29 Sep 2017

Myths About Knee Replacement

Many Patients opt for knee replacement, WHY?

The most common reason to this is a promise to achieve a better lifestyle and movement.A hope of gaining a more active,pain-free lifestyle and the mythical claims sometimes lets the patients go into surgery be living the myths for their well being.

Some look at knee replacement as an ultimate solution and some look at it as something to be avoided if at all possible.

For Indian patients there is a fine line and a perceived interpretation between what’s TRUE and what’s NOT.

 

Here are some of the myth’s about Total knee replacement:

 

1)  Knee Replacement  means replacing the whole knee joint

The thought itself is scary ,it is in fact a misnomer,what really is done is a balancing the deformed tissues and a resurfacing of the degenerated articulation joint surfaces.The rest of the joint recession is the same.Lot of patients are scared of the word TKR because of the literal meaning which is actually a myth.

2) Exercise physiotherapy would severe knee pain and maintenance function with out the need for a knee replacement?

This is a myth in patients with an end stage the arthritis the exercise alone will not maximize the function.A combination of total knee replacement with targeted physical therapy will give the higher functional outcome and pain relief.

3) New technologies improve surgery outcomes

It is a myth and nothing more than a marketing gimmick.The truth is that a small incision does not improve patients perceived outcomes.

4) Advanced implant designs improve patient results

Advanced implants for ex.mobile baring knees,single radius knee or high flex knees,do not improve outcomes as per current literature.

5) Total knee replacement is painful

Its a myth.Advances in pre and post surgical pain management ensure that the patient do not feel any pain during or after the surgery.pain management is a part and parcel of total knee replacement.

6) TKR effects active life negatively

NO it does not,the fact is that it helps patients attain a better life style.Driving,walking and social activities will be much easier and comfortable. It gives you the ability to be on your own rather then being dependent on others for mobilization.

7) Knee replacement patients take long time to recover

This is also a well known concern it is nothing but a Myth..!!

Full recovery can be expected in three to six weeks with truly minimally invasive tissue sparing approaches.in fact most of my patients are ambulatory and do not an do toilet activities independently in 24 to 48 hours after the surgery.

Usually in 3 weeks the patients are able to do basic outdoor activities.

8) Knee Replacement does not lost very long

Some people say it last 10 years or less but it is a Myth.Knee replacement can last a long time,even longer then 20 years.with modern advancements in technology and techniques the knee’s work efficiently then they used to decade ago.

9) New technologies are prefect

Advances in the surgical techniques for ex.computer assisted surgery,navigation,robotics and patient specific instrumentation are some of them,The benefits remain uncertain at this time.This technologies help in implant positioning but an impact on pain and function of the knee has not been proven yet.

Well in a jist computers and robots are controlled by the same surgeon who perform the surgery,needless to say robot will do what it is commend to (food for thought).

To know the truth about the knee replacement the surest way is to talk to professional surgeons who can bust the Myths that have been hunting in short don’t get carried away with the new punch lines every now an then in the industry.

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13 Sep 2017

Solutions for Shoulder Surgery

Shoulder Pain.                                                                                                 

Shoulder pain and injury are common. Your shoulder is the most mobile of all your joints. Just think about how much it can actually move.

The reason for this movement is a very small joint contact zone. This essentially means that your shoulder is quite unstable. That is why your shoulder muscles are so vital to a normally functioning shoulder.

In most cases, if you are suffering shoulder pain it is because your muscles are simply not strong enough or they are uncoordinated.

Luckily, both of these dysfunctions can be normalize after a quality assessment and injury-specific exercises.

How common is shoulder pain?

  • Shoulder pain is a common problem; it is the third most common cause of seeing a orthopaedic surgeon after back pain and knee pain. 1% of adults with new shoulder pain consult their doctor each year and 16-26% of them report of shoulder pain at a given point of time.

How does the shoulder work?

The shoulder is the most mobile joint in the body. The main shoulder joint(glenohumeral joint) is a ball and socket joint with a large ball on a small socket, hence relies on the tough sleeve covering the joint called the capsule to keep it together(provide stability). There are many muscles around the shoulder, which aid in the stability of the joint, but the most important group of muscles are the rotator cuff muscles which form a cuff(rotator cuff) around the ball and help control movements of the joint. The integrity of the rotator cuff muscles are very important for normal function of the shoulder. Shoulder is an important joint as problems with the shoulder could affect your ability to do your normal tasks like personal hygiene, combing hair, washing and day to day jobs around the house. Although shoulder is thought of as non-weight bearing joint a significant amount of force passes through the shoulder on using the arm for lifting objects. The dependence on the shoulder increases as we get old with painful legs, as walking with a stick would be difficult, hence maintaining good shoulder function is important in the short and long term.

What are the causes of shoulder pain?

Shoulder pain can be caused due to various conditions in the shoulder and non-joint related conditions like heart problems (left shoulder), liver problems(right shoulder) and neck problems can masquerade as shoulder problems, hence a thorough clinical assessment is important to get to the right diagnosis and treatment.

When should I be worried of shoulder pain?

Most of the times shoulder pain can be due to problems with the tissue around the shoulder or the problem with joint per se, but sometimes shoulder pain can be due to serious problems which need immediate attention like, cancers, infection or severe damage to the joint. There are some complaints which need to be taken seriously like, fever, weight loss, mass or swelling around the shoulder and any past history of malignancy (cancers), trauma (Injury) or recent convulsion (fits), and sometimes night pain/constant pain would need urgent assessment by an orthopaedic surgeon trained in shoulder surgery. Any swelling/ Skin color change or change in shoulder contour with loss of rotation in the arm or significant change in sensation or weakness in the arm will need urgent attention.

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13 Sep 2017

Anterior Minimally Invasive Hip Surgery

Who doesn’t want to lead a better quality of life, especially after undergoing Hip surgery? Have you ever undergone any Hip surgical procedure which is [patient friendly, less invasive, less painful, muscles sparing (causing no damage to the muscles) and which provides faster recovery??

If not, then read further to know about Anterior Minimally Invasive Surgery (AMIS) and why it is considered as the best.

What makes Anterior Minimally Invasive Surgery (AMIS) the best?

In this type of surgery the surgeon approaches the hip joint from anterior (front) side by utilizing the natural muscle plane and gets excellent access to the hip joint without cutting or detaching any muscles. This results in less bleeding less pain and very fast recovery for the patient.

Is there any evidence that this is a Minimally Invasive Patient Friendly approach??

Though this technique is relatively new in India ,in Europe it has been in practice since 1930s.Many research studies done so far have shown that (AMIS)patient have shorter recovery time  and return to normal function much faster than the traditional  approaches.

In Another research MRI’s done in patients one year after THR (AMIS) had shown AMIS as truly minimally invasive approach as there was no tendon or muscle damage. The Patient’s hip looked great as if they had natural hips.

Is AMIS Safe??Is there a higher complications Rate?

Absolutely no!!AMIS is less complicated because in traditional TOTAL HIP Replacement (THR or THA) dislocation and leg length inequality are two of the more common complications that surgeons experience. The surgeons pre-operatively determine appropriate sizes for prosthetic implants using templates and adjust bone cuts based on static x-ray and do the procedure on the patient positioned in the lateral position without imaging or X-ray guidance.

The prosthesis length is adjusted and the implanted based on the soft tissue tension and the stability of the new hip replacement. Due to this, tightening up of hip joint causes over-lengthening of the leg to gain stability. The end result weekend, detached tendons and muscles causing dislocation due to poorly placed components.

AMIS approach ensures proper positioning, sizing, and placement of the implant as the patient lie flat on their back allowing X-rays for each and every step of the procedure. The end result a perfect hip replacement consistently without any single case of hip dislocation in years. Every time a hip replacement is done, the leg length is close to perfect. There are no precautions like bending or hip flexion imposed on patient after the AMIS as the procedure is stable.

 

 

Why doesn’t every surgeon perform AMIS?

This procedure requires specialization in joints replacement and substantial number of cases to master the technique. A specialist and trained surgeon has many tricks to make the procedure safe and reliable.

This technique is still a new one in India and it takes years for AMIS to gain popularity in India. The surgeons who have been doing joint replacements through the traditional approach find it difficult to shift to this technique through AMIS is beneficial for patients.

What Are The Future Risks And Considerations?

The AMIS approach significantly reduces the risks associated with total hip replacement including leg length inequality, dislocation and intra operative fractures and avoids many potential complications. There are general risks associated with any joint replacement the most common of which includes infection and blood clots-infection rates for total joints are approximately 1% for primary total joint replacement in healthy individuals. Very special state of art operating rooms integrated with modern technology.

How long is the hospital stay?

Patients often go home the next day after the procedure .Patients with some medical conditions are made to stay in the hospital for a few days. Else patients are discharged after 1 or 2 days.

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