Hip Arthroscopy in Delhi

The procedure of inspecting interior joints with a tiny 4 mm lens arthroscope is known as Arthroscopy. Incisions are made on the diseased joints for the diagnosis and treatment.

Hip arthroscopy is a surgical procedure to treat the problems in the articular cartilage, labrum , or other soft tissues that surrounds the diseased joints. The cause of problems in hip can be due to some injuries or due to certain orthopedic conditions.

Orthopedic conditions include:

• Dysplasia: In this situation the socket becomes shallow and the labrum become more sensitive to pull apart.
• Femoroacetabular impingement : Here the bone grow around femur head or socket and bone get damaged.
• Synovitis: This condition refers to the inflammation of the synovial lining.
• Snapping Hip Syndrome: The tendon gets damaged due to wear & tear or excessive damage.
• Loose bodies: loosely movement of some bone or cartilage fragments within the joint.

Procedure:

• A tension is made on the leg in order to get the surgeon an opportunity to observe the hip clearly and to insert the instruments properly.
• A small incision is made in the area of disease joint.
• Other incisions made for the insertion of other instruments.
• Diagnosis and treatment is done according to the situation.
• The duration of the procedure depends on the complexity of the disorder in the hip.

Advantage:

• Less pain
• Fast recovery
• Negligible blood loss
• Less chances of infection
• Usually done as a day care procedure.

Dr. Raju Eswaran an experienced orthopedics provides the Hip Arthroscopy in Delhi. Along with arthroscopy treatment he is expert in  various orthopedic treatments such as joint replacement, joint preservation, sports and exercise medicines. Quality services are given to  the patients in an affordable cost.  

Email Id : drrajueswaran@gmail.com

Visit Us: www.drraju.in

Arthritis Signs And Symptoms

What is arthritis?

Arthritis is an inflammatory disease of a joint. With arthritis, you will feel pain in the joints,  especially when walking. Sometimes the skin, located on aching joints, begins to redden and there is a fever. 

If one joint is inflamed, the disease is called monoartrit, and if the process involves several joints, then - polyarthritis. If you do not treat the disease, they will be amazed at all the articular tissues: the  cartilage, and its shell. The disease can occur suddenly, in this case, doctors say an acute arthritis,  and  evolve over time, progressing slowly (chronic arthritis).

Symptoms of Arthritis

Arthritis, as well as any other disease, has a number of symptoms.

Reactive arthritis is characterized by weakness and malaise. Since the disease manifests itself in the initial stage. Sometimes there are headaches, and body temperature can reach 38 degrees. Distinguish reactive arthritis may be the characteristic feature - leg joints are affected asymmetrically, and this  occurs after disappearing for nonspecific signs of illness. Parallel may appear symptoms of  inflammation of the urogenital system (burning sensation during urination) and conjunctivitis.

Rheumatoid arthritis is manifested in the fact that the joints are affected symmetrically. They  become swollen and inflamed. The pain will intensify at night, closer to awakening. In the afternoon, it almost completely disappears. In the early development of the disease people often saved from  unpleasant feelings by performing the exercise. The more the disease progresses, the less efficient  the process becomes. After the strike the small joints of arthritis, it will move to large, will form the characteristic knots. They are represented by small, dense formations, localized on the bend of the  joints. Throughout the illness the person will experience malaise, poor appetite, weakness. During  periods of exacerbation occurs fever. Sometimes join symptoms such as numbness in arms and legs, pain in the chest during breathing, inflammation of the salivary glands, as well as photophobia and  pain in the eyes.

Infectious arthritis is acute onset of characteristic signs of intoxication. The body temperature rises  to higher values, accompanied by chills, headache and muscle pain. Sometimes you may experience nausea, vomiting followed, but this feature is often characteristic of young children. The joint, which is struck by illness, swells, its shape changes. The pain is worse during movement, it may radiate to  the next location of the site. A man tries to take the position in which it is easier to tolerate the  discomfort. The skin is heated around the place where the diseased joint. If people have symptoms of blurred retirement age, the children they appear brighter. The disease develops rapidly.

Gouty attack often finds a man at night. To give impetus to the disease may or eating large amounts of meat or alcohol. In most cases, infestation first joint of the thumb is located on the leg. But  sometimes the disease affects the knee or elbow. To inflammation site can not be touched, as a  person experiences severe pain which is accompanied by swelling and reddening of the skin. The  body temperature is normal, the episode has passed as suddenly as it had begun. The total period of  the disease - a few days.

Psoriatic arthritis, it will disturb the following symptoms: a gradual progression of the disease,  swelling at the site of injury, local temperature rise. In skin and scalp spots appear, they are red, gives a person the discomfort of itching and flaking. Just parallel affected nail plates, they begin to split.  Suffer from this type of arthritis can any joint, but more often affected fingers. At the same time, they thicken and resemble sausages. Pain in the initial stages of the disease does not occur, and if it is  present, in the morning. 

Osteoarthritis is manifested in the fact that the joints begin to ache gradually as the disease progresses. Also, a characteristic feature is the crunch. It affects both the joints of limbs and spine.

Traumatic arthritis develops the type of osteoarthritis. The symptoms are the same - is pain,  swelling and crepitation in the place where the inflammatory process.

Consult a doctor

To take out arthritis form your life you must meet an orthopedic specialist. Let us introduce our  orthopedic specialist Dr. Raju Eswaran who is a well reputed orthopedic consultant in delhi.

Injections for Knee Arthritis

Sometimes knee arthritis simply does not respond to medications & physiotherapy. It becomes desirable, then to inject the knee joint to improve the symptoms of arthritis. Here are some facts you should know before getting that jab.

click for info-graphics

1) Will it be painful?

That’s the most obvious question in everyone’s mind. The knee joint is the largest joint of the human body. It has lots of space inside to accommodate the injection & if carefully given (without the needle touching the bones of the knee), it is essentially a painless procedure after the local anaesthesia is injected in the skin. This injection (local anaesthesia) is done with such a tiny needle that its prick into the skin is virtually painless.

2) Will it be harmful to my knee & body?

This depends on the type of material injected into the knee joint. The most commonly injected material is a depot (oil based) preparation of a steroid like methylprednisolone. It works wonders for the acutely inflamed knee of inflammatory arthritis (like rheumatoid), but is merely a short term time buying procedure for the more common osteoarthritis. Repeated injections (more than 4 in a year) can be detrimental to the knee’s cartilage & will hasten its breakdown, thereby accelerating the progress of arthritis. Being oil based, very little of the steroid escapes into the body & is thus safe from that point of view, but caution is exercised in those with diabetes, glaucomas & kidney problems.

The second category of injection material actually lubricates the joint. It contains a high viscosity material that mimics the properties of healthy joint fluid & improves joint lubrication. It works best in early stages of osteoarthritis & its benefit has been shown in clinical trials (OASIS) to last upto an year (Synvisc One). It is of little use in very advanced stages of osteoarthritis & in all stages of inflammatory arthritis (rheumatoid). Apart from minor pain at the needle entry site that may occur in a few people, this injection is very safe & gaining popularity because of its joint preserving nature.

The third category of injection that is slowly emerging as a new entrant is the stem cell injection (Platelet Rich Plasma or PRP). Here 30 - 50 ml of one’s own blood is purified into 3-5 ml of platelet rich plasma & injected back into the knee. It is still in the experimental stages with inconsistent results. However since it is the patient’s own blood that is injected in a filtered manner, it does not have any side effects. The initial post-injection period is however more painful compared to the above two injections.

3) How long will the effect last & how often can it be repeated in osteoarthritis?

With the steroids, effect lasts for 2-3 weeks, synvisc one works for an year & with PRP the results are not yet known. Steroids are best not repeated, synvisc one can be repeated as many times as desired & with PRP the protocol of repeat injections has not yet been firmly established.

4) What precautions need to be taken for these injections?

If you have diabetes or glaucoma, please inform your orthopaedic surgeon. It is better not to get injected with steroids in these cases. Always get the injection in a sterile environment like the minor operation theatre. Rest for 1-2 days after the injection. Pain may temporarily increase immediately after injection, ice packs & anti-inflammatory medicines will take care of it.

Have realistic expectations from the injection, do not expect it to do magical things. Synvisc one for example starts working only after a month of injection. Do not expect the injection alone to do the trick for you, continue with exercises & lifestyle modifications (refer to my earlier blog). So if your orthopaedic surgeon recommends an injection, do not go into a panic mode, educate yourself about the injection & take a careful prepared decision that can change your lifestyle.

Knee Caps & Braces in Knee Osteoarthritis

Almost everyone with knee arthritis is wearing some sort of a contraption or the other for relieving their pain. These externally worn aids are called by various names, knee caps, braces etc. Do they really help? Let's find out.

Types of knee braces

1. Soft knee braces, like knee cap
2. Hard knee braces, like hinged knee brace
3. Offloading knee braces

Theoretically a brace should offload the diseased portion of the knee, in order for pain relief. It is therefore obvious that all soft knee braces like the knee cap are ineffective in doing so. Let's face it, something slightly thicker than socks cannot protect your knees. However they do bring about pain relief from a different mechanism. They tightly encircle the knee & the user's brain gets the feedback that my knee is tight or something is supporting my knee. What actually happens is that their wearing either takes away or distracts the brain from the knee pain or induces a reflex contraction of the thigh muscle (the quadriceps) that gives a feeling of having a stable knee. Pain after all is an unpleasant sensation conveyed by the nerves to the brain & diverting the brain's attention is the main way by which all the anti-inflammatory creams work. Most of them contain an irritant that sets up a minor pain sensation around the overlying skin, that diverts the brain's attention away from the bigger pain smouldering inside! It is a widely held myth that they actually penetrate through the intact skin & heal the hurt.

The rigid knee brace or the hinged knee brace is used in case there is injury to the collateral ligaments of the knee joint. The knee has 2 sets of ligaments called the collateral ligaments that run along the inner & outer side of the knee respectively. They usually get injured in a fall & depending on the direction of the fall either the inner (medial collateral ligament) or the outer (lateral collateral ligament) gets injured. These hinged braces are useful in helping these injured ligaments heal. They have absolutely no role in knee osteoarthritis, unless there is diagnosed ligament instability by a clinical examination.

The offloading braces are a whole new species of knee braces. These braces are designed so that once worn, they offload a certain portion of the knee & transfer that load to the other portion, something like Robin-hood (steal from rich & give to poor). They are very useful in moderate to mild stages of arthritis (decided by the x ray) in which one expects one half of the knee (usually the inner half) to be diseased & the other half of the knee (usually the outer half) to be healthy. In advanced arthritis (again decided by the x ray), wherein both sides of the knee are diseased, they have no role!

Do you need a brace?

Yes & no. You certainly don't need a knee cap or a hinged brace for arthritis. You are much better off & much more comfortable doing exercises & making subtle changes in your lifestyle (refer to my earlier blog post). If you have end stage knee arthritis, then also you won't benefit from any brace, you may be better off getting a knee replacement. 

If your doctor is able to diagnose isolated arthritis of one half of the knee, then you will benefit from an offloading brace. The problem with the offloading brace is that it also offloads your purse! Most such braces come upwards of 30000₹ per brace. Another problem is that you need to wear them throughout the day, which may be a challenge in our mostly tropical climate & if you are fond of tight clothing. Sometimes these braces simply don't fit us Indians as they are designed for Caucasians, we sometimes have a great discrepancy in the thigh & leg diameters & that causes the brace to lift off the skin in some places. An ill fitting brace will not work for you & might actually be counterproductive by constantly rubbing against the skin & eventually ulcerating it!

How soon will the brace start having its effect?

We are all in a terrible hurry to see results, especially after spending a fortune on the offloading brace. Results in term of pain relief takes time. Initially just like a new shoe, the knee may feel sore. Some people don't obtain that much relief in pain, but their mobility & joint flexibility improves. In a nutshell it is unrealistic to expect magic from the brace. Be prepared to wait out a few weeks for its effects to kick in.

Are offloading braces available in India?

Yes, but only on a doctor's prescription. All the braces available off the shelf are mostly ineffective as far as knee osteoarthritis is concerned.

Actionable advice:

1. Kick off your knee caps & exercise instead.
2. Adopt simple lifestyle changing measures (ref, my earlier post) to get relief from the pain.
3. Consult your orthopaedic surgeon to see if offloading braces will be useful to you.

Content copyright of Dr Raju Easwaran

Knee Osteoarthritis Treatment in India

Knee osteoarthritis is sometimes not considered to be a disease, it is simply a normal manifestation of ageing, like grey hair. Everyone will develop arthritis one day or the other, we are just genetically programmed to get it at different ages. Some develop it early, some develop it late. Knee arthritis is not the end of the road in terms of living an active lifestyle. With these suggested lifestyle modifications, you can delay or prevent the eventual manifestations of the disease.

Swim, swim, swim. It is a well known fact that in water we feel lighter due to the Archimedes principle. Stiff & painful joints ease up like magic in the water. If you don't know how to swim, simply walk across the length & breadth of the shallow section of the pool, or immerse your feet in the water, sitting on the edge. If you know how to swim, it is a great advantage. You know what, it is never too late to learn. If you also suffer from backache, it will improve with swimming. Another silent advantage is the amount of Vit D you make during an hour's swim with your body exposed to the sun!

Aerobic exercises for 30-60 minutes a day will keep you & your knees healthy. Brisk walking is one of the best forms of aerobic exercise. There is a lot of confusion regarding whether people with knee pain should do a regular morning walk or not. It is recommended that you walk on soft surfaces like grass or artificial turf or a high end treadmill with built in shock absorbing properties. Walking or running on hard concrete & similar surfaces can aggravate your knee pain. In case of confusion remember that apart from the knee you have a heart & a pair of lungs. They demand aerobic exercise & brisk walking is the best form of that. Exercise done properly didn't do anyone harm!

Resistance training or weight training done 2 times a week keeps your bones strong. You should do one type of exercise for the upper body like dumbbell curls & one variant for the lower body like the leg press. 8-12 repetitions should be targeted with 60-70% of the weight you can lift maximally. For example if you can do a biceps curl with 20 pounds, pick 12 pounds instead.

Let's face it. Orthopedic exercise is boring. We forget to do it often enough. One of the biggest challenges is to remember when to exercise. If we set target oriented goals like doing a set of exercises immediately before breakfast, lunch & dinner, then we are more likely to remember to do the prescribed orthopaedic exercises.

Say no to certain things, like squatting, cross legged sitting. If you have a lift don't use stairs. If you don't have a lift, use the stairs as sparingly as possible. 

Watch this space for more relevant information that may help your sore knees. Till then get up & exercise!
Know More about : Best Osteoarthritis Treatment in India
Know More : Knee Arthroscopy , Knee replacement surgery , Knee Ligament Injuries