Tuesday 24 July 2012

Urban Indians Are Physically Inactive.

www.jointreplacementclinic.com


The average British national is reportedly among the most inactive person on this planet. This revelation was made by one of the most prestigious medical journal, The Lancet, last week. Indians have been praised by the same study for being among the least inactive people.



But should this be a cause for celebration? Hardly. The study seems to have looked at India as a whole; the rural-urban divide seems to have been blurred. The rural Indian who walks miles to get his ration or water supply or to consult a doctor has been considered alongside urban Indians who in comparison seems pampered with metro rail networks and corporate hospitals.

A study done in a school in Greater Mumbai shows why urban India should be as worried as Britain about physical inactivity. The study done by Dr Aashish Contractor of Asian Heart Hospital in Mumbai's Bandra area showed that while 14 per cent of the schoolchildren who were studied were overweight, most of them didn't walk enough. The study counted the number of steps that children would need to take as per their Body-Mass Index to be classified as physically active.

Dr Contractor's research showed that 88 per cent of the boys and 85 per cent of the girls in that school failed to take the 15,000 steps per day and 12,000 steps per day respectively needed of 12-year-olds.



This lack of physical activity leads to obesity among children and eventually leads to chronic diseases such as hypertension, diabetes or cardiac diseases. The Lancet study showed that 5 million people die
due to physical inactivity every year. This is the same number of deaths caused by smoking. Urban Indians, who are as fond of their couch-seat in front of the television sets as they are of junk food,
need to wake up to the stay-fit mantra.
Read more at http://www.jointreplacementclinic.com/


http://timesofindia.indiatimes.com/city/mumbai/Urban-Indians-are-physically-quite-inactive/articleshow/15102227.cms

Sunday 1 July 2012

Surgery is no "magic wand", but it does get disabled people back on their feet again

‘Surgery makes you walk but it’s no magic wand’

Priyangi Agarwal, TNN Jun 26, 2012, 05.55AM IST
    "When I recall my pre-surgery days, I feel that life was as difficult as living with a disability!" This is how, Premlata Devi, an elderly who underwent knee replacement surgery described her pain. But what is it that actually leads to such acute crippling of the knees? Experts blame arthritis as the chief cause of trouble. According to the Arthritis Foundation of India (AFI), "Most forms of arthritis can be divided into osteoarthritis, rheumatoid arthritis and gout."
    AFI literature shows that osteoarthritis typically strikes the weight bearing joints such as knees, hips and back joints besides hands and spine. It is a progressive disease that mostly affects the knee. Rheumatoid Arthritis is an autoimmune disease (a condition in which body's own immune system becomes its enemy and tends to cause a disease). It causes chronic inflammation of the joints and sometimes the tissues around the joints. Gout, which is also known as the crystal induced arthritis, is an arthritic condition that occurs when uric acid crystals accumulate over the joints. Gout can affect joints in the big toe, ankle, foot, hand, wrist and elbow besides the knee. In rare cases, it may affect shoulders, hips or spine. "Problems such as pain and disability arise in all the three conditions mainly due to degeneration of joints," explained, Prof RN Srivastava, faculty, orthopaedic department, CSMMU. "Pain induced by damaged ligaments and parts of the knee is most felt in case of knees, which bear the maximum body weight," he stated adding, "The painful destroyed knee affects a person's day to day living in simple activities such as standing, sitting, walking, and others."

    
    Before Surgery - Disabled
    The worn, diseased or damaged surfaces of the knee joint can be removed and replaced with artificial surfaces in a surgical procedure known as Total Knee Replacement (TKR). "The surgery has helped many people return to a normal life," said Dr Srivastava. In the words of Premlata, "Knee replacement surgery made me walk after years, but it is no magic wand." Her observation is extremely important. "Patients should not aspire for overnight changes in their lifestyle. The surgery may make them walk but after sustained sessions of physiotherapy. Pre-operative counselling plays an important role here. It helps in setting up realistic targets for patients," said Dr Sanjai Srivastava, who regularly takes up arthroplasty.
    After Surgery - able to walk

    Experts suggest that disease can surely be delayed if not totally prevented. "Ageing, lack of nutrition and physical activity, vitamin D deficiency, obesity, hereditary and socio-economic factors are some causes behind degeneration of cartilage," they said.


    Friday 15 June 2012

    Injections ineffective for knee arthritis: study


    NEW YORK | Tue Jun 12, 2012 3:22am IST

    NEW YORK (Reuters Health) - Injections of the lubricating substance hyaluronic acid may be little help to people with knee arthritis, researchers reported Monday.

    Hyaluronic acid exists naturally in the fluids that bathe the joints, where it acts like a shock absorber and lubricant. People with osteoarthritis -- the common, "wear-and-tear" type of arthritis -- seem to have lower-than-normal levels.

    So one treatment for arthritis patients is to get injections of hyaluronic acid directly into the affected joint, a therapy also known as viscosupplementation. In the United States, it's been approved since 1997 for knee arthritis only; in Europe, it's been used longer and for more types of arthritis.

    But a new research review, published in the Annals of Internal Medicine, finds the benefits may be minimal for aching knees.

    Looking at 89 past clinical trials, researchers found that overall, viscosupplementation did seem to bring pain relief to some knee arthritis sufferers -- as compared to "sham" injections or no treatment.

    But when they focused on 18 larger trials (with at least a couple hundred patients), there were only "clinically irrelevant" effects, according to the researchers.

    On top of that, they report, the injections can carry side effects like swelling and inflammation in the joint soon after treatment.

    "We don't have evidence that viscosupplementation works, but it is associated with an increased risk of adverse events," said Dr. Peter Juni from the University of Bern in Switzerland, who worked on the study.

    "That is not very reassuring," Juni told Reuters Health. He and his colleagues recommend that the injections "be discouraged" for people with knee arthritis.

    But an orthopedic surgeon not involved in the study said hyaluronic acid injections should still be an option for at least some patients.

    "I think patient selection is key," said Dr. Joseph Bosco, from the NYU Langone Medical Center in New York.

    The injections are more likely to help someone with mild to moderate knee arthritis and "no big pieces of cartilage floating around in the joint," according to Bosco. (Osteoarthritis occurs when the cartilage cushioning the ends of the bones begins to break down.)

    Bosco also pointed to the limitations of the new study.

    It's what researchers call a "meta-analysis," which means the results of different studies are pooled together. The issue, Bosco said, is that the individual studies differ from each other -- in how they are done, the specific hyaluronic acid formulations and characteristics of the patients.

    "I think it's difficult to make an overarching comment on the use of hyaluronic acid, based on this," Bosco said.

    In general, the evidence on hyaluronic acid is not high-quality, according to Dr. John Richmond, who chaired the committee that devised the current treatment guidelines on knee arthritis from the American Academy of Orthopedic Surgeons.

    But he agreed the therapy should remain an option. "It's a reasonable way to manage pain" for at least some people, Richmond, also the head of orthopedics at New England Baptist Hospital in Boston, said in an interview.

    MANY OPTIONS, NO SURE THING

    In the early stages of knee arthritis, people may be able to go with non-drug options alone, like exercise or, if needed, weight loss. And pain relievers such as acetaminophen might help.

    But when that no longer works, people often arrive at a place where they are "stuck," Richmond said.

    Most commonly, they turn to non-steroidal anti-inflammatory drugs (NSAIDs) -- painkillers like ibuprofen, naproxen and the prescription drug celecoxib (Celebrex).

    But both Richmond and Bosco pointed out that regularly using those drugs has significant downsides, such as stomach irritation in some people.

    Injections of cortisone, which fight inflammation, can bring a temporary reprieve. But those should not be done repeatedly, Richmond said.

    The final resort is surgery to replace part or all of the damaged knee joint. But, Richmond and Bosco said, that may not be appropriate for younger, more active people.

    "Hyaluronic acid is no panacea," Bosco said. But, he added, "I think it should be kept in physicians' armamentarium" against knee arthritis."

    In the U.S., the injections are approved for knee arthritis that cannot be managed with non-drug tactics and simple analgesics like acetaminophen or topical rubs.

    When they work, the injections -- which involve anywhere from one to five separate shots, depending on the formulation -- offer only temporary pain relief. You might feel better for a few months, then need a repeat round of shots.

    Based on what's known so far, repeated rounds of treatment appear safe, Richmond said.

    But that gets pricey. With all costs and fees considered, one round of treatment approaches $1,000, according to Richmond. (In the U.S., Medicare and many private insurers will at least partly pay.)

    As for safety, some studies in the current review looked at "serious adverse events" -- including life-threatening conditions or problems severe enough to land someone in the hospital.

    Only eight studies actually described those events, which were more common in viscosupplementation patients -- 26 suffered serious problems, versus 14 patients in the untreated groups.

    But those "events" included cases of cancer, cardiovascular disease and musculoskeletal disorders. And Bosco and Richmond both doubted those problems could be pinned on hyaluronic acid injections.
    The trials typically lasted four months. Attributing something like cancer to the injections "doesn't make a whole lot of sense," Richmond said.

    Juni said there is an "unfortunate" lack of both safe and effective options for people with knee arthritis. But he also urged people with the condition to "not be too pessimistic."

    He said the basic approaches to knee arthritis, like exercise therapy and losing excess weight, can help ease symptoms in many people, if they stick with them.

    The study was funded by the Arco Foundation, a private research organization.

    SOURCE: bit.ly/atTzv0 Annals of Internal Medicine, online June 11, 2012.

    Tuesday 29 May 2012

    Physical activity should be encouraged to counter arthritis

    By Carolyne Krupa, amednews staff. Posted May 29, 2012.

    Staying active can help reduce pain, delay disability and reduce the risk of developing co-morbidities associated with the disease.

    For similar articles visit http://www.jointreplacementclinic.com/



    Staying physically active is key to helping patients with arthritis reduce painful symptoms, but not enough people are aware of the benefits, says the Arthritis Foundation.
    A report released by the foundation May 16 advises physicians and other health professionals to ask arthritis patients about their level of physical activity at every visit. In fact, it recommends that health care systems require such conversations take place.
    “This is not part of the regular dialogue that occurs between a physician and their patient,” said Arthritis Foundation President and CEO John Klippel, MD. “It’s important that health professionals embrace this report and, hopefully, become part of a movement that we hope to start in this country to help reduce the burden of arthritis.”
    The recommendation is one of several in the report, which emphasizes the importance of exercise for arthritis patients (arthritis.org/media/resources/OA_Physical_
    Activity_Rpt_508_v1_TAG508.pdf
    ).
    Beyond health professionals, the report discusses how parks and recreation agencies, business and industry, public health, transportation and mass media can help make it more convenient and accessible for patients to be physically active.
    Arthritis, the most common reason for disability in the country, encompasses more than 100 rheumatic diseases and conditions that cause pain, stiffness and swelling in joints and tissues. About 50 million U.S. adults have arthritis. The impact of the condition is expected to increase significantly with the aging baby boomer population, Dr. Klippel said.

    Helping patients overcome barriers

    Starting physical activity can be difficult for people with arthritis. The Arthritis Foundation recommends adults start with walking. They should engage in moderate activity for at least two hours and 30 minutes a week or one hour and 15 minutes a week of vigorous activity — or an equivalent combination, Dr. Klippel said.
    “Fifteen to 20 years ago, it was actually believed that physical activity was bad for arthritis patients,” he said. “There has been a real paradigm shift in the approach to physical exercise and activity.”
    In addition to reducing pain, physical activity can help patients slow progression of arthritis and delay the onset of disability, the report said.
    Doctors and other health professionals should talk with patients about their pain, fears of worsening symptoms and other physical problems they believe limit their physical activity, and help them find solutions. Physicians also are advised to direct patients to fitness classes and other community resources.
    “In their work with individual patients, health care providers have a unique opportunity to encourage adults, children and families to increase their daily physical activity,” the report said.
    The report is a follow-up to “A National Public Health Agenda for Osteoarthritis,” which was released in 2010 by the Arthritis Foundation and Centers for Disease Control and Prevention (arthritis.org/media/Ad%20Council%20101/OA_AGENDA_2011REV.PDF).


    Physical activity should be encouraged to counter arthritisThe 2010 report emphasized the need for four interventions to address the disease: physical activity; self-management; education injury prevention; and weight assessment and healthy nutrition. Dr. Klippel said the Arthritis Foundation will release reports on the remaining three interventions.

    For more interesting articles visit http://www.jointreplacementclinic.com/

    Thursday 3 May 2012

    Arthritis Sufferers Prone To Depression, Anxiety: CDC

    (RTTNews) - New data released Tuesday by the Centers for Disease Control showed many arthritis sufferers also experience anxiety and depression symptoms. The data was collected from 1,793 adults 45 years or older as part of the CDC Arthritis Conditions and Health Effects Survey.
    According to lead researcher Dr. Louise Murphy of the CDC, one-third off all respondents claimed to suffer either anxiety or depression as well in addition to arthritis. They also found that 84 percent of those who reported depression also suffer from anxiety.
    "People with arthritis face a lot of challenges associated with the physical symptoms. If you're worried about your livelihood and your ability to perform at your job, this can be very stressful," Murphy said in a news release.
    "When we looked at the characteristics of the people with anxiety, there was not a specific group that popped out which suggested that all people with arthritis have a risk of anxiety and depression," Murphy added. "Knowing the significant complications they can create shows there is a need to address anxiety and depression on a wider scale."

    by RTT Staff Writer
    For comments and feedback: editorial@rttnews.com

    link: http://www.rttnews.com/1874533/arthritis-sufferers-prone-to-depression-anxiety-cdc.aspx?type=hnr&utm_source=google&utm_campaign=sitemap

    Wednesday 4 April 2012

    Arthritis? Your weight could be the culprit

    More such articles available at http://www.jointreplacementclinic.com/index.php

    Dr Anjali Mukerjee, Hindustan Times Mumbai, April 03, 2012.

    (Link: http://www.hindustantimes.com/Entertainment/Wellness/Arthritis-Your-weight-could-be-the-culprit/Article1-834759.aspx)

    Shedding weight is a real challenge for most people. Extra pounds can impact how you feel and manage your daily chores. They also increase the risk of arthritis.

    Studies have shown that overweight women are four times more likely to suffer from osteoarthritis than normal women. Losing weight significantly reduces the risk.

    Simply, arthritis is an inflammation of one or more joints characterised by pain and stiffness. There are many forms, but osteoarthritis and rheumatoid arthritis are the most common.

    Rheumatoid arthritis is an auto-immune disorder, caused by antibodies that attack healthy joints, causing inflammation and pain. Being overweight seldom causes rheumatoid arthritis, but the role of obesity in osteoathritis cannot be negated. It can show up on weight-bearing joints like the knees, hip, ankles, neck and spine.

    Extra weight puts pressure on these joints and wears away the protective cartilage (tissue that cushions the joints). Weight loss can decrease stress on the knees, hips, and lower back. Some symptoms indicative of osteoarthritis are early morning stiffness, swelling, tenderness in the joints, fever and weakness.

    Common causes Increasing age, a genetic history of joint diseases or injury to the joints increase your chances of getting osteoarthritis. But the most common cause of osteoarthritis is being overweight. Excess fat leads to excessive inflammation, which, in turn, causes arthritis. Reducing weight would reduce inflammatory reactions in the body thus reducing arthritic pain. Cold weather and humidity tends to aggravate it. Follow these diet guidelines to feel better:
    Avoid foods that increase inflammation, like red meat, fried foods, biscuits, farsaan.
    Omega 3 supplements reduce pain and stiffness.
    Avoid PUFA oil (made from safflower seeds, sunflower seeds, corn oil) and switch to MUFA oil, rice bran oil, til and mustard oil, olive oil, rapeseed oil.
    Avoid taking iron supplements.

    More such articles available at http://www.jointreplacementclinic.com/index.php

    Thursday 22 March 2012

    Knee Replacement Surgeries

    KNEE ARTHRITIS
    Arthritis of the knee is a disease condition where in the normal smooth bearing surface of the knee-joint (articular cartilage) is damaged or lost, leading to pain, sometimes deformity that leads to loss of function and disability. The various causes that can lead to arthritis include age related wear & tear (osteo arthritis), wear & tear due to extra demand (e.g. obesity), injury to the knee, inflammation (rheumatoid arthritis) and other causes.
    SYMPTOMS
    Pain is the most important symptom. Pain is accompanied by loss of motion & restriction of activity leading to dependence on others and permanent disability. Deformity often accompanies arthritis due to bone damage leading to ‘bow knee’ or ‘knock knee’ deformity. Loss of balance, instability and loss of confidence are other outcomes of this disease process.
    CONSERVATIVE TREATMENT
    In earlier stages of arthritis, pain relieving medicines have a very important role. Physiotherapy and exercises help throughout the management of arthritis and also play a vital role after any surgery as well. It is in the best interest of the patient and the affected knee to have strong and active muscles around the knee which act as a motor to drive the machine i.e. the knee.
    ExercisesWalkingSwimmingWeight Control
    SURGICAL TREATMENT
    Depending on the patient’s complaints, age, activity, bone quality and stage of arthritis various surgical options are:
    Knee arthroscopy
    (Key hole surgery)
    Realignment procedure (Osteotomy)Partial knee
    replacement
    Total knee replacement (TKR)

    JOINT REPLACEMENT WHEN?
    • Pain not controlled by medicines
    • Stiffness (loss of motion)
    • Instability
    • Disability
    • Restriction of day to day activities
    TKR surgery is performed principally for pain relief. Although the range of motion of the knee may improve following surgery, this is not the primary aim of the surgery and extra motion should be regarded as a bonus
    SURGICAL PROCEDURE
    The damaged bearing surface of the knee joint (articular cartilage) is replaced by metallic prosthesis (made up of cobalt-chromium or titanium), which articulates with a polyethylene bearing. These prosthetic components are fixed to the bone using bone-cement or rarely using coated components onto which bone grows. The right decision about appropriate prosthesis for a particular patient is made.
    RISKS
    Total knee replacement is a major surgical procedure with very high success rates. However, like any other surgical procedure it is also associated
    with some risks, which are uncommon, but must be kept in the mind. These risks include:
    • Wear & loosening
    • Venous blood clots
    • Infection
    DESPITE ALL THESE POTENTIAL PROBLEMS, THE VAST MAJORITY OF PATIENTS ARE VERY HAPPY WITH THIS PROCEDURE...
    RECOVERY
    The patiens are admitted for less than one week after surgery. All patients usually walk on the next day of surgery. This is a major operation and may take 3 to 6 months for full recovery. Some patients continue to experience improvement in he performance of their new knee up to as long as 1-2 years. The recovery is much faster in thinner and hard working patients and those who are motivated to participate in active rehabilitation.

    Hip Replacement Surgeries

    HIP ARTHRITIS
    Arthritis of the hip is a disease condition where in the normal smooth bearing surface of the hip-joint (articular cartilage) is damaged or lost, causing pain, sometimes deformity that leads to loss of function and disability. The various causes that can lead to arthritis include age related wear & tear (osteo arthritis), wear & tear due to extra demand or injury to the hip joint, inflammation (rheumatoid arthritis) and other causes.
    AVASCULAR NECROSIS OF THE HIP
    Hip arthritis is also caused by an important condition called as ‘avascular necrosis’ which means death of femoral head because of loss of blood supply. Loss of blood supply can be caused by alcohol abuse, blood diseases like sickle cell disease, fracture of the hip, long term use of medicines called as steroids as well as some rare & unknown causes.
    SYMPTOMS
    Pain, loss of motion, restriction of activity, difficulty in walking, unequal leg lengths. Dependence on others, permanent disability, loss of confidence are other outcomes of this disease process.
    SURGICAL TREATMENT
    Depending on the patient’s age, gender, activity level, bone quality and stage of arthritis the surgical options are decided.
    TOTAL HIP REPLACEMENT (THR)
    WHEN TO THINK OF SURGERY?
    • Pain not controlled
    • Stiffness (loss of motion)
    • Disability
    • Restriction of day to day activities
    Hip replacement surgery is performed principally for pain relief and also to regain independence and ability to do day to day work.
    SURGICAL PROCEDURE
    The hip joint consists of femoral head (ball) inside the acetabulum (socket). In a hip replacement, the femoral head is either resurfaced or removed and replaced with a ball attached to a stem which is inserted into the shaft of the femur (thigh bone). The acetabulum is then enlarged and a new socket inserted.
    There are a variety of bearing surfaces that can be used depending on patient’s age, activity & bone quality.
    The components can be fixed with or without bone cement.

    Uncemented hip replacement

    Cemented Hip Replacement
    A decision is made as to the most appropriate combination of bearing surfaces and type of fixation for a particular patient.
    RISKS
    Total hip replacement is a major surgical procedure with very high success rates. However, like any other surgical procedure it is also associated with some risks, which are uncommon, but must be kept in the mind. These risks include:
    • Dislocation of the hip
    • Wear & loosening
    • Venous blood clots
    • Infection
    • Leg length inequality
    • Despite all these potential problems, the vast majority of patients are very happy with this procedure.
    RECOVERY
    The patients are hospitalized for less than 1 week after surgery. Most patients recover quite quickly from surgery. The recovery is much faster in thinner and hard working patients and those who are motivated to participate in active rehabilitation.

    X ray of a patient who has undergone
    both side hip replacement 7 years ago

    X ray of a patient who has undergone
    'Hip Resurfacing' surgery

    Joint Preservation Surgeries


    High Tibial Osteotomy
    While total joint replacement is sometimes the only satisfactory treatment available for advanced arthritis of the hip and knee, in early stages of arthritis, various joint preserving surgical options are also available for successful treatment.

    X ray picture of
    a patient who underwent a
    high tibial osteotomy
    KNEE ARTHRITIS
    High tibial Osteotomy
    When medicines no longer relieve pain, patient’s day to day life is affected and if the arthritis involves only one compartment, a surgery called as 'High Tibial Osteotomy' is successfully performed.
    'Osteotomy' is a bone-cutting surgery (osteo=bone, tomy=cut) and advised to younger patients with early arthritis with an intention to preserve the natural joint as long as possible. In an ‘osteotomy’ surgery, the deformed bone is cut and realigned so that body weight is transferred through normal part of knee joint and damaged arthritic part is off-loaded. This leads to very good pain relief and function and the need for knee replacement at a younger age is postponed by 9-10 years.
    AVASCULAR NECROSIS OF THE HIP
     

    Pre surgical X ray picture of a patient of avascular necrosis
     

    Intraoperative radiographs
    of the same patient

    Same patient two years later.
    He does not need a joint replacement yet.

    Avascular Necrosis of the hip

    For detailed article visit http://www.jointreplacementclinic.com/index.php

    Avascular necrosis of the hip


    Avascular necrosis of femoral head
    Various causes of hip arthritis are age related wear and tear, rheumatoid arthritis, ‘avascular necrosis’ of the hip etc. ‘Avascular necrosis’ means death of the head of femur bone because of loss of blood supply.
    Sickle cell disease, alcohol consumption, prolonged treatment with medicines called as steroids, fracture of the hip etc are most common causes of avascular necrosis of the hip joint. Some rare & unknown diseases can cause avascular necrosis of the hip as well.

    Sickle cell disease is very common in and around central India.
    Even though in India, arthritis of the knees is more common than the arthritis of the hip, in Central India especially around Nagpur region, there is higher prevalence of hip arthritis because of sickle cell disease.

    HIP ARTHRITIS
    Hip and knee are the most significant joints that are affected by arthritis. Every time we perform our day to day activities like walking, standing, getting up from a chair or bed etc all our body weight is always transmitted through our hip & knee joints. Therefore in patients with arthritis of hip and knee there is severe pain even in normal day to day activities. There can also be shortening of the lower limb.

    Beware of long term steroid medications
    Pain leads to restriction of activity and loss of freedom leading to disability (handicap) and dependence. Patients having advanced arthritis cannot do simple activities like walking, sitting, getting up from a seat due to pain. As the disease progresses, they cannot go outside the confines of the four walls of their home even for simple activities like shopping, buying milk or vegetables. In the advanced stages of arthritis even household activities like going to toilet, cleaning, washing, wearing socks or tying shoe laces evoke pain leading to serious disability and dependence on others like spouse, family members, servants or neighbours.

    Arthritis of hip joint.
    Various treatment options available for hip arthritis include pain-killer medications and joint preserving surgeries in the early stages. In the advanced stages only a hip joint replacement can help the patient get relief from pain and regain normal movement. Hip joint replacement is so effective and popular surgery all over the world that, in an online poll hip replacement was voted as the single most significant medical discovery of the 20th century.

    Hip arthritis in an 18 yr old patient of sickle cell disease
    SYMPTOMS
    Pain, loss of motion, restriction of activity, difficulty in walking, unequal leg lengths. Dependence on others, permanent disability, loss of confidence are other outcomes of this disease process.
    TOTAL HIP REPLACEMENT (THR)
    WHEN?
    • Pain not controlled
    • Stiffness (loss of motion)
    • Disability
    • Restriction of day to day activities
    Hip replacement surgery is performed principally for pain relief and also to regain independence and ability to do day to day work.
     The original article is available at http://www.jointreplacementclinic.com/index.php
    SURGICAL PROCEDURE
    The hip joint consists of femoral head (ball) inside the acetabulum (socket). In a hip replacement, the femoral head is either resurfaced or removed and replaced with a ball attached to a stem which is inserted into the shaft of the femur (thigh bone). The acetabulum is then enlarged and a new socket inserted.
    There are a variety of bearing surfaces that can be used depending on patient’s age, activity & bone quality.
    RECOVERY
    The patients are hospitalized for less than 1 week after surgery. Most patients recover quite quickly from surgery. The recovery is much faster in thinner and hard working patients and those who are motivated to participate in active rehabilitation.

    Hip Arthritis

    Arthritis’ or ‘Osteoarthritis’ is a degenerative condition of the joints that leads to severe pain and loss of function at that joint. In simple words, arthritis occurs when there is damage to the smooth covering surface normally present in the joints, known as ‘articular cartilage’ . As this normal smooth surface (articular cartilage) has limited capacity to heal or regenerate, any damage to the cartilage is permanent and leads to arthritis.
    Various causes of hip arthritis are age related wear and tear, rheumatoid arthritis, ‘avascular necrosis’ of the hip etc. ‘Avascular necrosis’ means death of the head of femur bone because of loss of blood supply. Sickle cell disease, alcohol consumption, prolonged treatment with medicines called as steroids, fracture of the hip etc are most common causes of avascular necrosis of the hip joint. Even though in India, arthritis of the knees is more common than the arthritis of the hip, in Central India especially around Nagpur region, there is higher prevalence of hip arthritis because of sickle cell disease.

    Avascular necrosis of femoral head
    Hip and knee are the most significant joints that are affected by arthritis. Every time we perform our day to day activities like walking, standing, getting up from a chair or bed etc all our body weight is always transmitted through our hip & knee joints. Therefore in patients with arthritis of hip and knee there is severe pain even in normal day to day activities. There can also be shortening of the lower limb. Pain leads to restriction of activity and loss of freedom leading to disability (handicap) and dependence. Patients having advanced arthritis cannot do simple activities like walking, sitting, getting up from a seat due to pain. As the disease progresses, they cannot go outside the confines of the four walls of their home even for simple activities like shopping, buying milk or vegetables. In the advanced stages of arthritis even household activities like going to toilet, cleaning, washing, wearing socks or tying shoe laces evoke pain leading to serious disability and dependence on others like spouse, family members, servants or neighbours.

    Involvement of hip joint
    in a 18 yr old patient of
    sickle cell disease
    Various treatment options available for hip arthritis include pain-killer medications and joint preserving surgeries in the early stages. In the advanced stages only a hip joint replacement can help the patient get relief from pain and regain normal movement. Hip joint replacement is so effective and popular surgery all over the world that, in an online poll hip replacement was voted as the single most significant medical discovery of the 20th century.

    Knee Arthritis

    The original article is available at http://www.jointreplacementclinic.com/index.php

    Introduction & overview
    In India, today we have more number of elderly people than ever before. According to the latest estimates available, more than 5% of our population is aged above 65 years (UNICEF.org, India, Wikipedia.org). In the year 2000, 4.5 crore people in India were above 65 years of age and this number has increased to 5.8 crore in 2010. Moreover, the number of people above 65 years of age is expected to increase to 6.5 crore in the year 2015 and 7.6 crore in the year 2020. Automatically therefore, the diseases more commonly seen in the elderly people are also increasing proportionally.
    According to the data published in the Indian Journal of Community Medicine in the year 2007, more than half of all people in the age group 67- 74 years suffer from arthritis. In the same research, it was reported that, almost all people beyond 85 years of age suffer from some form of arthritis or other. According to another survey ‘TNS Arogya 2006-07’ by an ISO accredited independent market research agency, conducted in 16 cities in India, including Nagpur, it was estimated that there are 7.8 crore people with osteoarthritis in India. This data was corroborated by World Health Organisation data which estimated 7 crore people with osteoarthritis in India.
    What happens in knee arthritis?
    In simple terms, 'arthritis' or 'osteoarthritis' is a disease condition where in, the normal smooth bearing surface of the knee-joint is damaged or lost. This condition produces pain and sometimes deformity, which in turn lead to loss of function and finally disability and dependence. The various common causes of knee arthritis include age related wear & tear (osteo-arthritis), wear & tear due to extra demand (e.g. obesity), injury to the knee (contact sports, accidents), inflammation (rheumatoid arthritis) and others.
    The original article is available at http://www.jointreplacementclinic.com/index.php

    What are the symptoms of knee arthritis?
    Pain is the most important symptom. Pain may be accompanied by swelling. Because of pain, there is loss of motion (stiffness) and restriction of activity. As the patient experiences pain, there is gradually restriction of outdoor activities first, and eventually patient becomes house-bound. There is pain on simple activities like walking and climbing stairs. It becomes extremely difficult to sit on the ground or get up from a chair. In the later stages even house-hold activities like bathing, cleaning and toilet become painful. In some patients there is also bone damage, leading to bow-knees or knock-knees. There is a feeling of loss of balance and loss of confidence. These patients become dependent on spouse, children, relatives or neighbours. Thus there is dependence on others and independence is lost. Dependence is associated with disability and finally the patient becomes handicap even though he or she may be otherwise mentally and physically healthy.


    WHAT IS THE TREATMENT OF ARTHRITIS?
    Medical / Conservative treatment of knee arthritis
    In the earlier stages of arthritis, pain relieving medicines have a very important role. However, taking pain killer medicines over a longer period are associated with major side effects. Thus pain killer medicines must be administered with due care; especially in arthritis, as some patients may need to take these medicines over a longer period. Physicians, who regularly look after patients with knee arthritis, commonly prescribe cartilage preserving medicines. Most popular cartilage preserving medicines are nutritional supplements like glucosamine and chondroitin sulphate. Although there is no convincing evidence that these medicines help build new cartilage, there is definite evidence that these medicines can reduce pain and improve function.
    Maintaining ideal body weight
    Extra kilos on the body are bad for weight bearing joints such as the hips and knees. Research has conclusively linked weight gain and obesity to osteoarthritis, specifically knee arthritis. The impact of extra weight is multiplied 5-6 times at the knee joints when bearing weight. If a person is overweight by 10 kilos, the forces acting on the knees are increased by 50- 60 kilos. This is like carrying another person on one’s shoulders all the time; and the resultant strain on knees can be easily imagined. Staying lean and fit is one of the most important things that one can do to improve the life of one’s joints.

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    Role of exercises
    Exercises of the muscles around the knee help to keep the joints healthy. In osteoarthritis, patients prefer to curtail their activities and take rest, which can be detrimental to the arthritic joints. As a result of lack of exercise, patients lose strength and flexibility of their muscles. The range of motion at the joint becomes limited and bones become weak. This results in progression of osteoarthritis. Exercises strengthen the supporting structures (muscles, tendons and ligaments) and increase the range of motion, shock absorption and flexibility of the joints. Strong muscles can bear the brunt of forces that crash into the joints as we move, while helping the bones to support the body. Exercises also strengthen the bones.
    Slow and fast walking, swimming, riding a stationary bike with increasing resistance are some of the exercises that are recommended to patients with early arthritis depending on presence of pain. Life style modifications like healthy eating, weight-control and yoga also help patients to relieve pain and can also slow down disease progression.

    Role of joint preservation
    When medicines no longer relieve pain and patient’s day to day like is affected, surgical options can be thought of. Various surgical options include joint preservation and joint replacement. In younger patients with early arthritis an effort is made to preserve he natural joint as long as possible by performing a bone-cutting surgery known as ‘osteotomy’ (osteo=bone, tomy=cut). In an ‘osteotomy’ surgery, the deformed bone is cut and realigned so that body weight is transferred through normal part of knee joint and damaged arthritic part is off-loaded. This leads to very good pain relief and function and the need for knee replacement at a younger age is postponed by 9-10 years.

    When to consider a knee joint replacement surgery?
    When arthritis has progressed to advanced stage and pain is not relieved by medicines, a knee replacement surgery can offer long term pain relief. When in addition to pain, there is stiffness, instability, loss of confidence, restriction of day to day activity, dependence and disability; the best treatment alternative available to the patient is a joint replacement surgery.
    WHAT IS KNEE REPLACEMENT SURGERY?
    In a joint replacement surgery, the damaged surfaces of the knee joint are replaced by metal prosthesis (artificial joints) generally made of cobalt-chromium alloy or titanium. Metallic prosthesis glides over a polyethylene bearing, thus providing pain free range of movement and ambulation. The prosthetic components are fixed to the bone using bone-cement or rarely using cementless technique, where in bone grows onto and into a porous coated component. The right decision about choice of an appropriate prosthesis for a particular patient is made by the treating surgeon in consultation with the patient, best suited to the patient’s daily needs and demands.
    A knee joint replacement can be either partial knee replacement or total knee replacement. In a partial knee replacement only damaged parts of knee joint are replaced such as patella-femoral replacement or unicompartmental knee replacement i.e. replacement of only one compartment (uni=one).





    What to expect after a knee replacement?
    Patients are hospitalised for less than 1 week after surgery. The patient usually starts walking on the next day of surgery. This is a major operation and may take a couple of months to recover completely in some patients. In others, the recovery is much faster, especially in thinner patients and those who participate enthusiastically in rehabilitation. After a knee replacement patient can comfortably participate in activities like long distance walking, light jogging, cycling and swimming. Many patients also go back to sports like light tennis and badminton without extra risk of damaging the new knee.
    Knee replacement is a highly successful operation in patients disabled by pain, and helps them recover fully from disability and gain their independence. All the patients disabled by knee arthritis are enabled by a knee replacement, so that they can perform all usual activities of daily living.

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