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30-40% of Indian population suffers from Arthritis!

by Pragati Singh
written by Pragati Singh

Hyderabad, October 2021: Mr L.S. Chouhan, IPS, Dy. Commissioner of Police, Traffic, Hyderabad City; flagged off the World Arthritis Day Cycle ride organised by Apollo Spectra Hospitals and Hyderabad Cyclists Group, on the eve of the World Arthritis Day (October 12th), today at Apollo Spectra Hospitals, Ameerpet. Also present on the occasion were Mr Chandrasekhar, CEO, Apollo Health & Lifestyle Ltd.; Dr Dasari Prasada Rao, Chairman, Nano Hospitals Pvt. Ltd. And Dr M Naveen Chandar Reddy, Consultant Orthopaedic Surgeon, Apollo Spectra Hospitals, Ameerpet. The Ride was organized from Shyam Karan Road to Lumbini Park via Raj Bhavan, Panjagutta and back.

Mr L.S. Chouhan, speaking on the occasion said, Bone health is of prime importance for a healthy life. In India we are all living in apartments, leading a sedentary life. Because of which vitamin ‘D” deficiency is a common feature, 8 out of 10 people have this serious deficiency. People should come out from their sedentary lives and get exposed to sunlight, adopt exercise, cycling and physical activities to lead a healthy life. On this occasion I advise and request the citizens of Hyderabad to follow traffic rules. It is generally a norm to break the rules and freely get away, but days have changed law is becoming stronger. Central Government has made the law stringent, our state is going to adopt it soon, penalties are going to be high, punishment is going to be stringent, Courts are also getting serious on the violations taking place on the roads. Every year 1.3 lakh people are dying on Indian roads and three times that number are getting crippled. In the state of Telangana around 8000 people are dying, most of these loosing lives are productive age group people, bread winners of the respective families, many young citizens. This issue has been neglected by citizens and my appeal to them is to take road regulations more seriously. Every day around 450 people are dying which is equivalent to one jumbo jet crash, a jumbo jet crash would be big news, but 450 people dying this way every day is not news, I want citizens to ponder over this. I would request everyone to follow the rules and set examples for others.

World Arthritis Day is commemorated across the globe on October 12th every year to raise awareness about Arthritis and on the existence and impact of rheumatic and musculoskeletal diseases. The theme for this year’s World Arthritis Day is Don’t Delay Connect Now – It’s in Yours Hands Act Now.

Mr Chandrasekhar said, off late we are seeing much younger patients coming with arthritis, earlier this used to be a disease of people in the age group of 50 and above. Rise in the incidence of arthritis is because of our changing lifestyles, people are becoming less mobile, lack physical activity. It is time to spread awareness in the community to be physically active. Youth suffering from such diseases can impair the growth of the country. Non-communicable diseases are becoming a significant part of the health issues cropping up in the populace, and therefore this awareness exercise is to create cognizance in youth to be physically active. Bone health is an obvious outcome of physical fitness, he added.

Dr Dasari Prasada Rao, the strong message from today’s cycle ride initiative is, cycling keeps our joints fit and maintains bone health. Participants between 10 to 75 years age were part of the ride and they strongly advocated the cause of cycling as a good means to keep healthy and that it protects people of all age groups from falling ill, while helping to stay healthy.

Arthritis is the most common joint disease affecting people in the age group above 50 years leading to decreased quality of life. Its prevalence is approximately 30-40% in India and is more common in women compared to men, says Dr M Naveen Chandar Reddy.

Arthritis is an inflammation of one or more joints. It can affect any joint but more common in knees. There are multiple types of arthritis but Osteoarthritis and Rheumatoid arthritis are the two most common types.

Osteoarthritis is a degenerative wear and tear of the smooth lining called cartilage of the joint. Osteoarthritis can affect any joints but its more common in weight bearing joints like knees & hips.

Osteoarthritis patients present with Pain, Swelling, Decreased Range of Motion and Stiffness of the affected joints. In advanced cases they have rest pain which indicates the severity.

The treatment depends on stage of the arthritis and it includes pain medication as and when required, Physiotherapy to strengthen the muscles around knee joint, Lifestyle modifications like avoiding squatting and sitting cross legged , weight reduction , cartilage supplements, visco supplementation, PRP injections. Total knee replacement is the treatment of choice for advanced stage of osteoarthritis.

Eating healthy food and doing regular exercises will keep the bones and joints healthy. It’s key to visit an orthopaedic doctor if one is suffering with joint pains to get it evaluated and treated at an early stage to lead a better quality of life.

About Apollo Spectra Hospitals

The Apollo Spectra specialty hospital offers expert and quality healthcare, in a patient-friendly and more accessible facility. There are world class surgical services and impeccable post-operative care for all patients, with access to advanced technologies, excellent infrastructure and the most qualified team of surgeons attending to patients.

The Apollo Spectra group has a network of 17 specialty hospitals across 12 cities – Bengaluru, Chennai, Delhi, Gurugram, Jaipur, Kanpur, Mumbai, Noida, Hyderabad, Gwalior, Patna and Pune. Over 1,30,000+ successful surgeries and more than 900 leading doctors, have ensured that it continues to set new standards in healthcare services.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Orthopedic News

Robotics transforming knee replacement surgeries

by Dr. Shubhang Aggarwal
written by Dr. Shubhang Aggarwal

By Dr. Shubhang Aggarwal, Senior Joint Replacement Surgeon, NHS Hospital, Jalandhar

From Siri, Alexa to Self driving cars and auto pilot planes to Satellite Mapping, the world has seen the power of technology beneficial for the common man. The medical field is not untouched; what we had seen as fiction in stories and movies, is now a reality; artificial intelligence and robots are helping people do their jobs better and easier. In the field of Orthopaedic surgery, robotics-assisted knee replacement is revolutionising the way knee replacements are done. These advanced robots have made their way into the operating room floor, assisting surgeons in attaining precision and accuracy during surgery. Today, robotics has become a new tool in hospitals to provide the best treatment.

What is a robotic joint replacement?

Imagine a pilot flying a plane through a thick fog. If it would have been a few years ago, he would use only his senses and imagination to land the plane safely. But with the advancement in technology, the same pilot now has high quality satellite guidance; the autopilot mode allows the sensors and an algorithm guide the plane to land smoothly. Similarly, things have changed from when an orthopaedic surgeon did a conventional surgery where he relied on eyeballing with his 2D vision for assessment of deformity and making the bone cuts. Now, he can use high-end robotics, with self learning artificial intelligence to create a live 4D map of the joint and sees the ideal placement of the artificial implant to be put and then the robotic tool burrs off just that much little bone, needed to get the perfect fit of implant, saving the natural bone and ligaments.

The technology has moved on from the previous implant positioning techniques that used long rods drilled into the central canal of the femur (thigh bone) to provide an attachment point for surgical cutting guides to jigless robotic planning and execution.

The most advanced innovation is the Navio Surgical System, a robotic platform that does not need any CT scan or MRIs and creates a real time image of the limb and deformity and the surgeon is able to visualise all around the knee and make a plan on how it is going to be after surgery even before the bone is touched. This robotic system clearly demonstrates the excellence in the field of knee replacement surgery. Using the Navio system, a surgeon is able to understand the unique anatomy of each individual knee, gets the knee in natural alignment of the hip and ankle and the perfect sizing ensures that the tracking of the knee is balanced in the artificial implant throughout the range of movement. The surgeon can now place the implant with sub-millimetric precision which works and feels just like your God given natural knees. Such robot-assisted Knee replacement surgery involves negligible blood loss, much less pain, little tissue invasion and accurate positioning the implant with long-lasting results.

After such procedure, a patient can start walking only 3 hours after the surgery and go back to home within 3 days as of now and with better anesthesia and rehab modalities, we are targeting one day discharge! So going with a Robotic knee replacement surgery the hospital stay period of a patient is reduced. It makes all the sense effective in these times of COVID hence decreasing the exposure to a minimal level.

What are the advantages of a robotic joint replacement?

The primary reason for the development of the robotic systems was the endeavor to improve outcomes for patients. Although, with research we have better metal and ceramics in hip and knee replacement prosthesis, but placement of these implants the right way makes all the difference. It has been observed that with use traditional methods of surgery, there are some number of patients who are dissatisfied with the outcome. With the use of artificial intelligence-enabled robotic technology and aim and hope that these procedures will get accuracy in implant positioning, and with natural soft tissue balance, tracking improves and that will consequently improve further the satisfaction levels from surgery.

The Navio system offers two important benefits: first, it helps the surgeon to create a highly individualised plan specific to the patient and he is not exposed to any potentially harmful radiation, as opposed to the earlier methods of CT scans. The second benefit is robotic assistance that combines advanced technology to gives a perfect accurate placement of artificial knee and aim at better long-term outcomes, for long lasting 30-40 years at much cheaper cost.

Over the past couple of years, studies have focused on the pinpoint accuracy of the robotic-assisted knee replacement system. A study by orthopedic surgeon Geoffrey Westrich and colleagues published in the Journal of Knee Surgery found that the robotic system allows increased accuracy and precision and is beneficial in the training of orthopedic surgeons. In another study by researchers in the United Kingdom, published in the Bone & Joint Journal in 2018, it was found that robotic-assisted total knee replacement was linked with a shorter hospital stay, decreased pain after surgery and improved early functional recovery.

Along with the precision, the robotic‐assisted procedures also offer more protection to the surrounding soft tissues at the surgical site and facilitate more healthy bone to be preserved. During the surgery, the implant or components that replace your old joints are typically made from metal, ceramic, or plastic. Robotic assistance allows your surgeon to place your implant more efficiently. And robotic surgery leaves much smaller and less invasive scars as compared to traditional surgery.

Paving the way for the future

The introduction of robotics has improved the way doctors do surgery, including the joint replacements. As the technology grows more and more people demand this kind of accuracy that robotics can provide for their hip and knee replacement surgeries. These AI-led robots allow the surgeon to combine his judgment and knowledge with the control and precision of a robot, changing the way surgeries would be done in the future.

About NHS Hospital

NHS Hospital is the state-of-the-art multi-specialty hospital providing the best Orthopaedic facilities in this part of the country. NHS is equipped with the latest robotic technology to offer advanced knee and hip replacement surgeries. The Artificial Intelligence-enabled cutting edge NAVIO robotic knee implant procedures exhibit superior quality with precision in knee replacement surgery to provide sub-millimetric precision to ensure 100% accuracy without disturbing the natural knee ligaments. Headed by Dr. Shubhang Aggarwal, a leading and senior super-specialist Orthopaedic & Robotic Joint Replacement surgeon in Jalandhar, NHS Hospital has a great team of highly skilled surgeons, who ensure correct diagnosis, excellent surgical outcomes, and a speedy recovery. Assisted by the latest technology and ultra-modern techniques, the experienced team of Orthopaedic surgeons ensures perfect surgeries and the best post-treatment results for every in-coming patient, giving access to the best medical care.

At, NHS Ortho-Robotics, patients experience minimal pain post-surgery and can start walking in just 3 hours after surgery. Most patients can bend their knees to 130 to 140 plus degrees and are able to climb stairs in 3 to 4 days. Through this minimally invasive procedure, longevity of the patient’s artificial joint increases, and they are sent home earlier post-surgery.

 

 

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Experts speakOrthopedic News

Lower Back Pain: The 10 prominent causes of it

by Dr. Shubhang Aggarwal
written by Dr. Shubhang Aggarwal

By Dr. Shubhang Aggarwal

In India, 20 percent people of 16-34 age group are treated for back and neck conditions in India. The percentage of young population going for back pain treatment is the highest, whereas, 45% people neglect their pain for more than 7 weeks which results to delayed treatment. Seeing the prevalence, the question arises how does lower back pain happen? Our lower back has a complex structure and it’s made up of the five lumbar vertebrae – L1 – L5. These are held together to form a column, by muscles and ligaments.The lumbar spine provides support for the back and takes most of the weight of the upper body. Therefore, the lower back is more prone to back pain than the upper back because the lower part of the back bears the mechanical load.

Here are the 10 prominent causes of lower back pain, and some of them are connected to the spinal cord and nerves and others are linked to conditions:

Trauma or injury:

injury to low back and occur with small simple falls at home for example while walking down fast from the stairs or slipping in the bathroom.

While road traffic accidents can cause very bad back injuries right from simple fractures to complete spinal cord injuries paralysing people.

Sports injuries often result in sprains and tears in muscles/ ligaments of the lumbar spine. More Violent injury can cause an intervertebral disc to move out of its place like a toothpaste coming out of the tube and it creates pressure on the spinal cord.

Bad posture

Stooping or bad posture the next most common cause of low back pain. Most people which is entry lifestyle tend to slouch, while sitting for long hours and even while watching TV they do not take proper lumbar support. Long hours of continuous sitting can cause abnormal strain on the disc and can weaken the spinal muscles leading to backpain.

Degenerative Disease

With age, our joints gradually deteriorate due to general wear and tear. The intervertebral discs also similarly start to shrink and the nerve roots become strained. Even mobility of the spine is lost and it becomes stiff. In such a scenario, the spinal canal becomes narrowed, causing a serious condition where intense pressure on the spinal cord causes pain, numbness and difficulty walking called as neurogenic claudication.

Vitamin D deficiency

Recognise to be another major cause for unexplained low back pain, vitamin D deficiency has come as an epidermic and can simply be treated by checking and confirming the low levels and proper exercise and supplementation of vitamin D.

Arthritis:

Osteoarthritis and other type of arthritis including Rheumatoid arthritis and ankylosing spondylitis eventually affect our lower back. When arthritis occurs, it causes inflammation within the joints, erosion of cartilage and bone and consequent pain weakness of muscles.

 Referred pain from abdomen or Kidney Stones.

When there is no structural or functional issue in the spine, still low back can happen due to referred in from Indra abdominal organs and kidney stones. Kidney stones can cause pain in the mod and lower back.

Pregnancy.

Backache or back pain is quite common during pregnancy, especially in the early stages. When a woman conceives, the ligaments become softer and it starts getting stretched to get her all set for the labour. This can put a strain on the joints of your lower back and pelvis, which can cause back pain.

Spinal Tumours

Many spinal tumours don’t have any symptoms but there are some that cause extreme back pain and neurological shortfalls including numbness and weakness. The location of the tumour in the spine plays a crucial role. It actually destroys the healthy tissue uch as the vertebrae (bones) in the spine, leading to back pain. About 70% of spinal tumors are located in the thoracic spine, which is located in the upper and middle part of the body.

Cauda equina syndrome

This is a emergency condition in which ruptured disc presses on the spinal cord causing symptoms in the lower limbs, and sometimes the bowel and bladder. If untreated it can result in permanent neurological damage and needs urgent surgical intervention.

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Experts speakOrthopedic News

Fractures in elderly are on rise: Here’s how one can prevent it

by Dr. Shubhang Aggarwal
written by Dr. Shubhang Aggarwal

Falls are quite common irrespective of the age, but as we age the occurrence of falls and the severity of injury resulting from it also goes up. Sometimes, it becomes the leading cause of fatal and nonfatal injuries in people above 65 if not managed well. Fractures of wrist, shoulder spine and pelvic are some of the common injuries of falls. It hinders the quality of life of the elderly community immensely as the treatment procedure involves prolonged hospitalization followed by decreased independence and mobility. However, many falls can be prevented with healthy lifestyle choices and safety modifications in the home.

Here are some of the ways falls and fractures in elderly can be prevented:

• Becoming physically active and maintaining your health make you less prone to falling.

• You need to comprehend your health and medications first in order to make the alterations in your lifestyle.

• Book yourself for a yearly eye examination and other important vitals like evaluation for cardiac and blood pressure issues.

• Your diet also plays a pivotal role. Enrich diet with dietary calcium and Vitamin D.

• Quit smoking and avoid excessive alcohol intake.

• Keep your medications up-to-date and check with your doctors with whom you consult frequently. Ensure that the medications are well-labeled. Make sure that the medications are consumed on scheduled time with a full glass of water, unless otherwise instructed.

• Consult the doctor for starting an exercise program according to your body’s specifications. The exercise program should have physical activities that aid agility, strength, balance, and coordination. If you want to develop your bone strength and slow down the progression of osteoporosis, climbing stairs, jogging, hiking, dancing, weight training and other activities can help build bone strength. Gardening and cycling can also improve health and life quality.

• Make certain the fact that you are wearing properly-fitting shoes that has nonskid soles. High heels are a complete no no. If you are wearing shows with laces then make sure that you have tied them properly. In case there is a problem in putting on your shoes, take help of a long-handled shoehorn. Never walk in your stocking feet. Slippers that have stretched and are too loose should be replaced immediately.

• Studies have shown that incorporating simple safety modifications at home, where most senior falls, can substantially cut down the risk of falls and related injuries. For example- place a lamp in the bedroom, keep the telephone handy, or flashlight near your bed. The bed should be comfortable enough to get into and out of. Be careful about the sheets you are using. Make sure you’re using non-slippery material such as wool or cotton. Make sure that the clothes in the closet are arranged properly and are easy to reach.

• At night, there should be adequate light along the route between the bedroom and the bathroom. In the living areas, arrange furniture so you have a clear pathway between rooms. Keep tables, magazine racks, footrests, and plants out of the path of walking.

• Washroom should have a slip-resistant rug adjacent to the bathtub for safe exit and entry. Hang the liquid soap dispenser on the bathtub/shower wall. Install grab bars on the bathroom walls.

• Make use of a sturdy, plastic seat in the bathtub if you have problem in bending down yourself to the floor of the tub or if you are unsteady.

• When a fall happens, consult your doctor immediately.

 

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Experts speakOrthopedic News

Pain after knee replacement surgery: When to see a doctor?

by Dr. Shubhang Aggarwal
written by Dr. Shubhang Aggarwal

By: Dr. Shubhang Aggarwal, Orthopaedic & Robotic Joint Replacement Surgeon, NHS Hospital, Jalandhar

Total Knee replacement surgery is now widely accepted as a precise, repeatable and successful surgery. A large number of cases of knee replacement surgery are carried out in India itself. With better trained doctors and good hospital infrastructure, the results of knee replacement surgery are getting better every day. However, there are a few patients who are not satisfied with their knee replacement surgery and they continue to experience pain. We need to identify the reasons for this and ensure that this does not happen.

What to expect after surgery?

With better tissue handling techniques and accelerated rehabilitation methods,  most patients can start mobilising 3-5

hours after surgery. There is some pain of the incision and sutures. Post surgery as the patient starts exercising, the pain gradually becomes much lesser and depending upon the person’s body type, age and deformity before surgery, it should go away within 25 to 30 days. With robotic surgery, the mobilisation is much faster and the amount of pain is much lesser and patients bend their knees much faster and more. Some might take a little longer than the others, especially if their muscles and bones are weak or they are elderly. Even comorbidities like diabetes or kidney disease can slow your recovery. If a person doesn’t have the above-mentioned conditions, then they should not have any pain and the joint should start feeling normal.

What to do after discharge?

Here are the few tips a patient undergoing knee replacement surgery should follow to speed up his/her recovery process:

  • Follow doctor’s instructions diligently:The patient should make sure that he/she is adhering to the doctor’s instructions. Many times people often ignore their surgeon’s suggestion and become doctors on their own by self-medicating. Such instances often yield poor results.
  • Exercising properly: Most patients can begin their knee exercise within hours of the surgery. But, they have to ensure that they are not overdoing the exercise because even that can cause some stretch pain or can hamper the alignment.
  • Avoiding falls: This is mostly experienced by elderly people. They should use crutches, a cane, a walker, and handrails to get around postoperatively until their strength, balance, and flexibility have improved.

When to see a doctor?

The big question is of persistent pain even after knee replacement surgery. Let’s understand the causes for pain after surgery also. In the initial period, the pain is of the incision and the surgical invasion itself. As that goes down gradually with exercising, the pain can be coming from the spine or the muscles which are weak. Pain after that could be due to weak muscles – mainly the quadriceps of the thigh muscle which brings the leg straight up.

One very serious complication can be infection, which of course in any good centre now with the operation theatre discipline and bacteria free filtered air in OTs should not happen but If a patient has any redness with pain or swelling, high fever then he/she must immediately consult the doctor. Infections require immediate treatment to prevent further serious complications. Although the rates of infection in any good center are less than 1 percent in the world, there is no harm in consulting the doctor once and ruling out these conditions.

Another reason for dull aching pain that goes on for months together is malaligned component or a knee which is not balanced properly. With the use of robotics, the artificial components put inside are actually balanced throughout the range of movement and the stretch on the ligaments is accurately assessed on the operation theatre itself. This ensures correct tracking of the knee just like the natural knee joint and hence no pain.

 

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Orthopedic News

ACL Tear: A common knee injury in sportsmen

by Dr. Shubhang Aggarwal
written by Dr. Shubhang Aggarwal

ACL (anterior cruciate ligament injury) is one of the main stabiliser ligaments of the knee joint. Injury or tear of the ACL is one of the most common injuries of the knee.

When?

It can occur at any age or in any sport, but generally seen in young people during sports that involve pivoting of the knee like soccer, basketball, hockey and skiing, when sudden stops or changes in direction occur during jumping and landing. It is also a common injury in contact sports such as Kabaddi and Wrestling and american football.

Besides sportsmen, the injury can happen to anyone in common activities like jumping actoss a puddle or if you miss the last step of the stairs in a rush or just simply climbing a stool.

Once torn an ACL can never repair itself. 40% of people can manage their sedentary life with occasional sports without a surgery but if someone wants tk run/ jog or play even weekend sports regularly or they experience feeling of giving way (instability) and sense of discomfort then a surgery is recommended to protect the knee from repeated damage and future arthritis.

What happens?

The ‘pop’ sound of ACL rupture may not be heard in every fresh injury case and we have to look for other

common symptoms like:

1- Pain: If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.

2- Swelling: This is most likely to happen in the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg on a stool or 2 pillows.

3- Trouble walking: If you’re not able to put pressure on your hurt knee to walk, climb stairs and walk on uneven ground. Some people find that the knee joint feels loose than it should be.

4- Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.

Symptoms in a chronic case: Instability is the most common symptom in an ACL deficient knee in which patient feels that his/her knee will buckle in certain movements/positions of knee especially while playing sports.

What is it?

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments inside the knee that cross in the centre and stop undue movement of your thighbone (femur) on your shinbone (tibia).

When injured, it puts stress on the knee.

Who is at risk?

1- Being female — possibly due to differences in anatomy, muscle strength and hormonal

influences.

2- Participating in certain sports, such as soccer, kabbaddi, basketball, gymnastics,

skiing and Wrestling.

3- Poor conditioning of muscles that can actually protect against violent movements.

4- Wearing footwear that doesnt fit properly

5- Using poorly maintained sports equipment or wrong techniques.

6- Playing on artificial turf surfaces

How Is It Diagnosed?

-Detailed History: Your doctor will want to hear exactly how you injured your knee. He’ll look

at both the knees to see if the sore one looks different.

-Clinical Examination: Your doctor may ask you to lie on your back and bend your hips and/or

your knees at certain angles. He’ll then place his hands on different parts of your leg and gently shift the leg around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.

-X-ray: Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out

broken bones.

-MRI: This exam can show both soft tissue and bone. If you have a damaged ACL, it shows up on the scan.

Treatment?

-Arthroscopy: This literally means to “look within the joint.” During this exam, an orthopedic

surgeon makes a small 4mm keyhole into your skin. He inserts a camera attached on a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects a magnified image of the joint onto a large screen. Your doctor can see what type of injury you have and repair as needed.

Treatment:

Treatment depends on how badly you’ve been hurt.

First is first aid: If your injury is minor, you just put ice on your knee, elevate your leg,

and stay off your foot for a while. You can reduce swelling by wrapping a crepe bandage around

your knee. Crutches/walker can help you to keep weight off your knee.

Medication: Analgesics and anti-inflammatory drugs help to reduce swelling and pain.

Rarely for intense pain and swelling, you may have to get the blood aspirated and get an injection into your knee with a steroid.

Knee brace: Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.

Physical therapy: You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help you regain a full range of motion. You may asked to exercise on your own.

Surgery is done when all else fails and is called Arthroscopic ACL reconstruction in which Surgeon will remove the damaged ACL stump through a keyhole and replace it with a graft sometimes made from the core of your hamstring muscle or a fibretape.

This is usually a daycare surgery and after surgery with proper rehabilitation ie Proprioceptive and strengthening exercises patients can resume brisk walk in 6 weeks and jogging in three months. Active contact sports again within six months.

With modern surgical techniques and fixation methods available, ACL surgery for sportsmen  especially, has proven to be highly successful procedure.

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Bone death
Experts speakOrthopedic News

Bone Death: No sure shot prevention but measures can be taken for early recognition

by Dr Rahul Bhan
written by Dr Rahul Bhan

As we come in terms with the relentless onslaught of the war waged against humanity by the most primitive of living things, a puny virus, we find that for most of our illnesses, only we are to be blamed. Yes, I am talking about the COVID- 19 pandemic that has brought the entire world to its knees.

We had only begun to understand the working of the virus and remarkably, we were able to figure out ways and means to prevent and treat the disease caused by the virus.  But then there was the malady of self-medication, practicing of unscientific measures, which proved in many ways the inherently unrealistic approach of most humans. I personally know of many people who started their own therapies for COVID management. Alas, we were faced with unheard of conditions like Black Fungus (Mucormycosis) and now Bone Death (Osteonecrosis). The scientific community is not ruling out the incessant use of life saving steroids for the unexpected rise in both Black Fungus and Bone Death cases.

The single factor that could be blamed for this upsurge in such cases was steroid use. It is an exercise for statisticians to determine whether these drugs were genuinely prescribed by doctors or blatantly self administered by some people. In vulnerable people who have other medical problems like diabetes, injudicious use of some medicines can be catastrophic and lead to disaster as the body’s immunity is severely compromised, allowing unusual conditions to surface.

Bone death is not something novel. It is the necrosis or death of certain areas of bone, especially the upper part of the thigh bone and a few other bones which results in crippling arthritis and disability. While this condition was known by names such as Osteonecrosis and Avascular Necrosis during the normal times, the pandemic has given it a new name, i.e., Bone Death. A significant percentage of Bone Death patients are found to have a history of alcohol abuse and steroid use, which clearly indicates that COVID-19 by itself is highly unlikely to cause the condition. It is more likely to target patients who are on steroids.

As of today, there are just a handful of patients in India who have had post-COVID Bone Death but it is something that needs a high degree of attention and the awareness on the part of health care workers as well as patients themselves. There is no sure shot way of preventing its occurrence, but there are definite measures that can be taken for its early recognition and identifying the group of patients who are at greater risk.

In medicine, we always say prevention is better than cure and it’s true here as well. Osteonecrosis, once established, usually requires surgery and sometimes joint replacement too. Doctors are a part of the society who are just a bit more informed and aware of the health issues and it takes a very long time to become an efficient doctor. It is in the best interest of patients to trust doctors and try not to indulge in self-harming medication. Adversity is the best teacher and this pandemic has proven the adage quite good.

We will get benefitted as more data is collated regarding all the manifestations of this viral infection and what it does to the various organs. This is no time to be scared, but it is also not a time to be unduly belligerent. Bone Death is not trivial and it is paramount that it is recognized and treated. General rule – post COVID, having hip pain that is not getting better with time – go and see your Orthopaedician and follow his advice.

Wishing good health to all.

Dr Rahul Bhan

Senior Orthopaedician, Deep Hospital, Ludhiana

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Orthopedic News

New study suggests that bone loss, fracture risk in women are linked to cognitive decline

by Pragati Singh
written by Pragati Singh

According to new research, women’s cognitive decline is connected to rapid bone loss and higher fracture risk.

Researchers from the Garvan Institute of Medical Research led the study, which was published in the Journal of Bone and Mineral Research.

The link between cognitive decline and bone loss was shown to be weaker in men, according to the study’s findings.
Over the course of 16 years, researchers studied adults aged 65 and up, and discovered a potential new method for identifying older people who may be at risk of fracture.

“Bone loss and cognitive decline are major public health issues, but both are’silent diseases’ that can go undetected and untreated for long periods of time, often until the conditions have progressed severely,” said Professor Jacqueline Center, Head of the Clinical Studies and Epidemiology lab at Garvan and an endocrinologist at St Vincent’s Hospital and senior author of the study.

“Our study has revealed a link between the two in women, which suggests that cognition should be monitored together with bone health, as a decline in one could mean a decline in the other. These findings may help refine best practice guidelines of how cognition and bone health are monitored in older age, to ensure appropriate treatment can be more effectively administered,” added Jacqueline.

Around the world, 200 million people are affected by osteoporosis and more than 35 million by dementia – numbers which are expected to double over the next two decades due to a global increase in life expectancy.

“Cognitive decline and bone loss both result in increased disability, loss of independence, and an increased risk of mortality. There is some evidence that older individuals with dementia have a higher risk of hip fractures, but whether the decline of both bone and cognitive health are linked over time has not been studied,” said Dr Dana Bliuc from the Garvan Institute, who is the first author of the paper.

“We set out to understand the long-term association, with our study the first to investigate both cognitive and bone health data over more than 15 years,” added Dr Dana.

The team used data from the Canadian Multicentre Osteoporosis Study (CaMos), which documented skeletal health in people living in the community since 1995.

The researchers looked at cognitive and bone health measurements of 1741 women and 620 men aged 65 years and older, who had no symptoms of cognitive decline at the beginning of the study.

“Our study has revealed a link between the two in women, which suggests that cognition should be monitored together with bone health, as a decline in one could mean a decline in the other. These findings may help refine best practice guidelines of how cognition and bone health are monitored in older age, to ensure appropriate treatment can be more effectively administered,” added Jacqueline.

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Bone death
InterviewsOrthopedic News

AVN most likely to affect younger age group: Experts

by Vaishali Sharma
written by Vaishali Sharma

The second wave of Covid-19 took a huge toll on the country. We all are preparing for the third wave of this deadly disease now. However, some patients recovered with Covid but still have to deal with this dark chapter of their lives. People are experiencing some long term symptoms or diseases associated with Covid-19. One such disease is something known as bone death. Bone Death, also known as Avascular Necrosis (AVN) was reported in Mumbai earlier in July. The doctors have expressed a cause of concern over the disease that is now being reported in various parts if the country.

To know more about this post-Covid complication, Medically Speaking spoke to several specialists: Padma Shree Dr. Yash Gulati, Ortho Surgeon and Senior Consultant, Spine Surgery and Joint Replacement, Indraprastha Apollo Hospitals; Dr. Nikunj Agarwal, Ortho Surgeon and Senior Consultant, Orthopaedics and Joint Replacement, Max Hospital; Dr. Siddharth Shah, Consultant, Knee and Hip Replacement Surgeon, SL Raheja Hospital.

 

Question: Dr Gulati, what is bone death? Is it possible to prevent it?

 

Dr Yash Gulati: The term bone death has been coined recently because of the increased cases of what doctors call Avascular necrosis (AVN). This commonly happens in the upper part of the thigh bone. The thigh bone or the femur bone has a ball that rotates in a socket. This ball has a very peculiar way of getting blood supply. If the blood supply gets damaged, a part of the head of that ball can get damaged and can cause the bone to collapse. This can happen in various other joints like the shoulder joint, knee bone etc. There are several causes of this disease. Steroids, fractures, prolonged alcohol consumption are some common causes. If the disease is detected early, it requires smaller procedures to treat it. If it is detected in the end stage, it requires joint replacement.

 

Question: Dr Agrawal, how will a layman realise that they need to get checked for AVN? What are the symptoms? What should one watch out for in their recovery stage?

 

Dr Nikunj Agrawal: Corticosteroid intake is the most common cause of AVN. If the patient has a history of prolonged steroid intake, there is a possibility that they could be developing AVN. In the early stages, the patient starts developing hip pain. In the later stages, they experience stiffness and restriction in the movement of the hip joint.

 

Question: Dr Shah, tell us a little about your experience with the patients of AVN.

 

Dr Siddharth Shah: Cases of patients with AVN after Covid-19 are increasing gradually. Patients usually experience symptoms like groin pain, buttock pain or sometimes pain in the upper part of the thigh. Some patients are unable to take weight on that leg and eventually start limping. Most of the patients of AVN include men. Data also shows that it is eight times more common in males than females. It happens most commonly between the age group of 20-55 years of age. All these patients were administered steroids during their treatment for Covid.

 

Question: Dr Gulati, why do people need to be wary of steroids? Are they required at all in mild Covid cases?

 

Dr Yash Gulati: Steroid is a wonder drug. It is excellent when it is used and very bad when it is abused. Unfortunately, during the pandemic, steroids were abused. A study by WHO showed that steroids were not appropriate in about 60% of the cases. The problem is that there was no standardisation of steroids at that time. The right amount of steroids need to be given to the patients, at the right time by the right people.

 

Question: You said that patients should consult doctors if they have hip pain or joint pain after a prolonged intake of steroids. What about the patients who do not have a history of steroid intake at all?

 

Dr Nikunj Agrawal: There was a lot of misinformation regarding the use of steroids. Most of my patients were from tier two and tier three cities who had been given steroids right from day one of Covid to 21 days. Such patients with a background of hip pain and joint pain could be suffering from AVN or bone death.

 

Question: Dr Shah, did your patients also have a history of steroid intake?

 

Dr Siddharth Shah: All my patients had a history of steroid intake during their recovery from Covid-19. There was no sign of steroid abuse in my patients. It is known that the total cumulative dose of steroids increases the risk of steroids. The lowest dose for the shortest period is most likely to reduce the risk of AVN.

 

Question: Dr Gulati, is there anything we can do to prevent it? Is it unpreventable? Because there were reports that 20% of people were at risk of AVN especially in the second wave of Covid.

 

Dr Yash Gulati: We take so many drugs that have side effects. Avoid the intake of steroids when not required. Alcohol abuse over a while is also a very important cause of AVN. To prevent AVN, we should avoid the intake of things that can cause it. Major damage can be prevented if AVN is detected early.

 

Question: Dr Agrawal, do you agree that early detection is key? What happens if it is diagnosed at a later stage?

 

Dr Nikunj Agrawal: Early detection is the key to the successful treatment of AVN. If it is detected early, the patient can be treated with minimally invasive techniques like drilling or smaller surgeries to decompress the ball. In the late stages, we have to change the joints or go for a total hip replacement surgery.

 

Question: What was your experience with the patients of AVN?

 

Dr Siddharth Shah: I would like to reiterate that early diagnosis is key. Secondly, as doctors, we should also have a very low threshold for investigations like MRI. In early cases, the X-rays of patients are going to be normal. MRI picks it up early. This will help us make a diagnosis in time. If the diagnosis is early, we would be able to treat the patients with medicines or surgeries which are less invasive. Nearly half of the patients who came to me had advanced disease so there was no treatment option other than hip replacement. I could treat the other patients with the help of certain special drugs, antiresorptive drugs like bisphosphonates. Apart from that, the patients were advised to take rest and not to put weight on the affected leg.

 

Question: Dr Gulati, are X-rays not enough for the detection of AVN? Should the people go for an MRI or a CT Scan right away?

 

Dr Yash Gulati: If it is visible on an X-ray then it is already quite late. It has to be diagnosed much earlier than that. There is nothing to panic about. If there is a symptom, go and see a doctor.

 

Question: Dr Shah, did you recommend MRI to your patients? Did they have any apprehensions about it?

 

Dr Siddharth Shah: I had recommended MRI to my patients. I explained to them their condition. Once we explain them, they do not have any apprehensions.

 

Question: Dr Agrawal, is there an age group that could be more susceptible to AVN post-Covid recovery?

 

Dr Nikunj Agrawal: AVN most commonly affects the younger age group. 30-55 years is the main age group that will get affected with AVN.

 

Question: Dr Gulati, who are the patients who would require a replacement surgery altogether? What would be the stage in which the surgery would be needed? What are the types of treatments a person can get?

 

Dr Yash Gulati: I would like to add something before that. MRI is not like a CT scan. MRI does not have radiations. Except in the first trimester of pregnancy, MRI is quite safe. So people should not be apprehensive about it. The treatment of AVN depends on the stage. In the early stage, practices like offloading, weight-bearing, bone marrow insertion, giving antiresorptive drugs can give good results. Joint replacement is done at the last stage. The decision of joint replacement is more of the patient than that of the doctor. Every joint replacement has a life of its own. We try to avoid joint replacement in younger people. However, if the disability is high, we have no other option. Pain and disability are the indications for joint replacement surgery.

 

Question: Were your patients mostly elderly or the younger generation who were recovering from Covid?

 

Dr Siddharth Shah: The patients who were recommended hip replacement were about 45 or 50 years of age. Hip replacement has a finite life. It may have to be changed after a certain period. Timely diagnosis can help prevent the progression of AVN to a severe stage where hip replacement becomes inevitable.

 

Question: What would be your last word for the people who are watching this?

 

Dr Nikunj Agrawal: Have a high index of suspicion if you have joint pain or hip pain and a history of steroid intake during Covid-19 recovery. Such patients should visit the doctors as early as possible so that they get treated at the right stage with minimally invasive techniques.

 

Dr Yash Gulati: Don’t panic. A very small percentage of people who take steroids during Covid will get affected with AVN. If you have symptoms, visit the doctor, get diagnosed early. As far as the steroids are concerned, make sure you get a judicious dose. Discuss it with your doctor. Be very wary of the drugs that you are getting.

 

Dr Siddharth Shah: One must not panic. Take treatment under medical supervision. Timely diagnosis is key. If there is an onset of any symptoms related to the hip joint, seek a specialist orthopaedic surgeon’s opinion for further treatment.

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Vitamin D
Medicine NewsOrthopedic News

Latest and Effective treatment for deficiency of Vitamin D depicted in a study

by Vaishali Sharma
written by Vaishali Sharma

In a recent study, it has been demonstrated that 25-hydroxyvitamin D3 is an effective treatment for vitamin D deficiency in some particular patients.

There are several million people worldwide with various fat malabsorption syndromes including those who have undergone gastric bypass surgery and those with obesity. These patients often have a difficult time absorbing vitamin D and both groups of patients are at an increased risk for vitamin D deficiency and therefore at higher risk for osteoporosis and osteomalacia (softening of the bones). Patients with obesity are also susceptible to vitamin D deficiency as vitamin D derived from intestinal absorption and cutaneous synthesis is diluted in a larger body pool of fat. Now a new study demonstrates 25-hydroxyvitamin D3 is an effective treatment for vitamin D deficiency for these specific patients.

According to the researchers, approximately one-third of adults are obese and require much larger doses of vitamin D to satisfy their requirement. “This vitamin D metabolite is better absorbed in patients with fat malabsorption syndromes and since it is not as fat-soluble, it does not gets diluted in the body fat and is effective in raising and maintaining blood levels of 25-hydroxyvitamin D in obese people,” explained corresponding author Michael F. Holick, PhD, MD, professor of medicine, physiology and biophysics and molecular medicine at Boston University School of Medicine.

Healthy adults, adults with a fat malabsorption syndrome, and obese adults were compared to evaluate if a more water-soluble form of vitamin D3 known as 25-hydroxyvitamin D3 was more effective than the same dose of vitamin D3 in improving their vitamin D status. The researchers observed that compared to healthy adults only about 36 percent of orally ingested vitamin D3 was found in the blood of patients with fat malabsorption syndromes including patients who had gastric bypass surgery. When the same adults ingested 25-hydroxyvitamin D3 the patients with fat malabsorption syndromes were able to absorb it as well as the healthy adults thereby raising their vitamin D status to the same degree. A similar observation was made in the obese subjects compared to the healthy controls. “Therefore using 25-hydroxyvitamin D3 could be a novel approach for treating vitamin D deficiency in patients with fat malabsorption syndromes and obese adults,” added Holick.

Vitamin D deficiency not only results in bone loss increasing risk for fracture but causes the painful bone disease osteomalacia. Patients who are vitamin D deficient with osteomalacia have unrelenting achiness in their bones and muscles. Vitamin D deficiency has been associated with an increased risk of many chronic illnesses including multiple sclerosis, type 1 diabetes, heart disease, type 2 diabetes, depression, neurocognitive dysfunction, and Alzheimer’s disease as well as infectious diseases including COVID.

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