NEWS AND ANNOUNCEMENTS

Early activity is important following hip replacement surgery. In fact, some patients are walking short distances the same day as the procedure.

Physical therapy usually starts the day after hip replacement surgery, and continues for about two months after the operation. Typically, a physical therapist will show you exercises to do at home while you are still in the hospital.

You may go to a rehabilitation facility for a period of time after you are discharged from the hospital; otherwise, you will go home. Either way, it’s important to stay active: walking and doing the exercises prescribed by your therapist or physician. Anticipate doing about 20 to 30 minutes’ worth of exercises several times each day, every day.

The benefits of early activity include:

• Aiding in your recovery process
• Providing circulation to your legs and feet, helping to reduce the chance of developing a blood clot
• Increasing muscle strength and enhancing hip movement

Exercises will be mild at first, and can include gentle movements, such as knee bends, ankle rotations, and leg raises. Longer term, you will be able to resume an active lifestyle. Low-impact sports make great exercise choices: swimming, golfing, walking, and cycling, among others. But some activities may need modified or eliminated to prevent excessive wear and tear on your hip, like basketball and running.

Bones plays a very important role in our body. it gives structure, protects organs, anchoring muscles and storing calcium. It is not only helpful when you take care of strong and healthy bones during the childhood and adolescences, you can also take care of it during the adulthood to protect healthy bones.

The bones are our body is constantly changing, new bones are made and the old bones are broken down. When you are at the young age your body makes new bone faster than the old bones are broken down and the bone mass increases. At the age of about 30 years most of the people reach their peak bone mass. After that age, the remodeling continues, but you lose slightly more bone mass that you gain.

Most likely you are likely to develop the disease called osteoporosis a condition in which the bones of the body becomes weak and brittle. The higher your peak bone mass, which is more the mass you have gained during the 30 years of age and less likely the situation is that you will develop osteoporosis at that age. Here are certain guidelines for you so that you can deposit more bone mass for a healthier future.

1. Family history: With many medical conditions family history plays an important indicator of your bone health. Those having in their family history to have the disease of osteoporosis are more likely to have the problem themselves. It’s an important question that you must ask your elders about the density of their bones.
2. Calcium Consumption should increase: When most of the people think of bone they thinks of calcium associated with it. The mineral that is very important for the proper development of the teeth and bones in our body. The key of consuming more calcium should be paired with the supplement of vitamin D also. Some of the researches have revealed that the postmenopausal women have shown less bone density and alone the calcium is not affecting the bones much. It should be accompanied with vitamin D. for calcium rich source are included in the diet like yogurt, spinach, milk etc.
3. Boost the bone density with vitamin K: The exact way vitamin K contributes is to the bone health is unclear. Some studies have specifically found that effects of vitamin K and D on calcium absorption rate, it turns out that two vitamin works well as a team as vitamin D stimulates the absorption of calcium in the intestine, vitamin K reduces the amount of calcium excreted by the body.
4. Exercise: on serious note exercise is a key to keep number of health issues away, and bone health is no exception to it. Studies has found that thin or low body weight had the highest bone density showing that exercise can have positive effect on bones density. Indulging in the exercise like running, walking, jumping, stair climbing etc. keeps bones strongest.
5. Less caffeine consumption: caffeine is not good for bones. The study shows that person who is not consuming calcium-rich food and is drinking more than 2 cups of coffee per day will accelerate bone loss in person.

Bone infection is the result when bacteria or fungi attack a bone. It is also known as Osteomyelitis. In children the bone infection occurs in the long bones of the arms and legs but, in the adult, they usually appear in the hip, spine, and feet. Bone infection can either happen suddenly or can develop over a period of time. If it is not treated properly, the bone infection can leave a permanently damaged bone in patients.

Causes of Bone Infection

Many organisms travel through the bloodstream and can cause a bone infection. An infection can start in one area of the body and spread to the bones through the bloodstream. An organism that infects a severe injury, deep cut or wound can also cause infections in nearby bones. Bacteria can enter the bloodstream at a surgical site like the site of knee replacement surgery or bone fracture repair. When the bone in your body breaks bacteria can invade the bone leading to infection. Few circumstances that increase your chances of bone infection are:

• Diabetes
• Intravenous drug use
• Hemodialysis, treatment used for kidney condition
• Trauma to tissue surrounding the bone
• Artificial joints can come infected
• Sickle cell disease
• Smoking

Symptoms of Bone Infection

Usually, the first indication to appear is a pain at the infected site. Other symptoms include:

• Fever and chills
• Redness in infected areas
• Irritability or generally feeling unwell
• Drainage from the area
• Swelling in the infected area
• Stiffness or inability to use the affected limb

Diagnoses

The doctor will perform a physical exam to check swelling, pain, and discoloration. He may also order lab and diagnostic test to determine the exact location and extent of the infection. Probably the doctor will ask for blood test for an organism which is responsible for the infection. Another test could be throat swabs, urine culture, and stool analyses. Bone scan and MRI scan can also be conducted. In some case, a bone biopsy may be necessary.

Treatments:

Antibiotic is required for the bone infection to be cured. The doctor may administer the antibiotic intravenously or directly into the veins if the infection is severe. You may need to take the antibiotic for up to six weeks in that case.

Sometimes the bone infection might require surgery. if you undergo surgery the surgeon will remove the infected bone and dead tissues and also drain out any abscesses or pockets of pus.

Pain is the major concern for patients who are about to have total knee replacement surgery. Postoperative all the patients with knee surgery want to know what are the discomforts they have to face, and about the medication, they have to take.  When you know about the pain and then you are in pain at least significantly it reduces the fear and helps you manage the expectation.

Some small tips are explained below which can be of great help for you in relieving pain:

1. Rest

Total knee surgery takes a large toll on your body, and you cannot expect to resume your regular activity within 4 to 5 days after the surgery. The damage caused to your knee is also over the period of time hence the healing and recovery time also takes over the period of time.

Pain, swelling and over activities are all co-related. The antidote to all three problems is rest. Being on the feet it causes both pain and swelling. The knee is very complex joint and also it has rich nerve endings in the body. So if and when it is overused the knee will cause discomfort and pain.

After the first week of recover be active in short spurts and rest for a longer period in between. Do expect that you will not be able to do your housework and activity like gardening before 2-4 weeks of time. That to the recovery time varies from person to person.

2. Ice

For pain management of the knee, ice is an essential item. Ice can reduce pain in combination with the medicine. Special recommendation by a doctor is made for the patients to use special wrap around compression bag. Gel pack can also be of greater help which you can keep changing regularly and then again keep them in the freezer. Rest while you are icing.

3. Medicate:

After the surgery, your surgeon will put you on pain relief medication. With so many narcotics there are side effects too so follow the instruction of the doctor is highly recommended. Pain may cause swelling which actually interferes with your physical therapy, your healing and certainly your progress. At low pain, the medication given by the doctors works more effectively.

4. Elevate

Elevate you leg as much as you can especially when you are sleeping or laying down put three four pillows beneath your leg. This technique to keep your legs elevated will lessen the amount of pain in your knees.

Dr Dhanajay Gupta was invited as a guest faculty Annual International Conference. The Board of the Egyptian Orthopaedic Association (EOA) organizes 69th Annual International Conference (11th Dec’17 to 14th Dec’17) at Intercontinental City Stars Hotel, Cairo, Egypt.

What is the total hip replacement?

The term is somewhat misleading. The total hip replacement is an implant used to recap the worn bones ends. The head of the femur bone is removed, a metal stem is then inserted into the femur shaft and on the top of the bone, and a metal or ceramic ball is capped. The worn out socket also called acetabulum is smoothened and lined with a metal cup which either could be made up of plastic, metal or ceramic. Now there is no rubbing of bone and hence the pain and stiffness are also reduced.

What is total knee replacement?

In total knee replacement surgery, the knee itself is not replaced in the surgery but rather an implant is used to recap the worn bone ends. This is done with the metal alloy on the femur and plastic spaces on the kneecap. This creates a new, smooth cushion and a purposeful joint that can reduce pain up to greater extent.

Who requires total knee or total hip replacement surgery?

The people suffering from arthritic pain that also limits the daily activity of living are considered for the hip or knee replacement surgery.  When the conservative measures like exercise, physical therapy, and medication are proven ineffective then certain examinations are done.  After a regular careful examination and diagnosis of the particular problem patients are recommended for the surgery.

How long by new joint (hip or knee) last?

All implants including knee and hip implant have a limited life expectancy depending on the patient’s age, weight, daily routine and medical conditions. A total time period for implant will vary in every patient. It is important to remember that an implant is just a medical device and apart from being worn and torn it may also mechanically fail. It is very important that the patients follow the surgeon’s recommendation after the surgery; however, there is no such guarantee for any specific life of the implant.

What are the major risks?

Most surgeries go well. Two serious complications are blood clot and infection. To avoid these complications the surgeon will recommend antibiotics, blood thinners or compression device.  Inside the operating room also proper care is taken so the infections can be avoided.

How long will I be in the hospital?

Most of the patients after the day of the surgery, in the next morning, are asked to do certain physical therapy in presence of a therapist. After two days mostly all the patients leave with all medication and instruction of physical therapy.

Despite the fact that osteoarthritis and rheumatoid arthritis are types of arthritis which causes joint pain, two diseases have different diagnosis. Fascinatingly though both are chronic and non-curable disease, they have completely separate conditions with different causes, symptoms and diagnosis.

Disease

The primary difference between rheumatoid arthritis and osteoarthritis is the nature of the disease.

Rheumatoid arthritis is an autoimmune disorder that produces inflammatory joint symptoms throughout the body. Osteoarthritis is a degenerative condition that is the result of increased wear and tear on joints. Osteoarthritis may produce inflammatory symptoms as well but primarily destroys joint cartilage over the time period.

Rheumatoid arthritis can develop in patients anytime between the age of 30 and 60 years of age while osteoarthritis generally develops later in life.

Causes

Osteoarthritis is caused by constant wear and tear on specific joints in patient’s body. It’s a chronic disease which usually gets worst with the age. Certain kind of jobs and sports can also lead to development of this disease. The activity places additional pressure on joints which as result wear down the cartilage. Even old injury which is not healed properly can increase the risk of developing osteoarthritis. It is also possible that a person has inherited cartilage deterioration.

The exact cause of rheumatoid arthritis is not known. What doctors know is that rheumatoid arthritis is triggered by autoimmune disorders where harmful antibodies are produced which are responsible for attacking the health joint tissue in patients. However what cause autoimmune disorder to develop in certain patients is not known. The primary factor which causes rheumatoid arthritis is thought to be genetic, environmental, and hormonal. Also  lifestyle like smoking and obesity.

Symptoms

Rheumatoid arthritis

• Joint pain, stiffness, swelling affecting multiple joints
• Symmetrical symptoms affecting both side of the body
• Morning stiffness lasting longer than 30 minutes
• Additional symptoms like fatigue, fever and malaise

Osteoarthritis

• Joint pain and stiffness usually affecting hands, fingers and knees
• Joints on one side affects worse than on the other side
• Morning stiffness lasting for fewer than 30 minutes
• Possible spine and hip pain

Diagnosis

Rheumatoid arthritis is diagnosed by performing a physical examination of symptoms as well as knowing about the medical history of the patients. Orthopedics Surgeon also perform blood test to look for the presence of antibodies that triggers rheumatoid arthritis. Imaging can be done to diagnose joint damage and inflammation.

Osteoarthritis is diagnosed with imaging test. X-rays and MRIs show the damage and deterioration of joints. Also by specific blood test it can be diagnosed.

Vitamin D is an essential vitamin that has powerful effects on several systems throughout the body of a human being. Actually, the human body makes it from cholesterol when the skin is exposed to sunlight. Also, it is found in some fatty fish, egg yolks, and fortified dairy products, although it is very difficult to get enough from diet alone. The recommended daily intake is usually around 400-800 IU, but many doctors recommend that you should have even more than that.

Vitamin D is necessary for strong bones because it helps the body use calcium from the diet. Traditionally the deficiency of Vitamin D has been associated with diseases like rickets; a disease in which the bone tissue doesn’t properly mineralizes, leading to soft bones and skeleton deformities. But advance research in this field reveals the importance of vitamin D in protecting against a many of health problems.

The common risk factor for vitamin D deficiency:

• Having dark skin
• Being elderly
• Being overweight or obese
• Not having milk, fish, and egg in diet
• Living far from the equator where there are little sun rays throughout the year
• Always using sunscreen when going out of the house
• Staying indoors for longer period

Most of the people who live near the equator and frequent sun exposure are less likely to be deficient because their skin produces enough vitamin D to satisfy body needs. It’s also true that most people do not realize that they are facing the deficiency because the symptoms are generally subtle.

Symptoms and health risk of vitamin d deficiency

Bone pain and muscles weakness can be the common symptoms. Low blood levels of the vitamin have been associated with following:

• Increases risk for cardiovascular disease
• Cognitive impairment in older adults
• Asthma in children
• Cancer possibility

Studies suggest that vitamin D could play an important role in treating different other conditions like type1 and type2 diabetes, hypertension, glucose intolerance and multiple sclerosis.

Test for Vitamin D Deficiency

The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. Level of 20 nanograms/milliliter to 50 nanograms/milliliter is considered an adequate measure in healthy people.

Below are some sins of deficiency of vitamin D

• Getting sick or infected often
• Fatigue and tiredness
• Bone and back pain
• Depression
• Impaired wound healing
• Bone loss
• Hair loss

Banarsidas Chandiwala Institute of Physiotherapy at Kalkaji, New Delhi in Association with ‘Fortis Hospital, vasant kunj’ and ‘Bone & Joint Care Society’ organizes Hands -On Workshop on “Total Knee Arthroplasty Techniques”.