Surgery: Archives

Hip Replacement July 16, 2020

Advantages of Anterior Hip Replacement Surgery

Today, the healthcare industry is simmering with innovation and new ideas. Transformation is happening at an astonishing pace and redefining the way in which patients are treated for any health-related issues. New-age technologies have boosted the success rate and are also turning out to be less invasive as compared to older methods. Especially, when it comes to treating hip pain and improving patient’s quality of life, hip replacement surgery is one of the most advanced and successful procedures in today’s medical space. Traditionally, Orthopaedic surgeons use to prefer a total hip replacement surgery by incising back or on the side of your hip. However, in recent times, surgeons prefer incising a cut in the upper part of the front thigh. This approach is called an anterior approach or anterior hip replacement. These surgeries may likewise be called small mini, modified, minimally invasive, or muscle-saving surgeries. The procedure involves replacing a damaged hip joint with an artificial hip that can be of metal or ceramic.

Though there are various approaches to the hip that can provide an exemplary outcome, over the past several years, the anterior approach has become more popular because of its minimally-invasive technique. Also, it lowers the risk of complexity before, amid and after the surgery. However, adopting this technique is highly preferred in patients with arthritis, but can also be used for patients undergoing THR due to any other reason like hip fracture, disorders that cause unusual bone growth (bone dysplasias), etc. A lateral or posterior hip replacement surgery and anterior hip replacement approach vary in certain ways but both the approaches share the same objective. Both the approaches are devised to provide adequate pain relief from the hip joint and allowing the patient to perform their normal chores with great comfort. Now let’s take a look at some benefits of Anterior Total Hip Replacement.

Benefits of anterior Total Hip Replacement

Compared to ancient science, after anterior THR, a patient suffers from less pain without causing much damage to surrounding tendons and muscles, which leads to a rapid and smooth recovery.
The patient will no longer need to be kept under observation post-surgery and can be allowed to go home immediately as per doctor’s advice.
Once the surgery is completed, it allows an option for the patient to walk out of their bed and cover small distances independently using any walking aid as soon as it’s comfortable.
The patient can also navigate through stairs with ease and comfort. While pursuing the stairs, lifting the stronger leg first onto the steps and starting with the weaker leg when coming back down through the stairs helps in preventing dislocation of the new implant. It is common for the patients to use cane, walker or any other equipment for walking assistance immediately after the surgery.
With the lateral or posterior approach, patients have to avoid bending and even sitting with their legs crossed for 6 – 8 weeks as this could result in hip dislocation. But with anterior approach patients are not restricted from any of these activities.

Life after anterior Total Hip Replacement

After implementing a successful anterior THR surgery, patients are able to bear weight on their new hip and can walk easily using any walking aid as per their support. The only thing that patients need to make sure is that their home stairs have a guardrail or banister installed, as to avoid any temptation of walking up or down the stairs unsupported. However, patients will need a personal trainer to restore the strength and movement in their joints and surrounding muscles. Mostly it will take up to 4-6 weeks to gain ample strength for the movement and performance of the daily routine activities. One can resume work after anterior THR, as it allows the majority of patients to start working after a month but we would recommend waiting for up to 3 months if it involves physical labour. Patients can expect their lifestyle to be a lot like how it was before having surgery but without the pain.

Summing up, anterior hip replacement by far is less painful and leads to a faster recovery of mobility and strength compared to a lateral or posterior approach. However, the recovery process still involves distinct phases to ensure the tissue is healing properly which will allow optimum functionality. It is important for every patient to know that every case is unique and the progression will completely depend on their unique set of circumstances. But, an anterior hip replacement approach is mostly likely to add more quality to a patient’s life.

Aortic Stenosis/TAVR/TAVI July 16, 2020

TAVR: Availability in India

TAVR (Transcatheter Aortic Valve Replacement) is a fairly new therapy that has been developed in the last 15 years. It is a minimally invasive procedure invented to replace the diseased valves of the heart. Because of its high success rate and relatively less complicated nature as compared to the open heart approach, today TAVR therapy is at the top of the list when it comes to treating Aortic stenosis. From Europe to the United States to the Asian countries, TAVR therapy clearly is the preferred option for most of the surgeons in the new-age era.

Earlier, more than 50 percent of patients were not recommended surgery due to various factors such as old age or other medical conditions. With TAVR entering the scenario, it has become easier for patients with complications to opt for better options. While TAVR comes with lower risk, it gives helpful treatment choices to individuals who might not have been otherwise considered for valve replacement. You are more likely to spend less time in the hospital after TAVR and it comes with fewer complications as compared to surgical valve replacement.

If by any chance you have been lately identified with severe aortic stenosis then need not to panic. The best advice is to seek immediate medical care. The earlier you’ll pay medical attention, the quicker you’ll be able to get back to your normal life. Usually, your doctor determines the best possible way for replacing your faulty valve with a procedure that suits best for you. With TAVR, a small incision is made in the leg and hollow tube called a sheath is inserted into your femoral artery.

The thought of a heart valve replacement can be frightening. Fortunately, the less invasive TAVR is an option for more patients unlike earlier. Presently, only two Indian companies are making valves. TAVR is being performed in around 30 centers in India. Out of these centers, only 7 are considered to be the major ones. This is significantly less than the total number of cath labs present in India. The progress for TAVR in India remains rather slow with barriers at various levels. The probable reasons for such a lower number could be:

Reluctance among professionals.
Regulatory approvals.
Lack of dedicated heart teams and specialized centers.
Lack of proficiency in TAVR.
Anatomical constraints amongst Indians not suited for the procedure.

As per the latest evidence, the average life expectancy post TAVR largely depends on the age factor of a patient. For example, for a 50-year-old patient, the average life expectancy is 31.5 years while it is just 4.6 years for a 90-year old patient. As per trials, the survival benefits are very limited when treating octogenarians (people between the age of 80-89 years) with TAVR. Also, co-morbid conditions of the patients such as diabetes or hypertension have a significant impact on the survival of patient after TAVR. More importantly, the quality of life in terms of activity and overall health receive a substantial boost after TAVR which is more beneficial in old age as compared to mere living.

The choice to treat aortic stenosis with TAVR is made after you ask a group of heart surgery specialists, who cooperate to decide the best treatment option for you. Without a doubt, TAVR therapy is changing the trend and is already proving to alleviate the signs and side effects of aortic valve stenosis. With local manufacturers entering the space with top-notch products satisfying all the necessary standards, TAVR therapy seems to be the best possible option available for treating aortic stenosis even in India.

Knee Replacement July 3, 2020

Arthritis – Symptoms, Causes, and Treatment

The word ‘arthritis’ is used to describe pain, swelling, and stiffness in one or more joints. However, it is not a single condition and there more than 100 types of arthritis and related conditions. The underlying cause varies with specific types of arthritis. It can cause everlasting joint changes and the common joint symptoms may include swelling, pain, stiffness, and decreased range of motion gradually.

These differences may be noticeable, such as lumpy finger joints, but usually, the damage can only be detected on X-ray. Apart from joints, some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin. Although there are numerous types of arthritis, the two most common ones are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is a chronic (long-lasting) joint condition, affecting millions of people globally. In this case, the cartilage (protective tissues covering the ends of bones forming a joint) breaks down, causing the bones within the joint to rub together. Other causes may include dislocated joints and ligament injuries.

Signs that you may have Osteoarthritis:

Joint stiffness and soreness
Grating sensation
Bone spurs
Loss of flexibility

Treatment of Osteoarthritis

A) General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

B) Medical Management

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

C) Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease; a condition in which your immune system mistakenly attacks your body. It happens when your immune system targets your joints lining. While RA affects joints on both sides of the body such as both hands or both knees, it can also affect your whole body.

Signs that you may have Rheumatoid arthritis:

Joint pain, swelling, and tenderness
Morning stiffness for at least 30 minutes after waking up
More than one joint affected (hands or wrists)
Fever

Treatment of Rheumatoid arthritis

The primary objectives in treating rheumatoid arthritis are reduction of inflammation and pain, preservation of function, and prevention of deformity. Success requires early and effective medication. Disease-modifying anti-rheumatic drugs (DMARDs) should be started as soon as the diagnosis of rheumatoid disease is certain and then adjusted with the aim of suppressing disease activity. NSAID drugs are members of a drug class that reduces pain, decreases fever, prevents blood clots, and in higher doses, decreases inflammation and provides some symptomatic relief in rheumatoid arthritis but do not prevent erosions or alter disease progression. They are not appropriate for monotherapy (therapy that uses one type of treatment) and should only be used in conjunction with DMARDs, if at all.

Possible causes of arthritis may include injury, abnormal metabolism, inheritance, infections, or immune system dysfunction. Seek immediate medical care if you have swelling or stiffness that doesn’t go away in a few days or if it becomes too painful to touch your joints. If joint pain isn’t connected to any recent injury, you must immediately consult your doctor.

It’s normal to have joint pain occasionally, but when the pain starts interfering with your daily movements, it’s time to seek medical help. The initial move is to get an accurate diagnosis of what’s causing your joint pain. You may be later referred to a rheumatologist or orthopedist (Doctors who specialize in arthritis and related conditions). During the medical examination, your doctor may ask questions related to your symptoms and medical history to assess your situation.

Although there’s no particular cure for arthritis, treatments have developed gradually. The treatment for arthritis aims at controlling pain, lessen joint damage, and enhance the quality of life. A variety of medicines and lifestyle changes can help accomplish this and protect joints from additional damage.

Heart Attack July 3, 2020

Living with a Coronary Stent – Benefits and Risk of Stenting

If you have coronary artery disease then there’s a high possibility that your doctor might suggest you to go for a stent placement surgery. But do you really need it? It’s a call of your doctor, considering your case he will suggest the best treatment for you. Stent placement is helpful but may pose risks in some cases. For those who don’t know what exactly is the purpose behind using stents and what stents are, this blog will help you get better insights.

Stents are tiny mesh tubes inserted to keep coronary blood vessels (arteries) open post angioplasty (a procedure to restore blood flow through narrow or blocked arteries). The coronary arteries supply blood and oxygen to heart muscle cells. If a coronary artery narrows, you may develop signs of angina, shortness of breath, a cold sweat, and light headedness. That’s when a stent can be lifesaving.

DES (drug-eluting stents) release a drug slowly from their outer coating to aid in preventing blockage at the particular site. Hence, DES are preferred over BMS (bare-metal stents) for the majority of the patients as they prevent recurring blockages. Stent technology has progressed over the years. In today’s scenario, stents are easier to implant and cause fewer complications and side effects.

Your doctor normally embeds a stent applying a minimally invasive method. They can help prevent arteries from becoming narrow or blocked again, however, they don’t cure heart diseases. But what is living with stents in your heart like?

Benefits of living with Stents:

Saves your life and alleviates damage to your heart muscles at the time of heart attack by replenishing blood flow to your heart.
Immediately relieves/decreases symptoms of heart disease.
Reduces the risk of heart attack or stroke in future.
Stent placement may diminish your requirement of a CABG (Coronary Artery Bypass Grafting).
Stenting is comparatively much less invasive versus CABG and also has a much shorter recovery period.

Harms/Risks of Stenting:

You may get an allergic reaction because any foreign object introduced inside can cause flaring up of immune reaction causing an allergic response. However, it’s rarer with currently used stents.
Angioplasty can lead to blood vessel damage or heart damage. The procedure requires the surgeon to enter the blocked artery via a catheter (tube). The catheter is entered via a distant artery, usually radial (arm) or femoral (leg). To enter an artery in the heart from such a distant site may cause damage to the artery, and when reached the heart artery (coronary), there are chances of damaging the small artery or the heart itself which can be taken care by the surgeon.
Rarely, some potential complications such as heart attack, stroke or renal failure (kidney failure) can also happen.
A scar tissue formation can happen inside your stent post stenting procedure necessitating another procedure for removing it.
Stenting also carries a risk of blood clot formation which needs medicines for prevention.
It cannot ultimately cure your CAD (Coronary Artery Disease). You have to continue managing your contributing risk factors for CAD such as hypertension, overweight, diabetes or high cholesterol.

Life after heart stent should return to normal routine a week after stenting. Avoid strenuous exercise and lifting heavy objects for a while. Consult your doctor about any other restrictions.

Consult your doctor immediately if:

The place where your stent was inserted starts bleeding or swelling.
You feel pain or discomfort.
You have symptoms of infection such as redness, swelling, drainage or fever.
You feel weak.
You experience chest pain or shortness of breath.

To prevent blood clots around your stent, your doctor may prescribe antiplatelet therapy post stenting. Antiplatelets are a combination of medicines that prevent blood cells (called platelets) from sticking together and forming a blood clot. The expected lifespan of a patient post multiple stent implantation really rests with the patient and how they manage their disease.

If you manage your risk factors well as per your cardiologist’s advice, you may live a prolonged and productive life even after getting stent implantation done in your major arteries. However, the most vital aspects which you should consider are diet and regular activities. The type and amount of food you consume can control your risk factors for a heart attack such as diabetes and obesity. Even minor modifications in your dietary habits can make a huge difference in the health of your heart.

Hernia July 3, 2020

Sutures and Staples: How do doctors choose between them?

If you get a minor cut or scrape at home while chopping food or while playing then it usually is self-treatable through the use of bandages or any home remedy. But, what if you get a nasty cut then how will you comprehend in case of a suture or a staple requirement? Usually, severe gash or wounds require the use of sutures, staples or surgical glues in order to close the wounds or surgical incisions. Doctors choose appropriate methods depending on the type of the wound or the surgery required.

Having said that, both sutures and staples have peculiar benefits and limitations that make them more or less appropriate for specific conditions. In many cases, sutures are essential for convenient healing. Severe wounds and deep cuts are prone to infection and other complications, and the longer a wound stays naked and vulnerable, the greater the risk of infection becomes. Sutures are one of the most common methods used for closing wounds of the skin. However, in cases of major wounds, the selection of an optimum method of wound closure is extremely vital. The type of material and technique depends on many factors such as depth, appearance, size, location, bleeding, age, material availability, and your doctor’s preference.

Sutures

This is the most common method used for closing skin wounds. Sutures are basically thread-like medical devices that can either be permanent or temporary in nature, depending on their material of the composition.

Your doctor uses a surgical thread to sew or stitch two ends of the skin together. Temporary sutures get degraded in the body. However, the suture type to be used is decided by your surgeon based on your medical history. Your doctor may prefer to use permanent sutures in case you have:

A major wound that might take a prolonged period to heal.
To close your surgical wounds.
Tying off blood vessels or bowel parts.
If your wounds involve connective tissues or muscles.

Biodegradable sutures are preferred in cases of lower skin layer wounds, internal mouth surface wounds, internal soft tissue or smooth muscle wounds. Wounds with vasculature close to the skin surface are also preferred to be stitched by biodegradable sutures.

Sutures must be removed within 1-2 weeks of their placement, depending on the intensity and location of the wound. Immediate removal reduces the risk of marks, infection, and tissue reaction.

Staples:

Doctors prefer to use a surgical stapler in case of a long skin wound or an incision in a difficult-to-reach area. Alike sutures, staples can also be permanent or dissolvable in nature. Permanent staples need to be removed by your doctor. However, with dissolvable staples you have a lower risk of getting infected.

There are a plethora of benefits associated with the use of staples:

They permit rapid wound closure causing the lowest damage.
They are easier to apply and remove as compared to sutures, and anesthesia is given for a much lesser time.
The most vital advantage of using staples is a decreased infection risk.
Wounds also heal better with staples and lower are the chances of scar formation.

Surgical staples need to stay in for some days or up to 21 days in some cases before they can be removed. How long the staples must stay in place depends mostly on factors such as:

Size and placement of the incision.
The type of surgical procedure.
The complexity or severity of your incision or wound.

Numerous signs that your surgical staples may be ready to be extracted include:

The area has recovered completely and the wound won’t reopen.
There’s no pus, fluid, or blood drainage from the area.
There aren’t any symptoms of infection.

It is evenly important to take post-care of your injury or wound, once the stitches or staples are removed. Check with your doctor on how to take the necessary precautions which will help restore and heal your scars.

Despite the fact that they differ in many ways, sutures and staples are cosmetically equal when it comes to scarring. Conclusively, a doctor will decide the choice of technique and device based on his or her experiences and preferences according to the case.