NEWS AND ANNOUNCEMENTS

ACL reconstruction surgery also known as anterior cruciate ligament surgery is done to repair the worn out knee ligaments. Knee injuries mostly occur during playing games and sports like basketball, cricket, football, hockey and gymnastics. As these sports, involve sudden movement and variations in direction, chances of knee injuries increases leading to ACL reconstruction.

While performing ACL surgery, the worn out ligament is eliminated and substituted with a tendon piece from the other knee part. ACL reconstruction is performed by making small cuts around knee area. A specialist doctor also known as orthopaedic surgeon performs this surgery.

Purpose

The basic purpose to perform ACL reconstructive surgery is to repair the worn out or old ligament so that the patient can move the knee again. Not every torn ligament requires ACL surgery but those who can bear the pain can go for the surgery.

ACL reconstruction is normally done if:

• The individual is young and energetic
• The individual is suffering from tenacious knee pain
• The individual is not able to perform his routinely activities like walking and lifting
• The individual is a sportsperson and want to continue with his profession

Procedure

At the time of surgery, a small cut is made in the anterior of the knee for an arthroscope, which is a thin tube equipped with a camera and surgical equipment’s. With the help of the camera, the surgeon is able to see inside the knee while performing the surgery.

Firstly, the torn ACL will be removed and then the doctor will clean the area properly. Then he will make small holes into patient’s tibia and femur in order to attach the bone plugs with posts, bolts, clips, or washers.

The surgeon will then test patient’s knee’s range of movement and tension to make sure that the graft is safe. At last, the surgeon will stich the opening, dress the wound and will stabilize the patient’s knee with a brace.

The length of the surgery completely depends on how trained and skilled the surgeon is.

Generally, the doctor advice you to go home on the very same day.

Risks Involved

Like any other surgical procedure, ACL reconstruction also involves some risks, including:

• Blood loss and clotting of blood
• Sustained knee pain
• Some kind of infection
• knee rigidity or feebleness
• Damage of range of movement

Indecorous healing if the immune system of patient reject the graft.

If you are suffering from any kind of knee injury, you can undoubtedly go for ACL reconstruction, as the success rate of the surgery is very high.

Hip replacement surgery has become very popular nowadays, but hip replacements don’t stay forever. When they deteriorate or fail too early, patients require revision surgeries in order to rectify the complications and obtain new implants. Revision surgeries are thought to be riskier than basic hip replacement surgery, but they can help the patient in getting relief from pain.

In hip revision surgery, the surgeon removes the problematic or dead hip implant and swaps it with a latest implant. This procedure, though risky and complicated, can dismiss pain from complications and you again get an opportunity at reinstating mobility.

Reasons behind Revision Surgery

The primary reason behind hip replacement revision surgery is the deterioration of the previous hip implant. Symptoms that reveals the need of revision surgery includes sudden pain, swelling or trouble while moving the joint.

If you are experiencing these signs and symptoms, you are advised to see a doctor immediately. Yet, these signs don’t always mean a revision surgery is needed.

The Revision Procedure

Revision process is almost similar to the previous surgery; the only difference is that it is a kind of revision on the general surgery. The surgeon makes a new cut. Then he detaches scrubs and restructures the hip replacement. Time of recovery is also same.

Re-incision

The surgery may be done on the previous incision or the surgeon can make a new one. This time the incisions made by doctor are extended and wider than the cuts made during the initial surgery.

Removal & Reconstruction

The next step is to remove the damaged or failed parts of the previous used cement. The doctor before the surgery also removes unhealthy or ill bone and tissue and then he arranges the area for the new implant. Depending on the degree of the impairment, this can take time. In case of excess bone loss, the doctor will restructure the bone by means of bone grafts, screws and metallic plates. Afterwards, the new device is implanted by the surgeon.

Recovery

In order to help the process of healing, the patient is suggested to wear a brace or splint Movement is restricted more at least 6 to 12 weeks.

How to Prevent the Need of Revision Surgery

Prevention in the case of hip replacement is possible only when proper care is taken by the patients. He needs to take some precautions during the recovery period. Displacement and blood clots can be a serious issue and generally, these complications occur if a patient is doing excess of physical movement. Your surgeon will advise you to do exercise on regular basis and this must be strictly followed.

All reconstructive procedures for the PCL require a graft. A common technique involves grafting the torn PCL with segments of the hamstring tendons. If the surgery involves the reconstruction of multiple ligaments at once, different graft materials may be used.

In general, most techniques utilise specially designed screws allowing secure immediate fixation of the graft material within bone tunnels drilled into the knee. The surgery is frequently carried out as a day surgery procedure.

What to expect after the PCL reconstruction?

Most patients experience only mild discomfort when they wake up after a PCL reconstruction. The knee will have a bulky absorbent pad applied, which may become damp with the irrigation fluid used during the procedure. It is normal for the fluid to have a faint red tinge, and small amounts may continue to drain for 24-36 hours. If more than one ligament has been reconstructed a knee brace may be used to help protect the repair. Most patients will go home the same day.

How Long will it take to recover?

Unless instructed otherwise, patients can bear as much weight on the leg as comfort allows immediately after the surgery. Crutches may be used for comfort where necessary, and are usually required for 2-3 days. Most people are walking reasonably comfortably by 2 weeks and can commence running in a straight line by 6 weeks. It is important not to over-exert too early after the procedure as this can increase discomfort and swelling. Other activities can be gradually reintroduced within ones level of comfort. Driving is allowed the next day. People with desk jobs can return to work as early as 1-2 days, while people in more heavy manual employment may require 6 weeks.

The rehabilitation program runs over a 6-12 month period prior to returning to competitive sports or unrestricted activity.

What are the risks?

PCL reconstruction is a very safe procedure. The most common side effect of PCL reconstruction is temporary discomfort or slight bruising. Due to the skin incision patients may notice a numb patch on the outer aspect of their leg past the skin incision. This is of no functional significance and is unavoidable. The numb patch tends to shrink with the passage of time and does not affect the result of the reconstructed ligament.

Graft failure due to poorly understood biologic reasons occurs in approximately 1% of grafts and a further 1% of grafts rupture during the rehabilitation programme.

As with all operations if at any stage anything seems amiss it is better to call up for advice rather than wait and worry

Psoriatic arthritis is a prolonged (long-lasting) disease in which a person suffering from psoriasis acquires the signs and symptoms of arthritis joint pain, stiffness and swelling. Psoriasis is a common, congenital skin disorder that produces greyish-white scaling over a pink or dull-red skin rash.

According to a survey report 5% to 10% of the 3 million people suffering from psoriasis expound psoriatic arthritis. Both men and women are equally affected by Psoriatic arthritis. Generally, the disorder begins between ages 30 and 50. However, children can also suffer from this disease. Usually the symptoms of Psoriatic arthritis are mild but still in some cases the symptoms can be quite stern.

Types of Psoriatic Arthritis

There are five types of psoriatic arthritis.

Asymmetric inflammatory arthritis – Frequently the knee, ankle, wrist or finger are involved, with an aggregate of one to four inflamed joints. In this kind of arthritis both the sides of body are not equally affected.

Symmetric arthritis – Many joints are inflamed, more than four, and in this kind of arthritis both the sides of body are equally affected. Fingernails often are ribbed and potholed. This disorder can mimic rheumatoid arthritis.

Psoriatic spondylitis – the joints linking the spine and pelvis at the lower back, and sometimes other spine joints, are inflamed, which cause morning stiffness and back pain.

Isolated finger involvement – This only involves the last finger joint adjoining the nail. More than one joint is inflamed.

Arthritis mutilans – This is the most severe and oddest kind of psoriatic arthritis. Due to the destruction of the joints and nearby bones, the fingers get shorten.

Symptoms

Symptoms of psoriatic arthritis include:

• A pink or dull-red, flaky skin rash occurring in patches, mostly on the back of the arms, front of the legs and scalp
• Inflammation the fingers, toes or spine
• Morning joint toughness
• Lower back ache

Apart from arms and legs psoriatic arthritis can affect other parts of the body also. For instance, people with active psoriatic arthritis can face the problem like fatigue and anaemia. Normally, in arthritis person gets inflammation of tendons and the spots where tendons attach to bones, including the heel or fingers.

Treatment

The basic and commonly used treatment of psoriatic arthritis is to take nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen or naproxen. Corticosteroids like prednisone, taken by mouth, is used occasionally, as you may feel some side effects if you are continuing it for a longer time period. If the joints are inflamed severely, infrequent injections of a steroid can be taken.

These days people have hectic work schedules and they hardly pay attention to their health. As a result of this, their body suffers and they fall prey to a number of diseases. Our body’s immune system is responsible for protecting our health by attacking the foreign substances that enter our body like bacteria and viruses. But at times, the body’s immune system attacks its own healthy cells thinking that they are foreign. This medical condition is known as an autoimmune disease. Rheumatoid Arthritis is also an autoimmune disease in which the body’s immune system attacks its own joints and results in inflammation of the tissues that line the inside of joints. It causes swelling, pain and stiffness around the affected joints. If treatment is delayed, your cartilage can be damaged and elasticity of joints is affected. Further it results in joint deformity or restricted movement. If you see any signs and symptoms of Rheumatoid Arthritis, then you must immediately contact the medical specialists for early diagnosis and treatment of the problem.

Various symptoms of Rheumatoid Arthritis may include:

• Pain and swelling in joints
• Tender and warm joints
• Stiff joints usually in morning
• Tiredness
• Fever
• Unexplained weight loss

Some people may experience these symptoms in severity whereas for other people, these symptoms may just come and go. When Rheumatoid Arthritis is in its early stages, it tends to affect the smaller joints first such as joints that link your fingers with hands and toes with feet. Later on as the diseases progress, one may notice symptoms in other joints of the body like ankle, knees, wrist, shoulder and hips. Rheumatoid Arthritis has the tendency to affect those areas of the body also that don’t contain any joints and may include:

• Heart
• Kidneys
• Skin
• Eyes
• Lungs
• Blood vessels etc.

One should get the treatment for Rheumatoid Arthritis as early as possible so that effective results could be achieved. Rheumatoid Arthritis can’t be cured completely but with the help of various treatment options, you can get relief from its symptoms. Your doctor will prescribe you medicines depending upon the severity of your condition. It may include nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs and biologic agents. Physical therapy may also be recommended by your doctor so that your joints can become flexible and you can regain mobility. If medications fail to give you any result, then surgery is done where the damaged joints are either repaired or replaced. One must consult only a specialist in this field so that you can avail best services.

“Stronger the bones, healthier the you”. It is important that you have strong bones from an early age as that will help you in living a healthy life. There are two main nutrients that play a key role in keeping your bones and teeth stronger – Calcium and Vitamin D. Calcium makes the structure of your bones and teeth whereas Vitamin D helps in the absorption of calcium and bone growth. If the health of your bones is not good then later in life, there are high chances that you will develop diseases like osteoporosis and rickets. These diseases make your bones very weak and brittle. As a result of this, your bones tend to break easily with just a simple fall. A healthy balanced diet is very important in keeping your bones strong as they give you the required nutrients.

Daily requirement of calcium and vitamin D by adults:

• Adults < 50 years – 1,000 milligrams of calcium and 200 international units of vitamin D
• Adults > 50 years – 1,200 milligrams of calcium and 400-600 international units of vitamin D

The above mentioned requirement of calcium and vitamin D can be fulfilled by consuming variety of foods:

Yoghurt – Generally people try to get vitamin D from exposure to sun, but yoghurt is a good source of calcium as well as vitamin D. You must eat one bowl of yoghurt every day to make your bones strong.

Milk –  Milk contains calcium that will provide you with 30% of your daily dose of calcium. There are some brands that offer milk fortified with vitamin D, you can try that also.

Cheese – Cheese is a rich source of calcium but that doesn’t mean that you eat a lot of it. 1.5 ounces is enough for your daily requirement that will make for 30% of calcium. You should eat it in moderation.

Sardines – It is a fish that a very good source of both calcium and vitamin D. It tastes delicious and you can try adding it in your pastas or salads.

Eggs – You can eat egg as it gives you 6% of daily requirement of vitamin D. It is easily available and also can be prepared fast. Egg yolk has vitamin D.

Salmon – Though salmon is a rich source of omega-3 fatty acids but you should also know that it fulfils your 100% daily requirement of vitamin D. Enjoy and keep your bones & heart healthy.

Spinach – If you consume one cup of cooked spinach then you will get 25% of daily calcium along with fibres, iron and vitamin A.

All the above mentioned foods must be included in your daily diet for better and stronger bones.

Patient was suffering from Hip osteoarthritis and unable to walk for past 5 years. Dr. Dhananjay Gupta performed hip replacement surgery of both sides. Patient got discharged just after week of surgery and now she is back to her normal life and walking on her feet.

CME organised by Manipal Orthopaedic Club and Fortis Hospital Vasant Kunj at Hotel Classic Grande Imphal on 24-May-2017, Wednesday to discuss the ‘Common Mistakes In TKR and How to Avoid Them’.

More than 30 0rthopedics surgeons had attended the CME including Dr. Dhananjay Gupta.

Complex reconstructive surgery done by Dr. Dhananjay Gupta enables kashmiri woman to walk after 68 years of moving with a limp.

According to Dr. Dhananjay Gupta, 80% of the knee pain problem can be reduce by wight loss.