HIPANDKNEE
Key Surgeries
Total Knee Replacement
This is a common surgery for people with severe arthritis of the knees. However there are innumerous negativities as people have seen complications following operations. Our specialist center is catered to providing this treatment with the important difference of having the only published complication rates in India, and success comparable with the best in the world. There are minor technical details to be taken care of that can be ascertained only after examination of the individual patient. We cater the design of implant to suit the arthritis pattern of the individual patient.
Partial Knee Replacement
Many people get bad arthritis of the knee at a young age. While total knee replacement is offered to many younger patients across the globe, it is better to avoid it when possible in the less than 60 age group. In countries like India where arthritis is often predominant on one side of the knee, partial or ‘Unicompartmental’ knee replacement provides for cure of the patients’ symptoms while allowing a lot more activity for a young patient as compared to a total knee replacement. It can also be easily changed to a total replacement after wearing out, whereas revision of a total replacement is far more complicated surgery.
Revision/ Complex Knee Replacement
Knee replacements should technically last for over 20 years but go wrong earlier for many reasons. That’s why it is important to take utmost precautions the first time and adhere to quality standards. When re- surgery is required, it is usually not the fault of the implant but of the technique or related to infection. Either way, the situation has to be dealt with very carefully. This requires detailed investigations, planning with the appropriate specialists and in the case of infections, often two – stage surgery. Antibiotics must not be randomly given as they can cause problems. Many cases of severe knee arthritis are complex to manage especially when they have been neglected for long and might require specific implants and thereby higher cost. These need to be tackled in a center with the appropriate facilities and surgeons with specialty experience.
Total Hip Replacement
Hip arthritis and replacement is less common in India as compared to knee arthritis. Similarly the conditions causing hip arthritis are often complex and require optimal planning. These also occur in younger patients. However, with proper technical decision making, results of hip replacement have been proven to be much superior and recovery even faster than knee replacement surgery. There are a variety of implant choices with higher longevity in hip surgery. Contrary to Knee Replacement, a well- performed Hip Replacement surgery can potentially last much longer. We hence do not have hesitation in offering this surgery to much younger patients.
Complex/ Revision Hip Replacement
Unsatisfactory joint replacements can become causes for re- do surgery. In the case of hips, failure of surgery can lead to dislocation, unequal leg lengths, fracture and loosening of implants besides causes like infection. Revision surgery is undoubtedly a complex undertaking but success can almost always be achieved in a specially catered center with thorough planning.
Anterior Cruciate Ligament (ACL) Reconstruction
Ligament injuries are common in the knee not only out of sports but also in traffic accidents and in trivial falls especially in ladies. The ACL can rarely be repaired and mostly the body requires a newly created ligament. This surgery is much easier than commonly perceived as it is done without any open wound, with keyhole surgery; one can walk taking full weight on the leg the same day of surgery and do stairs as well as go home the next day. The use of braces after surgery is also obsolete in specialist centers around the world. In many instances such ligament injuries can be managed without surgery too; most required surgeries can also be scheduled as per logistic convenience.
Cartilage Reconstruction
Cartilage loss causes arthritis. If cartilage injury is detected early, further progression can be halted with various techniques. Cartilage can now also be made to grow back if the loss is in patches. There is widespread ongoing research and a lot of marketing, but only some techniques have been certified and approved with promising results in the rightly selected patients. Our comprehensive center is a recognized provider of cartilage regeneration services by ICRS (International Cartilage Research Society).
Arthroscopic procedures
Arthroscopy is not a procedure as commonly termed even by surgeons but rather a means of curing many ailments in joints that cause mechanical problems. The reason for doing and extent of cure can be determined by a thorough examination and chat with patient about their problem, not just by sharing MRI reports as these are often misleading. We routinely do it as ‘day surgery’ where the patients have their surgery and walk out of hospital the same day and thereby get it at cheaper costs.
Meniscus surgery
Contrary to what was thought before, meniscus can be repaired easily in many circumstances and further wear and tear in the knee avoided. Repair surgery however is not as successful if there has been a long time gap between injury and repair and also depends on the type of tear in the cartilage. It is important to note that over a half of meniscal tears happen with other damage in the knee like ligament or cartilage injuries that must be recognized and require adjuvant treatment before pouncing into surgery for meniscus alone.
Knee Injection therapy
There are three basic types of injections: steroids, hyaluronic acid and Platelet rich plasma (PRP) available for use in both the hip and knee joints. All have specific indications on their own to prevent surgery or can be used with keyhole surgery as adjuvant treatment. PRP itself is of different types for use in different conditions. The best for a particular patient can be determined only after careful examination and discussion.
Joint Preservation
A variety of surgical procedures for young people with arthritis come under this heading: realignment, cartilage regeneration, hip decompression and revascularization using bone marrow stem cells, etc. They have to be customized for the individual patient after careful examination and adequate imaging.
hipandknee
Non-operative treatments
Exercise Therapy
Arthritis in the 21st century is considered a lifestyle-related disorder than a specific illness. Lack of physical activities leads to early muscle weakness which in turn is the forerunner of arthritis. Exercise can reduce unnecessary strain on the joints by keeping the muscle in good shape. If diagnosed early it could be completely reversible. Correct techniques and persistence on the part of the patient are important.
Gait training
Abnormal walking patterns due to pain or neglected injury can contribute towards the development and further aggravation of arthritis. An objective assessment of walking provides vital clues to increasing muscle efficiency. We have developed an indigenous device which helps analyse a person’s gait in a simple out- patient setting. As a result of this new technology our approach to rehabilitation is different and more comprehensive. Similarly, such assessment helps patients who have had reconstructive surgeries to re- develop normal walking patterns and achieve quality life- style.
Balance/Proprioceptive training
Faulty posture, altered bone shape and flat foot lead to muscle imbalance and loss of one’s sense of joint positioning. This in turn causes damage to the cartilage surface and thereby arthritis. However, there are only a few centres in India where balance-related problems are assessed and managed. We have got balance assessment laboratory at our centre where this type of problem is addressed regularly and appropriate training given to rectify the issues.
Injury prevention strategy
Various factors can lead to injury during sports. The commonest among those are lack of physical fitness, abnormal bone shape and loose ligaments. Many a time players get into the sports without doing proper warm-ups and stretches. This can negatively impact their performance as well as end up with career-threatening injuries. Hence a thorough assessment by a specialist orthopaedician or physiotherapist is essential before you start your sports career or after you come out from an injury. This helps in proper advice and rehabilitation to avoid further injuries.
Ergonomics – related advice
Most of us have experienced knee pain at some time in our lives. Persisting pains seem to be getting frequent in our younger generations. Lack of outdoor physical activities and exercise due to working from home as a result of the COVID pandemic and the technology revolution have all contributed to this. People hence need education on the importance of proper seating arrangement, use of work equipment and how to conduct their postures over prolonged times.
Footwear modifications
Many people don’t realize they have altered foot shape like flat feet or high arch feet until unless it was told by friends, family or doctors. This is most of the time genetic and can lead to abnormal strain to the foot as well the knees, especially precluding one from exercise or appropriate physical activity. Simple modifications like customized arch support or footwear can solve this problem before it becomes more severe and leads to permanent damage.
Chondroprotectives
Recent advancements have brought forth newer varieties of medications that work towards regeneration of cartilage. These are safe for prolonged use and also avoid the side- effects of traditionally prescribed allopathic medicines. These however need to be carefully prescribed in line with current scientific evidence which is best done by the relevant specialists.
Injection therapy
A variety of injections like Platelet Rich Plasma (PRP), Cell therapies, Hyaluronic acid (HA) and steroids are available for treatment of early surface damage or early osteoarthritis (EOA). These could be undertaken as outpatient procedures or in combination with Arthroscopic Cartilage or ligament reconstruction for enhanced results.
In some conditions like Avascular Necrosis of the Hip joint (increasingly seen post- COVID), Bone Injections to the hip joint are also providing benefits and can be undertaken as daycare procedures.