Total Knee Replacement: What we know and our Experience at KMC Hospitals Group
Dr S ChockalingamD.Ortho, FRCS [UK],FRCS [Tr & Ortho], Dr P R Ramasamy MS [Ortho], FRCS [UK]
This is an article I wrote for KMC News which is distributed to Referring and primary care doctors in Trichy Region on 14th December 2009
Total Knee Replacement is one of very successful and common Orthopaedic Operations we do at KMC Hospitals. The incidence of this surgery increasing in number reflects what is happening around the world.[Ref 1] The reason is why it is not more popular than it is at the moment is the cost of the surgery. This is obviously the point I would like to start of this brief about this surgery. The reason it is expensive at present to the reach of the common man is the technology that goes behind in the implant that is used.[ref 2]
The implant often made of strong Cobalt Chrome alloy, though titanium and ceramic are used in some designs. Any metal however polished, will have surface irregularities if one looks under the electron microscope. The surface finish and the material then become very important in reducing this irregularity and thus help in reducing the wear of the material with which this articulates.[Ref 3 and 4]
The material with this metal articulates is a specialized plastic called Ultra High Molecular Weight Polyethylene. Newer highly cross linked Polyethylene has come into use in hip replacement surgery.[ ref 5] However the quality of the Plastic used is controlled in the way this plastic insert is manufactured. This helps in the long term success of the knee replacement surgery.
The long term success of the knee replacement surgery is more important that looking at short term benefits of this surgery.[Ref 6] Any material placed between the end of the femur and tibia will relieve the arthritic pain. What is more important however is the durability of the material in staying without damaging the underlying bone!
The damage to the underlying bone is the worst scenario when faced with the failed knee replacement surgery. One fears this as the damage often starts without any warning such as pain. When one faces a failed knee replacement, the surgical challenges becomes daunting and more importantly becomes very expensive.
This brings me back to the opening paragraph of this brief, the cost of this joint replacement surgery.
A little bit more cost at the initial replacement surgery has been shown to reduce the chances of revision surgery in the long run. Revision surgery after total knee replacement is not something an ordinary individual can tackle not only as a patient but also financially. One cannot expect the Government to subsidize that cost as well as it will be impossible.
What we do at KMC Hospitals to ensure the long term success of this surgery are as follows.
We have a dedicated team involved in this surgery. The chances of infection developing after such surgery should be kept to absolute minimum and we do this by controlling the theatre environment and the personnel involved. We have only used prosthesis which has follow up data in the long run. Post operative protocols have now been developed to suit our working conditions. There are specific appropriate pain control and rehabilitation in place for these patients, both of which go hand in hand.
I have shown some examples of patients we have operated and what they look like and what they can do after such major surgery!
After total knee replacement this patient is able to sit cross legged! and riding a two wheeler at four weeks!, a patient works as a security at the age of 70 going to work by bicycle|!
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97.
Kester MA, Herrera L, Wang A, Essner A. Knee bearing technology: where is technology taking us? J Arthroplasty. 2007 Oct;22(7 Suppl 3):16-20
McEwen HM, Barnett PI, Bell CJ, Farrar R, Auger DD, Stone MH, Fisher J. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech. 2005 Feb;38(2):357-65.
Lancaster JG, Dowson D, Isaac GH, Fisher J The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement. Proc Inst Mech Eng H. 1997;211(1):17-24.
Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. J Arthroplasty. 2008 Jun;23(4):559-66. Epub 2008 Feb 13.
Ritter MA. The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis J Bone Joint Surg Br. 2009 Jun;91(6):745-9.
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Wednesday, June 1, 2011
Empower with Knowledge: Ortho Problems Awareness Campaign at Puthur Trichy India
4th September 2010
Empower with Knowledge:
This is the theme we took on when we decided to meet the pensioners who have many ortho problems. Myself and Dr Aravindan decided to address the pensioners in Trichy on the current Ortho Problems. When possible i will upload my powerpoint presentation used for this talk.
The Bone And Joint Decade announced by the WHO was the basis of this talk concentrating on the arthritis, osteoporosis, back problems and road traffic accidents. We were able to highlight the problems and the treatment methods and preventive methods adopted to the World Class Standards.
I have written enough on the ortho problems already and i will stop here
Regards
Chockalingam
The Proof is in the pudding: Awareness strategy adopted for Total Knee Replacement
10th June 2010
Total Knee Replacement is one of the successful surgeries, in Orthopaedics and Surgery in General. The surgery has the benefit of relieving one's pain and improving the quality of life for an individual. This can be proved by various quantification methods such as Joint Specific Scoring Systems, and Quality of Life improvement tools.
I use these tools in my practice to the standards followed in the UK Joint Replacement Units. The quality of improvement can be quantified in other methods such as QALY. This method shows that the qualtiy of life improvement for the years ahead is comparable to Cardiac Bypass Surgery and better than cataract surgery.
Remember these two surgeries compared are done more frequently than the Knee Replacement surgery. Hence when I started my practice, we sat down with the marketing department at KMC Speciality hospital and worked on a strategy to improve the awareness.
I decided one of the ways would be to take the outcome improvement to the public directly and orgnaised the meeting called Meet Our Patients. We called on the press to interact with my patients who had knee replacement directly with no preconditions.
Patients were more than happy to narrate their quality of life improvement directly to the press who in turn took to the public through their media.
Proof is in the pudding,Right!. We are now in the process of orangising the awareness of arthroscopy in joint problems. I am calling more than 100 of my patients who had arthroscopy of knees, shoulders,ankles, elbow at KMC Speciality to come and narrate their experiences directly to the press.
We are calling this Sports Injuries and Arthroscopy Awareness meeting and organised this sunday.
I will post more on this later.
Regards
Chockalingam
Saturday, May 28, 2011
The Bone and Joint Decade 2000-2010, Ten years on........
This is an article I am writing for increasing the awareness of bone and joint disorders among the public and the medical community alike.I hope you find it useful
World Health Organisation [WHO] endorsed the launch of “Bone and Joint Decade [BJD]- 2000 to 2010” in Geneva in January 2000. The key goal is “to keep the people moving by prevention and treatment of bone and joint problems. This will in turn reduce the cost and the burden to the individuals, the carers and the society at large”.
BJD-India duly followed with National Action Network launched from Pune by eminent doctors. This was endorsed by the Government of India. As we are on the verge of this decade behind us, it is time for us to reflect and hence this article.
Arthritis affecting a joint such as knee and hips are very common in India. Every other person over the age of 65 in India is affected with arthritis. Unfortunately the treatment is not sought or often delayed.
The road traffic accidents are not only common, but also results in severely injured people. The deaths are frequent and multiple numbers of people are involved in the same accident. This is reflected in the Official statistics of the department of Road Transport and Highways, Government of India.
Unfortunately such affections of the bone and joints leave people with physical disability. The patients become dependent on the family and the society adding to the mental suffering. Some of the patients are left crippled due this pain. The true extent of their suffering is revealed in the limitation of their activities of daily living let alone their limitations in the society.
When one is not able to do even routine activities such as walking, secondary health problems arise. These include sedentary lives, increasing obesity, diabetes, high blood pressure and heart diseases. WHO recognised this growing trend in the society often leaving a financial burden.
Diet and exercise play important role in the health of our bone and joints as much as for our heart. Yet our life style had become sedentary. Increasing incidence of overweight and obesity has aggravated the bone and joint problem such as arthritis. Specific remedies for certain arthritis such as Rheumatoid are not sought. These lead to crippling deformities and disabilities. On the other hand, there is misuse of pain killers leading to other problems such as kidney failure.
Wearing a seat belt is the most effective way to prevent injuries when travelling in a car or a bus. Yet many of us remove the seat belts or consider it a hindrance to wear. Traffic rules and restrictions are rarely followed resulting in serious and disabling injuries.
“A painful advanced arthritic joint can be cured with a joint replacement” is a well known fact to many in a Western country such as UK. However people in our villages are left suffering due to the lack of awareness. This lack of awareness is present even in educated persons living in cosmopolitan cities.
With this launch of Bone and Joint Decade, WHO highlighted the need for the improvement in the diagnosis and treatment of such disorders. WHO encouraged prevention through education campaigns. Ten years on since the Bone and Joint Decade launch by the WHO, the real question had there been an any improvement at all ?
In spite of all being written early in this article, there is certainly more awareness created by this WHO initiative. The government of India through its participation in this Bone and Joint Decade has shown its commitment in prevention and treatment of these disabling conditions.
Government Welfare schemes helping them finance the treatment ensures that poor are not left alone in this treatment reach. One has to mention one such scheme for the people below the poverty line at this juncture which has benefited and continues to a huge number of financially disadvantaged section of our society.
More people are seeking treatment rather than neglecting these ailments. They are asking for the accurate diagnosis as much as the treatment itself. This is especially facilitated when they see others benefited due to the treatment options such as joint replacements. People have started to recognise the fact that “Early and appropriate treatment of injuries prevents long term disability”. Technological advances such as key hole treatment of joint problems with arthroscopy are now known.
Every year many hospitals follow the activity week to focus their year long efforts to the public in October[ 12th to 20th of October of 2010 for this year]. Many hospitals and doctors are conducting free camps to facilitate such an awareness. Their efforts should be lauded with reverence for the public service.
There is certainly a larger section of our public where the awareness has not reached as we still see a significant number of disabled people due to the bone and joint problems. Hence more concerted efforts should be done from the community in general and the medical community in particular.
Education in road traffic accident prevention should reach the “prospective road users” namely our children. Public awareness campaigns should increase in number and reach the inner villages. Medical schools should increase the training given to the doctors in dealing with bone and joint problems. There is a need for the entire community to celebrate this bone and joint week in October.
May I conclude this article saying that “Let the end of the Bone and joint Decade -2000-2010 herald a new beginning in spreading awareness of the increasing number of Bone and Joint problems. These are either preventable and when affected, many of them are certainly curable”
Dr S Chockalingam
Consultant Trauma and Orthopaedic Surgeon
KMC and KMC Speciality Hospitals,
Trichy
World Health Organisation [WHO] endorsed the launch of “Bone and Joint Decade [BJD]- 2000 to 2010” in Geneva in January 2000. The key goal is “to keep the people moving by prevention and treatment of bone and joint problems. This will in turn reduce the cost and the burden to the individuals, the carers and the society at large”.
BJD-India duly followed with National Action Network launched from Pune by eminent doctors. This was endorsed by the Government of India. As we are on the verge of this decade behind us, it is time for us to reflect and hence this article.
Arthritis affecting a joint such as knee and hips are very common in India. Every other person over the age of 65 in India is affected with arthritis. Unfortunately the treatment is not sought or often delayed.
The road traffic accidents are not only common, but also results in severely injured people. The deaths are frequent and multiple numbers of people are involved in the same accident. This is reflected in the Official statistics of the department of Road Transport and Highways, Government of India.
Unfortunately such affections of the bone and joints leave people with physical disability. The patients become dependent on the family and the society adding to the mental suffering. Some of the patients are left crippled due this pain. The true extent of their suffering is revealed in the limitation of their activities of daily living let alone their limitations in the society.
When one is not able to do even routine activities such as walking, secondary health problems arise. These include sedentary lives, increasing obesity, diabetes, high blood pressure and heart diseases. WHO recognised this growing trend in the society often leaving a financial burden.
Diet and exercise play important role in the health of our bone and joints as much as for our heart. Yet our life style had become sedentary. Increasing incidence of overweight and obesity has aggravated the bone and joint problem such as arthritis. Specific remedies for certain arthritis such as Rheumatoid are not sought. These lead to crippling deformities and disabilities. On the other hand, there is misuse of pain killers leading to other problems such as kidney failure.
Wearing a seat belt is the most effective way to prevent injuries when travelling in a car or a bus. Yet many of us remove the seat belts or consider it a hindrance to wear. Traffic rules and restrictions are rarely followed resulting in serious and disabling injuries.
“A painful advanced arthritic joint can be cured with a joint replacement” is a well known fact to many in a Western country such as UK. However people in our villages are left suffering due to the lack of awareness. This lack of awareness is present even in educated persons living in cosmopolitan cities.
With this launch of Bone and Joint Decade, WHO highlighted the need for the improvement in the diagnosis and treatment of such disorders. WHO encouraged prevention through education campaigns. Ten years on since the Bone and Joint Decade launch by the WHO, the real question had there been an any improvement at all ?
In spite of all being written early in this article, there is certainly more awareness created by this WHO initiative. The government of India through its participation in this Bone and Joint Decade has shown its commitment in prevention and treatment of these disabling conditions.
Government Welfare schemes helping them finance the treatment ensures that poor are not left alone in this treatment reach. One has to mention one such scheme for the people below the poverty line at this juncture which has benefited and continues to a huge number of financially disadvantaged section of our society.
More people are seeking treatment rather than neglecting these ailments. They are asking for the accurate diagnosis as much as the treatment itself. This is especially facilitated when they see others benefited due to the treatment options such as joint replacements. People have started to recognise the fact that “Early and appropriate treatment of injuries prevents long term disability”. Technological advances such as key hole treatment of joint problems with arthroscopy are now known.
Every year many hospitals follow the activity week to focus their year long efforts to the public in October[ 12th to 20th of October of 2010 for this year]. Many hospitals and doctors are conducting free camps to facilitate such an awareness. Their efforts should be lauded with reverence for the public service.
There is certainly a larger section of our public where the awareness has not reached as we still see a significant number of disabled people due to the bone and joint problems. Hence more concerted efforts should be done from the community in general and the medical community in particular.
Education in road traffic accident prevention should reach the “prospective road users” namely our children. Public awareness campaigns should increase in number and reach the inner villages. Medical schools should increase the training given to the doctors in dealing with bone and joint problems. There is a need for the entire community to celebrate this bone and joint week in October.
May I conclude this article saying that “Let the end of the Bone and joint Decade -2000-2010 herald a new beginning in spreading awareness of the increasing number of Bone and Joint problems. These are either preventable and when affected, many of them are certainly curable”
Dr S Chockalingam
Consultant Trauma and Orthopaedic Surgeon
KMC and KMC Speciality Hospitals,
Trichy
Friday, May 27, 2011
Health Awareness among men over forty years of age, meet by Sugam Charity
Sugam Charity Health Awareness meeting 2 on 11th of April 2010
Following the successful meet organized for women over forty on the 13th feb 2010, Sugam Charity organized the second meet for gents over the age of forty years. The aim of the meeting was to spread the awareness of life style diseases which are rife in this age group.
The format of the meet is to give awareness talk to spread the knowledge and to provide an individual assessment of these people. This is different to the master health check up though one part of it is based on the master health check up as described below.
Master Health Check up is now given as a standard to most corporate employees as part of their corporate social responsibility. The corporate bodies also take up this role to ensure they have healthy employees who in turn will take less sick leave and increase their productivity.
However this type of check up is not given to the people in the villages, one due to the lack of model of someone giving them the option of health check up as corporate bodies. but it is mainly due to the lack of awareness. sporadically the Sons and Daughters who are working in cities bring their kith and kin for these health check up, however the common man misses out.
This type of health check up can bring up the problems, hopefully at an earlier stage so that the treatment can be effective. It would also ensure people with risk factors are advised accordingly so that life style diseases do not affect them in the future.
The second part of this activity is where the charity wants to concentrate. Spreading the awareness by giving them not only their health information but also with an interactive forum at their doorstep.
This has been made very much possible by the talks given by the doctors and more importantly by the Nursing School Principal of KMC, Trichy and her Team. We at Sugam Charity cannot thank them enough as they do this on a sunday when most of us would rather spend relaxing at home. We also thank the Management of the KMC and KMC speciality hospitals for allowing us to use their team the education materials for this public exercise activity.
We at Sugam Charity hope that we have done some good to these people, only time can tell us so.
Regards
Chockalingam
"savour this moment, time is as important as money and health"
You would have read my previous blog on money and health the conundrum, if not please read before this blog.
I discussed the importance of health over money and in fact described a way of combining money and health. Thus we spend time to acquire money and assets to make us happy in the future.
Some of us would spend more time on acquiring health than the time we spend on acquiring money. this may be due to the fact that we value health more than money or we have lots of money already.
Acquiring health, we may do by going to a gym, for a swim, jog in the park, eat healthy as opposed to indulging in junk foods etc. Acquiring money, we may do by doing a job, working overtime, have a second job, work harder in further education to acquire a better job which will result in a better paid job.
But life is not entirely tomorrow. life is not yesterday either. Life is today with work towards a better tomorrow. Working in a health sector, we do see people who do not have a choice in a better tomorrow. A 39 year old, a father of two young kids, presents to me with shoulder pain, only to be diagnosed to be suffering a cancer which has already spread all over his body! shocking is it not ? this makes you think
What is life, is it more money with an ability to enjoy the wordly pleasures, or is it being healthy which we can acquire with good food and exercise. not completely. it is an ability to enjoy the worldly pleasures with a healthy mind and body at this point of time. as i said today we can plan to an extent for tomorrow, however can be unpredictable.
This brings me to the title of this blog, namely "savour this moment". Today at this point of time, be happy and healthy. Being happy and healthy now will not be enough for tomorrow which is also going to be your life. Hence whatever you do to acquire money and health for tomorrow, enjoy the act of doing so.
i.e enjoy your job which you will have to do today for a better tomorrow. If you cannot enjoy the job you are doing now, please look for your job which you will enjoy and savour the moment. Similarly if you do exercise, choose an activity which you enjoy and choose a healthy food which you enjoy.
feel sorry for people who do not do their job with pleasure and well, as they are not only wasting their life. Also feel sorry for people who do not care for their and their kith and kin's health as they are also wasting their life. Appreciate the person who enjoys doing something to a wealthier and healthier tomorrow.
now to the second part of my title,"Time is as important as the money and health". I hope you would have got this by now. Essentially savour this moment of time, as your life is the time now, .
If we savour this moment doing our job happily and keeping ourselves healthy, then we are indeed enjoying our life. Is is not what we all want.
Regards
Chockalingam
I discussed the importance of health over money and in fact described a way of combining money and health. Thus we spend time to acquire money and assets to make us happy in the future.
Some of us would spend more time on acquiring health than the time we spend on acquiring money. this may be due to the fact that we value health more than money or we have lots of money already.
Acquiring health, we may do by going to a gym, for a swim, jog in the park, eat healthy as opposed to indulging in junk foods etc. Acquiring money, we may do by doing a job, working overtime, have a second job, work harder in further education to acquire a better job which will result in a better paid job.
But life is not entirely tomorrow. life is not yesterday either. Life is today with work towards a better tomorrow. Working in a health sector, we do see people who do not have a choice in a better tomorrow. A 39 year old, a father of two young kids, presents to me with shoulder pain, only to be diagnosed to be suffering a cancer which has already spread all over his body! shocking is it not ? this makes you think
What is life, is it more money with an ability to enjoy the wordly pleasures, or is it being healthy which we can acquire with good food and exercise. not completely. it is an ability to enjoy the worldly pleasures with a healthy mind and body at this point of time. as i said today we can plan to an extent for tomorrow, however can be unpredictable.
This brings me to the title of this blog, namely "savour this moment". Today at this point of time, be happy and healthy. Being happy and healthy now will not be enough for tomorrow which is also going to be your life. Hence whatever you do to acquire money and health for tomorrow, enjoy the act of doing so.
i.e enjoy your job which you will have to do today for a better tomorrow. If you cannot enjoy the job you are doing now, please look for your job which you will enjoy and savour the moment. Similarly if you do exercise, choose an activity which you enjoy and choose a healthy food which you enjoy.
feel sorry for people who do not do their job with pleasure and well, as they are not only wasting their life. Also feel sorry for people who do not care for their and their kith and kin's health as they are also wasting their life. Appreciate the person who enjoys doing something to a wealthier and healthier tomorrow.
now to the second part of my title,"Time is as important as the money and health". I hope you would have got this by now. Essentially savour this moment of time, as your life is the time now, .
If we savour this moment doing our job happily and keeping ourselves healthy, then we are indeed enjoying our life. Is is not what we all want.
Regards
Chockalingam
Thursday, May 26, 2011
Understand the "Shortest Possible Route in the Shortest possible Time" Logic
If you want to succeed in life, you have to be ahead of others. this is applicable in education, work, business and life in general. The logic then sounds right meaning that "it is an efficient way of finishing a job or work", right?. The logic then sounds OK eh!. no not really.
But not really in certain situations. you would understand this very well if you see the traffic in India. When you understand this "shortest possbile route in the shortest possible time" strategy is being followed by the driver on the other side, you begin to explain the so called accidents in road traffic.
In Other words the title logic cannot and should not be followed where you want a system to be streamlined and everyone following the same rule. this not only applies in traffic, also in a work place, education, health sector. In short it should not be followed wherever you need people in a organized area such as work place or society in general to follow a prescribed path.
Back to the traffic analogy, driving in a country like UK where the people are prepared to take a longer route so that there is an order is easier and safer, as they do not follow the logic as safety is more important.
however this does create a problem. if everyone follows the exact route, you do not get eccentrics who are often the one who would move in leaps and bounds and often change the world. so you do need eccentrics who are going to be different and think laterally. hence you do need to nurture them and not discourage them completely. for example a person who leaves a college in the middle of his course may be thought of not following the order. but he might be the next Richard Branson!
Back to the title, sounds right and it is right in certain situations. But not really in lot of situations where you do need order when many people are involved.
Hence the best thing we can do is to understand the logic and see the benefits and use them. It is also important to understand when there are dangers when this logic is being used.
For example in Indian Traffic, when you see a pedestrian or cyclist crossing in front of you in a car attempting to move forward. instead of thinking, " is he a maniac trying to kill himself being hit by my car", you would think " go on, i understand your logic"
I will detail how understanding this logic helps you in other situations in future blogs
Regards
Chockalingam
But not really in certain situations. you would understand this very well if you see the traffic in India. When you understand this "shortest possbile route in the shortest possible time" strategy is being followed by the driver on the other side, you begin to explain the so called accidents in road traffic.
In Other words the title logic cannot and should not be followed where you want a system to be streamlined and everyone following the same rule. this not only applies in traffic, also in a work place, education, health sector. In short it should not be followed wherever you need people in a organized area such as work place or society in general to follow a prescribed path.
Back to the traffic analogy, driving in a country like UK where the people are prepared to take a longer route so that there is an order is easier and safer, as they do not follow the logic as safety is more important.
however this does create a problem. if everyone follows the exact route, you do not get eccentrics who are often the one who would move in leaps and bounds and often change the world. so you do need eccentrics who are going to be different and think laterally. hence you do need to nurture them and not discourage them completely. for example a person who leaves a college in the middle of his course may be thought of not following the order. but he might be the next Richard Branson!
Back to the title, sounds right and it is right in certain situations. But not really in lot of situations where you do need order when many people are involved.
Hence the best thing we can do is to understand the logic and see the benefits and use them. It is also important to understand when there are dangers when this logic is being used.
For example in Indian Traffic, when you see a pedestrian or cyclist crossing in front of you in a car attempting to move forward. instead of thinking, " is he a maniac trying to kill himself being hit by my car", you would think " go on, i understand your logic"
I will detail how understanding this logic helps you in other situations in future blogs
Regards
Chockalingam
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