Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints.
These surfaces closely replicate the original anatomy.

When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of  people over 50 years when have pain, swelling and deformity fail to respond to medicines, physiotherapy, injections and rest.

Aim of the surgery

    Correct the deformity: Relieve the pain and give near full movements almost immediately after the procedure. Details including techniques and safety, it is a safe, rewarding surgery with a success rate of as high as 99.5% when done by an able and experienced professional.
    Anaesthesia: Usually it is the spinal cord epidural where one is rendered numb for 3 to 4 hours waist down. Sometimes a general anaesthesia is given. A 4 to 5 inches cut is made in front of the knee and all the damaged cartilages, bones, loose bodies are removed from the lower end of the thigh, upper end of the tibia (usually of few millimetres) and the surface re-crafted to match the size and shape of the artificial joint (it is usually imported). They are fixed with bone cement. The ligaments and muscles are reattached and the parts closed.
    Recovery: Stand up and walk a few steps with a walker the day after the procedure i.e. in 24 hours. Physiotherapy in hospital for 5 to 7 days and/or walking, progressively longer walks and exercises over the following 15 days. Stitches are removed in 15 days. The patient can return back to normal activity in 4 to 8 weeks the surgery.
    Activities: Normal walks of 3 to 5 km per day Climbing stairs, cycling, swimming, and driving can be performed with the new implant(s) now.
    Avoid: Squatting/kneeling Prohibited: contact sports like football, cricket, tennis; jumping; adventure sports Longevity of joints: 15-35 years depending on the materials used.

Joint Replacement Surgery - When Should You Go for  it

Yoga is recommended for people with joint inflammation or arthritis. In the case of certain individuals with different sorts of arthritis, studies have shown that consistent yoga practice can lessen joint pain, improve flexibility of the joint and release the stress and strain to provide better rest. Yoga comes with a wide range of practices; however, for the most part, it includes adopting specific bodily postures. It also includes breathing and meditation exercises. 

Some of the yoga postures to cure arthritis are as follows:

Sun salutations: They are the perfect way to begin a day. They can be reflective and calming as you develop the strength to breathe fresh air. Stand with both feet touching, and afterwards, join your hands, palm-to-palm, and place them on your chest. Breathe out and raise your arms upward. Gradually twist backwards and extend your arms over the head. Unwind your neck and breathe in. You must keep in mind that it is one breath for every movement.
Kid's pose and child's pose plus: This is a truly gentle and simple approach to stretch the lower back. Get into the stance by dropping down onto your knees, spread your knees wide and join your toes. Place your hips back onto your feet or heels and stretch your arms forward onto the ground.
Bovine pose (cow pose): Get on all fours with your hands; keep your wrists directly under the shoulders, and spread your fingers wide. Your knees need to be at the hips' width and directly under your hips. Point your abdomen upwards, as your shoulder bones push down towards your abdomen, and tilt your pelvis up and back so that you are sitting.
Furious cat: Turn around the cow pose to do the furious cat pose. From all fours, pull your belliy in and your back arches into a back bend. Point your hips back toward your lower legs to build the space between every vertebra.
Prostrate twisting: Bending should be very useful, but if the bending or twisting brings on any pain, leave it quickly. Lie on your back, draw your knees toward your abdomen, and wrap your arms around your legs, giving yourself a little hug. Shake yourself from side-to-side or forward and backward.
Bridge pose: Lie in a straight position on the floor, twist your knees, and set your feet on the floor. Breathe out and press the inner parts of your feet and your arms into the floor. Push your tailbone up, tighten your hips, and lift them off the floor until your thighs are parallel to the floor. Keep your knees right above your heels and lift the upper part of your hips toward your stomach.

Arthritis - 6 Yoga Positions That Are Beneficial for You

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Osteoporosis is a degenerative condition connected with the bones. In this condition, the bones become absolutely brittle and hollow over a period of time. In normal scenarios, bones usually get broken down and repaired over time. They are known as the living tissue of the body. But when the old bone does not get removed due to the lack of new bone creation, this is known as osteoporosis. This disease can affect both men and women. Many women go through this condition after menopause. Let us find out more about the symptoms of this condition.

Causes: There are a variety of things that cause the painful symptoms of osteoporosis. Hormonal changes that affect the sex and thyroid hormones as well as adrenal and parathyroid glands are known to cause this condition. Also, low calcium intake over a prolonged period, especially after childbirth and during menopause can cause this condition in many women. Further, eating disorders where the patient practices severe restrictions when it comes to food intake, can also have a bearing on the person, which keeps the right nutrients from reaching the bones. Steroids and other kinds of medicines that have been used on a prolonged basis in order to treat cancer, gastric reflux, seizures and to cure transplant rejections, can also lead to this condition. Celiac disease, lupus, rheumatoid arthritis, inflammatory bowel conditions and liver or kidney disease can also lead to osteoporosis.

Fracture: One of the most common symptoms of osteoporosis includes fragile bones that may lead to fractures. Even a minor movement or a fall can cause a fracture as the bones are brittle and hollow. Because the bones are more delicate than usual, these fractures can be triggered easily by an impactful action like a particularly loud sneeze or a persistent cough.
Neck and Back Pain: Compression fractures in the spine are a common occurrence for people who are suffering from osteoporosis. The vertebrae that have collapsed can pinch the nerves radiating from the spinal cord. This can be a very painful condition that goes from tender pain to debilitating sharp pain.
Height: One of the most noticeable symptoms of osteoporosis includes the visible loss of height. A patient suffering from this condition will appear to have shrunk suddenly, in a very mild way. It can cause a condition known as kyphosis, which is basically a stooped back. Owing to this condition, there may be severe pain in the neck and lumbar, or lower back region as well.
Emergency Situation: If you happen to be experiencing debilitating and sudden pain in the hip or wrists or other such areas, then it is recommended to see a doctor immediately as this could indicate a fracture.

Osteoporosis - 4 Common Signs!

Radiology is a special branch of medical science that uses various techniques of imaging for the diagnosis and the treatment of several types of diseases in the body. The different types of imaging techniques used in radiology are X-rays, Computerised Tomographic scan (CT Scan), ultrasound, Magnetic Resonance Imaging (MRI) and nuclear medicine which includes Positron Emission Tomography(PET).

Role played in evaluating hip replacement
Hip replacement surgeries have become extremely common in the recent times, and radiological evaluation remains the mainstay of the overall hip replacement procedure. Thus, the role played by radiology is quite significant in such situations. All the specific anatomical landmarks and the measurements are used to make sure the placement is perfect during the hip replacement surgery. Radiological imaging helps in the assessment of the following conditions that are as discussed below.

The length of leg
The inequality in the length of the two legs is prevalent after a hip replacement surgery which can create a great deal of discomfort and inconvenience to the patients. A greater difference in the length of the two legs increases the chances of dislocation, and this is a situation where radiological evaluation plays a crucial role. With the help of radiological imaging, the length of the legs can be made almost equal.

The horizontal center of rotation
In this case, horizontal center of rotation helps in the assessment of the acetabular component of the prosthesis. This is calculated by the measurement of the distance between the center of the head of the femur and the acetabular teardrop. This distance should be bilaterally equal, and it is just not possible without the help of the imaging techniques of radiology.

Acetabular inclination
The acetabular inclination is the angle formed between the face of the cup and the transverse axis. If the angle is less, then it results in a stable hip, but the abduction is limited. On the other hand, if the angle increases then there are high chances of dislocation of the hip. Thus, with the help of radiological evaluation, proper and effective angular inclination is given which is optimum for the patient.

The stem positioning of the femur
The main aim of the stem positioning of the femur in a hip replacement surgery is placing the stem in a position which is neutral within the shaft. To get a proper idea of the positioning, the imaging techniques are of utmost importance which cannot be achieved perfectly without the imaging.

Thus, the crucial role the different techniques of radiological imaging plays during the overall procedure of a hip replacement surgery can be perceived. With the use of the different imaging techniques, the results obtained are closer to perfection.

How Radiological Evaluation Can Help In Case Of Hip Replacement?

Non-inflammatory pain and tenderness in joints, muscles and ligaments can lead to a chronic condition called Fibromyalgia. It is estimated that it affects 5 % of the population annually. Though there are many conventional medications available to address this situation, none of them focuses on healing the disease from the root. This is precisely where Ayurvedic techniques differ. Let us look at a time tested way to address Fibromyalgia through ancient Ayurveda.

Ayurveda for Fibromyalgia
There are some common symptoms of Fibromyalgia. These include aches and stiffness of the body, generalized fatigue, chronic headaches and migraines, swelling and numbing sensations in the joints. Ayurveda treats a particular disease on the basis of the  vata  imbalance. The condition also affects the central nervous system thus leading to pain and tenderness. Accumulation of Ama or toxins is also the other major factor for Fibromyalgia.

Ayurveda focuses mainly on these two factors and creates a balance in suppressing them. The famed panchakarma therapy and the herbal oil massage can help in reducing the toxin levels. They also work additionally as a detox thus helping in eradicating the harmful by-products. Along with it, a diet plan should also be followed for stimulating the growth naturally. These include vegetables, fibers, and juices of carrot, cucumber, beetroot, spices like cumin, coriander, ginger asafetida and coconut milk.

Also, some limitations are needed, and a person should avoid spicy foods and reduce the intake of caffeine products. Alcohol should be curbed when a person is under the treatment plan. Few herbs like "Dashamula quath" and 'Triphala choorna' are recommended for cleansing the colon. Mental stress is also one of the major factors, and hence a relaxed attitude should be followed along with certain lifestyle changes. Ayurveda wants the body to get the necessary sleep and rest in its treatment plan. In the treatment of Fibromyalgia too, it is no different. The Ayurvedic physician would lay out the entire cycle of the treatment procedure, and they have to be followed religiously. A person can see the reduction in the pain within a few weeks of following the treatment.

Ayurveda is safe
The biggest advantage of an Ayurvedic treatment is that it is extremely safe and that there are no side effects. They effectively act as a detox thus getting rid of the harmful substances from the body along with curing of the symptoms. Ayurveda not only takes care of the pain but identifies the problem from the root. Hence it effectively curbs the chances of Fibromyalgia from reoccurring.

Fibromyalgia - How Ayurveda Is Safe For It?

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