Dr. Rakesh G. Nair Nair

Humans are prone to much more complex and extensive experiences in life than any other animal species, this is because we also enjoy highly developed cognition and mental abilities in comparison to the other species. However, our cognitive abilities also mean that we are more prone to bad experiences and health issues that may require intensive treatment or even at times surgeries.

Having to undergo a surgery may sound like an exceptionally difficult or painful prospect, but with the help of modern medical practices and the use of state of the art technology and equipment, there are times when patents are able to get excellent results. One among many such advanced practices is the use of minimally invasive spine surgeries.

There may be times when we may injure ourselves or may develop health issues that make it difficult for us to go about our daily lives and at such times a surgery on the spine may be required. It is however, risky to carry out a full-fledged surgery on the spine because of the fact that our movements in general and the central nervous system may be put at great risk when the spine is tweaked or worked with. This is one of the biggest reasons why modern medical practitioners suggest and prefer carrying out the minimally invasive surgery.

Understanding the practice:
In order to be able to develop a conviction for the practice, it is important to make sure that you understand the practice in general. As the name suggests, the surgery is done in a manner in which large incisions are not made on the spinal region and the procedure is done only by the creation of a small hole. The surgery is carried out with the use of non-conventional tools that can be manoeuvred through smaller openings and the process is carried out with the help of a small incision around the spinal region.

Advantages of the minimally invasive surgery:
As opposed to the regular open surgery, there are a lot of advantages for the patients that opt to undergo the minimal surgical procedure.

1. The biggest advantage is that the patients are able to recover much sooner and the pain is also cut down to a minimal level because of the surgical opening being so small.
2. The muscles that get affected due to the surgery heal much faster and they do not have any long term side-effects which is much more common in a conventional surgical procedure.
3. The chances of damage to the spine are cut down to a great extent because it is minimally exposed during the surgery.
4. Finally, the time taken for the procedure and the after care is also brought down because of the simplicity of the surgical procedure.

As we step into an era of advanced medical practices, it may be important to quickly adopt and adapt to the new age practices so that a better future for patients may be carved out and established all across the world. If you wish to discuss any specific problem, you can consult an orthopedist.

We may be lost in progression and may have a lot to achieve in life, there may be things that we just cannot let go off, such as success and in such a rush for advancement and success we may be overlooking health in the bargain. Though we may not realize it, but as age progresses, the health takes a toll and the disease fighting and sustenance abilities of the body also start to decline. One of the most common problems that a lot of people go through is the weakening of the bones.

There may be instances, particularly in women, where they may feel fatigued and tired and this is something that most women may ignore so that they may be able to concentrate on the other aspects of life. However, more than often, the problems that the women face are known to be symptoms of health issues such as Osteopenia. Osteopenia is a problem of the bones where they gradually lose their natural ability to make sufficient amount of calcium necessary for the health and safety of the bone structure and when the problem takes a sever turn it may lead to osteoporosis.

Knowing the symptoms:
The problem of osteopenia may not have obvious symptoms in the beginning but people who suffer from the problem may complain of the following issues:

1. A lot of people may experience lower back pain when they are suffering from osteopenia.
2. The back pain may also arise from the hunching of the back which is another symptom of the health issue.
3. There have been instances of patients suffering from lowering of the height when they are suffering from the bone related issue.
4. The fracturing of bones becomes more likely for people who suffer from the problem.
5. Lots of people may also end up losing teeth due to the issue.
6. One of the biggest symptoms is that the patients of osteopenia usually also develop osteoporosis in the advanced stages of the issue.

Treating Osteopenia:
Though there is no confirmed cure for the issue, it is possible to be able to control the problem and limit its ill-effects or symptoms. With a revision of dietary habits to include foods that help in the increase of calcium you may be able to control the problem to a great extent. It may also be possible to keep the issue under check by following healthy lifestyle habits such as quitting smoking or following regular exercise routines or taking the right treatment or medications as suggested by a specialist. Sometimes a disease can be a result of an underlying illness that you are unaware of, which is why self-diagnosis or treatment may not be advised and it is always wiser to take help from your physician. If you wish to discuss about any specific problem, you can consult an Orthopedist.

You might be an elite athlete or just a commoner. There is always a possibility for you to develop back pain while carrying out your daily activities. You might not be aware, but regular activities such as sitting at the computer, running on the treadmill or simply crawling into your bed for a good night sleep can affect the health of your spine. You are always at the risk of damaging your spine, these damages lead to back pain. It has been found that faulty postures can cause back pain by causing straining of the back muscles, injuring the tendons and damaging the vertebrae or ligaments. Back pain can be caused due to the overuse of a particular activity or for undertaking a new activity.

However, it is often very difficult to pin point the exact reason behind the occurrence of back pain. Here are the common causes for back pain:

1. The screen trouble: You are likely to develop back pain, if you spend long hours sitting in front of the commuter. Researchers believe that spending nine hours or more a day by texting on smart phones or tablets or typing on the computer is dangerous. You must take break at regular intervals while working on the gadgets to avoid back pain. Your monitor of the computer should be placed at the level of your eye.
2. You skip the core exercises: The health of your spine depends on the core regions of your body as well. The core region includes your back, side, pelvic, and buttock muscles. It is important that you practise the core exercises like lunges, squats, and planks. They help in strengthening the muscles around your core region and keep your spine healthy.
3. Improper sleep pattern: Your sleeping pattern is as much important as your walking or sitting pattern, when it comes to the health of your spine. If you sleep on your stomach, pressure is placed on joints and muscles. This may cause straining of the muscles or ligaments in the spine region.
4. Smoking: Cigarettes are not just unhealthy for your lungs or heart, they are equally bad for the spine. Cigarettes contain nicotine. Researchers have found that nicotine hampers the flow of blood to vertebrae and disks in between the spine. Insufficient supply of blood to the spine region results in low absorption of calcium by the bones in this region. Therefore, you end up developing back pain.
5. Blame it on your emotions: Back pain adds to your emotional stress. But believe it or not, the reverse is equally true. Depression and emotional stress increases or sometimes even initiates back pain. When an individual is depressed, his or her glands releases stress hormones known as cortisol. This hormone causes the muscles in the back region to tense up.
    

Bones play a significant role in our body. They make our structure and help in organ protection, anchoring the muscles and storing calcium. From childhood to adulthood, bones are continuously changing. While new bones are generated, the old bones are torn down. So, it is important to keep our bones healthy with the advancement of old age. There are many ways by which we can avoid unhealthy bones in old age. Some of these ways have been discussed below:

Adequate amount of calcium intake in our body greatly influences healthy bone with good bone density and mitigate the risk of osteoporosis and bone fractures in old age. Older adults need 1,200 mg of calcium a day by having milk, yogurt or cheese. We should also include non-dairy products like tofu, broccoli, almonds, and green leafy vegetables. These items contain Vitamin D, which help the body in absorbing and process calcium. Good sources of calcium are dairy products and fish such as sardines and salmon.

According to the Institute of Medicine, 1,000 mg of calcium a day is needed for most adults and 1,200 mg/day for women after menopause and men after 70. Adults that are 70 years and older require 800 IU of vitamin D a day to in order to prevent falls and fractures.

Physical Activity: Physical activity reduces the risk of osteoporosis and keeps your bone mobility healthy and strong. According to research, avoiding use of tobacco and alcohol contributes healthy bones. Consumption of these poses threat to the health of the bones. Alcohol increases the risk of osteoporosis as it has the ability to interfere with the body’s absorption of calcium.
Eating disorders and other conditions: People with anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn's disease, celiac disease and Cushing's disease can affect your body's ability to absorb calcium. So, one should have a healthy diet and maintain a disciplined life.

Certain medications: Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, are damaging to bone. Other drugs that might increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications, such as phenytoin (Dilantin) and phenobarbital, and proton pump inhibitors. So, while taking medicines one should consult doctor so as to avoid those medicines for long term which affect bone’s health. While taking these medications one should eat adequate amount of calcium as medicine and food in order to minimize the side effects.

Avoid taking caffeine as it makes our body to excrete calcium more quickly. So drink less regular coffee, tea and soft drinks and avoid high caffeine energy drinks. Avoid using salty foods that causes loss of calcium and weakens the bone. Foods that are processed and canned have high salt, so avoid eating these foods.

I am Dr Rakesh Nair. I am an exclusive knee replacement surgeon. Today I am basically going to talk about how to prevent damage to the knees by doing the right type of exercises.  So, the topic today is going to be Osteoarthritis and Osteoporosis. How are they interconnected? How are both important in terms of treatment?

Let us start initially with Osteoarthritis. What do I mean by Osteoarthritis? 

Osteoarthritis means a worn out joint. The same knee which has souls start wearing out as you get older. Therefore, it is called a Primary. So, whether you have a problem at some age or not, this pain is going to happen to you, whether it happens at 25, 35, 40, 45 years. It might also happen at the age of 75 years. Most of my patients are going for surgery between the age group of 75-85 years. So here I am going to show you the right forms of exercises where your knee can last for the lifetime. So, we are looking at an average of 8 spans of 80-85.

So, will your knee last long?

The chances are very less because the present data says that the 80% of the general population has artificial knees because we are out living our knees. We are living much more than our knees can last.

What is Osteoarthritis? means what exactly happens to the joint?

The knees are made up of bones which are a thigh bone which is on the upper side and it is covered with the fine layer of the cartilage which is hardly 1 cm. The same thing is with the bone which is the Shin bone which is the lower part, again which is covered with the cartilage. Between these layers, we have a lubricant fluid connecting both the legs on the side we have strong ligaments which hold the joint together.

What exactly happen in Osteoarthritis?

In Osteoarthritis, the same cartilage which you see starts wearing out. There are small pieces which start wearing out. The joint which straight started getting bent which either like a bow like a deformity or a knock knee deformity depending on how strong or how weak your muscles are. When a  straight knee finally become bent then we have to look for some surgical options.

What are the symptoms of pain in the knee?

The first and the foremost symptoms are when a patient feels pain while climbing and getting down from stairs. So this is the first sign of Arthritis when you get to know that your knee is wearing out. Then they complain of pain, swelling. In the advanced stages, we will see the patients with bent knees, either bent inwards or outwards.

Today, I am going to tell you that can we prevent this damage?

For this, I am going to stress on exercise protocols for strengthening. Now, you need to understand that there is a difference between cardiac training and muscle strengthening. Most patients believe in walking as an exercise. But I would say that walking is the main form of exercise if not balanced properly with strengthening is going to cause wear and tear on the knees.

First, you need to strengthen the muscles which are there in the front and the back of the knees. So we are talking about strengthening the cardio steps and about strengthening the hamstrings. I would be giving you the practical demonstration of how we can do the same. 

These are the normal exercises which I ask 70 years old individuals to do.

• Initially, the patient is lying down and push the knees downwards. Neeche dabaav daalo or thoda dheela karo. Push down and relax and do it till the count of 50. So, this is the basic first exercise you should do when you start any other exercise. 
• The second exercise is leg race. This should also be from 5-50 counts. When you can comfortably do 50 counts at a time then we start the same in sitting posture.
• Lie down with the face down and start bending the alternate knees upwards and then release. This is what you would do for a hamstring strength

So these are the exercises which you can do from the age of 20 years to 80 years. Depending on the muscle strength, you can gradually increase the intensity of an exercise and take it to the next level.

If you are able to strengthen your knees simultaneously as you increase your cardio activity, that would be the best form without any damage to your knees. Another thing is that if you can balance your cardio in terms of saying that if you could do cycling, swimming, walking or running and balance all 25% of your work out when you are working out in the gym. So when you are going to the gym, the first thing should be doing is not going to the tread mill, you should start with the cycling as it is non-weight bearing exercise. Do it for 10 minutes, gradually as you warmed up you can do cross stepper and lastly, you can go to the tread mill. That is the commonest mistake when we talk about cardio. Tread mill should not be the primary exercise when you go to the gym.

Maximum work can get by the trainers in the gym because most of the times you end up doing squats and crunches. Basically, your lower body is not that strong to take the whole grant of the weight. So, I would suggest that if you are 35, 40, 45 years and if you are little heavy in the upper body then please do not start with free hand squats.

First, do the machines. On machines, you can do leg extensions, hamstrings and press rings. And when you start feeling that your lower body is capable of taking weight then start doing squats and lunges. And if you are going to avoid it, it will not make much difference, you can increase your muscle strength in terms of your leg extension and hamstrings.

Running can cause irreversible damage to the knees after the age of 40-45. The 25-year-old individual can run because at the young age, the cartilage has the tendency for the recovery. But after the age of 35 years, there is degeneration. If you want your knees to stay healthy between the age of 35-80, then you need to take care good care of it.

Let me give you some tips on running.

It is important that you wear good running shoes while running and walk on a good walking track. Avoid walking on the roads. Please try to walk on the grass or a mud track. Because walking on the road may cause nerve stress. 

Before you start indulging into exercise, I would suggest you to have blood tests of  Calcium, Vit- D3 and Vit- B12. You will be surprised, when you are deficient in either of these and you are going to take the exercise to the next level, then you will face some damage. Only if the reports of these blood tests are normal then only take your exercise to the next level. Otherwise, there will always the chance of injury.

I always ask females to do basic bone density along with the blood tests which I told you previously. Maximum damage to the female body is done during menopause. But if your basic density of Vit- D3, Vit- B12 and calcium is normal then you will suffer from least damage even after the menopause.

All the above mention tips will definitely help you.

For further information, you can contact me through Lybrate.

Osteoporosis is a disease of the bones. It occurs when the mesh-like structures present inside the bones becomes thin. This is a condition in which the bones become extremely fragile and have a tendency of breaking easily. The broken bones cause extreme pain. There are artificial medicines available in the markets for treating this condition. However, treatment of osteoporosis can be best done by the naturally produced Parathyroid hormone (PTH).

It is secreted by the parathyroid glands in our body. It is an 84-amino acid polypeptide. The most interesting thing about PTH treatment is that it actually builds new bones. Other medications for osteoporosis only reduce the rate of loss of bones. PTH helps in increasing the amount of calcium in body. It also prevents bone loss due to osteoporosis. It is often considered to be an anabolic agent. If an osteoporosis patient is given low doses of PTH, his or her bones get strengthened. It also helps in increasing the bone mass.

Why a doctor recommends PTH for osteoporosis? Is it better than other drugs?
Traditionally, bisphosphonates were used to treat osteoporosis. However, it has been observed in a number of cases that bisphosphonates only help in slowing down the loss of bone density. However, PTH increases bone mineral density. Therefore, it is a better option for the treatment of osteoporosis. It is usually given to patients who have extremely low bone mass. It has been found effective in cases where other medications failed to show results. Moreover, it also works for postmenopausal women.

Doctors believe that it can also be used for treating men with osteoporosis who are at high risk for fracture. It improves the microarchitecture of the bone and can do wonders in altering the bone size. Moreover, it has lesser side-effects on the health of the patient. It is known to cause dizziness and nausea and no major discomfort. It has also been noticed that patients who are being treated with PTH develop less back pain. These are also cost-effective for the long term treatment of osteoporosis.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Knee replacement is a surgery wherein an artificial joint is used to replace a diseased, damaged or worn out knee. This surgery is common among people who fall in the age group of 60-80, but recent trends seem to suggest that younger people are opting for this surgery as well. The lifetime of the artificial knee joint is around 20 years, provided the knee is well cared for.

Why do you need Knee Replacement?

Most common reason is “high grade osteoarthritis” due to wear and tear of the knee joint. The pre-hospital study of the Knee joint is mandatory and would decide what kind of Replacement is suitable to the patient. If there is diabetes or hypertension associated with this, then it should be controlled well before undergoing surgery. Hemoglobin of at least 10 gm% is required.

If the mobility in your knee joint is reduced leading to impaired functioning of the knee joint, then you might need a knee replacement surgery. You may experience pain while walking, sitting and, in some cases, resting as well.

Some of the common reasons why you may opt for this particular surgery are:

1. Gout, where, small crystals are formed inside the joint.
2. Rheumatoid Arthritis, an autoimmune disorder, wherein the immune system of the body attacks the body’s healthy tissues.
3. Hemophilia, wherein, the blood ceases to clot normally.
4. Injuries to the knee
5. Disorders that cause unusual bone growth (bone dysplasias)
6. Death of bone in the knee joint following blood supply problems (avascular necrosis)
7. Knee deformity with pain and loss of cartilage
8. Unusual growth of bones in the knee joint

Knee replacement surgery is classified into:

1. Partial Knee Replacement: In this surgery, only one part of the joint is replaced.

2. Total Knee Replacement: Total knee replacement surgery involves replacement of both sides of the knee joint.

The usual hospital stay period is around 2-3 days after the surgery is completed. Initially, you will require the help of crutches to walk for at least 2 months. You may also be asked to do gentle knee strengthening exercises. It may take up to two years to recover completely from a knee replacement surgery. If you wish to discuss about any specific problem, you can consult a orthopedist.

Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Why is it done?

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have moderate or severe knee pain at rest.

The Procedure

The procedure begins with you being administered general anesthesia, after which, an incision of 9-12 inches is made on the knee. The part of the joint that has been damaged is gotten rid of, following which the surfaces of the bone are redesigned to hold an artificial joint. Cement is used to attach the artificial joint to the shin, knee cap and the thigh bone. Once the fitting is complete, the artificial joint is supported by the surrounding muscles.

Results

For most people, knee replacement provides pain relief, improved mobility and a better quality of life. Consult a doctor about what you can expect from knee replacement surgery.

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car and if you have enough muscle control to operate the brakes and accelerator.

After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

Aftercare

The duration of the hospital stay is around 2-3 days. The effects of the surgery start becoming noticeable within a month of the surgery being carried out. Initially, you may require walking aids. It takes about 5-6 weeks to regain your ability to walk without any external or physical support.

You will have to undergo physical therapy after the surgery to improve your muscle strength. The physiotherapist may prescribe various exercises to strengthen the muscles around the knees. You need to follow certain precautions after the surgery; squatting and kneeling become certain activities which you should avoid. Avoid activities that places undue stress on the knees.

Benefits of Bilateral Total Knee Replacement

I am Dr. Rakesh Nair. I am an exclusive knee replacement surgeon practicing at Zen Hospital in Chembur. I am also attached to the Fortis Group of Hospitals at Vashi and Mahim and Holy Family Hospital at Bandra. Today, I am going to talk about Bilateral One Stage Total Knee Replacement. To understand the basic term which I have used here when I say Bilateral One Staged, I say both knees and one sitting. They are done together once the patient is wheeled in. They are not done in a gap of a few days. That’s what I mean by both knees and one sitting.

In the surgery, all we remove is hardly 7-8 mm of bone from the thigh bone and around 7-8 mm from the shin bone, that is the lower part and all we do is just change the cap. It’s like changing the cap of a tooth, so your bone and your muscle are your own. We are not chopping off the whole knee and replacing it. So, that is the reason why I am using the terminology Knee Resurfacing, we are changing only the cap.
Once the cap is changed, we are able to mobilize the patient, the same evening if required. And, with the advanced anesthesia techniques that we have, I am able to make the patient walk the same evening. So, there are some videos here also which would tell you the same where the patient has been operated in the morning by around 12 o’clock once he or she is wheeled out the operation theatre. In another four hours by 4 o’clock evening, the patient is walking with full weight on the leg without much pain because of the pain techniques that we in terms of the pain management.

Now, why would I say that we should be doing both knees in one sitting? So, what are the advantages of doing both knees in one sitting? If you see the further videos which I would also show you, most of the patients who come to me have severe deformities. They, like, have severe bow legs, legs which are severely bent, either towards the inside or either towards the outside. So, doing one knee and then doing another knee is not going to help at all because the patient is not going to be able to walk. So, when I do both knees in one sitting it restricts the surgical procedure so it is like saying I do everything under one anesthesia. The patient gets short of medication. The medicines also which go into the body is once you are wheeled into the operation theatre. The most important part is that the patient can be mobilized very easily because immediately both the legs are straight and the patient can walk with full weight bearing on both the legs. So, I can make the patient walk in the evening or the next day depending on how strong the bones and the muscles are. Another thing is, it reduces the hospitalization also, plus the hospital cost also goes down because we don’t double use the medication nor the stay is doubled. The stay is same; it varies between 3-7 days depending on how strong the patient's knees are before surgery. So, I would definitely advocate doing both knees in one sitting.

What are the main advantages and what would you say in terms of why wouldn’t we do a knee after a week or 10 days? There are studies which say that it is not the number of joints, so the number of knees you do in which causes the problem or the commonest cause which is an infection. The problem arises if you keep on wheeling the patient into the operation theatre. So, if somebody says that we do a knee today and then we do a knee after 4 or 5 days then cases of infection will increase because the patient is being wheeled into the operation theatre on two separate occasions. So, it is not that I have not done both the knees in one sitting, which is a better option because the chances of infection are less than doing one knee now and then doing the other knee after 4-5 days, where the patient gets the same medicines repeatedly plus he is bought into the operation theatre again and his stay also increases in the hospital.

We would be showing you some videos where the patient, how the patient is walking before surgery. If you see most of these patients, the legs are severely deformed. So, all of them I have been able to do a One Staged Bilateral Knee Resurfacing where I have done both the knees in one sitting. You see them how they are walking before surgery, you see them how are they are walking after surgery. And, if you compare the function, they are really able to walk very comfortably.

My patients even sit cross-legged after surgery but that is not. I will show you one of these videos which are showing the patient sit cross-legged after surgery. But that is not something which we promote. It is just to show that they get very good function and they would definitely be able to sit cross-legged but that is not something we tell the patient to do because that compromises on the life of the knee. So, there are a lot of records and results which say that, whether we do a Bilateral One Staged Knee Replacement or whether we a One Staged Knee Replacement, the complications in terms of infection, an embolism is always similar. In fact, it is much more in a unilateral knee than in a bilateral knee.

We use body exhaust play suits, again, during surgery. I will show you this video which is showing you the body exhaust play suits where we are working in a very sterile environment. We would not want to give any infection even from the OT personnel to the patient. So, these are body exhaust playsuits which prevent the impure air breath out of the operating team, it is not allowing it to go to the patient. In fact, it is sucked up by a rotating fan which is there on top of the body exhaust playsuits and the whole impure air is taken out from the patient’s atmosphere. Even our conventional methods of mixing cement have been changed and we are using basically vacuum mixing for cement so there again is no impurities in the bowl in which we are mixing the bone cement to fix the implants to the bone.

We have all the options in terms of the knee replacement where we even have computer assisted Total Knee Replacement. We have Unilateral Knee Replacement where basically the unilateral knee replacement is used for younger patients who have deformities or pain in the insides of the knee where only a part of the knee has been damaged, the rest of the bone is all right, that’s where we use the Unilateral Knee Replacement. The latest what we have is the Customized Jigs in Total Knee Replacement where we get the MRI done of the affected knee. On the basis of the MRI, ceramic Jigs are made and on the basis of the ceramic Jigs, the positioning of the implant can be as perfect as required. Obesity has always been, the patient has always come up to me saying, “Doc, I am little on the heavier side, I am so heavy, is it a contraindication to my surgery?” So, obesity as such is not a contraindication to surgery. Definitely chances of wound healing are a problem but, instead of a week to ten days, it will take another week to ten days for healing. Otherwise, it is not a contraindication to the surgery.

Now, a very important question which comes from the patient is, “Doctor, how long will these knees last?” So, I give a very simple answer to that is that, the more you take care of it, the longer it will last. So, the longevity of the knee all depends on how strong your muscles are before surgery, how strong your bones are after surgery or before surgery and depending on that we normally get a bone density done for the patient and we treat the patient either on a yearly injection for osteoporosis or daily injection which are meant to fill up the bone and that decides on how well the implant is going to hold on and how long the life of the knee is going to last.

For further information, you need to contact me through lybrate.com.

 

My mother aged 65 years has severe arthritis of both knees, should she get both knees replaced in one sitting?

You should do both knees in one sitting if the severity is same in both the knees and the patient is unable to differentiate the painful knee. In case the patient says one knee is more painful than address one knee at a lime. Your own knee is always the best till it lasts.

What are the advantages of doing both the knees in one sitting?

• Exposure to the risk of anaesthesia reduced to only once
• Aids simultaneous rehabilitation especially in severely deformed knees
• Bilateralprocedure reduces cost
• Earlier return to baseline function and convenience for the patient and relatives
• Shorter cumulative hospital stays

What are the risks associated with bilateral Total Knee Replacement (TKR) and are there any studies to support the same?

The risks of cardiac and infection related complications for bilateral TKR are lower than the combined risk of two unilateral TKRs. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-Bilateral Total Knee Arthroplasty published in The Journal of Bone And Joint Surgery.

Result: Records were available for 11.445 simultaneous-bilateral arthroplasty Procedures and 23.715 staged-bilateral procedures.

Conclusions: Simultaneous-bilateral total knee arthroplasty was associated with clinically important reduction in the incidence of infection and malfunction within one year after arthroplasty.

What is the latest Technology available which could help improve surgical outcomes?

Custom Fit Knee Resurfacing: A knee with your name on it i.e. customized specifically based on your dimensions.

Understanding Custom Fit Knee Resurfacing: You are unique and so is your individual anatomy and thus lack of accuracy leads to discomfort and even further corrective surgeries That is why Custom Fit Knee replacement surgery, which utilizes MRI (Magnetic Resonance Imaging) technology to create personalized positioning guides for total Knee replacement is recommended.

Practical Benefits Of Custom Fit Knee Replacement

• MRI of the affected knee is done based on which we can make a customized jig for better fitting of the implant for the patients
• No intra medullary instruments so minimal chances of fat embolism
• Minimally Invasive (just a 4-5 inch incision)
• Improves the speed of the operation theater time (40% reduced surgical time)
• Increases implant inventory efficiency (know sizing)
• Faster recovery of the patient
• Perfect patient alignment thus better mobilization

What is the role of body exhaust 'space' suits in Bilateral TKR?

• 'Space' suits maintain a more sterile environment and offer more mobility to the surgeons.
• Space suits are used to help reduce contamination from the operating teams from entering the wounds.
• The impure air exhaled by the operating team is pushed down by the rotating fan in the helmet of space suits and absorbed by the laminar air flow in the 0.T.