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

Anterior Cruciate Ligament (ACL) injury is one of the most common knee injuries. Athletes who play high strain sports like football, rugby and basketball are more at risk in developing this kind of injury.
The ACL is one of the four primary ligaments in your knee. The injury occurs when the ligament is overstretched.

Signs and Symptoms
ACL happens in steps:
a) First, you might hear or feel in your knee a 'pop' sound
b) Next, you might experience pain and an inability to move or continue with your activity
c) Then your knee will swell up
d) Lastly, hemarthrosis develops

Causes
The ACL injury can happen in various ways. Injury may occur if
1. You change directions quickly
2. You stop suddenly
3. You slow down while running
4. You jump and land incorrectly
5. You are tackled, like in football, through direct collision or contact

Diagnosis
The doctor will use the following tests to diagnose ACL injury:
1. Pivot-shift test: This test is done to check for instability
2. Anterior drawer test: This test is done to check for the suspected tear in the ACL
3. Lachman test: This test more or less resembles the anterior drawer test. It is considered far more superior in diagnosing ACL injury than the anterior drawer test.

Treatment
Treatment of ACL depends on the patient's age and lifestyle. A younger patient, who is involved in sports will need surgery to restore agility. An older patient can heal without surgery.
1. Conservative Management: This is recommended for people who are older and lead a quieter lifestyle. Also if the knee is overall stable, the doctor might opt for this treatment. Bracing and physical therapy is enough in this case. To protect the knee stability, braces are given. Crutches are also used to keep from exerting weight on the injured leg. When the swelling subsides, some exercises are performed. This is part of the rehabilitation program. Exercises will strengthen leg muscles that surround the knee.
2. Surgery: If the patient is young and has a very active lifestyle, surgery is very much needed. There are three surgical methods:
a. Primary repair- this method is not recommended barring bony avulsions, which are typically seen in adolescents
b. Extra-articular repair- generally includes a tenodesis of the iliotibial tract
c. Intra-articular reconstruction- this is the standard treatment for ACL injuries.

All About Anterior Cruciate Ligament Injury

Natural Ways To Manage Arthritis

You might be aware that there is no way that you can prevent arthritis to happen except for being car. But what you can do is delay and reduce the risk of its potential onset. If your joints are healthy now, there is no guarantee that they will always be, unless, you take good care. 

Do you know a few kinds of arthritis can be modified. They are:

1. Gout - Have a healthy, balanced diet which is low in cholesterol, alcohol and sugar. This will help you fight against the onset of gout.

2. Osteoarthritis - To modify the risk factor of osteoarthritis, it is important to maintain a healthy weight.

How to defeat arthritis?

1. Keep a check on your weight: If you are obese, you are putting more pressure on your joints and as a result, they wear out soon. By losing weight, you can make a lot of difference in your joint health.

2. Ensure good water intake: Our body is 70% water. And water is one of those things which is the most important for us. Staying hydrated is very important, even for your joints. Because when the body is dehydrated, and the body needs water, it uses the water stored in our bodies, incl the water in the cartilage.

3. Try to avoid any injury: No one really wants to get injured but it is important to be careful and cautious against injuries of any kind. The more injured your joints are, the more susceptible they are to wear and tear now, and arthritis later in life.

4. Don’t stress with physical tasks: There is a way and correct posture to do them, but many people ignore those and perform the tasks clumsily. This puts additional pressure on your joints.

5. Get Your share of Vitamin D: Vitamin D is very important for us. If your body has adequate amount of vitamin D, then you are less susceptible to arthritis. It is wise to get the levels tested and if low, a doctor consulted for proper medication.

If you would like to consult with me privately, please click on 'Consult'.

From Lybrate: If you found this tip useful, please thank the doctor by clicking on the heart icon below. Also, spread good health by sharing this tip with your loved ones over WhatsApp, Facebook and other media.

Pain- free Arthritis? Here’s How To Make It Happen!

The deltoid muscle is situated around the shoulder joint that makes up the shoulder. It is classified into three parts - front, side and rear deltoids. It is one of the most frequently used muscles in the body, its major functions are abduction and forward elevation of the arm.

Causes
A deltoid strain is a condition where you experience pain and tenderness in the shoulder area due to various causes like overuse of the deltoid muscle. It is very common in weightlifting and various sports such as cricket. It may even lead to partial loss of function in the deltoid muscle. Deltoid strain may be caused due to overworking of the muscle without adequate rest. It may also be caused due to lengthening of the deltoid muscle under stress or direct trauma to the muscle.

There are three types of deltoid strains

Grade 1 deltoid strain: It is characterized by tight muscles with some possible swelling. There may be mild pain when you use your shoulders for any activity.
Grade 2 deltoid strain: This strain is a result of a major injury to the deltoid muscle; there may be visible swelling and pain while carrying out activities that require movement of the shoulder. Lifting your arm to the front or the sides becomes difficult and painful.
Grade 3 deltoid strain: This form of deltoid strain is the most severe of the three; it may cause the shoulders to become immobile. You usually will experience excessive pain and severe swelling. You might not be able to move your arm and carry out any activity that requires the shoulders.
Diagnosis
The diagnosis of a deltoid strain starts with a physical exam where the doctor will understand the symptoms of the deltoid strain. Various imaging tests such as x-rays may be required for the diagnosis. The basic treatment for shoulder strain comprises of the RICE protocol (rest, ice, compression and elevation) which is used to treat grade 1 and grade 2 strains. Grade 3 strains may require surgery in addition to the above treatment methods. In case of excess pain, the doctor may prescribe non-steroidal anti-inflammatory drugs to ease the pain.

All About Deltoid Strain!

When you experience any kind of bone and joint pain, you may be wondering what the best remedy might be to get relief. Some people ignore the pain, and it worsens, while others take over-the-counter medicines. However, the best remedy for bone and joint pain is to visit a pain management specialist. The field of pain management has evolved over the last twenty years. Nowadays, there are dedicated pain management specialists who are experts in treating bone and joint pain.

Here are 3 reasons to consult a pain management specialist for bone and joint pain:
1. Pain management specialists are trained especially for understanding any kind of bone or joint pain. They undergo special training based on bone and joint pain management and thus know how best to recognize and treat such pains.

2. Pain management specialists have a multidisciplinary approach towards treating bone and joint pain. The aim of pain management is to provide overall treatment and pain management specialists know about the best ways to take care of joint and bone pains. Pain management involves interventional procedures, psychological therapies, medication management and physical therapies. Pain management specialists also provide you with lifestyle modification remedies and assign you exercise schedules and diet plans. Alternative medicines like acupuncture and massage therapies are also provided by pain management specialists.

3. Pain management specialists cooperate with you and come up with the best solution for your bone and joint pain. Pain is such an aspect, which has no fixed cure and the remedy varies from person to person and depends on the nature and severity of the pain. Thus everyone should receive a personalized treatment, which is most suitable to cure the pain that has occurred to them. Pain management specialists work with patients, discuss a lot and come up with the best treatment procedure, which would complement the patient. For example, a neurostimulation device can be prescribed to a patient who suffers from complex regional pain syndrome and did not have success with other treatment procedures. In many patients with a shattered spinal disc, pain management specialists prescribe injections, which work effectively to give relief and treat the condition.

A pain management specialist can make the best assessments on bone and joint pain. Being trained especially in bone and joint pain management, you can bank upon pain management specialists to receive the best treatment for your bone or joint pain.

3 Reasons to See a Pain Management Specialist for Bone and Joint Pain

What is Developmental Dysplasia of the Hip?

Developmental dysplasia of the hip or DDH, is a condition that affects the hip joint in newborns and young children. The hip is like a ball-and-cup, formed by the round top of the thigh bone - called the femur - and a cup-shaped socket in the pelvis. The hip joint is stable in spite of its large range of motion and is kept in place by ligaments and other soft tissue structures. The normal infant hip is not mature at birth but develops into a strong and stable joint as the child grows.

What happens in hip dysplasia?

In DDH, the hip does not develop normally as the cup and ball are either partially or completely out of alignment. DDH can vary from mild to severe depending on whether the cup is shallow, soft tissue structures are lax or a combination of all. These problems may cause the hip to become unstable, and even come out of the joint. This is known as a dislocated hip and is believed to occur in around one in 1000 infants. One or both hips can be affected. DDH isn't painful in babies and young children. Untreated DDH can result in limping in young children. This can progress to hip pain and arthritis at a later date.

How common is it?

DDH is more common in girls and first-born children. It's more likely to occur if there's a family history or if the baby was breech. Swaddling or wrapping a baby's legs too tightly can also lead to DDH. Certain traditional practices like wrapping the children, etc. are known to increase the risk, while carrying them with limbs separated apart is known to decrease the risk of dysplasia. All newborns should have both hips carefully examined by a health professional. 

Treatment options

Treatment depends on the child's age and the severity of the condition. Young babies with confirmed DDH are usually treated in a brace or harness that holds the legs apart. This helps the hip socket to deepen and the hip to become stable with growth. Regular monitoring of the hip position is necessary to ensure good outcomes. Surgery may be necessary if brace treatment is unsuccessful, or if a hip dislocation is first noticed when the child is older.

What is the long-term outlook?

Most infants who are diagnosed and treated early do not have any hip problems in later life. Earlier the diagnosis and treatment, the better the outcome, as late diagnosis often requires surgical treatment and can mean a higher likelihood of ongoing hip problems.

Developmental Dysplasia Of Hip - How Common It Is?

Don't wait any longer, manage your Hip Replacement online with a Lybrate doctor today

Consult for Hip Replacement - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES