Dr. N.S.Shah's Knee & Hip Specialty Clinic(Panacea Specialty Clinic)

Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced by 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.

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 3 months to recover completely from a knee replacement surgery.

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

Hip replacement is a common surgical procedure that you may need if your hip has been damaged due to arthritis, a fracture, or other serious conditions. All of these can make common activities like walking or getting in and out of a chair very painful and difficult. If you are facing the same difficulties despite medications, changes in lifestyle and physiotherapy, it is time to go in for a hip replacement.

Causes of Hip Pain
The most common cause of long-term hip pain and disability is arthritis.

1. Osteoarthritis- This is an age-related problem that causes wear and tear of the hip joint. Usually, older people get this arthritis. What happens in osteoarthritis is that the cartilage cushioning the bones of the hip wears away. The bones then rub against each other leading to hip pain and stiffness.
2. Rheumatoid arthritis- RA is an autoimmune disease in which the synovial membrane in the hip joint becomes inflamed. This damages the cartilage causing pain and stiffness.
3. Post-traumatic arthritis- This arthritis follows a hip injury or fracture. In this the cartilage may become damaged leading to hip pain and stiffness.
4. Avascular necrosis- The lack of blood to the femoral head can cause the surface of the bone to collapse resulting in arthritis.
5. Childhood hip disease may also require this surgery.

Hip replacement- How it’s done?
Hip replacement surgery is one of the safest operations in medicine. The hip is a ball –and –socket joint and in a total hip replacement the damaged bone and cartilage is removed and replaced with metal or plastic prosthetics. Hip replacement surgery is usually performed in a traditional manner or using a minimally-invasive technique. The main difference between the two lies in the size of the incision for surgery.

During standard hip replacement surgery, a patient is given general anesthesia. This is followed by a cut along the side of the hip after which the surgeon moves the muscles connected to the tip of the thighbone to expose the hip joint. Post this the ball portion of the hip joint is removed by sawing off the thigh bone. After this, the artificial joint is attached to the thighbone by using either cement or a special material. The surgeon then removes any damaged cartilage from the surface of the hipbone and attaches the replacement socket portion to the hip bone. Most hip replacement surgeries today are performed using the standard technique however; the minimally-invasive technique, is getting more and more popular. In this, the surgeon makes one to two cuts from 2 to 5 inches long and then carries out the same steps like in the standard hip replacement surgery. The patient may have to stay in hospital for 3-6 days post a hip replacement surgery and has to undergo long-term physiotherapy to attain normal use of the hip joint.

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

Osteoarthritis, although a disorder occurring in old age, can affect young people too. What exactly is osteoarthritis? It is a condition in which the cartilage in the joints, which act as cushioning between two bones, start wearing away. This causes the bones of the joints to rub against each other, thereby resulting in pain, stiffness, swelling, inability to move freely and sometimes formation of bone spurs. Also, the bones become susceptible to more damage because the shock absorbing capacity is decreased.

Causes
The most common cause of osteoarthritis is age and almost everybody will develop some degree of this disorder at some point. However, there are risks of developing this disorder at earlier ages too. The possible reasons are listed below.

1. As already discussed, age is one of the main reasons for the wearing off of the cartilage tissues.
2. Excess weight causes a lot of increased pressure on the joints, especially knees, thereby causing the cartilage to wear out faster, leading to osteoarthritis.
3. Some people develop osteoarthritis in the knee due to inherited abnormalities from previous generations.
4. Women are more susceptible to this disorder than men. Women above 55 years are likely to experience osteoarthritis in the knee.
5. The occupation of an individual can also be a reason for this disorder. Those individuals who have jobs in which repetitive stress to the joints is normal, they tend to suffer from osteoarthritis in the knees earlier.
6. Athletes who are involved in football, tennis, running, etc. are also susceptible to osteoarthritis in the knees. However, regular and moderate exercise helps in strengthening the joints and thereby decreasing the risks of this disorder.
7. People with metabolic disorders, who have excess iron or excess growth hormones, tend to have a higher risk of osteoarthritis.

Symptoms

1. Engaging oneself in a number of physical activities causes an increase in pain, but it gets better with rest.
2. Swelling around the knee area occurs.
3. Joints feel warm.
4. The knee becomes stiff, which occurs most when one has been sitting for a long time.
5. Mobility of the knee is decreased and it becomes difficult to sit and get up after sitting.
6. Crackly and creaking sounds are heard when the knee moves.

There are various treatments of osteoarthritis, but one of the main remedies is weight loss. Doctors recommend certain specific exercises to reduce the pain. For medications, certain anti-inflammatory drugs and pain relievers are suggested. There are many more treatment methods, but these are some of the most effective ones. In case you have a concern or query you can always consult an expert & get answers to your questions!

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:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. 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.

1. 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.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. 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. 

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

You know it’s time for a knee replacement surgery when you can’t walk, move or get up from a chair without pain in spite of taking medications, physiotherapy and following a pain management therapy for a long time. Knee replacement surgery is also known as arthroplasty, and it’s one of the most common bone surgeries around.

Causes of Knee Pain
Most people suffering from arthritis of any kind- osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis are the ones who may require a knee replacement surgery when their condiition becomes severe.
It helps ease pain and helps one move freely.

1. Osteoarthritis- This is mostly caused due to age-related ‘wear and tear’ of the knee joint and usually occurs in people who are older than 50 years. In this condition, the cartilage that cushions the three main bones of the knee wears away. This makes the bones rub against one another, causing stiffness and knee pain. Osteoarthritis is the main reason why people go for knee replacement surgery.
2. Rheumatoid arthritis- In this type of arthritis, the synovial membrane that surrounds the knee joint becomes inflamed. This chronic inflammation then damages the knee cartilage and leads its loss and attendant pain, and stiffness.
3. Post-traumatic arthritis- This happens after a serious knee injury. It can lead to tears of the knee ligaments and bones which leads to damage to the knee cartilage.
4. Loss of blood flow to the bones – osteonecrosis – also may require knee replacement surgery.
5. Those with deformities like knock knees and bowed legs also may require knee replacement.

Knee Replacement Surgery
During this surgery, an orthopedic surgeon removes the damaged part of the knee and replaces it with an artificial metal or plastic joint. This artificial joint is then attached to the thigh bone, the shin, and the kneecap with a special cement-like material.

Different Types of Knee Replacement Surgery

There are four main types of knee replacement surgery-

1. Total knee replacement- This is the most common type of surgery. In this, your surgeon replaces the entire knee including the thigh bone and shin bone that connect to the knee.
2. Partial knee replacement- This type of surgery is performed if arthritis affects only one side of your knee. However, this type of surgery is done only if you have strong knee ligaments. This is performed through a smaller cut than is needed for total knee replacement.
3. Kneecap replacement- This type of surgery replaces only the under-surface of your kneecap.
4. Revision knee replacement- This is a complex surgery which is performed in case you have very severe arthritis.

A knee replacement is actually a knee "resurfacing" because only the surface of the knee bones is actually replaced during the procedure. It is a relatively safe procedure and the patient does not have any side effects. All a patient is required to do is take proper rest and follow the instructions of your doctor. If you wish to discuss about any specific problem, you can consult an Orthopedist.

When your daily activities are limited due to severe pain or joint damage, it is when a joint replacement may be the best option. Joint replacements are done to restore movement and reduce pain. The most commonly replaced joints are the hips and knees. With advances in medical technology and operational expertise, these procedures have undergone major changes in the way they are done. The success rates have also proportionately gone up.

Hip replacement: The hip is a bone and socket joint, wherein the hip joint sits in the femur, which is the thigh bone. This could require replacement either due to a severe injury or due to regular wear and tear with aging. Replacement is considered when non-medical therapies like exercise and painkillers fail to improve the quality of life. In advanced joint replacement, both the ball and socket portions are completely replaced with artificial components (could be metal, plastic, or ceramic).

Knee joint replacement: The knee is a modified hinge joint formed between three bones – the patella (knee cap), the femur (thigh bone), and the tibia (shin bone). The knee can be affected either due to regular wear and tear or as a part of the trauma. When the knee joint is affected, the patient’s ability to move is greatly diminished, and thus requires treatment. If nonsurgical measures fail, then surgical correction is required.

What happens during the joint replacement?

• These are major operations and are done in the hospital setting, with 1 to 2 days of hospitalization
• The operation takes about 4 to 5 hours
• The damaged cartilage or bone is removed and the part is prepared to receive the prosthesis
• Titanium alloy is often used as it has the unique ability to fuse to the bone
• Sometimes, plastic or ceramic is also used
• These simulate the movement that was previously produced by the natural joint
• Post operation, infection control is extremely important
• Pain control initially could be through injection, and then gradually move to ad-hoc basis
• With the pain and limitation on movement gotten rid of, the new joint should be gradually accustomed to movement. The surrounding tissue also requires time to heal and support the normal movement.
• Return to movement should be gradual and under a physiotherapist’s guidance. Advance exercise as directed.
• Diet should be modified to ensure the required nutrition is provided for proper healing
• Other equipment like a walking stick, shower bench, handrail, or a walker may be required.
• The first few weeks could require extensive help to move around and get back to normal activities.

Whatever the part replaced, with total joint replacement, these precautions should be adhered to, to ensure complete recovery and successful return to a stage of pre-operative movement. In case you have a concern or query you can always consult an expert & get answers to your questions!

The Anterior Cruciate Ligament or ACL tear is a very common problem with athletes and with people who have an active lifestyle. In fact, this can also be caused by any accident due to sudden movement.

Importance of ACL-

The ACL is the supporting ligament, which runs diagonally from back to front right in the middle of the knee, connecting the femur bone and the tibia, and helps the tibia not to come before the femur. Thus the balance of the knee during back and forth movements and the entire stability of the knee joint is secured by this very important piece of ligament.

What leads to an injury to the ACL?

Here are a few actions that may result in a ligament tear.

1. Sudden stopping while running or slowing down from a fast speed

2. Sudden change in direction

3. Uncontrolled jumping from a height

4. Direct hitting with an object or person

What happens when the ACL is torn?

If the ACL is torn, the stability of your knee is gone, and you feel as if you have no control over the joint. Moreover, it causes extreme pain and instant swelling. Swelling usually appears within 24 hours of the injury.

Treatment of ACL Injury-

Recovery from an ACL tear is possible only after a surgery. Without surgery, the affected will not be able to return to sports or athletics, or may not be able to run and make swift movements again as before. However, to avoid surgery, there are non-invasive treatments for the aged and people who require moving less.

• Non-invasive Treatment: Bracing is one treatment where braces are given to support the knee joint during movement and also to avoid further injury. This is effective for the elderly who need minimum movement and may manage daily activities with a braced knee. Also, crutches add to the support and let the weaker knee get rest. This is followed by physical therapy. But the swelling has to reduce before starting it. Many exercises and controlled movements over a long time help in getting back agility in movement gradually.

• Surgical Treatment: Once the swelling subsides, doctors would plan for an Arthroscopic (Key-Hole Surgery) ACL reconstruction. In this Doctor make a graft of a tendon. This graft is inserted into the joint and fixed in anatomical position in femur and tibia Arthroscopically so that the newly created ACL functions like the natural one. This is the only way to get back the ligament in whole as the torn ligament cannot be stitched. Surgery is done through arthroscope and recovery time is 15 days for resuming day to day activities and 3 to 6 month for resuming sports activities with continued physical therapy after the surgery. If you wish to discuss about any specific problem, you can consult an Orthopedist.

Arthritis is a common musculoskeletal condition that affects elderly men and women. Joint pain, stiffness and inflammation are the most common symptoms of this condition. This pain can get so bad as to affect your movement and leave you unable to do simple things like walking up stairs or even simply turning a doorknob.

Arthritis cannot be reversed but with medication and a few lifestyle changes, your quality of life can be improved.

1. Exercise and weight loss: Though it is difficult to do, losing weight can help relieve the pain of arthritis. This takes the pressure off your joints and increases the range of possible motions. Though exercising may be the last thing you want to do, it can help increase your flexibility and help strengthen your muscles. Aerobics, stretching and strength training are ideal for arthritic patients.
2. Assistive devices: Arthritis can make a person knock kneed or bow legged. Wearing unloading braces, shoe inserts or walking with a cane or shoe inserts can help redistribute your weight and take the pressure of your joints. It can also help relieve pain and prevent arthritis from worsening.
3. Eating right: Some types of food can worsen arthritic symptoms. This includes processed foods like white flour and sugar, yeast, chemical additives, gluten, hydrogenated and trans fats, milk products, caffeine, alcohol and tobacco. Hence, avoid consuming these foods and instead have a diet rich in fruits, vegetables, nuts and whole grain. You could also try alkaline foods like green leafy vegetables, wheatgrass and aloe vera.
4. Massage therapy: A massage not only de-stresses the body, but can also relieve muscle and joint pain by improving blood circulation. Massages also help break up muscular waste deposits and increase the amount of oxygen circulated in the body. This helps transport nutrients to tissues and carries toxins away. Ideally, an arthritic patient should have a massage 2-3 times a week in the beginning and at least twice a month once the condition has stabilised.
5. Supplements: Along with eating healthy, including a few supplements in your daily diet can also help alleviate arthritic symptoms. When it comes to rheumatic arthritis; the anti-inflammatory properties of vitamin C help fight arthritis by promoting bone and cartilage growth and reducing infection. Fish oil is rich in Omega-3 fatty acids that help reduce inflammation, Vitamin D is another supplement that helps relieve arthritic pain by helping the bones absorb calcium faster and preventing further loss of cartilage. If you wish to discuss about any specific problem, you can consult an Orthopedist.