Info For Patients

General Orthopedics

Orthopaedics is the branch of medicine related to the study and treatment of disorders of bones, joints and other parts of the skeletal system like muscles, ligaments etc.
The most common orthopaedic related problems are back pain, knee pain, fractures of bones and ligament sprains amongst others.

If you have been in any kind of an accident or fall leading to an injury with swelling and pain you should immediately head to the emergency department of a hospital. After the emergency doctors have seen you, usually an orthopaedic surgeon is called to check if there are any fractures or ligament sprains. In this scenario you will usually be required to get x-rays or an MRI or CT scan depending on which part of the body is suspected to have been injured. here...

Key Areas in Orthopedics

Injuries and Trauma:
- Fractures: Breaks in bones that can range from hairline cracks to complete breaks, often requiring immobilization or surgery.
- Dislocations: Occur when bones in a joint are forced out of their normal position, necessitating repositioning by a healthcare professional.
- Soft Tissue Injuries: Include strains, sprains, and tears that can impact muscles and ligaments, often resulting from sports or physical activities.
Common Conditions:
- Arthritis: A group of conditions causing joint inflammation, leading to pain and reduced mobility. Common types include osteoarthritis and rheumatoid arthritis.
- Tendonitis: Inflammation of tendons due to overuse or injury, often affecting areas like the shoulder, elbow, or knee.
- Carpal Tunnel Syndrome: A condition caused by compression of the median nerve in the wrist, leading to pain, numbness, and weakness in the hand.
Diagnosis and Evaluation:
- Imaging Techniques: X-rays, MRIs, and CT scans are commonly used to assess bone and joint conditions.
- Physical Examination: A thorough assessment of the affected area helps determine the extent of injury or disease.
Treatment Options:
- Non-surgical Treatments: These may include physical therapy, medications (like anti-inflammatories), corticosteroid injections, and lifestyle modifications to manage pain and improve function.
- Surgical Interventions: In cases where conservative treatments are ineffective, surgery may be necessary. Common procedures include:
  - Arthroscopy: Minimally invasive surgery to diagnose and treat joint problems.
  - Joint Replacement: Surgery to replace damaged joints, commonly performed on hips and knees.
  - Fracture Repair: Using plates, screws, or rods to stabilize broken bones.
Rehabilitation and Recovery:
- A crucial part of orthopedic care is rehabilitation, which may involve physical therapy to restore strength, flexibility, and function after injury or surgery.

Importance of Orthopedic Care

Orthopedic care is vital for maintaining mobility and quality of life. Whether you’re an athlete or someone dealing with age-related wear and tear, early diagnosis and appropriate treatment can lead to better outcomes.

When to See an Orthopedic Specialist:

Persistent pain in joints, muscles, or bones
Swelling or bruising after an injury
Difficulty in movement or performing daily activities
Symptoms that don’t improve with home care

Total Knee Replacement- What You Need To Know (FAQ)

1. What is Osteoarthritis of the knee?

In the knee joint there is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the undersurface of the patella (kneecap). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.

2. What is Knee Replacement?

A knee replacement is really a cartilage replacement with an artificial surface. The knee itself is not replaced, as commonly thought, but rather an artificial substitute for the cartilage is inserted on the end of the bones. This is done with a metal alloy on the femur and plastic spacer on the tibia and occasionally the patella (kneecap). This creates a new smooth cushion and a functioning joint that does not hurt.

3. Why Do People have knee Replacement Surgery?

For the majority of people who have knee replacement surgery, the procedure results in:

a decrease in pain
increased mobility
improvements in activities of daily living
Improved quality of life.

4.How many types of knee Replacements are there?

Partial and total knee replacement

5.What is partial knee replacement?

In some patients, only one part of the knee is damaged, while the remaining parts are completely healthy. In these cases, it is possible to replace only the damaged part of the knee with a metal and plastic implant. This can usually be done through a smaller incision.

6.When is the right time to undergo a knee replacement?

There’s no precise formula for determining when you should have a knee replacement. But if you’re having trouble doing your daily activities and require analgesics daily to do this activities. If the deformity is more then one can think of knee replacement.

7.What Are Alternatives to knee Replacement?

Before considering a total knee replacement, the doctor may try other methods of treatment, such as exercise, walking aids, and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged knee and help you to avoid or delay surgery.
All medicines can have side effects. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.
For knee pain without inflammation, we usually recommend the analgesic medication acetaminophen.
For knee pain with inflammation, treatment usually consists of nonsteroidal anti-inflammatory drugs, or NSAIDs. When neither NSAIDs nor analgesics are sufficient to relieve pain, doctors sometimes recommend combining the two. Again, this should be done only under a doctor’s supervision. Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects.
Topical analgesic products may provide additional relief. Some people find that the nutritional supplement combination of glucosamine and chondroitin helps ease pain. Sometimes, corticosteroids are injected into the hip joint.
If exercise and medication do not relieve pain and improve joint function, the doctor may suggest a less complex corrective surgery before proceeding to knee replacement. One common alternative to knee replacement is an osteotomy. This procedure involves cutting and realigning bone, to shift the weight from a damaged and painful bone surface to a healthier one. Recovery from an osteotomy takes several months. Afterward, the function of the knee joint may continue to worsen and additional treatment may be needed. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure

8.How long will my new knee last, and can a second replacement be done?

We expect most knees to last more than 10–15 years. However, there is no guarantee, and 5–10 percent may not last that long. A second replacement may be necessary.

9.What are the major risks?

Most surgeries go well without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are 1 percent or less.
Should I exercise before the surgery?
Yes. You should discuss preoperative physical therapy. Exercises should begin as soon as possible.

10.Will I need blood?

You may need blood after the surgery. You may donate your own blood, if able, or use the community-blood-bank supply.

11.How should I prepare for the surgery?

Once DR Vishal Pusshkarna has ordered a knee replacement surgery, the patient will need to schedule an appointment with general physician to get medical clearance if require. The patient will need to meet with the anesthesiologist to review their medical history, receive a physical exam and have their blood taken. Patient would be taught pre op exercises by your physiotherapist. Once the anesthesia clearance is done patient would be given date for surgery.
Patient would be admitted a day prior to surgery.

12.How long will I be in the hospital?

Most knee-replacement patients are hospitalized for five days after surgery. If you need more time for rehabilitation, other options might be available to you. Make arrangements before your surgery to have someone stay with you after you are discharged.

13.What are my anesthesia options?

You may have a general anesthetic, which most people call “being put to sleep,” or a spinal anesthetic. The choice is between you and the anesthesiologist.

14.Will I have pain after surgery?

Yes, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within two days. The day of surgery, most patients control their own medicine with a special pump that delivers the drug directly into their epidural.

15.Will I need a walker, crutches or cane?

Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or crutches. Your equipment needs will be determined by the physical therapist.

16.Will I need help at home?

Yes. In the first several days or weeks after surgery, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. Family members or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required.
17.Will I need physical therapy when I go home?
Yes. Physical therapy will continue after you go home with a therapist in your home or at an outpatient physical-therapy facility. The length of time required for this type of therapy varies with each patient. We will help you with these arrangements before you go home.

18.When will I be able to get back to work?

We recommend that most people take at least one month off from work, even if your job allows you to sit frequently. More strenuous jobs will require a longer absence from work.

19.How often will I need to see my doctor following the surgery?

Ten days after discharge for suture removal. The frequency of follow-up visits will depend on your progress.

20.How will my physical activity be restricted after surgery?

High-impact activities such as contact sports, running, singles tennis and basketball are not recommended. Injury-prone sports are dangerous for your new joint. You will be restricted from crossing your legs. Your surgeon and therapist will discuss further limitations with you following surgery. You are encouraged to participate in low-impact activities such as walking, dancing, golfing, hiking, swimming, and gardening.

Hip Replacement - All You Should Know (FAQ)

1. Who Should Have Hip Replacement Surgery?

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply) is the most common cause of this type of damage in India. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteoarthritis, injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.
Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. In such kind of people we prefer dual mobility cup. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.

2.Why Do People Have Hip Replacement Surgery?

For the majority of people who have hip replacement surgery, the procedure results in:

a decrease in pain
increased mobility
improvements in activities of daily living
improved quality of life.

3.What Are Alternatives to Hip Replacement?

In early osteonecrosis i.e. Stage I / II Before considering a total hip replacement, we may try other methods of treatment, such as exercise, walking aids, medication and core decompression .
In Osteonecrosis or avascular necrosis, there is death of bone caused by insufficient blood supply so we drill holes in to the femoral head and inject stem cells into the femoral head which will help increase the blood supply. This may help to avoid or delay your surgery.
An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.
All medicines can have side effects. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.
For hip pain without inflammation, we usually recommend the analgesic the analgesic
For hip pain with inflammation, treatment usually consists of nonsteroidal anti-inflammatory drugs, or NSAIDs. When neither NSAIDs nor analgesics are sufficient to relieve pain, we sometimes recommend combining the two. Again, this should be done only under a doctor’s supervision.
Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function.
Can we do Core decompression for stage III/ IV?
Core decompression is not effective for III/IV as there is already depression at weight bearing part of the femoral head. Core decompression with not help in improving mechanical symptoms caused by deformation of head.

4.What is Hip Replacement Surgery?

A total hip replacement is an operation that removes the arthritic ball of the upper thigh bone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic liner that is usually fixed inside a metal shell. This creates a smoothly functioning joint that does not hurt. The parts used to replace the joint are the same and come in two general varieties: cemented and uncemented.

5.Is a Cemented or Uncemented Prosthesis Better?

The answer to this question is different for different people. Because each person’s condition is unique, the doctor and you must weigh the advantages and disadvantages.
Cemented replacements are more frequently used for older, less active people and people with weak bones, such as those who have osteoporosis, while uncemented replacements are more frequently used for younger, more active people.
Studies show that cemented and uncemented prostheses have comparable rates of success. Studies also indicate that if you need an additional hip replacement, or revision, the rates of success for cemented and uncemented prostheses are comparable.

6.Am I too old for hip-replacement surgery?

Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for an opinion about your general health and readiness for surgery.

7.How long will my new hip last, and can a second replacement be done?

We expect most hips to last more than 10–15 years. However, there is no guarantee, and 5–10 percent may not last that long. A second replacement may be necessary.

8.What are the major risks?

Most surgeries go well without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are 1 percent or less. Dislocation of the hip after surgery is a risk.

9.Should I exercise before the surgery?

Yes. You should discuss preoperative physical therapy . Exercises should begin as soon as possible.