FAQ
It is important for the patients to not just know about the surgical procedure,
but also about the pre-operative steps so that the patient has an idea about what will be happening in the hospital.
Equally important is the knowledge of the post-operative steps so that the patient is aware of what exercises and lifestyle would be beneficial for a good surgical result.
Also, we have mentioned the do’s and don’ts associated with each surgical procedure so that the patient is reassured when performing any activity which he believes to be risky but is actually safe.
For further details, kindly click on the Treatments section above and select the relevant surgical procedure.
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Joint Reconstruction (Replacement/ Preservation)
There are many distinct types of arthritic conditions that could have an effect on the human body. The most common type of arthritis is Osteoarthritis. Its causes can be cartilage to wear away, ultimately ensuing in painful bone-on-bone contact.
The bones during a joint are coated with a tough, lubricating tissue known as cartilage to assist give smooth, painless motion to the joint. because the layer of cartilage wears away, the bone begins to rub against bone, inflicting the irritation, swelling, stiffness, and discomfort ordinarily related to arthritis.
Joint reconstruction is a surgical procedure, it is done to make the joints fully functional. This procedure is used to save the joints, repair or replace them. A good surgeon always tries to preserve the natural bones and tissue. It includes joint replacement, joint preservation and treatment of ligament injuries.
With increasing age, the joints of the parts of the body become old and wear out or the cartilage gets damaged, due to which they become inflamed and the joints of the bones start rubbing continuously, then this condition is called Arthritis. The process of replacing all these joints is called joint replacement surgery.
It is a procedure to maintain a natural joint and allow the joint to function pain-free. Through this procedure, the surgeon can prevent patients from getting a total replacement. This is usually determined by looking at the position of the joint.
KNEE REPLACEMENT
Total knee replacement replaces broken cartilage and bone with a artificial surface. The replacement implants embrace a metal alloy on the end of the femur (thighbone) and polyethene (plastic) on the shinbone (tibia) and patella (kneecap). The implants produce a new, swimmingly functioning joint that stops painful bone-on-bone contact.
In some patients, just one part of the knee is broken, whereas the remaining components are fully healthy. In these cases, it’s attainable to exchange only the damaged part of the knee with a metal and plastic implant. this will sometimes be done through a smaller incision and you’ll recover a lot of quickly. Your doc will confirm if this is often the most effective possibility for you.
With the assistance of a therapist or trainer, get yourself as physically match as you’ll before surgery. correct nutrition, weight loss (if overweight), and an optimum medical condition can help avoid complications. See your Dr. before surgery to make sure your blood pressure, heart, and lungs are in sensible shape. choose a surgeon who specializes in joint surgery, and go to a hospital that incorporates a dedicated joint unit to provide you with excellent care. Be ready to continue along with your exercise program after surgery.
In the past, a complete knee patient might usually expect to remain anywhere from 3-7 days, followed by six weeks or more of difficult medical care before returning to normal activities. With minimally invasive partial knee surgery, some surgeons are finding that patients may be discharged in as few as one to 2 days, with considerably quicker return to normal activities and fewer post-operative pain.
Walking with support (cane, crutches, or walker) usually begins the day after surgery. Walking support is also continuing for 3 to four weeks. The hospital will arrange for these devices as needed. If you have got a walker, cane or crutches that you simply often use, please bring them to the hospital. Most patients can climb stairs after one or 2 days and are discharged home at that time. Returning to your daily activities can rely somewhat on your individual circumstances. Consult your Dr. or therapist for recommendations.
Age is mostly not a haul if you’re in fairly physiological condition and have the will to continue living a productive, active life. you must see your personal physician for an opinion regarding your general health and readiness for surgery.
LIGAMENT INJURY
Ligaments connect bone to bone and help to stabilize the joints.
HOW SOON CAN I HAVE SURGERY FOR A TORN ACL?
Often the best time to have reconstructive surgery is immediately after the injury. This is before muscle wasting and knee stiffness has occurred. This will result in the fastest recovery.
However if there has been a delay in the diagnosis then sometimes the knee has become stiff and this is not the right time to proceed with surgery. It may take several weeks of rehabilitation to restore movement before surgery can proceed safely.
A few weeks of “pre-hab” can take months off the recovery time if stiffness is an issue.
If you have had a bad fall, have twisted your knee or lifted a heavy object and you have pain, strain swelling and difficult movement of the injured area, this may be tendon or ligament tear. The movement in the area of injury will be limited and painful. The damaged area will have numbness or tingling sensation. There will be swelling/inflammation and bruising over the affected area.
The joints of the knees, elbows, ankles and shoulders are most commonly affected. It is common for these injuries to occur while playing sports and is thus commonly seen in players and athletes.
The Surgery is performed by a Joint Reconstruction & Sports Injury Specialist Surgeon who is trained to treat problems of the bones & Joint.
Tendon and/or ligament repair surgery is required when natural healing process is not effective or when affected individuals are not able to return to normal activities and pain, swelling, difficult movement and discomfort persist even after adequate rest, ice & compression therapy, elevation, medications and physical therapy have been given.
Surgery is required when there is joint misalignment and instability leading to deformity and disability.
In case of a minor injury, it may take a few days to a few weeks for complete recovery. However, if injury is severe and surgery is required, it may take a few months to regain mobility and functionality. When doctor’s advice on medications and precautions are followed and physical therapy is done as prescribed, the patient will be able to use the affected joint after the healing is complete.
FROZEN SHOULDER
Frozen shoulder, also called adhesive capsulitis, is a thickening and tightening of the soft tissue capsule that surrounds the glenohumeral joint, the ball and socket joint of the shoulder.
Primary adhesive capsulitis and secondary adhesive capsulitis are the two types for frozen shoulder.
The major symptoms of frozen shoulder are pain and loss of motion.
Operative procedures to treat frozen shoulder include closed manipulation, arthroscopic and open surgical techniques.
HIP REPLACEMENT
Hip arthritis is any condition that leads to degeneration of the hip joint and its cartilage surfaces. Some of these conditions are osteoarthritis, rheumatoid arthritis, avascular necrosis and congenital dysplasia (dislocation) of the hip. Fractures and other injuries to the hip joint can also lead to hip degeneration. Hip arthritis is a degenerative condition that affects the hip joint, and often leads to a significant impairment in the quality of life. The ability to walk, work and live pain free can be adversely affected.
Most commonly, hip arthritis pain is described as increasing pain in the groin and anterior (front) thigh area. This usually begins with pain only during activities. It progresses to pain at rest and eventually disturbs sleep at night. With longstanding arthritis in the hip, motion in this area can be extremely limited, especially in flexion (bending) and internal rotation.
Early conditions are normally treated with anti-inflammatory medications, exercise, weight loss, the use of walking aids, and over-the-counter supplements.
Total hip replacement surgery is very successful and has excellent short- and long-term outcomes. The surgeon removes the arthritis from the hip and inserts a ultra-high molecular weight polyethylene hip implants in to the hip. This provides for hip function, limb length equality and restoration of motion. The procedure can be done with cement, which is a grout type of substance.
Following surgery, the patient will keep sutures clean and dry for seven to fourteen days, followed by removal. For the first eight weeks care is given to prevent dislocation. A patient will use crutches or a walker for the first six to eight weeks. An exercise program begins thereafter. Improvement in mobility and pain relief may take six to nine months.
Modern hip replacements have a 90-95% survival rate at 15-20 years.
ANKLE SPRAIN
There are four symptoms common to all ankle sprains, pain, swelling, bruising, and joint instability.
Ankle sprains are the result of a sudden twisting and pressure on the ankle. Sprains happen when normal range of motion in the ankle is disrupted. They occur for several reasons but the most noted
are activities such as running on uneven pavement or stepping in a hole, jumping and landing on someone’s foot, playing basketball, slipping on wet surfaces, wearing loose footwear or excessively using a fatigued joint. Not listening to the body when it is tired increases the chance for an ankle injury.
Most ankle sprains require Rest, Ice, Compression and Elevation (RICE), followed by rehabilitation and muscle strengthening. When the ankle sprain is managed immediately with RICE, symptoms may be minimized despite the severity of injury.
Surgery for a sprained ankle is rarely necessary, although some very severe sprains and some ankle fractures will require an operation. Most patients recover satisfactorily by following a non-operative treatment plan prescribed by their physicians.
ACL/PCL RECONSTRUCTION
Can Anterior Cruciate Ligament (ACL) injury or Posterior Cruciate Ligament (PCL) injury heal itself?
Just like most human body parts, ACL or PCL can heal itself by fibrosis, but only when the injury is very small. Even though the tissue is healed, it will not be able to withstand the shearing force that a human body has to endure. Hence, in some situations, surgery may be the best choice. It is always advisable to consult a doctor to know the best treatment option for an ACL injury or PCL injury.
ACL or PCL injury may occur while playing sports or during an accident. The only treatment option for ACL injury or PCL injury is surgical reconstruction of ACL or PCL. In this surgical reconstruction, the surgeon removes the injured PCL or ACL, then he/she uses a portion of the ligament from Medial Collateral Ligament (MCL) to reconstruct the ACL or PCL.
The necessary steps that the patient has to take after surgery are:
The patient has to take rest in bed for a few days.
While in bed, the leg has to be elevated (Ice is applied to help with pain and swelling).
Crutches are provided to the patient in order to decrease the weight on the leg while walking.
The patient may have to wear knee braces.
Once the doctor feels confident about patient’s recovery, the patient can start playing sports. This will usually take 3 months to 6 months.
The doctor may prescribe medicines to manage the pain.
The doctor will suggest physiotherapy for 3 weeks to 3 months.
After the surgery, the patient will slowly recover in stages. The recovery will usually progress in the following way: The patient will have to stay in bed for a few days after the reconstruction.
After that, in ACL Reconstruction the patient can start walking on the 2nd day with the help of knee braces and crutches. And In PCL Reconstruction the patient can start weight bearing after 6 weeks with knee braces support.
The patient has to undergo physiotherapy for a few weeks (3 weeks) to a few months (ideally 3 months) after which they can get back to their regular lifestyle.
After 6 months the doctor may permit the patient to get back to sports.
The patient can start walking 3 to 4 days after ACL reconstruction or PCL reconstruction. In some cases, when the surgeon is confident, he/she may allow the patient to walk on the same day of surgery but with the help of crutches and knee braces.
If ACL injury or PCL injury is left ignored, then the patient may start to experience instability in the knee. The patient may not be able to walk properly, climb properly or run confidently. The injury may put extra pressure on the knee which may lead to osteoarthritis.
The patient will be under anesthesia during the surgery, hence the patient will not experience any pain. After the surgery, the patient may have pain for which the doctor may prescribe medicines (which will have painkillers
It depends. ACL tears can be partial or complete. With stretching and strengthening exercises and often a good knee brace, it is possible to live with a tear. If you find you cannot lead the life you wish and are unwilling to modify it, then surgery is for you. “Modify your life to fit your knee or modify your knee to fit your life” is the standard quote. However, surgery is frequently recommended for very active patients, particularly those involved in sports.
Yes, but you need to keep your dressings dry. You can cover them will plastic wrap. If you have a longer dressing it may be easier to step into a tall kitchen trash bag, then secure it with an elastic. If this doesn’t come up high enough, cut a hole in the bottom of a second bag and pull it up and over the first bag until everything is covered, then secure with an elastic. An anti-skid mat is a good idea.
You should not drive as long as you are taking narcotic pain medication. If it is your left knee, you can resume driving when you feel your reaction times are back to normal (typically 6 weeks). If it is your right knee, usually allow driving 3 months after surgery.
After ACL reconstruction surgery, you can go to sports and gym after about 5 months to about 8 months depending on your recovery and also keeping in mind the advice given by the doctor according to your condition.
Preservation
You should not drive as long as you are taking narcotic pain medication. If it is your left knee, you can resume driving when you feel your reaction times are back to normal (typically 6 weeks). If it is your right knee, usually allow driving 3 months after surgery.
Knee preservation arthroscopy (KPA) is a range of keyhole procedures performed to treat structural damage in the knees early
Age — Preservation techniques often are more successful the younger you are.
Weight — The more you weigh, the greater stress and demand is placed on your joints. Every pound you lose relieves three to five pounds of pressure on the hip, knee or ankle. Losing weight is the best thing you can do for an arthritic joint.
Muscle strength and conditioning — Muscles provide power to movement. They also serve as shock absorbers, protecting your joints. Maintaining or restoring muscle strength and flexibility reduces joint stress and pain.
Severity — Your doctor may sometimes manage small areas of cartilage thinning or erosion with minimally invasive procedures. However, if the cartilage is almost all gone — leaving bone touching bone, or if the bone underneath the cartilage is deteriorating, surgery is sometimes the best option although some injections can still help in those situations.
Location — Many joint preservation techniques focus on the knees. But there are an increasing number of alternatives to hip and shoulder replacement as well.
If the arthritis is only in one part of the knee then the patient may benefit from high tibial ostetomy. In this surgery the stress of weight bearing across the knee is more evenly distributed by realigning the bone. It relieves disproportionate heaviness on the diseased (or arthritic) side of the knee joint.
For healing of high tibial osteotomy, there requires about second day of partial weight bearing, which is again followed by six weeks of full weight bearing with crutches and about 12 weeks of rehabilitation with physical therapy. Majority of patients fully recover to full activity by about six months.
Clinical evaluation along with full length X-rays are required for evaluating a high tibial osteotomy. Patients usually younger than 55 yrs old, only mild deformity, good movements in the knee and arthritis in only one part of the knee are the indications for HTO.