Dr. Patnaik discusses new age treatments for bone and joint pain such as knee replacement surgery. Knee replacement surgery involves removing arthritic bone and cartilage and replacing them with prosthetic components. The surgery begins with exposures of the knee joint and bone cuts to prepare the joint surfaces. Trial implants are then inserted to test fit and alignment before cementing the final tibial and femoral components in place. Post-operative x-rays are taken and patients receive follow up care including physical therapy for pain management and regaining mobility. The presentation emphasizes the importance of infrastructure, clinical support and multidisciplinary teams for successful joint replacement surgeries.

1. NEW AGE TREATMENT FOR
BONE AND JOINT PAIN.
Dr Smarajit Patnaik
Senior Consultant Orthopaedic Surgeon
Bone & Joint Preservation, Reconstruction and
Replacement Surgeon
Apollo Hospitals, Bhubaneswar

2. Bone pain

4. What is Osteoporosis?
It literally means
“porous bones”
It is a disease where
the bones become
brittle and weak due
to a decline in bone
mass

5. 3/98 medslides.com 2
Internal Structure of
Normal & Osteoporotic bone
Normal Osteoporotic

6. Osteoporosis – its impact
• Osteoporosis is 1 of the 5 costliest
diseases of ageing – the others being
diabetes, hyperlipidemia, hypertension
& heart disease
• Like the others, it is a silent disease -
asymptomatic till a bone breaks ….at
which time it may be too late

7. The end result of
Osteoporosis 

8. Spine
WristHips
Osteoporotic Fractures:
If Osteoporosis is left
untreated, it
progresses
painlessly until a
bone breaks (i.e.
fractures), usually
after minor injury
Fractures typically
occur in the wrist,
hip & spine

9. Osteoporosis
In the spine: it leads
to progressive collapse
of the vertebral
column 
loss of height …
leading to…
stooping posture & pain

10. Fracture Risk:
 At 50, a woman has a 15% chance
of having a hip fracture during her
remaining life (1 in 6)
 By 90, 1 in 3 women will have sustained a
broken hip
 With rise in life expectancy worldwide,
the number of hip fractures is expected
to rise from 1.7 million in 1990 to 6.3
million in 2050

11. The Indian Scenario:
 About 61 million are estimated to suffer
from Osteoporosis
 Fractures from osteoporosis occur almost a
decade earlier than the West (? Low dietary
Calcium/ Vit D, poor nutrition)
 Awareness is poor – simple dietary
supplementation with Calcium and Vit D
may reduce fracture risk by as much as
40% over a 1.5 yr period
 Indian males are more prone to have
Osteoporosis than their Western
counterparts

12. …….UNDERSTANDING BONE
GROWTH
Bone is a dynamic,
living, growing tissue
Throughout life, it is
constantly being
formed and
replaced by what is
called
BONE REMODELLING

13. Bone Remodeling
Upto 35 yrs of age…
Bone formation is greater than
bone loss
Therefore bones are stronger
After 35 yrs of age …
Bone loss is greater than bone formation
Therefore bones becomes fragile, more likely to break

14. DEXA scanner – the gold
standard

15. Who is at risk?
A thin frame
Fast lifestyle with
little or no exercise
Advancing
age

16. Who is at risk ?
Stooped posture
or already
broken bones
Diet low in
CalciumSmoking and
excessive alcohol

17. Who is at
risk?
Early
menopause
Absence of
menstruation due to
estrogen deficiency
Prolonged use of
steroids e.g.
Asthma

18. Factors influencing peak bone mass
Affecting peak bone mass:
genetic / racial
diet/calcium
Exercise
Affecting bone loss:
 premature menopause
 amenorrhoea
 exercise/diet/weight
 smoking/alcohol/caffeine
 use of corticosteroids
Aim is to
increase the
peak&
reduce the
descent!

19. Stimulate bone growth
Improve balance/Reduce falls
Treatment goals:
To prevent fractures!
 Life style modifications
(e.g. exercise, diet, smoking)
 Prevention (treating persons at
risk before osteoporosis develops)
 Medication (for treating
developing or established
osteoporosis)

20. Diet rich in calcium & Vit D
Avoid smoking & excessive
alcohol
Exercise
Consult your doctor for screening
and ? need for drug therapy
How to preserve your bones !

21. IMPORTANT
SAFETY MEASURES
Keep halls, stairs,
passages well lit
Use sturdy, low-
heeled,
soft-soled shoes
Watch out for wet
floors, clean up
spills immediately
PREVENT FALLS
& FRACTURES

22. Joint pain

23. Osteoarthritis is a condition in which the natural
cushioning between the joints wears away. When this
happens, the bones of the joint rub against one
another which results in pain, swelling, stiffness and
decreased ability to move.
Arthritic Knee

24. Symptoms of Knee Arthritis
 Pain
 During activity
 At rest or sleeping
 Swelling and tightness
 Bone spurs
 Grinding sound during movement
 Stiffness and decreased range of motion

25. When is Knee Replacement Surgery Right for
You?
 Experience significant pain.
 Knee function and mobility
decreases.

26. Arthritic knees

27. Patient Positioning

28. Midline incision with standard
medial para-patellar arthrotomy

29. EXPOSURE OF THE JOINT

30. Arthritic knees

31. To form rectangular flexion space, after tibia has
been cut perpendicular to its axis, plane of
posterior femoral condylar cuts must be externally
rotated approximately 3 degrees from posterior
condylar axis

32. Tibial cut with extra-medullary jig in
position

33. Alignment axes considered for ext.
rotation of femoral component
 Resection perpendicular
to antero-posterior axis
(AP) or parallel to
epicondylar axis (epi)
results in resection line
(x) that is slightly
externally rotated
relative to posterior
condylar axis (PC). This
results in correct
positioning of femoral
component. Location of
epicondylar axis and
anteroposterior axis of
the knee.

34. Distal femoral cut

35. Different femoral cuts made with the 4-in-1
cutting zig

36. Extension and flexion gap

37. Trial reduction

38. Final prepared bone cuts

39. Tibial component Implantation

40. Femoral component
Implantation

41. Reduction of final components and
patella tracking

42. Cement setting time

43. Preparation of patella

44. Closure of the wound

45. Dressing of wound

46. X-Rays

48. Post op follow-up….. 3 months

49. Why Apollo Hospitals?
 Infrastructure
 Clinical support
 Multidisciplinary team approach
 Pain less surgery
 Life time follow up