High Flexion Knee Replacements

We have with us Doctor Dr Neelam V. Ramana Reddy(MS Ortho; MCh Ortho (UK)) who is a Consultant Joint Replacement Surgeon,at Wockhardt Bone & Joint Care at Kamineni Wockhardt Hospitals, and King Koti Hyderabad.

Doctor Neelam talks to us about "Hi Flexion Knee Replacement"

Arthritis of knee is the world’s leading cause of disability. Arthritis causes pain, swelling, inability to walk, reduced bending of knee, inability to sit cross legged, deformity and so on.

Conventional total knee replacement is a well-known treatment for advanced knee arthritis. Knee replacement surgery provides excellent results to the patient, relieving him from pain. The surgery also improves walking ability and allows pain-free knee bending. Most importantly, it improves the quality of life of the patients.

Flexion is the action of bending a joint, such as your knee or elbow. The opposite motion is extension, which is the straightening of a joint. Generally, traditional knee replacements accommodate flexion up to 110 degrees and have not been designed to allow the patients to squat and kneel, which require higher flexion. Many daily activities require a higher range of motion: Gardening, golfing or activities such as kneeling for prayer and sitting cross-legged can demand up to 130-150 degrees of bending.

Recent innovation of knee design (High Flexion Rotating Platform Knees) is a breakthrough where complete flexion upto 155 degrees could be achieved. Desire for high flexion may be dictated by patient’s favourite activities or cultural background. Many daily activities require the ability to flex the knee beyond 120 degrees.

The fixed bearing conventional knee provides 110 degrees of flexion. For most patients, this is not enough. The rotating platform knee is specially designed to safely accommodate up to 155 degrees of flexion in patients who has good pre operative range of motion. This means that with appropriate rehabilitation a patient can resume an active life style after total knee replacement – deeply bending the knee for recreation. Day to day activities, which may include prolonged kneeling, squatting and cross-legged sitting, can be done.

Complete knee bending is a pre requisite for the patients of Asia, Japan and more so in Indian continent. This will raise high level of confidence in patients to get surgery done as they will also get good flexion. So now day’s patients should not hesitate to get knee replacement done due to reduced knee bending after knee replacement.

To know more about Knee Replacement Surgery or to fix up an appointment with Doctor Neelam Reddy, please write in to enquiries@wockhardthospitals.net or log on here

Rheumatoid Arthritis : Causes and Treatements

Today we have with us, Doctor Srinivas JV , Consultant Orthopedic Surgeon, Wockhardt Hospitals,Bangalore who will be explaining about Rheumatoid Arthritis, its causes and treatments.Doctor Srinivas has done his MS in (Orthopedics) from AIIMS, New Delhi, followed by a Fellowship In Joint Replacement Surgery And Arthroscopy From Charite, Hambolt University, Berlin, Germany.

Rheumatoid Arthritis is a chronic autoimmune disease that causes inflammation of the Joints and in some cases inflammation of the tissue around the Joints as well as other organs of the body. Autoimmune diseases occur when the bodies own immune system attacks tissue and cells in the body due to a failure to recognize its own constituent parts.

The disease is chronic in nature and requires prolonged periods of treatment. Medication is generally regulated according to the progress made by the patient. If Rheumatoid Arthritis is not detected in the early stages and treated accordingly irreversible joint damage could occur. Untreated cases could lead to major complications effecting the eyes, nervous system, lungs and kidney.

Joint replacement surgery may be necessary for joints that have been irreparably damaged, however this is only possible for the major joints i.e. hip, knee, shoulder and some times elbow.

Symptoms of Rheumatoid Arthritis

Rheumatoid Arthritis is characterized by Joint pain generally in the hands and feet accompanied by stiffness which is worse in the mornings, swelling in the joints and loss of proper function. The disease can affect people of all ages. In some cases the symptoms develop gradually over the years and in others there is rapid progression.

Causes

The exact cause of Rheumatoid Arthritis is unknown. The disease is thought to be a combination of genetic and environmental factors, hormones could also be involved. Rheumatoid Arthritis is an auto immune disease where the bodies own immune system attacks the joints and organs. The cartilage wears down, the space between the bones narrows and in advanced stages the bones rub against each other causing the bones to erode. The joints become very painful and inflamed.

Rheumatoid Arthritis is not hereditary however it is more prevalent in some circles of society than others

Diagnosis:

A simple blood test would be enough to diagnose the disease. However blood tests in the early stages may not detect it. Generally a 6 week period is given before the patient is treated to rule out other diseases.

Treatment:

Rheumatoid Arthritis needs to be treated with specific medication to help control and slow down the disease. Poor awareness of the disease among the general public and the medical community often leads to late or wrong diagnosis. Patients are generally treated symptomatically with pain killers, anti-inflammatory drugs and steroids that merely give temporally relief. However, the disease it self is not treated leading to complications and possible irreversible damage.

In recent times there has been a breakthrough in the treatment of the disease with biological therapy (designed to restore the ability of the body’s immune system). This new therapy has yielded good results and is increasingly being used for patients where conventional medication fails to work or where there are too many side effects.

What does the doctor say?

It is important to diagnose and treat the disease in the early stages to avoid complications later on in life. With the right treatment the quality of life can be improved.

The lack of awareness about the symptoms of Rheumatoid Arthritis among the medical fraternity often results in late diagnosis. In children the disease is often confused with Rheumatic fever where the children are treated wrongly, many children suffer from the disease for months and even years before the disease is diagnosed and the proper treatment is given.

Orthopedic Surgeons View

As earlier said, the disease has to be diagnosed at early stages and medical treatment instituted in these patients. In spite of treatment or due to inadequate treatment, people with rheumatoid arthritis develop severe joint destruction. The symptoms of severe destruction would be that the patient experience severe pain in the joint, restricted movements at the joint and difficulty to carry out the daily activities. Most common joints would be knee joints, hip joints, shoulder joints, elbow joints. Patient also develops pain and deformity of small joints of hands and foot making them difficult to carry out their daily activities.

The role of joint replacement surgeon comes only when there is severe destruction of major joints. Most commonly done joint replacements are for hip and knee. Very rarely shoulder and elbow replacement are done. Hip and knee replacement are indicated when patient is not able to walk and do their daily activities, joint pain is severe and not controlled by medications or when patient has developed deformities(commonly flexion deformity in hip and flexion, varus and valgus deformity in knees). By performing joint replacement surgeries these patients do experience complete pain relief in joints and there deformity completely corrected. They are able to move around and do their daily activities. It is seen that a procedure called synovectomy along with joint replacement will reduce the disease load in the body and requirement for medication is also reduced.

If the patients can over come the fear of surgical intervention and the financial burden for the surgery than they can have better quality of life after surgery.

Dr JV Srinivas,
M.S. (Orthopedics)
Consultant Orthopedic Surgeon
Wockhardt Hospitals, Bangalore

To Schedule an appointment with Dr JV Srinivas please write to enquiries@wockhardthospitals.com

Guide To Arthroscopy-Part 2

Arthroscopy can be used to treated varied bone and joint problems.They include 1)Rotator Cuff procedure 2) Repair or resection of torn cartilage from knee 3) Reconstruction of anterior cruciate ligament in knee 3)Removal of inflamed lining(synovium ) in knee ,shoulder, ankle, wrist 4)Removal of loose bones or cartilage in the knee,shoulder joint or wrist.

The extent of the surgery required and recovery time will depend upon the complexity of the problem.Occasionally during arthroscope, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscope alone.The extensive open surgery may be perfomed while you are still anesthetized,or at a later date after you have discussed the finding with your surgeon

Possible Complications of Arthroscopy

Infections and instruments breaking are the most common complications,but occur in less than 1% of all arthroscopic procedures.

Advantages of Arthroscopy

Arthroscopic surgery is easier on the patient than 'open surgery". Arthoscopic surgery means less incisions,less wound trauma,and leseer recovery time.Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.

Recovery after Arthroscopy:The small punctured wounds take several days to heal.The operative dressing can usually be removed in the morning after surgery and adhesive strips can be applied to cover the small healing incisions.

However it generally takes several weeks for the joint to maximally recover.As specific activity and rehabilitation program may take several weeks for the Joint to recover.As specific activity and rehabilitation program may be suggested to speed up your recovery and protect future joint function

It is no unusual for patients to go bacl t work or resume daily activities within a few days.Athletes and others who are in goof physical activity may in some cases return to their athletic activities within a few weeks.

What happens to You during Arthroscopic Surgery

During surgery the anesthesiologist or the nurse may start an IV (intravaneous).You will receive either local or general anesthesia.

After your anesthesia takes effect,the doctor will make two or three tiny incisions in your knee .A solution is injected to distend the knee cavity, and the arthroscope and a small tube with a powerful light and lens is inserted.The doctor examines your knee joint to determine what is causing the problem.Often, the injury can be repaired at this time,using special surgical instruments.Following arthroscopy the instruments are removed,incisions closed and knee is bandaged.

To Know more on Wockhardt Hospital Bone and Joint program write to us at enquiries@wockhardthospitals.com