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 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!

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

Myths about Total Knee Replacement

Myth#1 - Knee replacement is a surgery for old people. “I’m too young for a knee replacement.”
Fact - Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. Living with a painful joint that prohibits you from working or participating in normal life activities is an outdated way of thinking. Age is not necessarily a limiting factor. Often times, a patient is actually fearful about the uncertainty of surgery. Once they are able to resume many of the activities they enjoyed before the surgery, with increased mobility and with less pain, they are very happy they had the surgery. The quality of life one achieves by living without knee pain is priceless.

Myth#2 - “I should wait as long as possible to undergo knee replacement surgery” 
Fact - You don't need to suffer by waiting until the pain is intolerable. The longer life of joint replacements enables people to consider surgery earlier and at a younger age. Osteoarthritis is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficult. Delaying surgery lowers a patients’ quality of life not only before the operation, but even for up to two years following surgery.

Myth#3 - “I should continue with medications as long as possible”
Fact - Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration  etc. All these medicines are NOT curable.

Myth#4 - Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain.
Fact - Till date there is NO cure for advanced knee arthritis and these alternate therapies are not backed by established scientific data. All these modalities give temporary pain relief in early to moderate arthritis for some duration only and are NOT curative. Often times, a patient who is actually fearful about the uncertainty of surgery lands up trying these in order to avoid surgery. 

Myth#5 - After a knee replacement, it takes months to recover.
Fact - Depending on the activity, most patients who undergo knee replacement are able to perform routine tasks within a few weeks. A return to rigorous activity takes only a few months. One becomes independent for himself before discharge from hospital. There’s no prolonged best rest required after the surgery.


Myth#6 - After knee replacement, I’ll have to give up some activities and sports.
Fact - You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks. It will take a bit longer to return to more rigorous activities and contact sports. Squatting and sitting cross legged though possible but at best should be kept to minimal.

Myth#7 - Knee replacement surgery leaves a large scar that is noticeable.
Fact - Scarring is minimal compared to traditional surgery. In fact, the scar is typically only 3 to 5 inches long. As time passes, the scar will fade and become less noticeable.

Myth#8 - Knee replacement is a very painful surgery. There is lots of pain in post operative period.
Fact - With modern day pain management such as in a multimodal approach, ensures that the patient does not feel any pain in post op period and has a smooth recovery.

Myth#9 - Knee replacement is done one at a time.
Fact - Both the knees can be operated at the same time if the patient does not have significant co morbidities and is deemed fit to undergo the procedure by the doctor.

Myth#10 - The new knee lasts for 5-6 yrs. only.
Fact - With modern day precision including computer assisted knee replacement and advancement in biomaterials, the survivorship has increased considerably. Today's joint replacements last 25 years or longer and, for most people, will last a lifetime.

Myth#11 - Knee replacement cannot be done a second time.
Fact - Knee replacement can be done multiple times what is called as a revision joint replacement surgery with good survivorship.

Myth#12 - “I am obese, I cannot undergo Knee replacement surgery.”
Fact - Knee replacement can be successfully done in an obese patient though the recovery is somewhat prolonged and might require additional implants. However, patients who are morbidly obese and have restricted mobility primarily due to obesity are better off after a bariatric procedure.

Myth#13 “I have diabetes or hypertension or heart ailment, so  I cannot undergo Knee replacement surgery.”
Fact  - diabetes hypertension or heart.



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.

 13 Myths About Total Knee Replacement (TKR), Busted!

Pain related sleep disruption has affected a large number of people around the globe. Statistics has it that, in India, about 25% of the population suffers from pain-related sleep deprivation. Studies call it  the vicious cycle of pain and sleep  as pain affects your ability to sleep and lack of sleep makes the pain even worse.

Back pain and arthritis are examples of some common pain-related medical disorders. People with these types of chronic pains have reported persistent sleeplessness or have had immense trouble falling asleep.

The following are the primary sleep disorders associated with chronic pain:

Insomnia: It is a medical condition that is characterized by an inability to fall asleep no matter how physically exhausted you are. Insomnia can be acute (lasting for one night to a week) or chronic (that lasts for more than 3 weeks).
Hypersomnia: It is a condition wherein you tend to sleep excessively; in this condition, you will have trouble being awake throughout the day or can fall asleep at any point of time.
Sleep Apnoea: This is a sleep disorder wherein breathing pauses and resumes repeatedly. Risk factors include obesity, age and gender; it is more commonly observed in men. This condition can be chronic with symptoms such as snoring loudly or feeling very tired even after one has had a night s sleep.
Restless leg syndrome: It is a sleep disorder wherein you continuously move your legs while sleeping. However, this condition can also cause you to move your legs even if you aren t sleeping.
Some of the causes of sleep disorders due to chronic pain are:

Pain
Worry and anxiety
Sweating at night
Depression and other mental disorders
Treatment

A pain and sleep disorder should be simultaneous as both the components of it, pain and sleep, are interrelated. Some of the ways people with chronic pain can still have a good night s sleep are:

Limiting caffeine intake
Abstaining from alcohol and smoking, as these disrupt the sleep cycles, thus aggravating the existing pain.
Practicing meditation and other relaxation techniques
Pain killers or sleeping pills can be administered, but only with the doctor s advice.
Hot water fomentation over painful area during night, for better sleep.

Back Pain and Bad Sleep

Panchakarma is an ayurvedic technique which is used to detoxify the body, boost the immune system and restore the balance in the body. Due to lack of exercise and a poor diet, the waste material generated by the body is not effectively discharged. This causes accumulation of toxins in the body that can result in diseases.

Panchakarma can be used to treat and heal the pain in the joints and the spine. There are specific treatments in panchakarma that targets these regions, they are:

1. Abhyanga - Abhyanga is a technique where warm oil is used to cover the entire body. The oil is then gently massaged so that it can penetrate the underlying tissues. It is used to lubricate the joints, muscle toning and to increase blood supply around nerve endings.

 2. Pindasweda - In this technique hot cotton bags consisting of herbs, rice, and sand or medical powder are used to massage the body. This rejuvenating therapy induces perspiration in the body by which the herbs and the heat penetrates into the body. It is used to treat problems of the joints such as gout, arthritis, and sciatica.

 3. Upanaha - A combination of herbal medicine is applied to the affected part and then covered with medicinal leaves. The herbs help in easing the muscles and tendons of the affected part. It relieves pain, reduces swellings and improves mobility in the joint.

 4. Kati vista - In this treatment, medicated oil is pooled into a collar made from dough and then placed on the lower back for a specific amount of time. It strengthens the lower back, lubricates the spine and acts as a muscle pain reliever.

Soothe Your Joint and Spine Pain with Ayurvedic Panchakarma

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

Consult for Neuroanesthesiologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES