Surgery: Archives

Hip Replacement July 23, 2019

Know Your Hip Implant: The Different Types of implants And What Makes Them Tick

Getting a hip implant is a huge boon for those whose lives have been significantly affected by hip trauma and arthritis. Millions of patients across the world have undergone this surgery and found a new lease on life. However, as with any surgery, apprehensions remain. Will it work for me or my loved ones? Will they or I be able to go back to our normal routines again? What are hip implants made of? While the previous two questions and many more have been or will be covered in our other blogs, this blog will focus on the last question, “What are hip implants made of?”

After all, a hip implant is likely to last for the patient for the next 15-20 years, which is a significant part of one’s life. Having a thorough knowledge of the entire process takes the fear of the unknown out of the picture, and helps the patient approach their surgery with an open mind.

So the question you must be asking yourself is that “Is a hip implant really necessary?” The answer to that differs from case to case. A THR is only recommended if the patient suffers from chronic hip pain that hinders their daily activities and is unabated by non-invasive therapies like weight reduction, physical therapy, and painkillers. Another factor that is considered is, if pain affects the patient’s ability to sleep.

So what will a Total Hip Replacement procedure entail?

In simple terms, a Total Hip Replacement procedure will consist of the following steps:

The damaged ball of the hip joint is taken out and replaced with a metallic stem and is placed into the femur’s hollow center. This stem can be either cemented or press-fit into the bone.

A ceramic or metal ball is then positioned on the stem’s upper part. This serves as the replacement for the worn-out femoral head.

The damaged cartilage surface of the socket is replaced and held in place with cement or screws.
Finally, a metal or plastic spacer is positioned between the new implants to facilitate a smooth and frictionless movement.

To know more, click: (Video link)

The final decision of which implant to use rests on the orthopedic surgeon.

However, the selection will take into account one’s level of activity, weight, age, lifestyle factors and most importantly, the extent of damage and the optimal fit. Each implant is different in its own way and thus, surgeons prefer to rely on 1-2 styles and brands depending on their practice and experience.

What makes for a good implant?

While each surgeon has their own reasons for preferring one implant over another, what they all look for in an implant are that it should:

Help the patient regain their usual activities and movement

Have expected durability of 15 to 20 years

Should have a good track record of minimum 5-10 years in Total Hip Replacement use

Meets the patient’s unique requirements and needs

A brand or a style that is familiar to them.

Depending on the patient’s need the surgeon may choose a press-fit or cemented implant.

Cemented Implant: The artificial implant is stuck to the natural bone with a quick drying cement.

Press-fit Implants: The preferred standard of care presently, press-fit implants allows the natural bone to grow and hold the implant in place.

What constitutes a hip implant?

While the natural hip joint has only two components, the ball and the socket, a Total Hip Replacement implant has four different parts.

1) Acetabular component (socket)– This is the part that makes up the socket portion of the new hip. The cup-shaped component is fit into the patient’s resurfaced socket. In traditional hip implants, this component is composed of metal but there are a few implants whose acetabular component is made of ceramic or a combination of plastic and metal.

2) Acetabular liner: This high-grade polymer or plastic liner fits into the acetabulum and permits the ball to glide normally in the socket.

3) Ball: This is the other main component of the hip joint and fits directly into the new plastic socket. The ball in a normal hip is the upper end of the femur. In an implant, the ball is attached to femur with the use of a femoral stem. Balls can be manufactured from metal, plastic, ceramic or even a combination of these materials. They come in different sizes and shapes to fit different patients.

4) Femoral stem: This is the part that attaches the ball to the femur. This component is especially important as it supports the entire joint. Usually made of a porous metal, the stem allows natural bone growth and facilitates attachment to this piece and replaces the thighbone.

What the implants made of?

Total Hip Replacement implants are composed of high-grade plastic polymers, metal, ceramic or a combination of them all. The femoral stem is usually made of titanium, titanium-cobalt alloy, stainless steel, cobalt-chromium alloy or other metallic alloys. The other components, on the other hand, can be composed of either metals, plastic or ceramic material or even a combination of these materials. The reason these metals are chosen is that they have been proven to be both strong yet flexible enough to allow regular movement. These materials also do not cause immune reactions in the patient’s body.

Depending on their composition, implants can be categorized as:

1. Metal on Metal/MOM in which both the ball and socket components are metallic in nature.

2. Polyethylene and Metal on Polyethylene (MOP): When the socket is made of plastic/polyethylene and the ball is metallic, it is termed as MOP.

3. Ceramic on Metal (COM), Ceramic on Polyethylene (COP) and Ceramic on Ceramic (COC): These are rare compositions and not preferred by many surgeons. These are usually used for patients who are allergic to metals.

Which material is better?

When it comes to implants, no material is significantly better than the other. The choice depends on surgeons and their assessment of their patient’s needs. For the longest time metal on metal Total Hip Replacement implants were thought to be the best. All this changed in 2010 with the Depuy metal implant debacle where it was found that the implants came with a high risk of metal poisoning. Many surgeons prefer titanium implants as they have a long record of proven effectiveness. As of now, metal on plastic and ceramic implants are the standards of care. The former is more preferred for aged patients, while the latter is more suitable for younger, more active patients.

When it comes to choosing the best material, both have their own pros and cons. While ceramic does not get as worn out as metal or plastic, they can develop cracks or break suddenly. However, these problems have been ironed out in the newer generation of implants that show fewer incidences like these. The main issue restricting the use of ceramic implants is that compared to metallic implants, fewer long-term clinical outcomes with ceramic implants are published.

It is normal to be a little apprehensive when faced with the prospect of having something semi-permanent implanted in one’s body. But the truth is that there is little to worry about. Total Hip Replacement is a common surgery with high rates of success. So go out there and get ready to get back on your feet!

Hip Replacement July 19, 2019

Get Back On Your Feet: A navigational guide to life post Total Hip Replacement surgery

Undergoing surgery can be stressful for anyone, especially when you are not sure about how soon you can recover and jump back to your routine. For Total Hip Replacement surgery (THR) patients, the recovery period can be even more stressful due to fatigue and reduced mobility. However, following the doctor’s advice especially during the initial few weeks post-surgery can ensure a faster and seamless recovery.

Need a little help figuring out the dos and don’ts while recovering from a Total Hip Replacement surgery? Here’s a short guide.

Wound care: Proper wound care is crucial to healing. A typical surgery wound may have sutures or staples till about approximately 2 weeks post-surgery. Keeping the wound dry till it is completed healed is one of the biggest things to look out for. Ideally, one should continue to bandage the wound to prevent chafing and irritation from clothing.

Diet: It is normal for Total Hip Replacement patients to experience a loss of appetite; after all, the body has been through major surgery. The medicines too can aid in amplifying this effect. However, this is no excuse to skip a meal. A balanced diet and plenty of fluids are key to a complete recovery.

Physical Activity: The best way to gain the capacity to resume your normal activities is exercise. Exercising in the first few weeks post-surgery is very important in the recovery process. A Total Hip Replacement patient is expected to gain the capacity to go back to their light normal activities within 3-6 weeks after surgery. Don’t be afraid of any discomfort caused during the first few weeks while going about your activities, this is a natural part of healing.

You should slowly start walking around indoors and gradually move outside. Following the physiotherapist’s instructions and regular exercises can go a long way in restoring your mobility and hip strength. After a while, you should be able to go back to our routine.

Precautions:

For the initial 6 to 8 weeks, one cannot cross one’s legs from the knees
Don’t elevate the knee higher than the hip

Take care not to lean in a forward position while sitting or while you are about to sit

Don’t try to pick anything from the floor in the sitting position
Don’t excessively turn your feet inward or outwards while bending down
Don’t bend at the waist more than 90 degrees

Do keep the legs facing forward

Keep the operated leg in front while sitting or standing
Kneel on the knee on the operated side

Apply ice to decrease pain and swelling only through an ice pack or wrapped in a towel

No direct application on the skin
Apply heat before any activity to help with Range of Motion
Reduce but don’t stop performing your exercises if you experience pain in your muscles

So there you have it. The essential guide to recovering from Total Hip Replacement in an easy and relatively painless manner.

Heart Attack June 25, 2019

Free your heart – Your guide to stents and their lifesaving benefits

Let’s face it, anything medically related to the heart is a scary experience for most, especially when one is not aware of the procedure in detail. After all, it is one of the most major organs of our body and is responsible for keeping us alive! Most medical jargon can be confusing and thus, liable to make one even more apprehensive, something that should be avoided when one is already suffering from cardiac complications. While most of us are aware of bypass surgeries, stents are something that many people are either not aware of, or are unsure about the exact nature and working of. If you are one of them, then there is no need to worry anymore. Here is your guide to stents and how they help you lead a fuller and healthier life.

To begin with, let us understand what causes heart disease. As most of us are aware, our heart contains many arteries that supply oxygen-rich blood to its muscles and helps it pump. Now, for certain reasons, such as lifestyle, genetic and environmental, these arteries get clogged with fats, specifically, cholesterol. This decreases the blood flow to the heart and makes it pump less efficiently, or worse, causes the blood to clot and leads to a heart attack. This is where stents come into play. These are tiny tubes that are used to keep your arteries wide and blockage free, decreasing the risk of heart disease and to heart ongoing heart attacks. They are usually metallic in nature and are coated with medicines that gradually release into the bloodstream and prevent further blockages.

How does the process work?

To begin with, a small incision is made in a blood vessel located in your abdomen, arm or neck. Your cardiac surgeon will then insert a small tube known as a catheter through the vessel to the artery which is clogged. This tube contains a tiny balloon at its end, that your doctor will inflate in order to widen the artery and restore blood flow. The stent is then placed and the balloon and catheter are removed. The procedure typically lasts an hour and requires an overnight hospital stay for observation. Risks for getting a stent may include: 1) Hemorrhage at the spot of tube insertion. 2) Blood vessel damage at the time of insertion. 3) Infection. 4) Arrhythmia. 5) In rare cases (1-2%), people implanted with a stent may develop a clot at the site of stent placement, increasing the risk of a heart attack or stroke. As this risk is maximum during the first couple of months post-procedure, you will most likely be put on a course of aspirin or some other blood thinners to prevent clot formation.

Is a stent permanent?

In most cases these days, yes. A stent is a permanent wire mesh implant in your artery. While feeling a little worried about having a permanent implant in one’s heart is a scary prospect, the good news is that not all stents are permanent. Dissolving stents are the latest technology available for patients these days. Unlike metal stents that carry a chance of inflammation and resultant blood clots, these temporary stents made of a primer known as polylactic acid, last only about 3-4 years and dissolve into carbon dioxide and water in the end. Instead of the artery being held in place with stiff metal, a dissolving stent lets the artery return to its natural shape and curvature. In fact, stents like those made by Meril, are ultra-thin (50 µm or 65µm) that promote early vessel healing, allow the artery to be flexible and dilate and constrict naturally.

So a dissolving stent is perfectly safe?

There are some drawbacks associated with dissolving stents, namely vessel recoil, the thickness of these stents leading to manoeuvrability and crossing problems, problems in seeing a non-metallic stent through imaging techniques and absence of firm crimping on balloons for delivery. Even with these drawbacks, experts believe that the evidence favours dissolving stents, as they are a rapidly evolving technology. In the near future, dissolving stents will most likely overcome these drawbacks and become the first choice of use for cardiologists.

Can my stent develop a blockage?

Combined with proper diet, exercise and lifestyle changes, your stent implant can last you decades. However, there is a small possibility of the stents developing blockages too. To reduce such occurrences, modern stents are drug-eluting ones that are coated with drugs that reduce the risk of blockages. Even with a stent in place, there are chances that you may develop a coronary artery blockage in other locations or arteries. However, there is no need to live your life in fear. These complications and risks can be easily managed by aspirin therapy, cholesterol and triglyceride control and lifestyle modifications.

Knee Replacement June 25, 2019

Post-Total Knee Replacement Recovery. Is It Only All About Bed Rest?

Are you recovering from Total Knee Replacement or TKR? Congratulations! You made it past the first hurdle! With a little attention and care, you will soon be back on your feet! Can’t figure what is allowed and what is not? Here is a simple guide to post-op healing to help you put your best foot forward!

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.

A knee replacement could be more precisely termed as knee “resurfacing” as this procedure actually involves replacement of the surface of the bones.

What should I particularly pay attention to post surgery?

No surgery is 100% painless and TKR is no different. While the chances of intense pain, complications and inflammation are minimal, there are some things you can do to make the situation more comfortable. The first and foremost thing to remember is to follow your surgeon, medical team and physiotherapist’s orders.

Remember RICE. Rest. Ice. Compression and Elevation should be the new best friend of every post-op TKR patient. The first one needs no explanation. One should rest and that too as advised by the doctor. Keeping the ankle above the heart also helps to decrease the swelling, raise blood circulation and prevent blood clots. Apply an ice pack for 10-20 minutes for 3-4 times a day. If the initial swelling has subsided, you can also opt for a heat pack. Use a compression cloth for additional help.

Do go undergo physiotherapy sessions: Following one’s physical therapist’s orders is paramount to regain one’s health as soon as possible. Perform them just as advised even though it may be uncomfortable at first. Exercise is a great way to get used to your new knee and heal faster too! In fact, post-operative exercises increase circulation which prevents dangerous blood clots. Gentle exercises like quadriceps sets, straight leg raises, ankle pumps, knee straightening exercises and more, are just some of the exercises a post-op TKR patient will be asked to do.

Take the prescribed medications: Adhering to the medical schedule as prescribed by one’s doctor is crucial for one’s healing process. It not only helps in reducing inflammation and pain but also helps avoid infection and blood clots.

Do manage your weight: An increase in weight means more stress on your new knee or even chances of arthritis on your other knee. So keep an eye on your diet and let your body heal itself.

Avoid unnecessary stress to the knee: A healthy body heals faster, more so in case of surgeries like TKR. So while it may not be time to hit the gym yet, one can walk, swim or indulge in other low-impact activities to keep the blood flowing and your body healing. Remember to not twist your knee, sit cross-legged and pick heavy weights of more than 9 kilos at this time.

Consult your orthopaedic surgeon prior to getting any other surgeries: Whether it is a dental surgery or a major operation, it is best to get the green light from one’s surgeon before going ahead as these surgeries may up your infection risk.

Avoid smoking and alcohol: Goes without saying that both these substances can interfere with your healing process and make you more prone to complications. Alcohol especially should be avoided if the doctor has put you on a course of blood thinners or high dose painkillers.

Maintain your posture: Do not engage in activities that jerk your knee or can cause you to fall down. Both these situations must be avoided at all costs.

Don’t hold yourself to milestones: Everybody heals differently. Every patient will progress at their own rate, so don’t be disappointed or stressed if your or your loved one is not progressing as steadily as one would like. Celebrate the accomplishments that you have made and strive for the next.

Warning signs to be on the lookout for

TKR is one of the most common and low-risk surgeries in the world. It sees very few complications with serious complications at a chance of less than 2% and even lesser when it comes to fatal complications. 90% of implant recipients observe a significant improvement in the quality of life and increased mobility. However, there are some risks associated with the procedure that may surface months or maybe even years after the surgery. While there is nothing to be scared of, any chronic significant pain should be discussed with your orthopaedic doctor. Here’s what the pain might signify:

Infection: This is by far the most common complication. An infection is not necessarily postoperative, it can happen months or even years after the main surgery. Sometimes an infection in a different part of the body can affect your implant and cause infection.

Fracture of bone around the knee.

Loosened implant: A loosened implant is not something that happens days or even weeks after the surgery. It can take years to develop and is one of the most common causes of pain post surgery.

Kneecap problems: Issues with kneecaps are a major cause of total knee replacement surgery. However, due to its complex nature, it is difficult to ensure that the new kneecap works just like the original. This requires expertise from skilled surgeons.

Alignment problems: If an implant is badly aligned it may end up not performing as per expectations or indeed exacerbating the issue.

Others: Bursitis, pinched nerves or complex regional pain syndrome are few other rare complications and causes of pain post TKR.

Thanks to advances in technology, TKR patients can now become mobile even faster than before. Adequate rest, exercise, medication and strict adherence to post-op instructions can ensure faster recovery rates and healing outcomes. So go out there and enjoy your new knee without any stress in your mind!

Knee Replacement June 25, 2019

Worried About What Total Knee Replacement Entails? Put Your Fears To The Rest With Our Handy Guide!

Deciding to get any surgery is an important decision and Total Knee Replacement or TKR is no different. What makes this decision even more vital is the crucial role our knees play in our lives. Needed for the single most common movement in our lives, walking, our knees are a feat of natural engineering. Everything from climbing stairs, running, kicking, squatting and even sitting requires this joint to function smoothly. Which is why it is no surprise that chronic knee issues can make life very difficult for both those who are suffering from the disease and their caretakers or family. In such a scenario, opting for TKR gives the patients and their family a new chance at enjoying an improved quality of life. Wondering if it is the best option for your or your loved ones? Here’s some information that could help your decision-making process.

What is TKR?

One of the most common surgeries conducted in the world today, Total Knee Replacement is a complete replacement of the knee joint with a suitable metal implant. The procedure is conducted under general anaesthesia and takes about 2-3 days of hospital stay. While the final decision rests on you and your orthopaedic surgeon, Total Knee Replacement surgery is advisable for those who are not responding to other treatments, are in significant distress or have been reduced to limited mobility.

A knee replacement could be more precisely termed as knee “resurfacing” as this procedure actually involves replacement of the surface of the bones.

What is the procedure like?

TKR is actually a misnomer which leads people to believe that the entire knee with get replaced. This is certainly not the case! Only the damaged parts of one’s knee are replaced. The surgeon will first remove all the damaged cartilage from the ends of the bones and reshape them. The new implant is then attached to the ends of the bone and a plastic spacer is put between them to reduce friction and ensure smooth movement. If the damage is significant, the surgeon might also replace the back of the kneecap with a plastic button.

Is getting TKR done in India a wise decision?

Absolutely so! In fact, India is fast becoming a hub for TKR, with many foreign patients opting to get operated in India in order to not only save costs but also get treated with the latest tools and technology. What’s more, is that the success rate of TKR in India is deemed to be one of the finest in the world! To add to that, the costs of undergoing TKR in India is significantly less than in other countries. Careful regulation of implant prices by the government also means that TKR need not be a major drain on one’s resources. With a huge pool of trained and skilled orthopaedic surgeons and hospitals equipped with advanced infrastructure, one can rest assured that one’s loved ones are in good hands.

I have heard that TKR recovery involves both pain and inflammation?
Recovering from any surgery requires time, care and precaution, and TKR is no different. As long as you carefully listen to the orthopaedic and follow their instructions carefully, there are very few chances that anything can go truly wrong. To ensure that you or our loved one experience minimal discomfort, here are some things that one can do, like apply an ice pack 3-4 times daily for a minimum of 10-20 minutes. If the cold is an issue, one can also opt for heat packs, but only once the first swelling subsides. Keeping the leg elevated above the heart and performing ankle pump exercises also help to decrease swelling, raise blood circulation, and most importantly, prevent the formation of blood clots. If in case the swelling does not reduce even after regular icing, then it is best to consult your doctor/PT to get a prescription an NSAID medication. Alternatively, one can wear a compression cloth provided by one’s doctor to get relief from the inflammation.

How will TKR benefit my & my loved one’s life?

95% of patients see a significant improvement in the quality of life and mobility post surgery and physi-cal therapy. In the rare 10% of cases, the patient may still end up a degree of pain. That being said, the chances of unsuccessful implantation are pretty rare and complications rarer still and the benefits far outweigh these chances. The biggest benefit of TKR though is the immense quality of life improvement it bestows on the patient. Instead of being bedridden, wheelchair bound or on crutches, they can take on life with a greater enthusiasm and take up their previous hobbies and interests. They can go for walks with their friends and loved ones, attend social gatherings without fear of pain or discomfort and even become more independent. This is especially crucial for older patients as being housebound or having limited mobility reduces their social interactions which can be detrimental to their mental health in the long run.

Is an imported implant better than an Indian one?
Not at all! Indigenous knee implants are not only more cost-effective than their imported counterparts, but they are also a better fit for the Indian knee morphology that is different from those of westerners. Do consult a doctor to get credible solutions for your healthy life.

Many people put off undergoing or discourage their loved ones from undergoing TKR as they feel that medicine and alternative treatments may be better than going under the knife due to the potential complications. Unfortunately, this only makes the patient lead a progressively poorer quality of life. Opting for a TKR with its low complications and the high success rate is not only the right option for those in significant pain and discomfort, but it is also the best way to regain one’s or one’s loved one’s previous quality of life.