FAQ

Acute or sudden onset injuries are best treated with ice wrapped in a thin cloth. The ice will help with the pain and will control inflammation. Any injury less than 6 weeks old can be iced. After that, warm compress is advised as it will help with the healing.

Don’t take your knees for granted. The earlier you start taking care of them, the better it is for you as you age.

Here are a few tips:

• Stay physically active.
• Maintain optimum weight.
• If you experience pain during an activity, stop immediately.
• Treat injuries immediately with RICE – rest, ice, compression and elevation. If pain persists, consult your doctor.
• Stop smoking.
• Eat a healthy diet.
• Pay attention to your posture.
• Wear comfortable footwear.

Overuse is a common cause of knee pain and this pain usually goes away with rest. However, some initial signs of a knee problem include:

• Stiffness at knee joint.
• Slight inflammation.
• Inability to straighten knee.
• A feeling of weakness at the knee.
• Knee snapping or popping.

The most common cause is a muscle or ligament injury. Other causes include straining the back while lifting something, not maintaining proper posture and leading a sedentary life. Being overweight increases the risk of sustaining back strains and sprains. Arthritis and spinal changes associated with aging are other causes.

Back pain is a very common condition which most people experience at some point in their lives. Here are some practices that can help prevent back pain:

• Core strengthening exercises.
• Back stretching exercises.
• Maintaining good seating posture.
• Avoiding being seated for long durations and taking breaks and walking around.
• Lifting heavy objects the right way.
• Maintaining ideal weight.
• Quitting smoking.

Back pain can interfere with a good night’s rest. There are a few simple modifications to your sleeping posture that could help with back pain.

• Sleep on the side with the knees drawn up and a pillow between the knees.
• If you are a back sleeper, then a pillow under the knees will help.
• Sleeping on the stomach does strain the spine but if you cannot sleep in any other posture, then keeping a pillow under the lower abdomen/hips will help reduce the strain.

When an older adult falls, panic is the first reaction for everyone around. But this is when a calm mind is required. Reacting out of panic and trying to lift or move the person can cause more damage than the fall itself. When a person falls:

• Maintain calm.
• It takes some time to feel any pain so wait for a few minutes.
• Assess the situation jointly; if there is any suspicion of an injury, get professional help immediately. Do not move the person.
• If the person is unhurt, then it is best to get up by first turning to the side, then resting on all fours, and then using support to come to a standing position.

If a fracture is suspected, get professional help. Till help arrives, here is what you can do:

• If the wound is bleeding, use a sterile bandage or clean cloth and apply pressure over the wound.
• If there is visible dislocation of bone, do not apply the bandage on it.
• Do not try to push the bone back into place.
• If the neck or back is hurt, help the patient stay as immobile as possible.
• If it is a limb fracture, immobilize with a sling or splint.
• Apply ice wrapped in a thin towel intermittently.
• Reassure the patient and keep him/her warm.

A DEXA (dual energy x-ray absorptiometry) scan is a pain-free imaging test which measures the density of the bone using very low levels of x-rays. It helps determine risk for osteoporosis and fractures. The procedure will not take more than 30 minutes and is considered highly accurate.

When conservative treatment methods like medication, injections and physiotherapy do not give pain relief and quality of life is reduced, it might be time to consider surgical options. Emergency conditions of course may warrant a surgery.

After an orthopedic procedure, some pain is expected. The doctor will prescribe medication to help handle the pain. Physical therapy is a must after surgery to promote healing and attain maximum mobility. Recovery period varies from patient to patient – a number of factors like type of surgery, health of the patient, etc. all play a role. Recovery period can vary from a few weeks to a few months.

Minimally invasive surgeries are so called because they make only the smallest of incisions and hence reduce pain, the time to heal and the possibility of infection. Through the incisions, a small video camera and instruments are inserted to rectify the condition.

The life span of an artificial knee joint is said to be around 15-20 years. High impact activities are best avoided to further the life span of an artificial knee joint. Low impact activities like swimming, walking, etc. are considered safe.

A knee replacement surgery has a very high success rate. However, in some rare cases, it may fail. When this happens, the knee becomes inflamed and painful and daily activities become difficult. In such cases, revision surgery will be suggested. During a revision surgery, some or all the parts of the artificial joint will be removed and replaced with a new prosthesis.

Smoking decreases the supply of blood to the bones and other body parts. It reduces the production of osteoblasts (bone producing cells). Calcium is a mineral that is crucial to bone health and its absorption is reduced by smoking. Smoking causes a drop in the level of the hormone estrogen which leads to early menopause.

The ill-effects of alcohol on bones are many. When young people drink, their risk of osteoporosis later in life increases. We all know the importance of calcium for strong bones and alcohol inhibits calcium absorption. Alcohol also has negative effects on hormones. Estrogen production is reduced by alcohol consumption and reduced estrogen production means remodeling of bones slows down and bone loss begins. The production of cortisol and parathyroid hormone increase with alcohol consumption. Cortisol inhibits bone formation and bone loss sets in. The parathyroid hormone removes calcium from the bone cells and bone strength reduces.

Sportspersons are more prone to injuries because of the continual stress on their bones and joints. Strengthening the muscles hence gains importance for not just injury prevention but also for enhanced performance. A consult with an orthopedic doctor will not just help in the above two but a personalized care plan will also be formulated which will help keep the athlete in top shape.

A joint replacement procedure is considered only when the patient is experiencing severe pain that prevents daily activities, affects sleep and makes the patient dependent on others. Dependency on others can affect the mental well-being of the individual. In such cases, a joint replacement procedure can restore mobility and independence and improve quality of life.

Rheumatoid arthritis (RA) is an autoimmune condition that affects the lining of joints. By autoimmune, we mean that the body’s own immune mechanism attacks the healthy cells leading to pain and inflammation. The condition usually affects smaller joints first before affecting the bigger joints. The cause of RA is unknown but genetic links are suspected.

Neck pain that is a result of muscle strain usually needs no treatment and the pain will fade away on its own. If it persists, massaging the area, stretching and physical therapy will help. Maintaining good posture will help prevent neck pain. Neck pain warrants a doctor visit in the following cases:

• The pain persists, or increases after a few weeks from onset.
• The pain spreads to arms.
• Headache, numbness or a tingling sensation accompany neck pain.

Osteoporosis means porous bone. Osteoporosis is often called a silent disease because there are no symptoms. It may come to your attention only after a fracture develops –a fracture can occur very easily with a simple slip or fall or even with no injury at all. Due to low density and poor quality of bone, you will be at high risk for fractures, particularly at hip, spine and wrist.

Factors responsible for osteoporosis include:

• Age
• Menopause
• Low body mass index
• Low bone density
• Previous fractures
• Cigarette smoking
• Alcohol consumption
• Family history
• Low dietary calcium and vitamin D intake
• Prolonged bed rest/ physically inactivity
• Certain medications like steroids, anti-thyroid drugs
• Certain illnesses (Rheumatoid arthritis, Hyperthyroidism)

Osteoporosis can be detected by your doctor through clinical observation and / or bone mineral density (BMD) measurement.

There are many things you can do to lower your chances of developing osteoporosis. Lifestyle changes may be the best way of preventing osteoporosis. Here are some tips:

• Get enough calcium in your diet or through supplements (nearly 1200mg/day)
• Get enough Vitamin D (800 -1000|U/ Day)
• Exposure to sunlight for 10 -15 min at least 2-3 times a week is important for a healthy bones as sunlight is a very important source of vitamin D
• Avoid Excess of alcohol
• Stop smoking
• Engage in regular weight- bearing excercises throughout life
• Prevent Falls
• You should get treatment for underlying medical problem that can cause osteoporosis. If you are on a medication that can cause osteoporosis, ask your doctor if you can lower the dose or take another type of medicine.

The main indication of joint replacement is when osteoarthritis reaches the advanced stage. Osteoarthritis is an age related wear and tear of the joints that happen after the age of 35 -40. After the age of 40, stage I arthritis happens when the cartilage between the joints starts to degenerate. The initial stages can be managed by tablets, physiotherapy and regular exercise. When it reaches stage II, the joint lubrication becomes lesser over time, just like in the engine of a car. Patients can be benefited from an injection in the joint called viscous supplement. When it reaches stage III, Patients have continuous pain throughout the day and their quality of life is severely impacted. In such conditions, we do a key-hole surgery and address cartilage damage.

In India, the most common joint replacements are done for the knee joint, followed by hip and shoulder. Knee replacement largely depends on the age and degree of arthritis. When patients come in at a very early stage, only one half of the knee is affected Actually the knee has three compartments, an inside compartment, outside compartment and knee cap compartment. When one component alone is affected, that can be replaced and is called as unicompartmental knee replacement. The other joint replacements include elbow, wrist, joint and ankle but they are very rare. These are age related but more hereditary.  It is usually following an injury or weight related. When overweight people come in for surgery. I advice them to first optimize their weight before going ahead with the replacement. We recently did a surgery on a 88year old man from Jodhpur, so age is not a barrier. The whole idea is that even if the patients is going to live only for a few years after the surgery, he should be as self –reliant and independent ad possible.

The latest implants that are in the market today give a good bending capability in the knee and are called high flexions knee replacements. There is advancement in design by making a cut in the back of the knee. This cut helps achieve130- 145 degree flexibility. However, patients should have realistic expectations. They can’t expect to be as flexible as they were in their 20s.

These are artificial implants that comprise of two parts, metal and plastic. The joint space becomes narrow so we make cuts in the bone and replace it with a metal and put in a very high quality polyethene. Most of the current replacements are expected to last a life time. The implants normally outlive the patient unless in rare circumstances where people start doing aggressive sports and wear out the replacements. Both pre and post surgery physiotherapy are very important as it helps to strengthen quadriceps and takes off the load from the knee. The physiotherapy usually lasts for a month. Some patients with very positive mindsets even start walking 10 14 days! They can go back to office in 3weeks and driving within 2 months time.