The document discusses various orthopedic procedures including knee replacement, hip replacement, and spinal surgeries. It provides detailed descriptions of total knee replacement surgery, including preparing the knee joint, attaching implants, and post-operative recovery. It also covers partial knee replacement, hip anatomy, common causes of hip pain like arthritis, and hip replacement surgery.

2. ( http://www.armancare.com/bone_joint_care.html)
Knee Replacement,Hip Replacement,Hip Resurfacing,Arthroscopy
(key hole surgery)
Shoulder Replacement,Malunited fractures,Musculo skeletal
tumor surgery
Sports Injury Surgery – Knee Acl Surgery,Rheumatology
Services,Knee Replacement
Spinal treatments Minimally invasive spine surgeries like
kyphoplasty, nucleoplasty and microendoscopic surgery
Discectomy Microdiscectomy Decompressive Laminectomy
Artificial disc replacement Common pediatric tumors like
medulloblastoma, craniopharyngioma or Astrocytoma are
removed by surgical treatment and is followed by treatment by a
multidisciplinary team.

3. 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 is
arthritis.There are three kinds of arthritis:
Osteoarthritis - commonly known as 'wear and tear arthritis' or
degenerative arthritis since the cartilage simply wears out. When
cartilage wears away, bone rubs on bone causing severe pain and
disability.
Rheumatoid Arthritis - occurs due to inflammation of the joint
lining, resulting in erosion of the articular cartilage and eventually
damaging the knee joint surface.
Traumatic Arthritis - is caused by a serious knee injury or severe
tears of the ligaments in the knee.
Is there a cure ?

4. It depends on the problem. Some knee pain can be treated
through rehabilitation, other cases may require surgery. Non-
surgical or conservative treatment is effective in the early stages of
arthritis. Pain can sometimes be relieved through lifestyle
modification, anti-inflammatory drugs, corticosteroid shots, joint
fluid therapy, glucosamine/ chondroitin (dietary supplement),
physical therapy, bracing and arthroscopic surgery. These methods
can 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, it
may be time to consider Knee replacement Surgery. Doctors
generally try to delay Total Knee Replacement for as long as
possible in favor of less invasive treatments. However for patients
with advanced joint disease, knee replacement offers the chance
for relief from pain and a return to normal activities.

5. Knee replacement or knee arthroplasty
Is a surgical procedure to replace the weight-bearing surfaces of
the knee joint to relieve the pain and disability of osteoarthritis. It
may be performed for other knee diseases such as rheumatoid
arthritis and psoriatic arthritis. In patients with severe deformity
from advanced rheumatoid arthritis, trauma, or long standing
osteoarthritis, the surgery may be more complicated and carry
higher risk.
Knee replacement surgery can be performed as a partial or a total
knee replacement.
What is total knee replacement ?
Total Knee Replacement is a surgical procedure of implanting an
artificial knee (called prosthesis). The damaged cartilage and bone
from the surface of knee joint are removed and replaced with new
metal and plastic surfaces to restore the alignment and function of
the knee.

6. In Total Knee Replacement Surgery, the parts of the bones that rub
together are resurfaced with metal and plastic implants. Using
special, precision instruments, the damaged surfaces of the bones
are removed and replacement surfaces fixed into place. The
surface of the femur is replaced with a rounded metal component
that comes very close to matching the curve of your natural bone.
The surface of the tibia/leg bone is replaced with a smooth plastic
component. This flat metal component holds a smooth plastic
piece made of ultra-high-molecularweight polyethylene plastic
that serves as the cartilage. The undersurface of the kneecap may
also be replaced with an implant made of the same polyethylene
plastic.

7. What happens during the surgery ?
The patient is first taken into the operating room and given
anesthesia. After the anesthesia has taken effect, the skin around
the knee is thoroughly scrubbed with an antiseptic liquid. The knee
is flexed about 90 degrees and the lower portion of the leg,
including the foot, is placed in a special device to securely hold it in
place during the surgery. Usually atourniquet is then applied to the
upper portion of the leg to help slow the flow of blood during the
surgery. An incision of appropriate size is then made.
Removing the Damaged Bone Surfaces

8. Removing the Damaged Bone Surfaces
The damaged bone surfaces and cartilage are then removed by
the surgeon. Precision instruments and guides are used to help
make sure the cuts are made at the correct angles so the bones
will 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 implants
will fit properly.The amount of bone that is removed depends on
the 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.

9. The back surface of the patella (kneecap) is also removed.
Attaching the Implants
An implant is attached to each of the three bones. These implants
are designed so that the knee joint will move in a way that is very
similar to the way the joint moved when it was healthy. The
implants 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 and
back of the bone as well as the end.
The implant that fits over the top of the tibia usually consists of
two parts. A metal baseplate fits over the part of the bone that
was cut flat. A durable plastic articular surface is then attached to
the baseplate to serve as a spacer between the baseplate and the
metal implant that covers the end of the femur.

10. The implant that covers the back of the patella is also made of a
durable plastic.
Closing the Wound
If necessary, the surgeon may adjust the ligaments that surround
the knee to achieve the best possible knee function.
When all of the implants are in place and the ligaments are
properly adjusted, the surgeon sews the layers of tissue back into
their proper position. A plastic tube may be inserted into the
wound to allow liquids to drain from the site during the first few
hours after surgery. The edges of the skin are then sewn together,
and the knee is wrapped in a sterile bandage. The patient is then
taken to the recovery room.

11. Partial knee replacement surgery / unicompartmental knee
replacement ?
Unicompartmentalarthroplasty (UKA), also called partial knee
replacement,... is an option for some patients. The knee is
generally divided into three "compartments": medial (the inside
part of the knee), lateral (the outside), and patellofemoral (the
joint between the kneecap and the thighbone). Most patients with
arthritis severe enough to consider knee replacement have
significant wear in two or more of the above compartments and
are best treated with total knee replacement. A minority of
patients have wear confined primarily to one compartment,
usually the medial, and may be candidates for

12. unicompartmental knee replacement. Advantages of UKA
compared to TKA include smaller incision, easier post-op
rehabilitation, 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 or
inflammatory arthritis (Rheumatoid, Lupus, Psoriatic ), or marked
deformity are not candidates for this procedure.
What happens after the surgery ?
When you are back in your hospital room, you will begin a
rehabilitation program that will help you regain strength, balance
and range of movement in your knee. Your physiotherapist will
help you perform appropriate exercises. After 24 hours after
surgery, you will probably be asked to stand.

13. Within next 24hrs, you will probably begin to walk a few steps with
the help of walker. You will be discharged as soon as you surgeon
feels that you have recovered sufficiently. You can expect to stay in
the hospital for about 3 days after the surgery. You may or may not
be transferred to a rehabilitation facility for a few more days, as
determined by your surgeon. Your physiotherapist will instruct you
about proper home care, and may continue to work with you.
Hip replacement
The hip and its working

14. 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 joint
The head of the femur or "ball" of the hip joint articulates or
moves within the cup-like "socket" called the acetabulum of the
pelvic bone. Together, these structures are referred to as a "ball
and socket" joint. The ball shaped head of the femur fits into a
rounded socket (acetabulum) in the pelvis which enables the leg to
have a broad range of movements. The femoral head and
acetabulum are covered by a specialized surface called articular
cartilagethat allows the two surfaces to slide against one another
and enable them to move easily.

15. The joint is held together by several strong ligaments and a strong
dense tissue called the capsule which envelops the joint.
What are the common causes of hip pain
The most common cause of chronic hip pain and disability is
arthritis. Osteoarthritis, Rheumatoid Arthritis, Avascular Necrosis
and Traumatic Arthritis are the most common forms of this
disease.
Osteoarthriris
Commonly known as ' wear and tear arthritis’, often occurs in an
individual with advancing age, perhaps due to a genetic tendency.

16. Rheumatoid arthritis
Is an auto-immune disease where the inflammation causes an
erosion of the articular cartilage and eventually damages the hip
joint surface.
Avscular necrosis
Low blood supply to a part of femoral head leads to its collapse
and hence degenerate the hip joint. Alcoholism, fractures and
dislocation of the hip and long term treatment with steroids are its
prime 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 of
hip joint.

17. Is there any non-surgical treatment for hip pain ?
There are many ways to get relief from hip pain viz. changing one's
lifestyle and pain relieving medications.
What is hip replacement surgery ?
It is a procedure in which the head of the femur (ball) and the
acetabulum (socket) are replaced with artificial components, called
prosthesis. A healthy hip joint will allow the leg to move easily
within its range of motion while supporting the upper body and
absorbing the strain that occurs from common activities like
walking and running.

18. Who should have a hip replacement surgery ?
If all other conservative measures have failed to cure and the pain
is so severe that it is limiting your everyday activities such as
walking or bending, you should seriously consider Hip
Replacement Surgery. The goals of Hip Replacement Surgery
include correcting any deformity (inequality in leg length),
improving the function of hip joint, enhancing the quality of life
and relieving pain.
What is surface replacement of the hip ?
It's an advanced alternative of the traditional Hip Replacement
Surgery, wherein the damaged and worn out surface at the end of
the thigh bone (femur) is resurfaced with a metal cap. This implant
is potentially more stable and long lasting than the traditional hip
surgery and allows the patient to do multitude of strenuous
physical activities like squatting and sitting on the floor. This surgery
best suits young and/or active adults with better bone quality.

19. What is the hip prosthesis made of ?
A hip prosthesis is made up of many different materials. The
acetabular component that replaces the acetabulum, has an outer
shell made up of metal and the inner shell can be of plastic, metal
or ceramic or the entire socket may be made up of plastic. The
femoral component that replaces the femoral head can either be
of single piece or two piece design. A single piece design includes a
femoral stem made up of metal alloy and the femoral head that
joins the stem can either be of ceramic or metal alloy. This
component is also known as modular prosthesis.
What happens during the surgery ?
During surgery, once the hip joint is exposed, the head and neck of
the femur are removed. The shaft of the femur is then reamed to
accept the metal component consisting of the head, neck, and
stem.

20. The acetabulum is then reamed to accept a plastic cup. The ball
and socket are then replaced into normal position. Both of these
implants can be fastened into the bone with or without special
cement.
Procedure
Cemented procedure
The cemented procedure utilizes a doughy substance mixed at the
time of surgery that is introduced between the artificial
component and the bone. This type of fixation in total hips
remains the gold standard and is the method of choice for many
surgeons. Depending upon their health and bone density, people
over the age of 60 will receive this type of joint fixation.

21. Noncemented procedure
Despite its common use, not all individuals are candidates for a
cemented hip. Studies show that young active adults tend to
loosen their artificial components prematurely. The current trend
therefore, is to use an artificial joint covered with a material that
allows bone tissue to grow into the metal. A tight bond of scar
tissue if formed, which anchors the metal to the bone. This is
called a cementless total hip replacement.
This type surgery is technically more sensitive, requiring a more
exact fit of the metal component to the femur. In this procedure,
the surface of the metal is prepared with a small porous
roughened coat, which attracts bone in growth. This process is
called porous in growth or oseointegration. In general, the artificial
joint implants used in the non-cemented procedure are larger
than those used with cement but are still proportional to the size
of the individual bone.

22. There are other types of hip replacement procedures:
Hybrid fixation
Refers to a procedure in which one component (usually the socket)
is inserted without cement, and one component (usually the stem
for the ball of the femur) is inserted with cement.
Hemi-surface replacement of osteonecrosis
This is one option the surgeon will utilize to minimize tissue
reaction. It involves replacing only the diseased part of the joint. A
hemi-surface replacement is often recommended for people who
have avascular necrosis and have some remaining articular
cartilage on the acetabulum. The hemi-surface replacement
preserves and maintains bone by providing stress transfer to the
femoral neck and upper femur. It can also help avoid inflammatory
reaction and joint loosening.

23. Hip resurfacing
The surgeon uses specialized tools to prepare the bone for
resurfacing after dislocating the hip. The neck of the femur is
preserved rather than amputated as in conventional stem-type
total hip replacement. The head of the femur is prepared to
receive the resurfacing component, while the socket is shaped to
accept the new surfacing cup. After careful manipulation, the
socket is placed to allow bone to grow around it, providing further
stability, and the component is fixed into position on the femoral
head using bone cement.
What happens after the surgery ?
After your surgery, you will be shifted to the recovery room for
close observation. You'll be given a drip or two to restore fluids into
your body. When you wake up from surgery, you'll feel pain in your
hip and you'll find your leg swollen and bruised and the muscles
stiff and sore.

24. . Pain medication will be given to make you as comfortable as
possible. Once you are fully conscious and your blood pressure
and pulse rate become stable, you'll be shifted in the ward. You'll
lose appetite for a couple of days but it is vital to take fluids. The
scar on the side of your hip will fade to a thin white line, over a
period of time.
Your physiotherapist will visit you a day after the surgery, to teach
you specific exercises to strengthen your hip and restore
movement for walking. Initially you may feel unstable and
experience some discomfort but you'll be given a frame to assist
you in walking. Gradually you'll be walking with crutches or a stick
after few days. Over a period of 4-6 weeks, you will be able to walk
without support, as per your surgeon's instructions.

25. Once you, your surgeon and the physiotherapist are satisfied with
your condition and mobility you'll be discharged from the hospital.
Your stay in hospital will last for approximately 5-7 days.
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What is medical tourism?
Medical tourism, also known as health tourism or health travel, is a
term that describes travelling to a foreign country for medical,
dental, or cosmetic treatment. It involves the benefit of cost
effective treatment, private medical care, in collaboration with the
tourism industry. The concept of medical tourism is fast growing in
India and people from different part of the world are choosing
India as their desired destination.

26. Why Choose India?
Medical tourism is a rapidly growing sector in India and millions of
medical tourists from all over the world have come here to
experience a world-class healthcare service.
In 2010, about 600,000 patients travelled to India from over 30
countries for treatment, including the USA, Canada, UK, Russia, the
Middle East and Africa.
According to a study by the Confederation of Indian Industry (CII)
on healthcare, after software, the medical tourism industry is
poised to be the next big success story in India. It has predicted
that the industry will grow to earn additional revenue of $2.3
billion by 2012 and will soon account for a major share of the
country’s revenue.

27. There are several reasons behind this tremendous growth:
Patients come to India to get specialized treatments not available
in their home country. Indian hospitals excel in performing
complex cardiac surgeries, kidney transplants, bone marrow
transplants, orthopedic surgeries, infertility treatments amongst
their wide repertoire.
India provides world-class quality treatments at a fraction of the
priceof developed countries. The cost of medical treatment in
India is generally one tenth of western countries and among the
cheapest in Asia.
India has state of the art medical institutes and hospitals of
international standards with highly qualified medical professionals.

28. These centers are backed by high quality equipment and
technology. This fusion of highly qualifiedstaff assisted by the latest
equipment 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 in
terms of preferred destinations.
In countries such as Canada and the UK, patients almost always
have to wait weeks and sometimes months to avail of medical
treatments. In India the consultations with the doctors are prompt
and patients receive a turnaround to their treatment plan at a
quicker pace.
As English is a commonly spoken language in India, the patient will
be comfortable communicating with the doctors.

29. Medical tourists find that the cost of their treatment (including the
return airfare, holiday and accommodation) leaves them with a
total bill substantially less than they would have spent just on
having the procedure in the UK.
Why Arman
There are several concerns that flicker in the minds of the
foreigners who come for treatment to India, particularly for first
time fliers. The first among them is which hospital to choose for
their treatment.
India is flooded with hospitals, medical centers and hotels which
have their websites that attract the foreign patients. This makes
them even more confused and the complexity of decision making
becomes a challenging task.
We, at Arman can address all these concerns and issues by acting
as intermediary with hospitals, clinics, surgeons, hotels.

30. Arman is a healthcare facilitator that has painstakingly brought
together highly qualified professionals and hospitals of repute and
health care providers.
We take the responsibility of screening the hospitals by checking
their track record, accreditations, associations and have partnered
with the best internationally accredited hospitals in India.
Arman update and monitor our network of hospitals on a regular
basis and maintain a database on the hospital’s certifications, type
of facilities and other factors critical in choosing a medical center.
Arman also negotiate a lower price from the hospital which foreign
patients would not get by directly approaching the hospitals This
helps the patient to save a lot on the medical procedure costs

31. We provide assistance with logistics, documentations, permits and
other travel arrangements required for medical tourism.
Our coordinators are highly trained to foresee every need of the
patient and make the entire process hassle free from start to finish.
They help the patient plan his medical procedures before leaving
home, and schedules all his appointments, surgery, treatments
and plans for recuperation.
This in turn helps the patient to choose the hospital according to
his convenience and also get a clear picture of the cost of
treatment, accommodation beforehand that helps them to
arrange their finance.
We are aware that a lot of trust is put in our hands and ensure that
this trust is well placed by serving each patient individually with
care and comfort.

32. How We Work
Patient query received by the patient himself or his doctor/
hospital.
This query along with medical reports is forwarded to the
concerned hospitals to get expert opinions
After the hospitals respond, we create a package for the patient
which includes recommendation on the treatments, duration of
stay, and the costs involved.
The patient reviews the various options presented to him and
makes a decision based on budget and the line of treatment
recommended by the doctors. Occasionally, a patient may clarify
his concerns or questions he may have regarding the treatment
with the doctor by telephone.
In liaison with the patients, Arman representatives will make prior
bookings with the hospital, airlines, hotels.

33. Patient travels and checks into hospital to start the treatment. We
provide assistance through out your stay in the hospital which
include pre and post opeartive care.
Once fit and able to travel, the patient if wishes can enjoy the vast
tourist destinations within India before returning to their home
country fully rejuvenated. (at an additional
cost)(ebranding/mum/ts/19)
Arman Health Care Facilitators
OUR OFFICE IN INDIA
422, Bonanza, 'B' Wing,Sahar Plaza Complex, Next to Kohinoor
Hotel,
Andheri Kurla Road, Andheri East Mumbai India 4000059.

34. Contact: land line No: ( 022-28387433 )
Email :enquiry@armancare.com
OUR OFFICE IN CONGO
Arman Health care Facilitators,Gallery Saint-Pierre, 36 local
UtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa /
Ngaliema,DRC Mobile : +243998290384
OUR OFFICE IN KENYA
Arman Health Care Facilitators C/O Doctor Pharma Kenya Limited
Vision Tower, Muthithi Road,
Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329
Email : doctorpharmamt@gmail.com
Web:- http://www.armancare.com/bone_joint_care.html
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