Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

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

Gout: a brief idea

In the simplest of words gout can be defined as the inflammation of joints due to continuous accretion of urate crystals. An excess of uric acid can make a person suffer from gout. There could be a higher percentage of uric acid in a person's blood due to two chief reasons; an inept excretory system that fails to rid your body of surplus acid and also greater production of the acid. Arthritis is of three kinds; gout is one of those three. Homeopathy is known for its efficacy in treating gout. 
   
Homeopathic remedies for gout:
1. Urtica urens can cure gout: This homeopathic medicine is prescribed by a professional practitioner if the person is susceptible to cold. Urtica urens can work on a patient if he or she is allergic to snow,  air, touch and water. Hive like eruptions on your ankles, wrists, and shoulders can be treated through regular consumption of this medication.
   
2. Ledum can relieve you of pain: A painful, swollen area that develops on the small joints such as the joints of your toe fingers can be cured with the use of Ledum. The sensation of shooting pain in your limbs or feet can also be dealt with Ledum. Apart from that swollen small joints can be given momentary respite by falling back upon the cold compression therapy. Patients are advised to take this medicine if they exhibit intolerance to external warmth. 
 
3. Lycopodium is effective on sore joints: Chalky deposits of urate can be found in a person's knees. This results in chronic gout. Chronic gout has symptoms like limited urination. The urine may or may not have red sediments. People have also been reported with symptoms like extreme backache. Lycopodium successfully cures cases of unceasing gout.
     
4. Try out benzoic acid for a big toe: If your gout is accompanied by stinking yellow urine you probably need Benzoic acid. Gout could be so severe that it might result in a stiff limb. In certain cases it makes a person limp. The thumb of your feet might get swollen making you have a big toe. A big toe usually kills you with tearing pain.
    
5. Arnica deals with bruises: Arnica is your go to solution in case of a throbbing, stinging pain in any part of the body. This medication is a cherished answer to aches in every household. When gout is tender and it hinders free movement, this medicine comes to your aid. The medicine also heals bruised eruptions.

Homeopathy and Gout

Your knee is a very complex structure consisting of bones, ligaments, cartilage, tendons, muscles and meniscus. Most people encounter knee pain at some point in their lives. If your knee pain is chronic in nature, then it may last for a prolonged period.

Many causes may be responsible for your knee pain. Some of the causes are stated as follows:
1. Your knee is very much prone to injuries. Knee injuries may happen due to accidents, falling down carelessly or while playing sports. The most common knee injuries that may be the cause for your knee pain are mentioned as follows: 
a) Fractures may cause you to feel pain in the areas of your knee bones.
b) Anterior Cruciate Ligament injury (ligament injury caused by twisting and a sudden motion) or Medial Collateral Ligament injury (injury to the tissue in the insides of your knee) is very common to sportspersons and may be the reason for severe knee pain.
c) Sometimes your knee bones may get dislocated from their usual alignment. This can also make you experience severe knee pain.
d) Ligament injuries, meniscus tear or tendon tear can also be responsible for your knee pain.

2. Sometimes pain in your buttock or foot region can also result in mild knee pain.

3. At times chronic problems like osteoarthritis that affects the cartilage can cause the problem of knee pain. Other chronic problems like Gout, rheumatoid arthritis can also cause severe knee pain.

4. Being overweight can also result in knee pain.
The symptoms of knee pain may be different in each case. The most common symptoms are mentioned below:
a) Stiffness of knee
b) Swelling of your knee
c) You may also feel unstable
d) Difficulty in walking or bending of your knee.
e) You may notice redness in your knee area.

Knee pain must not be ignored. It is highly recommended for you to seek advice from an orthopedic as soon as you encounter any of the above mentioned symptoms.

Suffering from Knee Pain - Know What Causes it? 

Fibromyalgia is a condition characterised by extreme muscle pain that is followed by weakness, fatigue and issue with the state of mind. It is believed that fibromyalgia causes painful sensations by affecting the way your mind forms pain signals.

Indications now and then start after a physical injury, surgery, disease or critical mental anxiety. In different cases, side effects progressively show after some time with no single occasion that triggers it.

Here are some coping methods you can use to help yourself live well with fibromyalgia:

Minimize stress and tension in your life. Stress may play an essential part in activating fibromyalgia side effects and its symptoms. Many individuals with fibromyalgia tend to feel on the edge, anxious, and inactive around the time when the side effects fibromyalgia flare up.

Exclude yourself from unpleasant circumstances. People tend to amplify issues, making them appear to be far more prominent than they are. When you think of something to be a last chance situation, despite the fact that in reality, it is not, your body responds as though you are at risk. Work at treating your feelings as problems come by.

Make worksite adjustments. To continue working full-time, you should stay rationally and physically ready to handle your employment obligations. To keep away from stress and tension, you may need to give additional time during the day to complete your personal needs and sort out your problems. Converse with your manager and work out a timetable that allows you to manage your time.

Coordination. Coordination is important with an unending condition like fibromyalgia. Transparent conversations diminish the problems amongst you and your companion, family, friends and colleagues.

Figure out how to say no. Failing to say no to excessively numerous requests will make you overburdened. That will add to your anxiety level. To help yourself say  no  to a convincing companion, consider the circumstance before you reply and also think about the time you will be saving.

Keep a diary. Writing in a diary consistently can turn into a great channel for analyzing yourself and your situation. A few people can also figure out when their fibromyalgia symptoms started. That can help them see how and when the symptoms began.

Take a hot shower. Take a hot shower, a hot tub bath, or a steam bath. To begin with, it will help you to unwind the muscles that are tense. It will also decrease the pain and make your muscles more flexible and effortless to move.

Exercise frequently. As per physiotherapists, exercising routinely is vital to get rid of fibromyalgia. In light of the pain, delicate muscles, continuous weakness, and stiffness felt by individuals with fibromyalgia, many have turned out to be physically unfit. Hence, all of the above-mentioned treatments are very important in order to stay fit.

How To Deal With Fibromyalgia?

The entire humanity is now used to a fast paced, stressful life without time to think about their physical and mental health. Your body can adapt to this kind of lifestyle for a while. After which, one fine day, it might breakdown, with or without warning. Emotional stability is lost, and physical trauma is felt, and everyday activities may seem to be scary. Yoga comes to the rescue for all your problems. Be they physical or mental.

The real essence of Yoga lies around improving the life force at the base of the backbone. It attempts to achieve holistic goodness through various physical and mental workouts. Coming to the physical level, the procedures comprise of several postures or yogic asanas which can keep the body healthy, while on the mental level, there are some breathing techniques which helps in disciplining the mind. The benefits of Yoga are almost endless, and this is the reason why it has received international acclamation even when it had originated in India centuries ago.

How can Yoga aid you to live a better life?
No matter whether you are from the West or East, regular practice of Yoga can will offer tons of benefits which include:

Improvement of flexibility: This is the most significant benefit of Yoga where you can improve your posture with each practice sessions. Inflexibility can bring about a lot of movement issues; tight hamstrings can flatten the lumbar spine while tight hips can cause strain to the knee. Daily Yoga can relieve the connective tissues while improving posture.
Builds muscle strength: Strong muscles are not just meant for making you look good; it can protect you from conditions such as back pain, arthritis and falls among aged people. With regular practice of Yoga, you can see your muscles becoming stronger and flexible within a short span.
Prevention of joint and cartilage breakdown: While practicing Yoga, all the major joints of the body runs through a roller coaster of motion. This can prevent degenerative arthritis and squeeze the parts of the cartilage which are not usually used.
Improve the health of the bone: Several postures of Yoga demand you to bear your own weight such as the downward and the upward facing dog which also helps in making the bones in the arms stronger. Plus, Yoga is known to lower the cortisol levels which can boost the level of calcium in the bones.
Protection of the spine: The spinal disks which help in absorbing shock crave for movement through which they get the nutrition. Yoga can get you optimum backbends, twists and forward bends to keep the disks in a supple condition.
How has Yoga helped in improving health condition?
Timothy McCall, MD, wanted to come to India to research and investigate on the benefits of Yoga in 2002. Weeks before that he developed tingling sensation along with numbness in his right hand. He was scared and thought that it was something serious like multiple sclerosis or a brain disease but found that he had a nerve blockage in the neck and chest.

Even though it was incapacitating to some extent, this ailment was a blessing in disguise as he could allow Yoga experts to evaluate the cause of the problem and treat it and his experiment reaped benefits. He practiced Pranayama which is a breathing exercise, different moves and chanting to restore vital energy to the affected parts. This had not only helped him to get rid of these problems but also made his body even more flexible, improved his postures and relieved him of various symptoms.

Basic Yoga asanas that can help maintain health 

Sukhasana
Shavasana
Balasana
Vajrasana
Bhujangasana
Trikonasana
Uttanasana
Pashcimottanasana
Eka Pada Rajakapotasana
Ushtrasana
More real life examples can be cited where people suffering from chronic illness have gotten a complete relief by practicing Yoga. Across the world, this ancient Indian therapy has been acknowledged as an effective alternative therapy. If you wish to discuss about any specific problem, you can consult a doctor.

Yoga - Practice It Daily For A Stress Free Life!

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