ORTHOPEDICS
Total Knee Replacement
| Shoulder Replacement Surgery
| Meniscus Repair
| Bone Density Test
| ACL Surgery
| Carpel Tunnel Release
| Bunionectomy
| Rotator Cuff Repair
Total Knee Replacement
Total knee replacement is performed to treat and to restore the function of painful, disabled knee joints. The affected knee joints are replaced by artificial knee joints, a combination of metal and plastic. These are available in various designs. The metal meets the end of the bones and a plastic spacer acts as a buffer between them.
Details of Procedures:
Total knee replacement is recommended when severe knee pain:
- Disrupts night sleep
- Is insensitive to other treatments
- Limits usual activities
The pain and limited function of the knee could be because of:
- Osteoarthritis or rheumatoid arthritis
- Avascular necrosis
- Accidental injuries to knee joints
Facts and figures
- The knee is one of the strongest, largest, and most complex joints of the body. A man of 70kg applies about 210kg force on the knee while playing football, basketball, and running.
- About 270,000 knee replacements surgeries are performed each year in the USA. About 70% of these patients are age 65+
- The first artificial knee implants inspired by successful hip replacement surgery were tried in the 1940s and, currently, it is one of the most successful surgeries in the modern era.
Risk and Complications
- Loosening of the prosthesis from the bone
- Infection
- Bleeding
- Excessive scarring
- Medicinal or anesthesia reaction
Advantages
- 95% of the patients experience relief from the symptoms due to its high success rate.
- It not only provides relief from joint pain but also increases leg strength and mobility for about 10 to 15 years
- It improves the quality of life by allowing the patient to participate in activities which were restricted prior to surgery.
Disadvantages
- Unwanted stiffness of joint and loss of knee motion.
- Patellar complications can occur
Preoperative Preparation
- Complete physical examination
- Blood and urinalysis
- ECG and x-ray chest for the patient above 50 years
- Consult with the surgeon week prior and get the correct medicinal prescriptions.
- Inform the surgeon about smoking and alcohol habits.
- Visit a physiotherapist to understand the post-surgery rehabilitation program and using crutches.
- Plan for leave from work and domestic help at home.
- Don’t consume anything after midnight before surgery.
- Medical tourists are advised to wear comfortable clothes and to select a handicap-accessible hotel room for recovery after getting a discharge from hospital
Post operative care
- Patients need to wear special compression stockings to improve blood flow in legs for proper healing.
- Starlight activities using crutches or a walker from the first day after surgery, and physiotherapy 48 hours later.
- Carry out exercises regularly as per instructed by the physiotherapist for the best results.
- Normal recovery after surgery is seen within 7 to 10 days.
The patient will get discharged from the hospital only after the following criteria are met:
- Able to bend the knee at a 900 angle
- Get out of bed without any support
- Able to extend knee straight out
- Can walk using crutches or walker
- Carry on prescribed home exercises.
Dos, Don’ts and Precautions
- Strictly follow the diet regime
- Take prescribed medicines as per schedule
- Exercise regularly as advised by the physiotherapist
- Early mobilization will help strengthen the knee muscles
- Don’t bathe until the sutures or staples are removed.
Shoulder Replacement Surgery
Arthritis is a common cause of shoulder pain and mobility loss. Shoulder joint replacement surgery (arthroplasty) is performed to replace a shoulder joint with artificial components (prostheses). This restores the function and comfort to shoulders when the joint is severely damaged by degenerative joint diseases as arthritis or in complex cases of upper arm bone fracture.
Details of Procedures:
The shoulder joint replacement surgery is exclusively designed to treat:
- Osteoarthritis
- Rheumatoid and Post-traumatic arthritis
- Failed shoulder replacement surgery
- Avascular necrosis
- Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
Facts and figures
- The first total shoulder replacement surgery was performed by Péan a French surgeon in 1893 and started in the USA in the 1950s. Currently, 23,000 people undergo shoulder replacement surgery each year in the USA.
- Shoulder replacement surgery is relatively less common compared to hip and knee replacement surgery.
Implants
- Humeral component–It replaces the head of the humerus. It is usually made of cobalt or chromium-based alloys and has a rounded ball attached to a stem to insert into the bone. It comes in various sizes and may consist of a single piece or a modular unit.
- Glenoid component– Made of very high-density polyethylene, it replaces the glenoid cavity. The 100% polyethylene type is more common compared to other models featuring a metal tray.
Advantages
- This surgery relieves chronic pain and implants last for 15-20 years.
- There are significantly fewer complications. “No fatalities associated with shoulder replacement are reported,” says a published study, Science Daily (Mar. 27, 2007)
- Inexpensive than hip or knee replacement.
- Quick recovery(3 to 4 days)
Disadvantages
- Dislocation of implants may call for revision surgery.
- Shoulder stiffness may occur post-surgery.
Preoperative Preparation
- Physical examination
- Blood and urinalysis
- Diagnostic tests- x-ray or MRI
- Get a clear medicinal prescription.
- Inform about smoking and drinking habits.
- Plan for leave from work and house help during postoperative rehabilitation.
- Wear breathable clothes on the day of surgery.
- Don’t consume anything after midnight
Post operative care
- The operated arm is placed in a sling, and a support pillow is positioned under the elbow to protect the repair everyday for 4 to 6 weeks in a row.
- The physiotherapist starts a gentle passive-assisted range of motion exercises related to the use of a pulley device to help bend and extend the operated arm.
- Most patients resume eating, dressing, and grooming within 2 weeks post-surgery.
Meniscus Repair
Meniscus repair surgery is performed on torn or injured meniscus cartilage of the knee, which provides stability and cushion to the knee joint. The surgery is done either arthroscopically or through open surgery. The incidence of a meniscus tear is more common in athletes, especially those who play contact sports.
It also occurs in aged people, due to degenerative changes in the meniscus. This surgery is performed on injured cartilage when the non-surgical treatments fail to relieve the symptoms. Symptoms of a meniscus tear are:
- Severe pain, stiffness, and swelling of the knee joint
- Locking, restricted movement, or loss of sensation in the knee
Facts & Figures
- The prevalence of acute meniscal tears is quite common i.e. 61 in 100,000 cases.
- The ratio of male-to-female incidence is approximately 2.5:1. The meniscal injury is most common in males and females of 31-40 and 11-20 years respectively.
The rate of degenerative meniscal tears is 60% in patients above 65. - Surgical procedures of the meniscus are performed on an estimated 850,000 patients each year.
- Meniscus repair surgeries are double in the USA than in the rest of the world.
Advantages
- Timely performed surgery to repair the meniscus may reduce the risk of long-term joint problems and osteoarthritis by saving meniscal cartilage. This reduces the stress on the knee joint.
- This surgery relieves 80-90% of symptoms in most cases due to its high success rate.
- The procedure is just 1-2 hours since it is an outpatient procedure.
- Patients seeking meniscus repair through medical tourism can return home mostly within 1-2 days.
Disadvantages
- Slow recovery or continued pain and joint stiffness
- Corrective surgery may be needed if surgery fails and the meniscus is re-torn.
- A horizontal, long-standing, degenerative flap of the meniscus cannot be repaired by this surgery
Preoperative Preparation
- Complete physical examination.
- Blood and urinalysis.
- ECG and x-ray chest for patients above 50 years.
- Consult with the surgeon week prior and get the correct medicinal prescriptions.
- Inform the surgeon about smoking and alcohol habits.
- Plan for leave from work and domestic help at home.
- Don’t consume anything after midnight before surgery.
- Medical tourists are advised to wear comfortable clothes and to select a handicap-accessible hotel room for recovery after getting discharged from the hospital.
Post operative care
- After the arthroscopic meniscal surgery, patients are usually discharged from the hospital as the anesthesia wears off. Patients need to wear a knee brace or an immobilizer and are instructed to use crutches for several weeks following the procedure. It is important to follow the physiotherapy and rehabilitation program for the best results.
Bone Density
In osteoporosis, the bones become fragile and weak leading to easy fractures of the bones. DEXA, a bone density test, is performed to detect the risk of osteoporosis using X-rays to check the patient’s bone mass and the concentration of minerals like calcium.
Uses of the procedure
- The bone density test(s) is advised to identify the risk of osteoporosis or low bone density and, therefore, fracture. It comes in handy to diagnose and\or monitor the osteoporosis treatment. Hereditary reasons, age and body-weight, ethnicity, and medical conditions such as hypothyroidism may play a role in influencing risk factors for osteoporosis.
Here are the details of a few popular bone density tests
- Dual Energy X-Ray Absorptiometry (DEXA) – spine, hip or total body
- Peripheral Dual Energy X-Ray Absorptiometry (pDXA) -wrists, fingers, heel
- Single Energy X-Ray Absorptiometry (SXA) – heels and wrists
- Quantitative Ultrasound (QUS) – sheen bone, kneecap, heels
- Quantitative Compound Tomography (QCT) – spine and other sites
Preparation for the procedure
- The medical tourist must inform the healthcare provider regarding previous oral contrast or nuclear medicine tests. No other preparation is needed.
During the procedure
- Wearing an examination gown, the patient is subjected to diagnosis by lying down on a large machine. Smaller machines are used for the wrists, heels, fingers, and other peripheral bones.
- The X-rays images give an estimate of the mineral content packed into the bone segment. A higher content suggests denser and stronger bones, based on which the intensity of osteoporosis is measured.
Travelers guide
- Since the test is quick, safe, non-invasive, and painless, the medical tourist can resume daily activities immediately.
ACLS
ACLS or Anterior cruciate ligament (ACL) surgery is performed to reconstruct or repair torn ACL. The anterior cruciate ligament is situated in the center of the knee joint, extending from the femur to the tibia. The surgery needs to be performed mostly in the cases of an avulsion fracture and in most cases, the autografts are used to replace the ligament during the surgery. The surgery is performed arthroscopically.
Details of Procedures:
Normally ACL gets injured when a twisting force is applied to the knee while the foot is firmly put on the ground or due to a direct blow to the knee while playing football or rugby.
The aim of the surgery is to restore the normal or almost normal stability and function of the injured knee. Surgery also saves the other knee structure from injury and degeneration. The surgery is advised to repair a complete or partial tear of the ACL when there is
- Persistent instability of the knee post nonsurgical treatment and after the rehabilitation program
- An active sportsman or a person’s work requires enough knee strength and stability
- Chronic ACL deficiency, affecting the quality of life
Other associated symptoms may include
- Changes in smell, taste, alertness, sensation-hearing
- Motor function loss- bladder and bowel, balance, coordination, swallowing
- Eye abnormalities-uncontrollable movements, different pupil size
- Tremors in hands, difficulty in writing
- Obesity
- Symptoms due to pituitary tumor
- Symptoms related to hormonal imbalance
- Sensitivity to cold and heat
- Low blood pressure
Symptoms of a torn ACL:
- Severe pain at the knee soon after injury and /or an audible pop or crack sound
- A sudden feeling of instability followed by huge swelling of the knee
- Loss of strength, tenderness, restricted movement, and difficulty in straightening the leg fully
- Positive signs in the anterior drawer test and Lachman’s test.
Facts & Figures:
- Bonnet first discussed and mentioned ACL injury in medical literature in 1845.
- 1 in 3000 individuals in the USA had anterior cruciate ligament injury and 100,00 injuries per year occur from snow skiing.
- Female athletes are prone to get more ACL tear than male sportspersons.
Advantages
- About 80-90% of patients are satisfied with the outcome and 60% resume work immediately after undergoing the ACL surgery.
- Patients seeking an anterior cruciate ligament repair through medical tourism mostly return in 1-2 days.
- ACL repair is done arthroscopically, so the need for a hospital stay.
Disadvantages
- Improper healing may call for revision ACL reconstruction
- Limited exercises of thigh muscles post-surgery for some time.
- Postoperative stiffness with limited mobility of the knee.
Preoperative Preparation
- Complete physical examination
- Blood and urinalysis
- ECG and x-ray chest for the patient above 50 years
- Consult with the surgeon week prior and get the correct medicinal prescriptions.
- Inform the surgeon about smoking and alcohol habits.
- Plan for leave from work and domestic help at home.
- Don’t consume anything after midnight before surgery.
Post operative care
- A continuous passive motion device may be applied to patients that must be used while sleeping for the first two weeks.
- Physiotherapy starts2-3 days post-surgery. Follow the rehabilitation program rigidly and correctly for the best results.
Carpel Tunnel
Carpal tunnel syndrome is a progressive condition caused by compression of a median nerve in the wrist, leading to its severe pain and weakness. Carpal tunnel release is a surgical procedure, performed to treat this condition when everything else fails. Leaving this condition untreated for long can cause permanent damage to the median nerve leading to loss of function of the hand.
Carpal tunnel release surgery is advised in conditions that include
- Constant pain associated with numbness, muscle weakness, or atrophy
- Symptoms for more than 6 months and no response to non-surgical methods
- Progressive deterioration of hand functions
There are two types of surgeries for carpal tunnel syndrome for one or both hands:
1. Open Carpal Tunnel Release Surgery
2. Endoscopic or “Keyhole” Surgery
Facts & Figures:
Sir James Paget first mentioned the median nerve compression at the wrist following a distal radius fracture in 1854. In 1880, James Putnam presented a series of patients suffering from pain and paresthesia in the median nerve distribution. Being the most common surgery of the hand and wrist, approximately 260,000 carpal tunnel release operations are performed each year.
As per the National Center for Health Statistics,47% of these cases considered to be work-related. This condition is responsible for the highest number of days lost among all work-related injuries. Also, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.
Advantages
- High success rate with a good prognosis of the surgery. Almost 80-90% of patients resume daily activities post-surgery with restored normal function and increased strength of the hand.
- It is a quick outpatient procedure, safe, and uncomplicated, with the patient returning home immediately.
Disadvantages
- Patients may lose the full range of motion of the hand and wrist after surgery.
- Chances of recurrence of symptoms following open release are up to 20%
Preoperative Preparation
- Undergo all physical diagnostic tests, blood, and urinalysis
- Seek medical consultation regarding medicine doses and how to take them.
- Any smoking or drinking habit must be informed about immediately.
- Plan for absence from the office. Get help for mundane tasks at home until complete recovery.
- Avoid eating or drinking anything after midnight before surgery.
Post operative care
- The wrist needs to be kept wrapped in a bandage and a splint for about 1-2 weeks post operatively. Follow the gradual rehabilitation program of physical therapy to regain strength and flexibility of the hand, wrist, and forearm.
Bunionectomy
A bunionectomy procedure is performed to excise or removes the bunions, which is nothing but a localized painful swelling at the base of the big toe. The joint is enlarged due to new bone formation causing misalignment of the toe. The bunion is from either due to bursitis or the inflammation caused by degenerative joint disease.
Bunionectomy is recommended in the following conditions:
- Intense pain and stiffness
- Foot deformity and difficulty in walking and performing routine activities
- Conservative treatment has failed to relieve the pain and other problem
The reasons for the development of bunions include:
- Hereditary
- Congenital deformities
- Arthritis
- Nerve or muscle disorders in the foot
Facts and figures
- Bunions are more common in women than men, especially Belle dancers. This issue is aggravated by wearing high-heeled and narrow-toed shoes.
- According to a study by the American Orthopedic Foot & Ankle Society, about 88% of women wear too-small shoes and 55% of them have developed bunions.
Advantages
- According to the American Orthopedic Foot & Ankle Society, less than 10% of patients undergoing bunionectomy experience complications
- 85–90% of patients are satisfied with the results, relieving the pain and restoring the bone alignment
- After surgery, one can walk comfortably, and wear fitted shoes easily
- The procedure is done in 1 hour with only 1-2 days of recovery
Disadvantages
- Bunions may reform, especially by wearing misfit shoes after surgery
- Restricts the flexibility and of the big toe joint compared to that of the other foot
Preoperative Preparation
- X-rays for proper diagnosis
- Consult with the surgeon week prior and get the correct medicinal prescriptions.
- Inform the surgeon about smoking and alcohol habits.
- Plan for leave from work and domestic help at home during the rehabilitation period.
- Don’t consume anything after midnight before surgery
Post operative care
- One must follow the aftercare instructions given by the surgeon for the best results.
- In most cases, patients are discharged from the hospital as the anesthesia wears off.
Rotator cuff repair
Rotator cuff repair surgery is performed to repair or fix torn or injured tendons of the shoulder. A rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. They hold the arm in its ball-and-socket joint, aiding in shoulder movements.
The damage to the rotator cuff reduces the strength and limits the mobility of the shoulder joint significantly. Rotator cuff repair surgery can be done in either of three ways: open, mini-open, or arthroscopic.
The damage to the rotator cuff reduces the strength and limits the mobility of the shoulder joint significantly. Rotator cuff repair surgery can be done in either of three ways: open, mini-open, or arthroscopic.
Circumstances calling for surgery:
- Damage, tearing, or instability of the rotator cuff due to injury, accident, dislocation, or fracture.
- Medication and physiotherapy fails to heal injury and relieve the symptoms, even after 3-6 months of treatment
- When full shoulder mobility is required for overhead work or sports in young patients.
Facts & Figures:
- Introduced by Smith in 1834, the incidence of rotator cuff tendonitis has been found majorly in workers carrying out heavy manual labor.
- Shoulder pain is the third most common cause of musculoskeletal disorders after low back pain and cervical pain.
- Rotator cuff injury is generally seen in people above40, mostly between ages 55-85.
- Family history, and smoking and multiple steroid injections increase the chances of rotator cuff tearing and injuries respectively.
Symptoms of rotator cuff tear:
- Atrophy, pain, and weakness of the shoulder muscles during movement.
- Crepitus or crackling sensation during certain movements of the arm.
Exercises:
- Extension and flexor movement of the wrist, elbow, and hand
- Stretching and Strengthening exercises of arms and shoulder joints
One can gradually resume routine activities during the rehabilitation phase as the joints strengthened with exercises. It heals completely within 6 to 12 months of the surgery.
It is advisable to do rotator cuff repair relatively soon after the injury or tear to obtain the best outcome of the surgery.
Advantages
- Rotator cuff surgery is proven to be the most effective method to restore the comfort and function of shoulders in a healthy patient.
- Depending on the method used, the patient needs to be hospitalized for 1-3 days post-surgery, and medical tourists can return home after a maximum of 3 days.
Disadvantages
- If the tendon has been torn for a long time, the rotator cuff cannot be repaired
- Slow recovery with continued stiffness or recurrent pain.
- Improper healing can call for corrective surgery.
Preoperative Preparation
- Complete physical examination
- Blood and urinalysis
- ECG and x-ray chest for the patient above 50 years
- Consult with the surgeon week prior and get the correct medicinal prescriptions.
- Inform the surgeon about smoking and alcohol habits.
- Visit a physiotherapist to understand the post-surgery rehabilitation program and using crutches.
- Plan for leave from work and domestic help at home.
- Don’t consume anything after midnight before surgery.
- Medical tourists are advised to wear comfortable clothes and to select a handicap-accessible hotel room for recovery after getting a discharge from hospital
Post operative care
- Wear a sling for 3 to 6 weeks to keep the shoulder at rest.
- The incision area needs to be kept immobilized, dry, and clean.
- For best results, perform exercises correctly under your physiotherapist’s supervision.