Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

Bones are similar to a porous framework which is filled with minerals that make it hard and strong. With age, there is gradual degradation and the mineralized portion is lost, thereby leading to thinning of the bone. The word osteoporosis literally translates to porous bones, which is due to the gradual demineralisation. In addition to the natural ageing process, there are other diseases that can accelerate the demineralization process.

Women are more prone to demineralisation, and after the age of 40, they should take extra precaution to slow down the onset of the condition. The following are some ways to improve bone health and halt osteoporosis in the long run-

Diet: Ensure that your diet has sufficient amounts of vitamin D and calcium. Though calcium is the essential mineral for bone formation, vitamin D is required for the absorption of calcium, and therefore both these elements play a vital role in maintaining the quality of the bones in our body. Most people require about 1,000 mg of calcium and about 500 units of vitamin D for optimal bone health. This requirement goes up slightly in postmenopausal women.

Sun Exposure: In most people, exposure to the sun allows the body to make vitamin D, but careful sun protection prevents this from happening. Also, with age, the body s ability to form intrinsic vitamin D also declines. The body, therefore, relies on supplements. Most dairy products are good sources of calcium. In addition, spinach, salmon, turnips, and broccoli are some calcium-rich foods. Supplements of calcium carbonate or calcium citrate can be taken if your diet is lacking in calcium. Vitamin D also should be included in the supplementation. The treatment for osteoporosis is incomplete without these two supplements.

Exercise With Weights: The constructive tension that exercise puts on the body helps in bone building, whatever the age may be, which prevents the onset of osteoporosis. Any exercise which improves muscle mass strengthens the bones, and puts stress on the bones is advisable. Since the fractured area due to osteoporosis mainly includes the spine, lower back exercises, yoga, tai chi, and abdominal exercises all work wonders. Pick any of these and do them for 30 minutes three times a week.

Quit Smoking: Continuing to smoke while taking osteoporosis medications is completely useless. Nicotine negates all the effects which defeat the purpose of taking the medication and is as good as taking no medication at all. So if you want the bone thinning to stop, stop smoking.

Alcohol Consumption: While a drink or two per week is permissible, more than this can harm the bones significantly.

Constant Health Watch: Talk to your doctor about how other routine medications (if any) can affect your bone health. Also, identify how frequently you should check your bone mineral density and stick to the schedule.

Bone health and osteoporosis can be managed with some conscious efforts.

Bone Health And Osteoporosis - Know More About Them!

The human body allows for movement through the complex system of bones, muscles and joints. A break in the bone is medically known as a fracture and can be caused by constant stress, pressure or impact. It is common knowledge that with age, the bone strength decreases and incidence of fractures (osteoporotic fracture) increases. Based on the affected bone and impact, different types of fractures are commonly identified as:

Complete: When the breakage of the bone is complete, producing two or more pieces, it is referred to as a complete fracture.
Incomplete: When the breakage is incomplete, where the bone has cracked, but does not break into pieces, it is known as an incomplete fracture.
Another type would be the open or closed fracture:
Open fracture: When the skin is exposed and the bone breaks through this exposed skin, it is known as compound or open fracture.
Simple or closed fracture: The bone breaks, but the skin continuity is maintained. Again, here are different types including hairline, greenstick, oblique, etc.
What is the reason behind a fracture?
A bone will fracture when force is applied to it that is stronger than the bone itself. A key factor in a bone s susceptibility to fracturing is age. Both children and older people are prone to bone fractures. Children s bones are constantly growing and have not reached their full strength. Elderly people have brittle bones with old age and are prone to develop bone diseases, making them susceptible to fractures.

How they are treated?
Splint and pain medications are commonly used. Closed reduction where the fracture is reduced without opening up the tissues and open reduction, where the tissues are opened up are common approaches to managing fractures.

Can they be prevented?
Especially with children and in the elderly, extra precaution should be taken to avoid any kind of injury and fracture.

Develop an exercise routine to strengthen the muscles
Manage weight
Use the right footwear and exercise gear
Watch your medications (avoid sleep inducing ones)
Increase lighting in the room/home to improve clarity of vision for elderly
Make the home/living area fall-proof by reducing clutter, using railing in the bathroom and bedroom, using rubber mat, etc.
While a fall may seem inevitable, taking the above steps can help reduce the incidence and severity of a fall, thereby minimizing damage.

Bone Fracture - Common Types and How They Can be Prevented?

Pregnancy places a lot of demand on the expectant mother. While the emotional demands are not very evident, the physical ones are. The mother has to ensure that the developing baby gets all the required nutrients through her. Some of them are very critical, and not getting adequate amounts of these manifest as problems, which cannot be rectified later. Calcium supply and associated problems that may arise is one such example.
If there is a reduced supply of calcium and the bones and teeth are not formed properly, taking any amount of calcium is not going to correct the situation later, after delivery.

The bones which are forming in the developing baby are dependent on the mother for adequate supply of calcium. It is common knowledge that calcium is an integral component of bones, teeth, and skeleton. Hypocalcemia, which is a condition where there is reduced amounts of calcium in the body, can be quite severe during pregnancy.
In addition to the growing baby s needs, calcium also plays a vital role in the pregnant mother for muscular contractions, nerve conduction, hormone secretion, and blood clotting. So adequate intake of calcium during pregnancy is essential.
Now, the question arises as to how much calcium is good enough. For a normal female, about 1000 mg of calcium is required on a daily basis. This goes up by another 200 to 300 mg for a pregnant woman, especially during the third trimester when the bone and teeth formation is in full speed. This extra amount of calcium should be continued even after pregnancy, as calcium continues to be provided to the baby during the lactation phase.

Some of the symptoms of reduced calcium intake during pregnancy are aching muscles, brittle nails, weakened bones, severe cramping, and dry skin. If there is suspected hypocalcemia, it is best to seek medical advice. It is not advisable to take supplements without medical supervision. Increased amounts of calcium can produce a different set of symptoms.

While these are evident symptoms, there are other detrimental effects on the baby too. Calcium deficiency affects development of heart and associated structures and puts the newborn at a higher risk of developing hypertension. The baby s fat percentage and triglycerides are also increased. The bone mineral density is reduced. The delivery period could be prolonged, as muscular contractions and nerve conduction are severely impacted when there is less calcium in the system. Recovery from labor is also delayed.

It is possible that you are taking adequate amounts of calcium, but its absorption is affected. Reducing caffeine intake helps in better absorption of calcium. Iron, which is often given during pregnancy, prevents calcium absorption and so needs to be spaced out.

Calcium & Bone Disorders - How to Know If Your Are Suffering From Them?

Knee pain or injuries are very common and have numerous causes. Knee pain can emerge from delicate tissue wounds like ligament sprains and muscle strains. Bone conditions like knee joint pain, Osgood Schlatters, and biomechanical dysfunction can also cause knee pain. Treatment can include basic knee mobilization techniques, taping, massages or knee strengthening exercises completely through a careful recovery method after knee replacement or reconstruction.

Physiotherapy can help you overcome the pain and increase your strength and flexibility. A physiotherapist can suggest you a number of treatments and also help you understand your issue and get you back to your everyday routine. Physiotherapists are said to be successful in getting rid of the source of the knee pain by diagnosing a cause. This includes tightness around the knee and treating it with stretching and exercises.

Following are some of the exercises a physiotherapist might generally recommend for knee pain:

Hamstring stretch: Stretching keeps you flexible and increases your scope of movement, or how far you can move your joints in different directions. It additionally helps you reduce your chances of injuries and pain. Continuously warm up with a five minute walk first. Lie down when you are prepared to stretch your hamstring. Circle a bed sheet around your right foot, use the sheet to pull the leg up and hold for twenty seconds and then lower the leg. Repeat twice and switch legs.
Calf stretch: Use a chair for balance. Bend your left leg. Step back with your right leg and gradually straighten it behind you. Press your left heel toward the floor. You should feel the stretch in the calf of your back leg. Hold for 20 seconds. Repeat twice and then switch legs.
Straight leg raise: It helps build muscle strength to give support to the weak joints. Lie on the floor. Twist your left knee, foot on the floor. Keep the right leg straight, toes pointed up. Tighten your thigh muscles and raise your right leg.
Quad set: With these, you don't raise your leg. Just tighten the thigh muscles, also called the quadriceps, of one leg at once. Begin by lying on the floor. Keep both legs on the ground, loose. Flex and hold the left leg tense for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Cushion squeeze: This move strengthens your legs from the inside so that they can support the knees. Lie on your back, both knees facing inwards. Place a cushion or a pillow between the knees. Press your knees together, squishing the cushion between them. Hold for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Heel raise: Stand tall and hold the back of a seat for support. Lift your heels off the ground and rise on the toes of both feet. Hold for three seconds. Gradually lower both heels to the ground. Do three sets of ten repetitions. 

Knee Pain - How Physiotherapy Can Heal Knee Pain?

Spondylolisthesis refers to the condition which affects your spinal bones or lower vertebrae. Due to this condition one of the lower vertebrae overlaps the bone directly beneath it. Although a painful condition, it can certainly be treated with both surgical and therapeutic methods.

People with spondylolisthesis often find it difficult to perform routine activities. They usually encounter symptoms such as- persistent pain in the pelvic region, lower back; stiffness in the legs, hamstrings and hip muscles.

What causes spondylolisthesis?
The causes of spondylolisthesis can vary with lifestyle, heredity and age. Children may develop this condition due to an injury or birth defect. Nevertheless, people belonging to all age groups are susceptible to spondylolisthesis if the condition is genetic.

Over exercise or strenuous physical activities can cause spondylolisthesis because over stretching and carrying heavy weight or strain puts too much stress on the lower back.

Participating in sports like football, gymnastics, weightlifting are likely to trigger spondylolisthesis.

Spondylolisthesis can also be triggered due to sondylolysis. The vertebrae safeguard the spinal cord and work with tendons, ligaments, joints and muscles to provide flexibility, structure and support to the neck. Any sort of damage or wear and tear in the protective cartilage and bones in the neck can lead to cervical spondylosis, which in turn leads to spondylolisthesis.

What is the treatment for spondylolisthesis?
Treatment of spondylolisthesis depends on the severity of the pain. While non-surgical methods help ease the pain, a surgery is recommended when the bone has slipped to such an extent that your spine doesn t respond to medications.

Non-surgical treatment includes the following-

Taking anti-inflammatory drugs like ibuprofen to ease pain.
Practicing a few physiotherapy exercises to reduce lower back pain.
Use of minimally invasive Epidural Steroid Injections (EPIs) to get relief from lower back pain and pelvic pain caused by inflamed spinal nerves. When over-the-counter medications fail to treat tSpondylolysthesishe condition or ease the symptoms, then a surgery is inevitable.
Discectomy- It is a surgical procedure that makes small incisions to remove a part of the damaged disc to relieve pressure from the surrounding spinal cord or nerve root.
Laminotomy- This refers to a minimally invasive procedure that removes a part of the lamina which is the upper surface of the vertebra. This process is used to create more space within the spinal canal.
Foraminotomy- With this method excess bone tissues are removed so that they don t make the foramen narrow and compress the nerve root. Removing these extra tissues reduce back pain and ease symptoms triggered by nerve compression.
Medical attention is crucial for countering symptoms of spondylolisthesis. Although this condition may not seem life-threatening, if left untreated, it can lead to chronic, persistent pain and permanent nerve damage.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Spondylolysthesis - A Condition Which Affects Your Spinal Bones!

Don't wait any longer, manage your Knock Knees online with a Lybrate doctor today

Consult for Knock Knees - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES