Orthopaedics

You and your doctor may consider knee replacement surgery if you have a stiff, painful knee that makes it difficult to perform even the simplest of activities, and other treatments are no longer working. This surgery is generally reserved for people over age 50 who have severe osteoarthritis.

Once you are under general anesthesia (meaning you are temporarily put to sleep) or spinal/epidural anesthesia (numb below the waist), an 8- to 12-inch cut is made in the front of the knee. The damaged part of the joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal or plastic artificial joint. The artificial joint is attached to the thigh bone, shin and knee cap either with cement or a special material. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

Minimally invasive surgery has revolutionized knee replacement surgery as well as many fields of medicine. Its key characteristic is that it uses specialized techniques and instruments to enable the surgeon to perform major surgery without a large incision.

Minimally invasive knee joint replacement requires a much smaller incision, 3 to 5 inches, versus the standard approach and incision. The smaller, less invasive approaches result in less tissue damage by allowing the surgeon to work between the fibers of the quadriceps muscles instead of requiring an incision through the tendon. It may lead to less pain, decreased recovery time and better motion due to less scar tissue formation.

Currently this less invasive procedure is performed by only a small percentage of orthopedic surgeons in North America. Researchers continue looking at the short-term and long-term benefits of minimally invasive versus traditional knee replacement surgery.

The average hospital stay after knee joint replacement is usually three to five days. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is relieved when the new gliding surface is constructed during surgery.

After knee joint replacement, people are standing and moving the joint the day after surgery. At first, you may walk with the help of parallel bars, and then a walking device — such as crutches, walker, or cane — will be used until your knee is able to support your full body weight. After about six weeks, most people are walking comfortably with minimal assistance. Once muscle strength is restored with physical therapy, people who have had knee joint replacement surgery can enjoy most activities (except running and jumping). 

After knee replacement surgery, you are usually sent home or to a rehabilitation facility, depending on your condition at that time. If you are sent to a facility, the average rehabilitation stay is approximately seven to ten days. If you are sent directly home from the hospital, your doctor will usually have a physical therapist come to treat you at home. Your doctor also may have you go to an outpatient physical therapy facility as the final stage of the rehabilitation process. Outpatient therapy may last from one to two months, depending on your progress.

Remember, every person is different and the course of rehabilitation will be determined on an individual basis with the assistance of your doctor and physical therapist.

After knee replacement surgery, you should not pivot or twist on the involved leg for at least six weeks. Also during this time, when lying in bed, you should keep the involved knee as straight as possible. Kneeling and squatting also should be avoided soon after knee joint replacement surgery.

Your physical therapist will provide you with techniques and adaptive equipment that will help you follow guidelines and precautions while performing daily activities. Remember, not following the given precautions could result in the dislocation of your newly replaced joint.

The following tips should make your recovery at home easier.

• Stair climbing should be kept to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day.
• A firm, straight-back chair is extremely helpful in adhering to these joint precautions. Recliners should not be used.
• To help avoid falls, all throw rugs should be removed from the floor and rooms should be kept free of unnecessary debris.
• Enthusiastic pets should be kept far away until you have healed.

You should ask your doctor before returning to such activities as driving, sexual activity, and exercise.

Knee joint replacements have been performed for years and surgical techniques are being improved all the time. As with all surgeries, however, there are risks. Since you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent this.

Infection and bleeding also are possible, as are the risks associated with using general anesthesia. Other less common concerns that you and your doctor must watch out for include the following:

• Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems.
• Nerves in the knee area may be injured from swelling or pressure and can cause some numbness.
• Other bones may be broken during the surgery, which may require a longer hospital stay.
• The replacement parts may become loose or break.

When joint replacement procedures were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85% of the joint implants will last 20 years or more. Improvements in surgical technique and artificial joint materials should make these artificial joints last even longer.

Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.

During standard hip replacement surgery, you are given general anesthesia to relax your muscles and put you into a temporary deep sleep. This will prevent you from feeling any pain during the surgery or have any awareness of the procedure. A spinal anesthetic may be given to help prevent pain as an alternative.

Best hip replacement surgeon in Varanasi UP ,will then make a cut along the side of the hip and move the muscles connected to the top of the thighbone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with a saw. Then an artificial joint is attached to the thighbone using either cement or a special material that allows the remaining bone to attach to the new joint.

The doctor then prepares the surface of the hipbone — removing any damaged cartilage — and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.

While most hip replacement surgeries today are performed using the standard technique (one 8 to 10 inch cut along the side of the hip), in recent years, some doctors have been using a minimally-invasive technique. In the minimally-invasive approach, doctors make one to two cuts from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery.

The small cuts are thought to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing.

However, it’s important that the surgeon be highly skilled in this technique. Research has shown the outcomes with minimally-invasive approach may be worse than with standard hip replacement surgery if done by a doctor who is not very experienced with this technique.

Since there can be some blood loss during hip replacement surgery, you may need a blood transfusion, so you may want to consider donating your own blood before the procedure.

You will likely stay in the hospital for four to six days and may have to stay in bed with a wedge-shaped cushion between your legs to keep the new hip joint in place. A drainage tube will likely be placed in your bladder to help you go to the bathroom. Physical therapy usually begins the day after surgery and within days you can walk with a walker, crutches, or a cane. You will continue physical therapy for weeks to months following the surgery.

For anywhere from six to 12 months after hip replacement surgery, pivoting or twisting on the involved leg should be avoided. You should also not cross the involved leg past the midline of the body nor turn the involved leg inward and you should not bend at the hip past 90 degrees. This includes both bending forward at the waist and squatting.

Your physical therapist will provide you with techniques and adaptive equipment that will help you follow any of the above guidelines and precautions while performing daily activities. Remember, by not following your therapist’s recommendations you could dislocate your newly replaced hip joint and may require another surgery. Looking for Orthopaedic Surgery Hospitals in India? Now go through list of Top 10 orthopaedic surgeons in Varanasi,

Even after your hip joint has healed, certain sports or heavy activity should be avoided. The replacement joint is designed for usual day-to-day activity.

There are a few simple measures that you can take to make life easier when you return home after hip replacement surgery, including:

• Keep stair climbing to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day.
• Sit in a firm, straight-back chair. Recliners should not be used.
• To help avoid falls, remove all throw rugs and keep floors and rooms clutter free.
• Use an elevated toilet seat. This will help keep you from bending too far at the hips.
• Keep enthusiastic pets away until you have healed completely.

You should ask your doctor before returning to such activities as driving, sexual activity, and exercise.

Hip replacements surgery has been performed for years and surgical techniques are being improved all the time. As with any surgery, however, there are risks. Since you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent blood clots from occurring. Infection and bleeding are also possible, as are risks associated with using general anesthesia.

Other less common concerns that you and your doctor must watch out for are:

• Your legs may not be of equal length after the surgery.
• You must be careful not to cross your legs or not to sit too low because the joint may be dislocated.
• Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems.
• Nerves in the hip area may be injured from swelling or pressure and can cause some numbness.
• The replacement parts may become loose, break, or become infected.

Talk to your surgeon about these risks before undergoing the procedure.

When hip replacement surgeries were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85% of the hip joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these implants last even longer. If the joint does become damaged, surgery to repair it can be successful but is more complicated than the original procedure.

Joint injuries which look normal on x-rays but keep on hurting for more than 2 to 3 days may be
ligament and muscle injuries. Though they seem to be not very serious but a long period of
persistent pain and soreness keeps on troubling the person. The common injuries are

The knee is a joint which is very prone to testing injuries. These may occur during fall from
motorcycles to twist during sports, fall and slips from stairs or uneven surface. If after a knee injury
which looks normal on an X-ray the knee keeps on hurting, remains swollen, feels unstable or gets
locked it may be a sign of ligament injury. These injuries can range from simple sprains to complete
tears of the 4 main and 2 accessory ligaments. Sometimes a painful or locked knee may be due to
a torn meniscus which would also look normal on an Xray.

Ankle is a joint very prone to injuries commonly after an episode of slip or twist. The first episode
may be recent or an event which had occurred some time back. The common symptoms are pain
around the ankle or foot on long walks or exertion. Sometimes people may complain of frequent
twists which itself may be an indicator of a torn ligament.

Commonly occurs after unaccustomed sports or exertion. It is very common during a new activity
to which the body is not used to for a long time. Sometimes a new sports or exertion in the gym
can cause this problem. The pain is usually localised in the lower back and does not radiate down
to the legs. Soreness starts immediately after bending, after a few hours or after a nights sleep.
People must be aware that any pain which persists for more than 1 ro 2 days needs a review from
an expert.

The shoulder is a joint which is the most used and has the maximum range of motion. It is frequently
injured in people who play racket sports or who are doing heavy weight exercises in the gym. The
shoulder pain is a nagging problem and may persist for weeks or months. The X-rays are usually
normal. The pain begins in the last part of extreme rotation or movement. Scratching back or taking
the hand behind the head is difficult and painful. If it persists for long the pain may start to radiate
down to the arm or can lead to a stiff shoulder often called frozen shoulder.

Whenever a pain is severe or persists more than 2 to 3 days an opinion from a sports injury expert
is advised. After a thorough history and examination X-rays are needed to rule out bony injuries. If
the X-rays are found normal an MRI is advised. An MRI helps in picking up ligament sprains, tears,
muscular or tendon ruptures, meniscal or labral injuries. Mild sprains or partial tears may heal and
recover by a regime of rest, ice, support, medicines, exercise and gradual rehabilitation. This
may seem tedious but is the best way of a natural recovery but needs close follow up with your
doctor and physiotherapist. Large tears, ruptures or dislocations may need surgery which is now
possible on a day care basis with arthroscopy.

Arthroscopy has revolutionised joint surgeries. Not only it helps in accurate diagnosis of the
problem by real time visualisation but also helps in performing complex reconstructions on a day
care basis. A fine 4.5mm arthroscope is inserted in the joint under local or regional anesthesia first
for looking inside and confirming the problem. The entire surgery can be performed with fine
instruments which enter into the joint through another similar small incision. Torn ligaments and
tissues can be reconstructed, loose and torn fragments obstructing the joint can be removed. Even
bone avulsions with associated ligament avulsions can be arthroscopically fixed.

It is a very common surgery usually done on a day care basis through fine key holes. The entire
surgery is bloodless and done under regional block. The patient can be operated and sent home
on a day care basis. The common surgeries done are:

Anterior cruciate ligament reconstruction (ACLR)
Posterior cruciate ligament reconstruction (PCLR)
Medial patella femoral ligament reconstruction or repair (MPFLR)
Medial colateral repair or reconstruction
Lateral and postero lateral corner repair and reconstruction
Combined ACL PCL
Combined ACL PCL MCL LCL injuries
Meniscal trimming and repair
Loose body removal

The devices or implants used can range from titanium to bio composite material which can gradually
allow natural bone / tissues to replace it

It is frequently done for shoulder dislocations and rotator cuff tears. These injuries are troublesome
and may not resolve with simple medicines or exercises. The surgery is again a key hole surgery
done under anesthesia. The patient can be sent home in a day or two. The post operative
rehabilitation can be done at home . Like knee arthroscopy surgery the devices used are
biocompatible and usually do not need removal.

The wrist and elbow conditions like arthritis, stiffness, tennis elbow etc can be managed well with
arthroscopy. The are all done under local or regional anesthesia and are day care procedures where
the patient can be sent home the very same day.

Usually any pain, stiffness or instability which is persistent and does not resolve with medicines and
rehabilitation would need a detailed consultation with a sports injury expert. The problems are
discussed and a diagnosis is made based on history and examination. It can be confirmed with an
MRI. Many of the MRI findings are incidental or may not be related to the problem that you have as
it is a very sensitive tool and the report has to be analysed by your doctor. After a trial of
rehabilitation which fails to give good result or if you are a very active person a surgery may be
advised and done after a thorough understanding of the procedure.