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

Pelvic pain is generally referred to as the pain in the lower abdominal region. Pelvic pain might be acute, sudden, or chronic, recurrent, cyclical in nature. It may present as central or lateralized pain and might spread to the thighs and buttocks. Pelvic pain might be an indication that something is wrong with the internal reproductive organs located in the pelvic region such as ovaries, fallopian tube, uterus and vagina in which case occurrence of pain may be related to particular time in menstrual cycle.

Pelvic pain can be indicative of a pelvic infection or related to the pelvic bones/spine problems.

Also it may indicate that there is something wrong with the digestive system or urinary system.

Causes-

The causes are as follows:

Pelvic pain occurs commonly in disorders of the internal reproductive organs such as ovarian cysts or pelvic inflammatory disease (where in sexually transmitted bacteria spread through the reproductive organs and cause infection) or pain during ovulation.

Pelvic pain might also occur due to endometriosis (a form of disorder where the endometrial tissues that are located inside the uterus tend to grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus tend to grow within the uterus), , pelvic adhesions or ectopic pregnancy (when the fertilized egg gets inserted somewhere else other than the main uterine cavity),

Pelvic pain can occur due to bladder disorders, kidney stones, infection in the urinary tract, constipation, flatulence,inflammatory bowel disease, irritable bowel syndrome and chronic hernia.

It can also be a symptom in some cancers such as ovarian cancer, colonic cancer, advanced ovarian , endometrial and cervical cancer.

The following symptoms might occur along with pelvic pain:

Sustained pain in the hips and the groin

Sudden fever

Severe pain while urinating , passing stools or during sexual intercourse (dysparuenia)

Vaginal bleeding or vaginal discharge .

Blood in stool

Severe menstrual pain ( dysmenorrhoea)

Repeated instances of constipation or diarrhoea

Increase In pain with stress and physical movements

Investigations-

The Gynaecologist will do physical examination including bimanual internal examination. Also, complete blood count, urine for microscopy, vaginal swabs if discharge, stool examination. Ultrasound examination of the pelvis is an important investigation.

Treatment-

If the pain is gynaecological and depending on the cause doctors might suggest different therapies. In cases where pain is due to an ovarian cyst or endometriosis, doctors may prescribe birth-control pills. In cases of suspected pelvic infection, antibiotics are prescribed. Also, laparoscopic surgery might be advised in cases of acute pain due to cyst, endometriosis, or pelvic adhesions: for confirmation of diagnosis and excision or removal of cysts and endometriotic implants and division of adhesions respectively. In some cases of chronic pain, the gynaecologist may manage the case with inputs from gastroenterologist and pain consultant.

Causes and Symptoms of Pelvic Pain

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease, commonly called PID, is an infection of the female reproductive organs(uterus,fallopian tubules ovaries &cervix). PID is one of the most serious complications of a sexually transmitted disease in women: It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

Causes

Pelvic inflammatory disease (PID) occurs when bacteria move from the vagina or cervix into the uterus, fallopian tubes, ovaries, cervix
Most cases of PID are due to the bacteria that cause chlamydia and gonorrhea. These are sexually transmitted infections (STIs). The most common way a woman develops PID is by having unprotected sex with someone who has a sexually transmitted infection.

However, bacteria may also enter the body during some surgical or office procedures, such as:

 	Childbirth
 	Endometrial biopsy
 	Insertion of an intrauterine device (IUD)
 	Miscarriage
 	Therapeutic or elective abortion

Symptoms

Signs and symptoms of pelvic inflammatory disease may include:

 	Pain in your lower abdomen and pelvis
 	Heavy vaginal discharge with an unpleasant odor
 	Irregular menstrual bleeding
 	Pain during intercourse
 	Low back pain
 	Fever, fatigue, diarrhea or vomiting
 	Painful or difficult urination

PID may cause only minor signs and symptoms or none at all. Asymptomatic PID is especially common when the infection is due to chlamydia.

Other symptoms that may occur with PID:

 	Bleeding after intercourse
 	Chills
 	Fatigue
 	Frequent or painful urination
 	Increased menstrual cramping
 	Irregular menstrual bleeding or spotting
 	Lack of appetite
 	Nausea, with or without vomiting
 	No menstruation
 	Painful sexual intercourse

Diagnosis

 	Pelvic ultrasound. This test uses sound waves to create images of your reproductive organs.
 	Endometrial biopsy. During this procedure, a small piece of your uterine lining (endometrium) is removed and tested.
 	Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Pelvic Inflammatory Disease (PID) - Causes, Symptoms & Diagnosis Of It!

It is very challenging to find operative treatments for chronic pain that offer improved daily functioning. Spinal Cord Stimulation is an excellent pain management method that can be used for patients when their neck or back pain cannot be treated by surgery or other options.

Each year more than 14,000 patients undergo the spinal cord stimulator transplant. The procedure comprises of mild electrical stimulations to the spinal cord. This modifies the nerve activity reducing the pain sensation or sensitivity that reaches the brain.

Neurostimulation therapy recommended by doctors is very effective, especially for chronic pain sufferers. The benefit of this proven therapy is that the pain experienced by the brain is minimized to a great extent. The therapy was designed only after observing how pain is managed by the brain. The therapy approved by the FDA is used to treat the pain caused due to nerve damage in the legs, arms and in the trunk. Spinal cord stimulation for chronic back and neck pain is provided to patients in pain management centers. The staff taking care of patients in these centers are specialized and trained in pain relief -how it occurs and best ways to treat it. Injections are also used to ease the pain.

How to treat back Pain?
Probably the worst pain an individual can experience is back pain, in some cases so severe that it hampers daily life. The treatment options that are used for treating back pain include electrical stimulation to the back and medication to the spine. The most common reason for spinal cord stimulation is failed back surgery. The pain related to the following conditions can also be alleviated through this therapy, scarring of the protective layers of the spinal nerves, painful inflammation and arachnoiditis.

Devices Used for Spinal Cord Stimulation
The devices used for spinal cord stimulation are available in several types but they comprise mainly of three parts. The pulse generator with a battery, a lead wire with 8-32 electrodes and a hand-held remote control that is useful in adjusting the settings of the device, and to switch it on and off. Electrical pulses are delivered to the spinal cord through the electrodes. It is very important that the procedure is carried out by doctors who specialize in pain management or by neurosurgeons.


Spinal Cord Stimulation For Chronic Back And Neck Pain!

A neck strain and sprain is not a serious injury. However, they can still cause significant dysfunction and pain.
Causes of Neck Strain
The anatomy of the cervical spine is such that it not only houses, but also protects the spinal cord. Along with this it supports the head and allows it for mobility and motion. But this area, which allows the spine to be flexible can also leave it vulnerable for injury.

Triggers for the onset of neck muscle strain can be:

1. Too much time spent in an uncomfortable position, such as humping over the steering wheel while driving, bending over the computer monitor, talking on the phone while placing it in the crook of the neck.

2. Sleeping on a very high or too firm pillow can lead to an uncomfortable position of the head thus leading to the strain of the neck

3. Carrying heavy objects on one side of the body

4. Any trauma that might have impacted the neck, such as an accident, whiplash or a fall that might have had a head landing

Most events of a neck muscle strain or the soft tissue sprain, such as the tendons and ligaments lead to stiff neck along with pain in shoulders. There is also pain and difficulty in moving the neck or head.

Neck muscle strain remedies

Minor strains in the tendons, ligaments and muscles of the neck usually heal within a day or two. But till the symptoms subside, there are a few self care remedies that are effective in reducing the stiffness and pain. These are:

1. Application of cold or ice packs: The cold reduces the inflammation, which in turn allows the strain to heal. This ice pack should be applied for 20 minutes interval in the first 24 hours.

2. Application of heat: Heat helps in bringing the nutrient rich blood to the affected area in order to stimulate a healing response. Moist heat as well as heat from a hot shower or bath can be used. Some people might find relief from applying heat wraps such as thermacare.

3. Over-the-counter or OTC medications: Anti-inflammatory medication, such as naproxen and ibuprofen reduces inflammation, thereby leading to the reduction in pain. Pain relieving medicines such as acetaminophen can also be taken as this reduces the perception of pain.

4. Massage of the affected area: A gentle massage in the affected area helps in stimulating the blood flow of the area which in turn helps in a quick healing.

What You Need to Know About Neck Sprains and Strains

If there is a recurrent pain in the lower pelvic and the lower abdomen region of the body, chances are you might be suffering from pelvic pain. In women, severe pelvic pain can be a warning sign of some internal damage in the reproductive organs (ovaries, fallopian tube, uterus, and vagina) present in the pelvic region or the digestive system of the body. Although not common in men, pelvic pain might be indicative of an infection or severe pain in the colon region or the pelvic bones. Pelvic pain might be acute or chronic in nature and the pain might spread to the thighs and buttocks of the body.

The causes of pelvic pain differ among the genders, which are as follows:
1. For women, pelvic pain can be an indication of more serious disorders in the internal reproductive organs such as uterine cancer, cervical cancer, ovarian cysts, ovarian cancer and other pelvic inflammatory diseases (when the sexually transmitted bacteria spread to the reproductive organs and causes infections).
2. In women, pelvic pain might also occur due to endometriosis (a disorder wherein the internal endometrial tissues grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus start growing within the uterus), severe pain during ovulation and miscarriages.
3. The causes of pelvic pain in both men and women include sexually transmitted diseases, a disorder in the pelvic region or the bladder, kidney stones, urinary tract infection, colon cancer, and chronic hernia.

If you suffer from the following symptoms, chances are you might be suffering from pelvic pain:
1. Severe pain in the hips and the groin
2. Sudden fever along with the presence of blood in the stool.
3. Severe menstrual pain
4. You might feel severe pain while urinating or in the middle of a sexual intercourse
5. Bloody vaginal discharge might be indicative of pelvic pain in women
6. Recurring episodes of constipation or diarrhoea
7. Pain resulting from stress and intense physical movements

Treatment
If the pain is chronic, doctors might suggest prescribed a dosage of birth-control pills, antibiotic (especially for blood in the stool and pain due to infection) and anti-depressants. In extreme conditions, the doctor might prescribe laparoscopic surgery (operation by making minor incisions performed far from the actual source).

Can Severe Menstrual Pain be a Sign of Pelvic Pain?

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