Orthopaedic Surgeries

Orthopedic conditions

Arthritis
  • Osteoarthritis
  • Rheumatoid arthritis
Bursitis

Osteoporosis

Tumors

Pain (knee pain, hip pain, joint pain, muscle pain, etc.)

Arthritis and Bursitis are the most common orthopedic disorders which affect the musculoskeletal system mostly the bones and joints. These cause pain and dysfunction, making difficulty in daily life activities for an individual. These conditions are different from orthopedic injuries, like a shoulder dislocation or broken bone, which are often due to sudden trauma. Unlike accidental or traumatic orthopedic injuries, chronic conditions tend to be progressive in nature, these starts slowly and getting worse or evolving over time. These conditions may be genetic or age-related mainly in the old age, or they may be caused by overuse.

Importance of treatment

With advancement in the medical industry most of the orthopedics conditions are Treatable, and some cannot currently be cured, but can be treated to reduce pain and improve quality of life. What matters to have a proper diagnosis and targeted treatment which can help reduce problems down the road.

Recommendation of treatment will depend upon the type and severity of patient’s condition.

Osteoarthritis

The most common form of Arthritis is “Osteoarthritis (OA)”.It is a chronic (Long- lasting) degenerative joint disease. A joint where two bones comes together. Both the bones are covered with protective tissues called as Cartilage. Osteoarthritis (OA) causes or damage or breakdown of these cartilages and causes pain and stiffness and other symptoms when rub together. It can affect to any joint, the joints majorly affected with OA are of hands, knees, hips and spine. OA occurs most often in old age people, although it can occur in adults of any age.. Here’s everything you need to know about OA, from treatment to prevention and more.

Osteoarthritis can be classified in to 2 categories primary or secondary. The cause of primary osteoarthritis is not known. Secondary osteoarthritis is caused by another disease, mainly from injury, Infections or some kind deformity. Osteoarthritis starts with the breakdown/ damage of cartilage in the joints. As the cartilages rub over each other, the bone ends may thicken which form bony growths over it which is knows as spurs. Bone spurs interfere to the movement of joints. Bits of bone and cartilage may float in the joint space. A cysts with fluid filled forms in the bone which limits joint movements.

Factors contributing to osteoarthritis are

  • Heredity: Can lead to Osteoarthritis
  • Excess weight: Obesity or being obese can cause Osteoarthritis dues to stress on the knees.
  • Injury or overuse: Severe injury to a joint, such as the knee, can lead to osteoarthritis.

Major Symptoms of osteoarthritis

The most common symptoms of osteoarthritis is the pain during movements of the joints..The Symptoms usually develop slowly over years. Many symptoms may vary patient to patients.

  • Joint stiffness, especially after sleep or inactivity
  • Joint pain
  • Less movements of the joints
  • A grinding feeling of the joint when moved, as the cartilage wears away (in more advanced stages)

Diagnosis and treatment

This can be diagnosed by a proper examination and some laboratory tests. Treatment will depend on the patient’s symptoms, age, and overall health condition. The objective of treatment is to reduce joint pain and stiffness, and to improve flexibility in joints movement. Treatment may include.

Treatment available

Surgical procedure
  • Epidural Injections : These liquids mimic normal joint fluid.
  • Surgery:
    • Joint replacement surgeries
    • Knee Replacement
    • Hip replacement
    • Shoulder replacement

To diagnose and proper treatment of the arthritis. Patient need to contact his/her doctor. Although there is no cure for osteoarthritis, it is important to help in keeping joints functioning by reducing pain and inflammation by working on proper treatment plan in coordination with the doctor for improving the quality of life.

Rheumatoid arthritis

Rheumatoid arthritis (Rheumatism) is a chronic (Long- Lasting) disease. Joint inflammation is a major sign, In some of the cases the inflammation can be so severe which affects the looks and functions of the joints and other parts of the body. Rheumatism also causes deformities in the joints of the fingers. This makes difficulties in moving hands. Lumps, known as rheumatoid nodules are seen in joints, It may form anywhere in the body. The exact causes of Rheumatism are not known. It is an autoimmune disorder. Which means the body's immune system attacks its own healthy cells and tissues. Which causes inflammation in and around the joints.This may sometimes damage the skeletal system of the patient. Rheumatism can also cause damage to the other organ parts like heart and lungs. Rheumatism mostly occurs in people from the age of 30-50 but is not age restricted.


Symptoms of rheumatoid arthritis

The joints affected by Rheumatism are Hands, wrists, feet, ankles, knees, shoulders, and elbows. This causes inflammation in the areas on both sides of the body. Symptoms may vary patients to patient it may begin suddenly or slowly over time. The major symptoms are as follows

  • Stiffness, especially in the morning
  • Pain and swelling of the joints
  • Less flexibilities in movement
  • Fatigue
  • Fever
  • Lumps over the small joints
  • Difficulties in doing activities of daily living (ADLs)

Types of Rheumatism

  • Rheumatoid Arthritis of the Foot and Ankle
  • Rheumatoid Arthritis of the Shoulder
  • Rheumatoid Arthritis of the Hand

Diagnosis and treatment

It is very difficult to diagnose Rheumatism in the early stages because of very mild symptoms and the disease may not be seen on X-ray or blood tests.

Investigations suggested

  • X-Ray
  • Joint aspiration
  • Nodule biopsy
  • Blood tests
  • Ultrasound or MRI

Treatment based on the age and overall health of the patient. Since there is no definite cure of the Rheumatism. The one should consult the medical experts. The possible treatments may includes.

  • Physical therapy
  • Medicines
  • Splints
  • Surgery

Surgery is not a permanent solution for rheumatism but it helps in correcting the deformities caused by Rheumatism. Even after a surgery the problem can re occur, patient may even need more surgeries Joint repair or reconstruction can be done in many ways, including.

  • Joint replacement
  • Surgical cleaning
  • Joint fusion

Since rheumatism damages the joints and creates disability, It can cause pain and deformities in the body. It hampers the daily activities. This can also lead to problems such as depression and anxiety.
Rheumatism can also affect many non-joint parts of the body, such as Heart, skin, nerves, Muscles and blood vessels lungs. These complications sometimes can lead to severe illness and even death. Because there is no such cure available for Rheumatism doctor prepares the proper treatment plan for the patients in order to reduce the pain and improve the quality of life for the patient.

Total knee joint replacement surgery

Total knee replacement is known as Knee Arthroplasty, a surgical procedure to remove the severely affected knee by osteoarthritis,rheumatoid arthritis or any other condition and replace with an artificial joint(Implant).The objective of the surgery is to relieve pain and restore flexibility of the joints In a normal knee, the end of 2 bones femur and the tibia meeting with each other are covered with smooth cartilage.The cartilage acts as a cushion between these weight-bearing surfaces and allows the bone to move over each other.Muscles and ligaments give the stability side-to-side. A synovial membrane (a lubricating fluid) work as a lubricant for the joints to move smoothly.

Osteoarthritis ruins the smoothness of the cartilage dues to which when it rubs over another cartilage itcauses pain and stiffness in the joints, the pain and the stiffness can also be cause wear and tear or by anyother injury which further cause the breakdown of the cartilage and reduces the ability of pain free movements.The surface of the bones becomes roughened with irregular movement.

Rheumatoid arthritis (inflammatory arthritis) causes the joint to become inflamed and swollen as well which further damages the damaging the cartilage. Other associated problems are like osteonecrosis can also lead to deterioration of the joints. Which further require total knee replacement.

A proper Consultation is suggested with an orthopedic before undergoing the surgery.


The surgery

Total knee replacement surgery is a replacement of the worn surfaces with the smooth surfaces in the knee joint.An artificial knee which is made up of metal customized prosthesis according to the requirement of the bones which fits in the bones and are placed in place of the affected surgically.

The three main components of an artificial joint

  • Tibial component (to replace the end of the tibia)
  • Femoral component (to replace the end of the femur)
  • Patellar component (to replace the back of the kneecap)

Above components are used in total knee replacement surgery. Orthopedic Surgeon in coordination with an Anesthetist decides prior to surgery to perform the surgery under general Anesthesia or Spinal Anesthesia.The surgery takes time of 2 hour which begins with an small incision made in front of the knee joints.The surgeon will expose the knee joint, loosen the muscles and ligaments surrounding it, and turn the kneecap out of its place. The worn surfaces within the joint, including the back part of the kneecap, are removed and the ends of the bones are precisely reshaped. The components of the artificial knee joint are then attached to the bone ends using specialized bone cement, and fitted together. The muscles and ligaments are repositioned and, if necessary, the ligaments are readjusted to achieve the best possible knee function.

Antibiotics are given during and after the operation to prevent the development of infection in the new joint.A blood transfusion may also be required. This will be discussed by the surgeon prior to surgery.

Surgeon prescribes the measures to prevent the formation of blood clots and reduce leg swelling.He can suggest compression stockings, compression boots, and medication. Foot and ankle movement also is encouraged immediately following surgery to encourage blood flow in the leg muscles, which also helps to prevent leg swelling and blood clots. It is advised a continue the physiotherapy for some time in order to keep the movements in the leg.

Recovery

Surgeon and a physiotherapist will work together to set recovery and movement guidelines.Initially these include a set physiotherapy exercises, before progressing to gentle knee-bending exercises and walking.A set of exercises are designed for the faster recovery of the patient which strength the muscles and increase the flexibility of the joints.
Better recovery and the success of the surgery depend on the proper follow up of the instruction after the surgery with in the hospital and at home for quite some time. Patient need to stay in the hospital for 6-7 days. The doctors team will assess the patient when is suitable time to go home.

Risks of surgery

Every surgery has some level of risk involved same in the total knee replacement. As well as general risks of infections.

Follow up

Patients are required to follow up after 4-6 weeks to make sure that all is fine after the surgery.Some of the doctors even advise to get the x-ray done for the proper examination.