Category: Uncategorized

Hips are one of the most important joints in our body as they are responsible for supporting mobility and our weight. A problem in this joint can be a painful experience and in the worst case scenario, your doctor will recommend a hip replacement surgery. Thus, you should know five things before you plan to get your hip replaced with an artificial one.

Problems that lead to hip replacement surgery

The problem could start with a simple pain in the hips followed by stiffness and swelling. This could be a symptom of rheumatoid arthritis. An injury, loss of bone caused by the insufficient blood supply and bone tumours are other causes that lead to excruciating hip problems.

Selecting the right surgeon

Once you have identified the problem, it is important to identify an experienced surgeon who has a track record of successful surgeries. These days’ doctors are recommending surgeries for everything and anything at a drop of a hat. In surgery as technical as this, it is important that an experienced doctor is identified and his credentials are scrutinized by the patient’s family beforehand.

Understanding Hip Replacements

For an orthopaedic surgeon, performing a hip replacement surgery is like a cake walk as he or she has to place the replaced components right into the bone. Also, with the introduction of computer-navigated or computer-assisted invasive hip replacement surgeries, it has become easier to adjust the position of the hip, making the surgeries accurate, with a high rate of success.

Real-time procedures show that more than 95% of patients with hip replacement surgeries experience relief from pain. Moreover, with advanced technologies, the surgeries have become less painful and the rehabilitation of the patients takes lesser time.

What happens during the surgical procedure?

Like any other surgery, in a hip replacement surgery, a doctor starts by giving general anaesthesia, which helps to relax the joint muscles and helps the patient to go in a temporary deep sleep. This procedure prevents the body and mind from feeling any kind of pain. As an alternative, some doctors opt for a spinal anaesthetic instead to help prevent pain.

Post the anesthesia, the doctor makes a cut of around eight to 10 inches long on the side of the hip and moves the muscles connected to the thighbone. There are cases when a surgeon will make smaller cuts with a thought to lessen blood loss, but, this decision lies at the doctor’s discretion. Post this, the ball portion of the joint is removed by cutting the thighbone with a saw. The artificial joint is then attached to the thighbone using either cement or a special material.

In the process, the doctor removes any damaged cartilage and attaches the replacement socket part to the hipbone and closes the incision.

Potential risks post-surgery

There will be some blood loss post the surgery, hence the doctor will advise you to arrange blood before you plan to get hospitalized. Other than this, there are chances of blood clots, hip dislocation, leg length difference and hip implant loosening.

However, one should keep in mind that a hip replacement surgery should be opted for once all other alternatives have been tried and tested. These alternatives include weight loss, activity modifications, anti-inflammatory medications and joint supplements.

Weight Loss: Carrying around excess weight places more strain on the joints, and can lead to a higher chance of developing arthritis . In most cases, hip pain is usually due to obesity and many doctors recommend losing weight by getting involved in high intensive physical activity or weight training. Research has shown that reduction of body weight can dramatically reduce joint pain and improve exercise tolerance.

Activity modifications: Doctors usually recommend people of an older age to use a cane or a stick to walk in order to take pressure off an injured leg or hip. Canes can be used for multiple health conditions, including injuries, arthritis, problems with balance and for assistance to walk after surgeries. Yet, if you’re not using it properly or not holding it in the correct hand or way, you will not feel its full benefits while walking.

Anti-Inflammatory medications and joint supplements: Before any surgery, doctors recommend a number of pain-relieving medicines (steroids and non-steroids) which may help in temporary relief. However, these medicines will have their own share of side-effects.

As per the International Classification of Diseases, Musculoskeletal Disorders/ MSD include any disorder or injury that affect the musculoskeletal system, i.e bones, muscles, joints, discs and the associated tissues like ligaments and tendons. The problems in MSD predominantly impact the body movement and are known to be the second largest cause of disability worldwide.

With age, the bones become fragile, the cartilage resilience decreases, the ligaments start losing their elasticity, the muscle strength reduces and thus, the severity of these musculoskeletal disorders increases. Therefore, the prevalence of MSD is significantly higher in the elderly population (aged 65 years or above).

Below are the common bone health issues that appear in the aging population.

Osteoarthritis (OA)

Among people 65 and above, OA forms the most common joint disease. This disorder results from the wearing and breakdown of the articular cartilage (covering and lubricating the end of bones).
Its symptoms include:

• Stiffness, swelling, and pain in a particular area
• Loss of flexibility,
• Discomfort in moving the joint.

Even in old age, the following factors can aggravate and worsen the deterioration of the joint cartilage:

• Genetics: Some people are genetically predisposed to OA.
• Gender: Women have a higher risk of OA.
• Weight: Obese people have a high risk of developing OA.
• Joint Injuries: When injuries occur in and around the joints, they become prone to OA.
• Level of Mechanical Pressure: When a high level of mechanical pressure falls on one particular joint, it develops a greater risk of OA.

Osteoarthritis can affect any joint of the body, but most commonly occurs in the knees, neck, lower back, hips, small joints of the fingers, as well as the base of the big toe and thumb. Although there is no cure for OA, weight loss, regular exercises and physiotherapy can help to decrease the progression of the disorder.

Osteoporosis

The bone density is at its peak in the late 20s and after age 35, the rate of bone tissue formation decreases. As age progresses, the bone mass starts reducing, and the bones become weaker and porous. When the rate of deterioration of the old bone tissue highly exceeds the formation of the new ones, osteoporosis results.

In severe conditions, the bones become so brittle that even minor strains like coughing, minor knock or fall lead to breakage and fractures. Such Osteoporosis-associated breakages mostly occur in the hip, wrist and the spinal vertebrae.

Apart from such breakages, there are no visible signs and symptoms, therefore a patient with this disorder might not even know about their condition until they suffer from a fracture.

Osteoporosis shows a predominance among older women who have passed their menopause, as the estrogen (the hormone responsible for rebuilding bones ) declines rapidly in them.

Males are also affected, with one-third of all the hip-fractures occurring in men.

Oral intake of Vitamin D and Calcium and regular exercise can lower the risk of Osteoporosis.

Osteomalacia

Osteomalacia is one of the most common osteometabolic disorder of the elderly and is often associated with osteoporosis.

Osteomalacia is characterized by the softening of bones, especially due to the lack of Vitamin D. Vitamin D helps in the absorption of Calcium in the stomach and maintains phosphate levels, thus, helping in bone formation.

Like osteoporosis, people with osteomalacia can also fracture their bones easily and show increased muscle weakness, especially in the area where the muscle attaches to the bone. Another common symptom is bone pain, mostly in the hip, which often spreads to ribs, lower back, pelvis, and legs.

Oral supplements of Calcium, phosphate and vitamin D are often prescribed as a first line treatment of osteomalacia.

Sarcopenia

After age 40, the muscles start to lose their mass and function, and more than 50% of muscle mass is lost by the time a person reaches 80. Since muscles account for almost 60% of the body mass, sarcopenia forms one of the biggest causal factors of fall, frailty, and fractures in older people.

As people with sarcopenia suffer from loss of stamina and increased weakness, their physical activity reduces, which further shrinks their muscle mass. Other factors like damage to the nerve cells that send signals for movement to the muscle, reduction in hormones like testosterone and growth hormone and reduced calorie intake can also lead to sarcopenia.

The primary treatment for this disorder includes exercise, especially strength training and resistance training.

Conclusion

Untreated MSD result in fractures and falls, which form the most common cause of injury in elderly patients. Thus, it’s important to consult an expert orthopedic doctor, like Dr. L Tomar, who can treat your condition in the most effective manner and stop it from aggravating further.

The human knee is the biggest joint of the body and often supports the majority of the body weight, making it highly prone to musculoskeletal degeneration and other traumas. For instance, osteoarthritis is the most common joint disorder in geriatric patients that worsens with age and adversely affects the structure and movement of the knee joint.

When the pain from such disorders and other knee injuries cannot be managed using non-surgical procedures,  knee replacement surgery is suggested as the most effective course of action.

The aim of the knee replacement surgery is to reconstruct a pain-free, durable and fully functional knee joint that shows the best performance and aids in better movement after surgery.

Initial Problems with the Procedure

Previously, this procedure was not considered completely effective as, after the surgery, patients suffered from pain, lacked the full function of their joints, often suffered from infections and polyethylene wear-related complications. Another major issue that arose was reduced mobility due to problems in proprioception.

Proprioception can be understood as the ability which allows human beings to sense their leg and arm’s orientation in the environment, even when their eyes are closed.

Therefore, with existing problems in proprioception and motion of their joints, patients complained of not being satisfied with their surgery. For instance, one study in 2010 demonstrated that only in 70% of the total knee procedures, the patient expectations were fully met.

The Solutions with Innovations in Knee-Replacement Surgery

To tackle the negative feedback associated with the knee-replacement procedures, orthopedic surgeons have started focusing more on patient satisfaction and function than just survivorship and function. In the past few years, many studies have been conducted to understand the core reasons behind patient dissatisfaction with knee-replacement surgery and get insights to help patients.

With the advancements in science and technology, new medical procedures, surgical techniques, and prosthetic designs are coming to fore and the knee replacement procedure is evolving for the better. With the availability of a wide range of prosthetic components and surgical techniques, surgeons have become better adept at tailoring the operation as per the severity of the disorder.

Therefore, based on the extent of the disease, the surgeon can decide to replace the complete or partial section of the knee, leading to greater chances of success.

Therefore, apart from the total knee replacement (TKR) surgery, which was one of the most established treatment methods, partial knee replacement, also called as bi- or unicompartmental knee replacement (UKR) is also gaining prominence as an effective alternative to TKR. While in TKR, the surfaces of all the bones of the knee joint undergo replacement, in UKR, only the damaged portion of the knee undergoes replacement.

With the introduction of minimally invasive surgery (MIS) methods, computer navigation systems, infrared sensors, and gender-specific prosthetics, both these procedures show a higher degree of precision and accuracy

Benefits for the Patients

Research demonstrates that the introduction of surgical navigation leads to better outcomes post the knee-replacement surgeries. By employing the infrared sensing tool of the computer-assisted navigation systems, surgeons can accurately analyze the knee anatomy of the patient and carry out a proper evaluation of the current bone deformities.

Such accurate information of the surgery site helps surgeons to carry out the requisite procedure for proper implant placement and execute the operation with minimal error.

Moreover, as a result of such accurate and precise procedures, patients enjoy a lot more benefits, such as:

• Reduced risks during surgery with the least disruption of the soft tissues.
• Reduced postoperative pain and other complications
• Less need for blood transfusions with minimal blood loss
• Less painful and faster rehabilitation
• Decreased hospital stay period
• Earlier return to daily life and normal activities
• Better range of motion, including stair-climbing ability
• Better gait due to the maintenance of proprioceptivity
• Decreased need for pain-relievers
• Cosmetic benefits as a result of reduced skin incision.
• Improved longevity of the implants

One study has shown that with these advancements in UKR, the long-term (for 10-15 years) joint survival rates have escalated and 85% of the artificial knees remain functional even after 20 years.

Final Thoughts

Due to the high success rate and better recovery options after the current knee replacement procedures, more and more patients now show satisfaction with the procedures. Therefore, anyone suffering from advanced knee disorders should consult an experienced orthopedician like Dr. L. Tomar and undergo the surgery to enjoy a better quality of life.

Rehabilitation and satisfaction

A hip disease is very common in older people. Recent research states that around 42% of the people with osteoarthrosis have higher risks of having a bilateral hip disease and 25% of them need a total hip replacement or bilateral hip replacement.

What is a Bilateral Hip Replacement?

In the process of a simultaneous bilateral hip replacement (BTHR), doctors replace both of the hips in one operation at the same time in a day. It means, the patients have to be admitted in the hospital once for the replacement of both hips, and they have only one recovery period. Some of the patients may have higher risks of medical complications if they go through such a process. Your doctor/surgeon will discuss with you the relevant merits and safety from complications while advising you for BTHR.

Why do you need to get a BTHR?

You need to go through the bilateral hip replacement when you feel severe arthritis problem, and the pain makes it hard for you to live a normal life. Daily life activities like placing your shoes on the shelf, standing, and walking get difficult for you. You have unbearable pain when you do activities of high intensity. With time, arthritis worsens your health conditions and makes you unable to leave your bed too if not treated properly.

Benefits of simultaneous BTHR

Going through the simultaneous bilateral hip replacement offers you numerous advantages. Some of the significant benefits are as follows:

• Eliminates pain – One of the significant reasons for going through Bilateral Hip Replacement is that the patient wants to get complete relief from the hip pain. BTHR eliminates the pain that made it difficult for you to live a normal life.
• Restores your physical activity – After the post-op recovery, you can easily do your daily tasks. You have no issue/discomfort while walking/jogging or lifting an object with light to moderate weight. You can enjoy biking, swimming, hiking, and other physical activities that you stopped due to your hip problem.
• Only one surgery process – Hip replacement is of two types – single and total (bilateral). In BTHR, there is a single surgery process. A doctor replaces both of your hips at a time.
• Single stay at the hospital – As there is a single process for both hip replacement in BTHR, so you have to get hospitalized once.
• Reduced cost – Going through BTHR is money saving. Having a replacement for both hips twice is costlier in comparison with Bilateral Hip Replacement.
• Shorter rehabilitation period – If you go through hip replacement twice for both of your hips, you would have two recovery periods. You will have only one recovery/rehabilitation period if you choose to go through BTHR.
• Less time off work – To recover from any disease, you have to be off from your work. In replacement surgery, the leave period in longer, and it can be more extended if you opt single hip replacement process. In BTHR, you take leave for a shorter period.
• A single dose of anesthesia – Going through two hip replacement surgeries require two doses of anesthesia. You have to take only one dose of anesthesia if you opt for Bilateral Hip Replacement.

Apart from the advantages mentioned above, you can have some difficulties. The issues can be like total dependency on others, emotional support. Based on your health conditions, your hospitalization time may increase.

Conclusion

Going through a BTHR is beneficial for patients with arthritis. It would be more fruitful for you if you consult a surgeon such as Dr. L Tomar. You need to be very careful, and you should mention all your health issues so that your doctor can give the right advice to you. With this, you have minimum complications, and your recovery will be shorter. You will feel that going through BTHR is better in comparison with the one twice.

Hip and Knees are one of the largest and most important joints of our body, which work in tandem and enable humans to perform a range of physical activities, like running, playing and exercising.  Therefore, the treatment of the disorders affecting these joints is considered crucial and involves a host of solutions, ranging from pain medications, physical therapy, less invasive surgeries to alternative treatments like acupuncture.

But when all of it fails and the severe pain starts hampering the daily life activities, the joint replacement surgeries remain the only alternative to regain the movement and functionalities of these joints.

Joint replacement for the surgical treatment of osteoarthritis is considered one of the most common and successful surgical techniques.

Just in the USA alone, 330,000 hip replacements and 600,000 knee replacements are performed every year. But there is a reason that the number of hip replacements performed in a year outnumbers the number of knee replacements by more than a factor of five.

Understanding Hip Replacements

For any orthopedic surgeon, performing a hip replacement surgery is much easier than a knee replacement surgery. In the former, a doctor can feel everything and just has to place the replaced components right into the bone.

Also, with the introduction of computer-navigated or computer-assisted minimally invasive hip replacement surgeries, it has become easier to adjust the position of the hip, making the surgeries highly accurate, with a high rate of success.

Real-time procedures show that more than 95% of patients with hip replacement surgeries experience relief from pain. Moreover, with advanced techniques, the surgeries have become less painful and the rehabilitation of the patients takes lesser time, ranging from 2-3 months.

Knee Replacements are Different

Compared to the hip, which is a simpler joint, knees are formed by a complex connection of various bones, muscles, ligaments, all coming together to balance various off-center loads.

Therefore, the knee replacement surgeries are relatively complex, as the surgeon needs to release various soft tissues like ligaments, put the components into the bones in a balanced and stable manner.

Also, the rehabilitation time is greater than that for a hip replacement, with patients taking six months to one year to recover completely.

But Knee Replacements are Equally Successful

In spite of the complexity of the knee replacement surgeries, the introduction of advanced techniques like new surgical procedures and improved prosthetic designs have made them much more effective.

Most expert orthopedic surgeons like Dr. L. Tomar use the infrared sensing tool of the computer-assisted navigation systems to perform their operation with a high level of accuracy and precision.

Current surgeries use minimal invasive procedures and involve the accurate analysis of the knee anatomy of the patient and the accurate evaluation of the bone deformities. Such detailed techniques ensure that the operation is performed without any error and leads to minimum post-operative complications.

High Success Rate of Knee Replacement Operations

Owing to these advanced procedures, the knee replacement operations, be it total knee replacement or partial knee replacement show a high success rate.

As per the American Academy of Orthopedic Surgeons, about 90% of all the patients who undergo a knee replacement suffer from a lot less pain post-operatively. Such patients, in most cases, can get back to performing their daily activities efficiently and making the active use of their knees.

Another study by the University of Bremen found that all those patients who had undergone total knee replacement were able to engage in greater physical activities within one year of the operation.

Apart from being able to resume the normal activities, the implants that are added in the operation also show a long life, lasting over a decade. Therefore knee replacement surgeries are even being adopted by young patients suffering from osteoarthritis and other degenerative knee issues. Another study showed that 85 % of the artificial knees were functional even after two decades.

Apart from the effectiveness of the procedure, another factor that works in favor of the knee replacement technique is the minimal amount of side-effects. For instance, severe complications include infections in the knee occur in less than 2% of all the patients. The risk of forming blood clots is also low.

One study demonstrated that out of all the people being operated for total knee replacement, only 1.2% had to get admitted for blood clot formation within three months of their surgery.

Therefore, in spite of the complicated procedures, knee replacement surgeries are as effective as hip replacement and should be chosen in the case of advanced knee deformities.

People with problems in their knee joints try a lot of options like changing their lifestyle, trying strengthening exercises, alternative therapies like acupuncture and application of topical medicines.

Based on the severity of the joint disorder, even doctors recommend a range of non-surgical, less-invasive options first like cortisone injections, anti-inflammatory medications, glucosamine prescriptions, and physical therapy.  Only after a thorough examination of the joint area with X-Ray and MRI and a detailed study of their medical history, doctors ascertain the need for invasive surgery for patients.

Therefore, a knee replacement surgery or knee arthroplasty (KA) is recommended only as the last resort when a patient’s mobility and pain issues become unbearable and can no longer be managed with non-invasive techniques. Such scenarios occur frequently with aging patients suffering from an advanced stage of the joint disorder.

Since KA involves cutting the end of knee joint bones and fitting an artificial implant, the technique is classified as a major surgery, and often generates different kinds of fears in patients. Such fears of surgery, of losing their body part, of post-operative pain, of the long rehabilitation period and other unknown complications compel many patients to delay the procedure.

But delaying the procedure, even when it has been recommended by the surgeon can have a lot of negative repercussions for the patient

Worsening of deformities outside and inside the knee joint

Even though arthritis takes time to progress, with every bit of progression, the risks of the worsening of the joint deformity increases. In elderly patients, since most cases are of greater severity, there is a higher risk of the disorder to evolve into a bow-legged or knock-kneed deformity.

In such cases, joint replacement becomes highly complicated, with surgeons needing specialized implants, more time under anesthesia and expensive and extensive surgery for joint correction.

Risk of Increased lack of mobility and Disability

With the progression of joint disorders, the movement of the joint is hampered. This reduced movement further aggravates the situation as the soft tissues surrounding the joint, including the muscles, joint capsules and ligaments start contracting and become stiff.

This condition is highly evident in old patients with an advanced case of knee osteoarthritis, who are unable to fold their knees and suffer from immobility. Therefore, when advanced joint disorders are not treated in an appropriate manner, they develop a high risk of developing into a debilitating disability.