Bone and joint care


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Bone and joint care

  1. 1. ( Knee Replacement,Hip Replacement,Hip Resurfacing,Arthroscopy(key hole surgery) Shoulder Replacement,Malunited fractures,Musculo skeletaltumor surgery Sports Injury Surgery – Knee Acl Surgery,RheumatologyServices,Knee Replacement Spinal treatments Minimally invasive spine surgeries likekyphoplasty, nucleoplasty and microendoscopic surgeryDiscectomy Microdiscectomy Decompressive LaminectomyArtificial disc replacement Common pediatric tumors likemedulloblastoma, craniopharyngioma or Astrocytoma areremoved by surgical treatment and is followed by treatment by amultidisciplinary team.
  2. 2. What Are The Causes Of Knee Pain ?There are many different causes of knee pain, including injury,arthritis and infection.What is an arthritic knee?The most common cause of chronic knee pain and disability isarthritis.There are three kinds of arthritis:Osteoarthritis - commonly known as wear and tear arthritis ordegenerative arthritis since the cartilage simply wears out. Whencartilage wears away, bone rubs on bone causing severe pain anddisability.Rheumatoid Arthritis - occurs due to inflammation of the jointlining, resulting in erosion of the articular cartilage and eventuallydamaging the knee joint surface.Traumatic Arthritis - is caused by a serious knee injury or severetears of the ligaments in the knee. Is there a cure ?
  3. 3. It depends on the problem. Some knee pain can be treatedthrough rehabilitation, other cases may require surgery. Non-surgical or conservative treatment is effective in the early stages ofarthritis. Pain can sometimes be relieved through lifestylemodification, anti-inflammatory drugs, corticosteroid shots, jointfluid therapy, glucosamine/ chondroitin (dietary supplement),physical therapy, bracing and arthroscopic surgery. These methodscan ease pain temporarily and, in some cases, permanently.How do we know if knee replacement is required or not ? If you have difficulty walking or performing everyday activities, itmay be time to consider Knee replacement Surgery. Doctorsgenerally try to delay Total Knee Replacement for as long aspossible in favor of less invasive treatments. However for patientswith advanced joint disease, knee replacement offers the chancefor relief from pain and a return to normal activities.
  4. 4. Knee replacement or knee arthroplasty Is a surgical procedure to replace the weight-bearing surfaces ofthe knee joint to relieve the pain and disability of osteoarthritis. Itmay be performed for other knee diseases such as rheumatoidarthritis and psoriatic arthritis. In patients with severe deformityfrom advanced rheumatoid arthritis, trauma, or long standingosteoarthritis, the surgery may be more complicated and carryhigher risk.Knee replacement surgery can be performed as a partial or a totalknee replacement.What is total knee replacement ? Total Knee Replacement is a surgical procedure of implanting anartificial knee (called prosthesis). The damaged cartilage and bonefrom the surface of knee joint are removed and replaced with newmetal and plastic surfaces to restore the alignment and function ofthe knee.
  5. 5. In Total Knee Replacement Surgery, the parts of the bones that rubtogether are resurfaced with metal and plastic implants. Usingspecial, precision instruments, the damaged surfaces of the bonesare removed and replacement surfaces fixed into place. Thesurface of the femur is replaced with a rounded metal componentthat comes very close to matching the curve of your natural bone.The surface of the tibia/leg bone is replaced with a smooth plasticcomponent. This flat metal component holds a smooth plasticpiece made of ultra-high-molecularweight polyethylene plasticthat serves as the cartilage. The undersurface of the kneecap mayalso be replaced with an implant made of the same polyethyleneplastic.
  6. 6. What happens during the surgery ? The patient is first taken into the operating room and givenanesthesia. After the anesthesia has taken effect, the skin aroundthe knee is thoroughly scrubbed with an antiseptic liquid. The kneeis flexed about 90 degrees and the lower portion of the leg,including the foot, is placed in a special device to securely hold it inplace during the surgery. Usually atourniquet is then applied to theupper portion of the leg to help slow the flow of blood during thesurgery. An incision of appropriate size is then made. Removing the Damaged Bone Surfaces
  7. 7. Removing the Damaged Bone Surfaces The damaged bone surfaces and cartilage are then removed bythe surgeon. Precision instruments and guides are used to helpmake sure the cuts are made at the correct angles so the boneswill align properly after the new surfaces (implants) are attached.Small amounts of the bone surface are removed from the front,end, and back of the femur. This shapes the bone so the implantswill fit properly.The amount of bone that is removed depends onthe amount of bone that has been damaged by the arthritis.A small portion of the top surface of the tibia is also removed,making the end of the bone flat.
  8. 8. The back surface of the patella (kneecap) is also removed.Attaching the ImplantsAn implant is attached to each of the three bones. These implantsare designed so that the knee joint will move in a way that is verysimilar to the way the joint moved when it was healthy. Theimplants are attached using a special kind of cement for bones.The implant that fits over the end of the femur is made of metal.Its surface is rounded and very smooth, covering the front andback of the bone as well as the end. The implant that fits over the top of the tibia usually consists oftwo parts. A metal baseplate fits over the part of the bone thatwas cut flat. A durable plastic articular surface is then attached tothe baseplate to serve as a spacer between the baseplate and themetal implant that covers the end of the femur.
  9. 9. The implant that covers the back of the patella is also made of adurable plastic.Closing the Wound If necessary, the surgeon may adjust the ligaments that surroundthe knee to achieve the best possible knee function.When all of the implants are in place and the ligaments areproperly adjusted, the surgeon sews the layers of tissue back intotheir proper position. A plastic tube may be inserted into thewound to allow liquids to drain from the site during the first fewhours after surgery. The edges of the skin are then sewn together,and the knee is wrapped in a sterile bandage. The patient is thentaken to the recovery room.
  10. 10. Partial knee replacement surgery / unicompartmental kneereplacement ? Unicompartmentalarthroplasty (UKA), also called partial kneereplacement,... is an option for some patients. The knee isgenerally divided into three "compartments": medial (the insidepart of the knee), lateral (the outside), and patellofemoral (thejoint between the kneecap and the thighbone). Most patients witharthritis severe enough to consider knee replacement havesignificant wear in two or more of the above compartments andare best treated with total knee replacement. A minority ofpatients have wear confined primarily to one compartment,usually the medial, and may be candidates for
  11. 11. unicompartmental knee replacement. Advantages of UKAcompared to TKA include smaller incision, easier post-oprehabilitation, better post-operative ROM, shorter hospital stay,less blood loss, lower risk of infection, stiffness, and blood clots,and easier revision if necessary. Persons with infectious orinflammatory arthritis (Rheumatoid, Lupus, Psoriatic ), or markeddeformity are not candidates for this procedure.What happens after the surgery ? When you are back in your hospital room, you will begin arehabilitation program that will help you regain strength, balanceand range of movement in your knee. Your physiotherapist willhelp you perform appropriate exercises. After 24 hours aftersurgery, you will probably be asked to stand.
  12. 12. Within next 24hrs, you will probably begin to walk a few steps withthe help of walker. You will be discharged as soon as you surgeonfeels that you have recovered sufficiently. You can expect to stay inthe hospital for about 3 days after the surgery. You may or may notbe transferred to a rehabilitation facility for a few more days, asdetermined by your surgeon. Your physiotherapist will instruct youabout proper home care, and may continue to work with you.Hip replacementThe hip and its working
  13. 13. The hip is a ball-and-socket joint comprised of the following structures: • • Head of the femur • • Acetabulum of the pelvis • • Ligaments of the hip jointThe head of the femur or "ball" of the hip joint articulates ormoves within the cup-like "socket" called the acetabulum of thepelvic bone. Together, these structures are referred to as a "balland socket" joint. The ball shaped head of the femur fits into arounded socket (acetabulum) in the pelvis which enables the leg tohave a broad range of movements. The femoral head andacetabulum are covered by a specialized surface called articularcartilagethat allows the two surfaces to slide against one anotherand enable them to move easily.
  14. 14. The joint is held together by several strong ligaments and a strongdense tissue called the capsule which envelops the joint.What are the common causes of hip painThe most common cause of chronic hip pain and disability isarthritis. Osteoarthritis, Rheumatoid Arthritis, Avascular Necrosisand Traumatic Arthritis are the most common forms of thisdisease.Osteoarthriris Commonly known as wear and tear arthritis’, often occurs in anindividual with advancing age, perhaps due to a genetic tendency.
  15. 15. Rheumatoid arthritis Is an auto-immune disease where the inflammation causes anerosion of the articular cartilage and eventually damages the hipjoint surface.Avscular necrosisLow blood supply to a part of femoral head leads to its collapseand hence degenerate the hip joint. Alcoholism, fractures anddislocation of the hip and long term treatment with steroids are itsprime causes.Traumatic arthritis Serious injury to the hip or strange conditions of hip in childhood(congenital dysplasia of the hip) can also lead to degeneration ofhip joint.
  16. 16. Is there any non-surgical treatment for hip pain ? There are many ways to get relief from hip pain viz. changing oneslifestyle and pain relieving medications.What is hip replacement surgery ?It is a procedure in which the head of the femur (ball) and theacetabulum (socket) are replaced with artificial components, calledprosthesis. A healthy hip joint will allow the leg to move easilywithin its range of motion while supporting the upper body andabsorbing the strain that occurs from common activities likewalking and running.
  17. 17. Who should have a hip replacement surgery ? If all other conservative measures have failed to cure and the painis so severe that it is limiting your everyday activities such aswalking or bending, you should seriously consider HipReplacement Surgery. The goals of Hip Replacement Surgeryinclude correcting any deformity (inequality in leg length),improving the function of hip joint, enhancing the quality of lifeand relieving pain.What is surface replacement of the hip ? Its an advanced alternative of the traditional Hip ReplacementSurgery, wherein the damaged and worn out surface at the end ofthe thigh bone (femur) is resurfaced with a metal cap. This implantis potentially more stable and long lasting than the traditional hipsurgery and allows the patient to do multitude of strenuousphysical activities like squatting and sitting on the floor. This surgerybest suits young and/or active adults with better bone quality.
  18. 18. What is the hip prosthesis made of ? A hip prosthesis is made up of many different materials. Theacetabular component that replaces the acetabulum, has an outershell made up of metal and the inner shell can be of plastic, metalor ceramic or the entire socket may be made up of plastic. Thefemoral component that replaces the femoral head can either beof single piece or two piece design. A single piece design includes afemoral stem made up of metal alloy and the femoral head thatjoins the stem can either be of ceramic or metal alloy. Thiscomponent is also known as modular prosthesis.What happens during the surgery ?During surgery, once the hip joint is exposed, the head and neck ofthe femur are removed. The shaft of the femur is then reamed toaccept the metal component consisting of the head, neck, andstem.
  19. 19. The acetabulum is then reamed to accept a plastic cup. The balland socket are then replaced into normal position. Both of theseimplants can be fastened into the bone with or without specialcement.ProcedureCemented procedure The cemented procedure utilizes a doughy substance mixed at thetime of surgery that is introduced between the artificialcomponent and the bone. This type of fixation in total hipsremains the gold standard and is the method of choice for manysurgeons. Depending upon their health and bone density, peopleover the age of 60 will receive this type of joint fixation.
  20. 20. Noncemented procedure Despite its common use, not all individuals are candidates for acemented hip. Studies show that young active adults tend toloosen their artificial components prematurely. The current trendtherefore, is to use an artificial joint covered with a material thatallows bone tissue to grow into the metal. A tight bond of scartissue if formed, which anchors the metal to the bone. This iscalled a cementless total hip replacement.This type surgery is technically more sensitive, requiring a moreexact fit of the metal component to the femur. In this procedure,the surface of the metal is prepared with a small porousroughened coat, which attracts bone in growth. This process iscalled porous in growth or oseointegration. In general, the artificialjoint implants used in the non-cemented procedure are largerthan those used with cement but are still proportional to the sizeof the individual bone.
  21. 21. There are other types of hip replacement procedures:Hybrid fixationRefers to a procedure in which one component (usually the socket)is inserted without cement, and one component (usually the stemfor the ball of the femur) is inserted with cement.Hemi-surface replacement of osteonecrosisThis is one option the surgeon will utilize to minimize tissuereaction. It involves replacing only the diseased part of the joint. Ahemi-surface replacement is often recommended for people whohave avascular necrosis and have some remaining articularcartilage on the acetabulum. The hemi-surface replacementpreserves and maintains bone by providing stress transfer to thefemoral neck and upper femur. It can also help avoid inflammatoryreaction and joint loosening.
  22. 22. Hip resurfacing The surgeon uses specialized tools to prepare the bone forresurfacing after dislocating the hip. The neck of the femur ispreserved rather than amputated as in conventional stem-typetotal hip replacement. The head of the femur is prepared toreceive the resurfacing component, while the socket is shaped toaccept the new surfacing cup. After careful manipulation, thesocket is placed to allow bone to grow around it, providing furtherstability, and the component is fixed into position on the femoralhead using bone cement. What happens after the surgery ? After your surgery, you will be shifted to the recovery room forclose observation. Youll be given a drip or two to restore fluids intoyour body. When you wake up from surgery, youll feel pain in yourhip and youll find your leg swollen and bruised and the musclesstiff and sore.
  23. 23. . Pain medication will be given to make you as comfortable aspossible. Once you are fully conscious and your blood pressureand pulse rate become stable, youll be shifted in the ward. Youlllose appetite for a couple of days but it is vital to take fluids. Thescar on the side of your hip will fade to a thin white line, over aperiod of time.Your physiotherapist will visit you a day after the surgery, to teachyou specific exercises to strengthen your hip and restoremovement for walking. Initially you may feel unstable andexperience some discomfort but youll be given a frame to assistyou in walking. Gradually youll be walking with crutches or a stickafter few days. Over a period of 4-6 weeks, you will be able to walkwithout support, as per your surgeons instructions.
  24. 24. Once you, your surgeon and the physiotherapist are satisfied withyour condition and mobility youll be discharged from the hospital.Your stay in hospital will last for approximately 5-7 days.-----------------------------------------------------------------------------------What is medical tourism?Medical tourism, also known as health tourism or health travel, is aterm that describes travelling to a foreign country for medical,dental, or cosmetic treatment. It involves the benefit of costeffective treatment, private medical care, in collaboration with thetourism industry. The concept of medical tourism is fast growing inIndia and people from different part of the world are choosingIndia as their desired destination.
  25. 25. Why Choose India?Medical tourism is a rapidly growing sector in India and millions ofmedical tourists from all over the world have come here toexperience a world-class healthcare service.In 2010, about 600,000 patients travelled to India from over 30countries for treatment, including the USA, Canada, UK, Russia, theMiddle East and Africa.According to a study by the Confederation of Indian Industry (CII)on healthcare, after software, the medical tourism industry ispoised to be the next big success story in India. It has predictedthat the industry will grow to earn additional revenue of $2.3billion by 2012 and will soon account for a major share of thecountry’s revenue.
  26. 26. There are several reasons behind this tremendous growth:Patients come to India to get specialized treatments not availablein their home country. Indian hospitals excel in performingcomplex cardiac surgeries, kidney transplants, bone marrowtransplants, orthopedic surgeries, infertility treatments amongsttheir wide repertoire.India provides world-class quality treatments at a fraction of thepriceof developed countries. The cost of medical treatment inIndia is generally one tenth of western countries and among thecheapest in Asia.India has state of the art medical institutes and hospitals ofinternational standards with highly qualified medical professionals.
  27. 27. These centers are backed by high quality equipment andtechnology. This fusion of highly qualifiedstaff assisted by the latestequipment gives India the edge over other countries.With hospitals and clinics in every region including urban, semi-urban, or rural parts of the country, India has ample choice interms of preferred destinations.In countries such as Canada and the UK, patients almost alwayshave to wait weeks and sometimes months to avail of medicaltreatments. In India the consultations with the doctors are promptand patients receive a turnaround to their treatment plan at aquicker pace.As English is a commonly spoken language in India, the patient willbe comfortable communicating with the doctors.
  28. 28. Medical tourists find that the cost of their treatment (including thereturn airfare, holiday and accommodation) leaves them with atotal bill substantially less than they would have spent just onhaving the procedure in the UK.Why Arman There are several concerns that flicker in the minds of theforeigners who come for treatment to India, particularly for firsttime fliers. The first among them is which hospital to choose fortheir treatment.India is flooded with hospitals, medical centers and hotels whichhave their websites that attract the foreign patients. This makesthem even more confused and the complexity of decision makingbecomes a challenging task.We, at Arman can address all these concerns and issues by actingas intermediary with hospitals, clinics, surgeons, hotels.
  29. 29. Arman is a healthcare facilitator that has painstakingly broughttogether highly qualified professionals and hospitals of repute andhealth care providers.We take the responsibility of screening the hospitals by checkingtheir track record, accreditations, associations and have partneredwith the best internationally accredited hospitals in India.Arman update and monitor our network of hospitals on a regularbasis and maintain a database on the hospital’s certifications, typeof facilities and other factors critical in choosing a medical center.Arman also negotiate a lower price from the hospital which foreignpatients would not get by directly approaching the hospitals Thishelps the patient to save a lot on the medical procedure costs
  30. 30. We provide assistance with logistics, documentations, permits andother travel arrangements required for medical tourism.Our coordinators are highly trained to foresee every need of thepatient and make the entire process hassle free from start to finish.They help the patient plan his medical procedures before leavinghome, and schedules all his appointments, surgery, treatmentsand plans for recuperation.This in turn helps the patient to choose the hospital according tohis convenience and also get a clear picture of the cost oftreatment, accommodation beforehand that helps them toarrange their finance.We are aware that a lot of trust is put in our hands and ensure thatthis trust is well placed by serving each patient individually withcare and comfort.
  31. 31. How We WorkPatient query received by the patient himself or his doctor/hospital.This query along with medical reports is forwarded to theconcerned hospitals to get expert opinionsAfter the hospitals respond, we create a package for the patientwhich includes recommendation on the treatments, duration ofstay, and the costs involved.The patient reviews the various options presented to him andmakes a decision based on budget and the line of treatmentrecommended by the doctors. Occasionally, a patient may clarifyhis concerns or questions he may have regarding the treatmentwith the doctor by telephone.In liaison with the patients, Arman representatives will make priorbookings with the hospital, airlines, hotels.
  32. 32. Patient travels and checks into hospital to start the treatment. Weprovide assistance through out your stay in the hospital whichinclude pre and post opeartive care.Once fit and able to travel, the patient if wishes can enjoy the vasttourist destinations within India before returning to their homecountry fully rejuvenated. (at an additionalcost)(ebranding/mum/ts/19)Arman Health Care FacilitatorsOUR OFFICE IN INDIA422, Bonanza, B Wing,Sahar Plaza Complex, Next to KohinoorHotel,Andheri Kurla Road, Andheri East Mumbai India 4000059.
  33. 33. Contact: land line No: ( 022-28387433 )Email :enquiry@armancare.comOUR OFFICE IN CONGOArman Health care Facilitators,Gallery Saint-Pierre, 36 localUtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa /Ngaliema,DRC Mobile : +243998290384OUR OFFICE IN KENYAArman Health Care Facilitators C/O Doctor Pharma Kenya LimitedVision Tower, Muthithi Road,Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329Email : doctorpharmamt@gmail.comWeb:-