  come to us then they complain of pain when they are going up and down stairs they complain of funny sounds which are coming, they complain of difficulty and squatting difficulty in cross leg sitting. so this is the reason why you get all these pains. now Osteoarthritis is not the only reason why were doing knee replacements. knee replacements are also being done father causes like hemophilia, septic arthritis, septic arthritis means infections. a few other causes like imposed tuberculosis, again its an infection. now there are two types of knee replacement surgeries which are being don,e one is the unicondyler knee replacement and one is the total knee replacement, a unicondyler knee replacement what we do is we change only the middle aspect of the joint or the inner aspect of the joint and in total knee replacement we change the entire joint. now changing of the joint does not mean that we remove the bone from the top and bottom and we just put in a new knee, basically were just changing the damage surface so this is the model of a knee replacement surgery.

Basically there seven cuts which is involved in a total knee replacement the main cut being the table cut and the other cuts are the femoral cuts now the femoral cuts are again you know the distal anterior posterior the chamfer the box so once these cuts are done this is how the femur of the knee joint looks like of the implant. this is then fitted onto these cuts with the help of a bone cement and on the tibia we put a tibial plate which is again fixed with a cement and then we put a insert. the size of the cuts and the amount of bone which is being cut is generally decided inter operatively. the types of implants which are being used are different, the types of implants vary we have patient-specific implantations we have computerized implantations you know in which we can do computerised cuts during the surgery and we have high flex knees we have normal needs so huge variety of things which are coming. now coming to rehabilitation process after the surgery the rehabilitation process for you as a patient is the most important, see normally the patient requires two to three months to recover after the knee replacement.

We make the patient walk after 24 to 48 hours .now the reason why we are making you walk so early is so that we can get your knee to start moving we can prevent complications like DVT and we can start your physiotherapy for muscle strengthening as soon as possible. your physiotherapy will continue for at least two months after the surgery and you will be able to lead a completely normal life that is hardly any activity which is going to be restricted after your surgery, you can go for your cycling you can go for your mountaineering you can go for your running you can go for your walks, we will only advise you not to be squatting and not to be cross leg sitting other than these you will be allowed to do all other activities. the complication rates of the surgery has come down tremendously. about 10 years back the complication rates were much higher now the complication rates have really come down that is because the most common complication is infection. now infection the methods which we are using in this surgery they are better antiseptic methods that we are using, there are better barriers which are there in the hospital, better antibiotics so infection rates have come down. the other thing is the failure of the implants there is a much better understanding of how the knees functioning, there is a much better understanding of what the soft tissue balancing is required. so all these complications have really come down so I would advise you that

If you are really suffering from a lot of knee problem if you’re having to take a lot of painkillers if youre not being able to do your daily activity then you should get in touch with us and you start thinking of a knee replacement surgery. you can contact me and come and meet me at my clinic at dr Kheras wellness clinic, I am here everyday in the evening from 6 to 9. I am also available at Apollo spectra hospital, you can call text or video chat with me through Lybrate. Thank you.