Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:
Relieve pain
Help the hip joint work better
Improve walking and other movements.
Who Should Have Hip Replacement Surgery?
The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:
Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)
Osteonecrosis (a disease that causes the bone in joints to die)
Injury of the hip joint
Bone tumors that break down the hip joint.
Your doctor will likely suggest other treatments first, including:
Walking aids, such as a cane
An exercise program
Physical therapy
Medications.
These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.
The Procedure-
Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.
An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.
An equipment is then used to remove the ball socket of the joint by cutting the thighbone.
The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.
Once the joint is fixed, the ball of the thighbone is then put in the hip socket.
The fluids from the incision area are then allowed to drain.
The hip muscles are then put in place and the incision is closed.
Post -surgery-
After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.
After care-
It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. 

All About Hip Replacement

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

After a tough workout session or a strenuous day at the office, your muscles may feel floppy and exhausted until you have given them a chance to rest. However, persistent muscle weakness with no apparent cause or explanation can be a sign of an underlying medical problem.

What causes muscle weakness?
Voluntary muscle contractions and movement are generated when the brain sends a signal through your spinal cord and nerves to the particular muscle. If there are any hindrances in the connections between them, it can result in muscle weakness. However hard you try, the muscle is such cases becomes abnormal.

Here are some common causes of muscle weakness:

Lack of Use: One of the most common causes of muscle weakness, lack of muscle fitness may occur as a result of a sedentary lifestyle. If the muscles are not used, then the fibers are partially replaced with fat.
Ageing: As we age, our muscles tend to get weaker and lose strength. Muscles become bulky and recovery times during injury are greater. However, with physical activity, it is still possible to increase the muscle power. So stay active and instill strength in your muscles.
Infections: Infections and inflammation can cause temporary muscle fatigue. Even though recovery is quick, if the infection is severe the weakness can last for some time. Without proper care, it can lead to permanent damage.
Pregnancy: During and just after pregnancy, high levels of steroid in the blood and low levels of iron can cause muscle tiredness. Lower back pain is common during pregnancy and all your muscles may feel floppy.
Chronic Diseases: With conditions of diabetes, heart disease, kidney disease and anemia, it can lead to muscle weakness by thwarting the essential blood or nutrient supply to the muscles. Also, chronic pain related ailments cause weakness.
Injuries: Injury or trauma such as sporting injuries, pulls and sprains can deter the muscles. Along with localized pain, it can also lead to muscle weakness if not taken care of properly.
Sleep Disorders: With disturbed or reduced sleep there is a general sense of tiredness that leads to fatigue in the muscles. Insomnia, anxiety, depression and other mental disorders also affect the muscles a great deal.
Conditions affecting Nerves: Conditions like Myasthenia gravis or motor neuron disease affects the nerves and thereby fail to relay signals to the muscles, leading to weakness.
Genetic disorder affecting muscles: There are also certain inherited diseases which can affect the muscles like muscular dystrophy.
Spine-related disorders: Conditions like slip disc and other disorders affect the muscles served by the irritated or compressed nerves of the spinal cord.

Muscle Weakness - 10 Common Reasons Behind It!

A sprain refers to a break or a tear in any of the ligaments of your body. A ligament is a band consisting of tissues that connect the bones at any given joint in our body.

A strain on the other hand refers to a tear or a break in the entire muscle itself or a tendon (the band of tissues that connect the muscle to the bones).

Occurrence
Sprains usually take place due to unforeseen incidents like falls, accidents, and such other things that forces the body part to go out of its normal position. The most common types of sprains that people suffer from are ankle sprains which affect about 25,000 people every day on a worldwide basis.

Strains usually happen when you twist a whole muscle or a tendon. This condition most commonly occurs in cases of sportspersons who are engaged in contact sports like hockey, football, rugby, and such others.

Symptoms
The identification signs of sprains and strains are mostly very similar, which are listed below:
1. Pain and discomfort in the joints
2. Visible swelling or inflammation seen on the joints
3. Bruising of the affected area
4. Tenderness and softness of the affected joint

The overall intensity of the above mentioned symptoms might differ basis on the severity of the condition that is directly proportional to the nature of injury that you have faced. Some pains are so light that it may not affect your daily routine at all, whereas some pains are so intense, that you might not be able to move your affected joint at all.

Treatment
Some of the common methods to cure a sprain or a strain are listed below:
1. Rest the area which is affected
2. Apply ice bags or cold compress to soothe the pain
3. Compress the affected joint using a compression tape
4. Place the affected joint on an elevated area to speed up the healing process

Sprain Versus Strain

Arthritis is a disease that affects the joints, muscles and soft tissues, which cause stiffness, disability and pain. It is one of the complex conditions and has also been discovered in the remains of people living more than 500,000 years ago.

Although it is usually found in people above 50 years, in rare cases, it can affect younger generations as well. The three most common forms are osteoarthritis, fibromyalgia and rheumatoid arthritis. The symptoms of some arthritis, such as rheumatoid arthritis, include the following:

Joints turning red, warm, swollen
Painful joints
Unexplained fever
Fatigue
Weight loss
Swollen lymph glands
These symptoms typically last more than two weeks.

Few facts about arthritis
Most people, even though diagnosed with arthritis, are unaware of the following facts:

Snakes, bees, and ants: After years of treatment, some people have turned to specific natural therapies that come from snakes, bees and ants. As per a study by researchers in Brazil, bee sting venom helps reduce the symptoms of arthritis.
Gout is a form of arthritis: Repeated flare-ups, pain and swelling are the result of uric acid, built around the joints. This can be due to genetic predisposition, some diseases and consumption of excess meat, seafood, fructose-sweetened drinks or alcohol. The bunion joint that connects the big toe to the foot is often affected first in people who have gout.
Children get arthritis too: Juvenile rheumatoid arthritis is the most common amongst children and affects kids between the ages of 1 - 3 or 8 - 12 years. It strikes girls about twice as often as boys. As per a recent survey, 1 in every 250 children globally suffers from arthritis.
Injuries increase the risk of arthritis: Injured joints are prone to develop osteoarthritis (OA). People with knee injuries have six times the chance, while those with hip injuries are three times more likely to develop OA.
Climate cannot cure: People have a misconception that wet, cold climates cause arthritis rather than a warmer climate. Unfortunately, that's not the case. Orthopaedics confirmed the same frequency for both warm and cold climates. However, sore joints find warm atmosphere more soothing.
Obesity increases the risk: Excess weight is one of the primary causes of osteoarthritis, especially for weight-bearing joints like knees, and to less extended hips. But there is also a higher risk to joints like ankles, back, big toes and hands.
Animals can also develop: Not only humans but animals like dogs, cats and others can also develop osteoarthritis. The symptoms are almost the same as the ones faced by a human. It can also lead to a loss of appetite, which can cause weight loss.
Race counts: Both whites and African Americans experience arthritis at similar rates. However, blacks have higher chances of severe joint pain and limitations in activity as compared to whites.
Women are prone to arthritis: Statistics show that women have a significantly higher risk for all types of arthritis except gout. As per the Arthritis Community, Research & Evaluation Unit, women are twofold more prone to arthritis than men.

9 Amazing Facts About Arthritis!

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? 

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