Quality of life, Knee arthritis and Total knee replacement part 1

A 55 year old lady is having pain in her knee. this does not sound surprising, is it? Quite common you would say. But do we understand that she is suffering. Suffering! did you say? it is not cancer, is it, one might wonder.

Yes i did say suffering. This lady is literally house bound, cannot walk outdoors due to this pain. She is not able to go out to do her own shopping. How does this matter, She has a family who can take her outdoors in a car or a two wheeler and she does not need to do her own shopping, one might say.

She cannot go to a temple or to a church or do her prayer. So what one might say, many persons do not go out to to place of worship now a days you might say.

She cannot climb a flight of stairs or sit with her friends on the floor and have a friendly chat. So what, most people now do not sit cross legged on the floor nor need the use of stairs. one might argue.

I am telling you that she is not able to sit in an Indian Toilet to do her normal activity in the morning. One argues that if she uses the Western Closet, it should be fine.

But the fact that "this person should be able to do all the activities without pain" is what i am getting to! It does make more sense, that half of the population of Indians do not have access to Toilet facilities let alone have a Western Toilet in their own household! See my earlier blog for reference.

It does really matter when she says to you that she is not able to sleep without pain, one would agree that she is suffering. Even there, there are patients who keep taking tablets for over an year to be relieved of this suffering albeit to a short term benefit.

Can one actually quantify this suffering to make a case for intervening and help these people.

Yes is the answer.

please wait for my next blog for the answer and so more facts and thoughts!

Warm Regards

Chockalingam

Young's Modulus and some Physics and how We apply in Orthopaedics. Medical Students' Stuff!

Orthopaedics is a branch of medicine and surgery where the bones, joints and their ailments are diagnosed and treated. Correction of Deformity in Children is the literal meaning of the word "Ortho Paedics".



To correct the deformities due to fractures and other diseases and subsequently to prevent deformities primarily in fractures. we have to use materials other than the bone and the natural tissues.

One of the common materials used in this area are metals. There are various metals used namely Stainless Steel, Titanium, Cobalt Chrome, Plastics, Ceramics, Naturally available Gypsum and so on.

To understand how we choose different material and metal in this instance, one needs to be familiar with some physics.

This is where Young's Modulus of Elasticity which is what in Physics in Schools come to use.




If you pull any material with sufficient force, the material will elongate. This is easily understandable in a material like Elastic Rubber Band. The material will revert back to its normal length when the force is removed.

This property is true to a structure like Stainless Steel, Titanium, Cobalt Chrome etc. It is true to the bone as well.

We then to use a material which will have high strength but elasticity close to the bone. The measurement of elasticity is calculated by Young's Modulus. The high strength is denoted in the graph as the point where it is indicated "the material breaks"

This is where titanium scores over Stainless Steel in fracture fixation or joint replacements. Its modulus of elasticity is closer to bone than stainless steel, though stainless steel is very good indeed and the most commonly used metal in fracture fixation. Cobalt Chrome is commonly used in joint replacements as the wear is better.

Now what is Wear? here we are talking about the surface wear or the wear of the material's surface.

Wear is the damage by friction, shear or compressive force. you can scratch the stainless steel or plastic more easily than cobalt chrome. Hence you need a substance such as cobalt chrome for joint replacements where there is movement between two surfaces.

What is even better in joint replacement? considering the wear

we all have ceramic ware in our kitchen and dining room and we are often proud that it is there with us for a long time and not lose its shine. Yes we do use ceramic in joint replacements due to its surface hardness and resistance to wear. They are expensive like our domestic products compared to stainless steel.

Like our domestic ceramic cup, they were prone for breaking, however improvement in the manufacturing of these ceramic materials has made it unbreakable in joint replacments.

Now we do have these technologies available in a country like India and for use in a city like Trichy and the technology is helping us to provide a better care though at a price!

Now next time please do take time to talk to the Orthopaedic Surgeon treating you or someone known to you about the technology which goes behind.

Please watch the space as i would take time to more articles on the science in Medicine as the practice of medicine is considered to have Art and Science Component.


May be we can dwell into the art component which makes it human sometime in the future. Otherwise you wont have humans as doctors, rather you would be going to a robot doctor. May be we will and may not have a choice either in 2050 perhaps!!!!!!!!!!!!1



Warm Regards

Chockalingam

Total Knee Replacement at Trichy, Information for patients and relatives.

Please find the information prepared by us for the benefit of patients and relatives who wish to know about Total Knee Replacement. Please read, copy or print and use 

INTRODUCTION

The knee joint is among the strongest, largest and most complex joints of the body. Whenever

You walk , sit, squat, turn around, drive or perform many other seemingly simple movements,

You are depending on the knee for support and mobility. When your knee is healthy, you may

Take it for granted, not giving a thought about the job it does for you. But once it starts to

Become painful, stiff, and you are forced to restrict certain activities, you may come to realize

How much freedom of movement means to you.

Fortunately, today’s advanced medical technology makes it possible to replace the knee joint

With an artificial one that reduces pain, allows you to strengthen your legs, and improves your

quality of life.

Knee replacement is a procedure commonly performed throughout the world, and one that

offers an  outstanding rate of success.

In this brief, we will discuss how your knee works, how arthritis causes your pain, and the

Knee replacement surgery you will have. We will also help you can expect every step of the way.

HOW YOUR KNEE JOINT FUNCTIONS.

The Healthy Knee. The healthy knee joint is a remarkable mechanism. It is formed by the Bottom end of the femur (thigh bone), the top end of the tibia(shin bone) and the patella

(knee cap) . A healthy knee joint has cartilage between the bones that acts as padding. This

Padding helps assure a gliding movement of the knee that is both effortless and smooth.

The healthy knee joint also has a joint capsule which houses the synovial membrane. This

Membrane produces lubricating fluid which contributes to the smooth movement of the

Knee.

The human knee is designed to withstand a lifetime of stressful activity. However,

Sometimes arthritis intrudes, interfering with the knee’s ability to cushion the body from stress,

and eventually causing the pain that dramatically  erodes your quality of life.

WHAT IS ARTHRITIS?

Arthritis is not a symptom of “just getting old”. It is a degenerative or inflammatory disease

Of the joints that is not necessarily part of the normal aging process. Indeed, some patients

With arthritis present symptoms in their 20s and 30s.

Although there are several types of arthritis, one of the most common is called osteoarthritis.

If effects million of people in the world today.

Arthritis causes permanent deterioration of the cartilage layers that shield the joint from

Impact. Because cartilage cannot repair or replenish itself, it begins to crack, wear away and

Eventually disappear. The cushion your knee requires to absorb stress is gone, resulting

In bone-on-bone contact. The bones in advanced cases may be so rough and pitted from

Grinding against each other that they form bone spurs, which often cause stiffness.

In the first stages if osteoarthritis, your knee may feel stiff and  swollen. Later, you may feel

Pain and may be notice that one leg seems shorter or more crooked than the other.

Eventually, your mobility may become limited and you may need to alter your lifestyle to

Accommodate your sore, arthritic knee. If you are overweight or have a malalignment, the

Extra stress on your knee can accelerate the damage.

Regardless of your type of arthritis, you may have already had to curb or quit the activities

You enjoy. This is partly why arthritis can make people “feel” old, eventhough they are

still in the prime of life. But there is hope-you have options.

HOW TO KNOW WHEN YOU ARE READY FOR TOTAL KNEE REPLACEMENT SURGERY?

Total knee replacement surgery is an elective procedure. Along with your doctor, you will

Decide when the time is right for this surgery. Your doctor has more than likely treated your

Condition with plain medications, anti-inflammatory drugs or perhaps even minor surgery.

But now the pain has become severe. Even staying off your feet doesn’t help. You cannot

Sleep at night because of the discomfort. You are probably the best judge of when you

Will finally need total knee replacement surgery. When the pain becomes so chronic

That even medication does not seem to help, you are probably ready to consider surgery.

GEETING INTO SHAPE MENTALLY AND PHYSICALLY

Take the four essential steps that will help you get into shape before knee replacement surgery.

1.     Commit to the success of your surgery. Working as a team, you, your physician and

Your family must adopt a positive attitude toward the success of your surgery.

Together, you will gain a clear understanding of the commons goals and expectations

of the procedure.

2.     Loss excess weight. Because excess weight causes strain to be placed on already –

Damaged  joints, losing weight is one of the best ways to improve the condition

Of your knee and optimize surgical results. Remember to seek your doctor’s

advice before beginning your weight loss program.

      3.   Start a physician approved, low-impact exercise plan. After a comprehensive

           assessment of your condition, your physician or physical therapist may recommend

           a low-impact exercise plan that will strengthen your knee without creating further

           damage. Do not attempt an exercise program without consulting your physician!

       4.  Stop smoking. If you have not already done so, it is suggested that you stop smoking

            This will be good for you during and after your surgery.

ALL ABOUT TOTAL KNEE REPLACEMENT SURGERY

Surgeons and manufacturers have made remarkable advances in joint replacement technology

Over the last few years. The materials are long lasting and durable. The surgical methods have

Been fine tuned and standardized. As a result, the chances for a successful outcome are

Excellent.

THE COMPONENTS OF YOUR NEW JOINT. 

In total knee replacement (also known as total knee arthroplasty, or TKA), the joint’s bone-

End surfaces are resurfaced with man-made materials. In total knee arthroplasty, the implant

(prosthesis) design may vary according to your needs, but the most common implant consists

Of three component parts. The patella, or knee cap, is made of high- density polyethylene and

May be supported by a metal tray.

BENEFITS OF KNEE JOINT REPLACEMENT.

Once your new joint has completely healed, you will reap the benefits of the surgery.

These include:

·       Reduced joint pain (maybe no pain!)

·       Increased movement and mobility

·       Correction  of deformity

·       Increased led strength (if you exercise)

·       Improved quality of life ability to return to normal activities and pastimes

Most likely, running, jumping, or other high – impact activities will be discouraged.

RISKS OF KNEE JOINT REPLACEMENT SURGERY.

As with any major surgery, there are potential risks involved. It is important that you are

Informed of these risks before the surgery takes place.

Infection.  Because a bacterial infection from your mouth could infect your new joint, you

Will be asked to complete all dental work before surgery. Consult your physician before

Scheduling any post – Operative dental work.

Blood clots. You could develop blood clots. Many TKA surgeons prescribe anticoagulation

Medications after surgery. You may also need to wear elastic stockings for several weeks

To minimize the risk of blood clots forming and to prevent emboli.

Pneumonia. Pneumonia can sometimes develop in patients who are lying in bed right after

Surgery. Getting out of bed soon after surgery is encouraged.

MAKING PREPARATIONS FOR SURGERY

MEDICAL EVALUATIONS

Before surgery, your doctors needs to understand your overall health status. You will be

Evaluated in several ways.

Complete medical evaluation  Your doctor will take your health history, an inventory of

Medications you now take, and will adminster  a total physical. X-ray images will be taken of

Your knee that help the surgeon plan your surgery. Some patients will also need chest X-rays,

ECGs and other tests to ensure they are strong enough for surgery and recovery.

Preliminary lab work. As part of your pre admission process, you will need to undergo routine

Lab work. Your physician’s nurse can explain what each test is and why you need it.

Donate your own blood. You may be asked to donate some blood to have on hand in case

You need it during surgery. Some patients cannot donate their own blood. In these cases,

Using pre-screened blood bank blood is recommended.

GETTING YOUR HOME READY.

To make your life easier post-operatively, it pays to think ahead about how to adapt your

home environment for safety and greater efficiency. Here are some tips that can help:

Arrange for help now. You won’t be able to drive immediately after surgery. This means

You will need the assistance of someone who can drive you to your follow up doctor’s

Appointments, as well as help you with shopping and errands. Try to line up this person’s

Assistance now.

Reorganize your home.

Bending, kneeling and squatting will be impossible immediately following your surgery.

Also remember, you will be on crutches or a walker for a while. Place everyday essentials

In top drawers or easy-access places. Remove electrical cords and clutter that pose a hazard.

Don’t wax floors.

Obtain assistance items .  It makes sense to have certain assistance items ready when you

Return home. Some suggested items might be a cordless phone,large apron with pockets,

Reaching aids and bathing aids. Check with your surgeon and hospital to identify which items

Will be provided to you at discharge.

PACKING FOR  THE HOSPITAL

When packing your hospital bag, bring your list of medications and the telephone numbers

Of your relatives or designated “help” person. Bring walking shoes, loose, comfortable clothes,

Underwear, books, personal care items and cash for sundries. Please don’t bring jewelry, large

Amounts of cash, credit cards or other valuable items to the hospital with you.

A NOTE ABOUT MEDICATIONS.

It is very important to tell your doctor about every single medication you are taking, even

Aspirin or ibuprofen. Some medications are not compatible with anesthetic, and others

Could increase bleeding or cause other problems. Your physician will determine which

Medications you can continue up until your surgery, and which ones you must discontinue.

WHAT TO EXPECT THE DAY OF SURGERY

When you are admitted to the hospital you will change into a hospital gown. Your vital

Signs are taken by a nurse. An intravenous line containing medications and fluids will be

inserted comfortably into a vein on your arm or neck. At this point, your anaesthetist

will  arrive to begin administration of your anesthetic for surgery. Once you are transferred to t

the  operating table where the surgery will take place. This is often the last thing you remember

before  waking up in the recovery room. You may have general anesthesia or spinal anesthesia

With sedation.

WHAT TO EXPECT RIGHT AFTER SURGERY

In the recovery room, you will recover from surgery until you are awake and alert. You could

Experience chills or nausea-these are normal side effects of anesthesia. You may notice:

Driange tubes  and catheters.

Catheter may be in place.

Pain Medications. To manage the pain you may feel right after surgery, you will be given

Medication.

Elastic stockings.

You may be fitted with elastic surgical stockings that help prevent blood clots and improve

Circulation. You may wear there stockings every day for six to eight weeks following surgery.

CPM Machine. Your operated leg may be connected to a CPM (continous passive motion)

Machine, which slowly bends it up and down to improve range of motion.

You are returned to your regular hospital room once you are completely awake. Your family

Members may then visit you in you room.

TWO DAYS AFTER SURGERY.

IV tubes and lines are usually removed within the first few days following surgery. If a

Drain was placed in your knee, then it will probably be removed a day or two after surgery.

The start of physical therapy.

Physical therapy usually begins for most patients within the first few days following surgery.

The therapist focuses on helping to increase the knee’s range of motion with bending

Exercises. You will also be building strength in the knee and muscles of the leg. Often

The CPM machine is continued at a higher degree of bend.

Walking.

It is imperative that you get up and begin moving as soon as possible. This ambulatory

Activity helps prevent clots and speed your recovery. With the help of the therapist and

Nurses, you should be able to get from the bed to a chair(transfer) at least once or twice a

Day. You will eventually be able to transfer with  your crutches or walker.

THREE TO FOUR DAYS AFTER SURGERY

Your physical therapy will continue, except you will practice becoming more independent

In your exercises, transfers from bed to chair, stair climbing and other activities your

Therapist has designed for you. Your dressings will be changed, as well as your blood

Tested for coagulation.

Before you are discharged from the hospital, your physician and physical therapist will

Review instructions for your continuing care and exercises at home. You will be given

Prescriptions for medication you need.

LONG – TERM CARE OF YOUR KNEE.

Your knee replacement should give you years of service. You can protect it by taking

A few simple steps:

Watch for and prevent infection.

Because your new knee is sensitive to infections, you must be diligent about preventing

Them. You may need to take antibiotics before seeing the dentist. If you suspect a bacterial

Infection of any kind, notify your physician right away.

Follow-up care. When you leave the hospital,you will be given a schedule of follow-up visits.

These visits will ensure the long-term success of your operation. Your physician may want to

Check you several times during the first year and annually thereafter. Often,follow-up

X-rays will confirm proper placement and alignment of the implant.

Weight control.  Keeping your weight under control will reduce the amount of pressure

And stress on your new knee. Avoid high-impact sports and  participate regularly in low

-impact activities such as walking, swimming, golfing, or cycling. These are excellent

Ways to strengthen your new knee and get the exercise you need to stay fit.

I hope the information was useful and pass it on to your friends and people who need it

Warm Regards

Chockalingam

Rich but poor, Upper class citizens be ware! the Sunshine Vitamin

Rich but poor can be a theme, but i shall limit in this blog to one aspect.

Vitamins as we know are food nutrients which are needed in small quantity but are important in functions of the key organs of our body. Vitamins are named by English Alphabets such as A, B, C and so on.



Among these vitamins, Vitamin D is unique in that it is synthesized in the body and effects the function of organs and technically a hormone.

The synthesis is done in the skin when exposed to sunlight and hence the condition of the skin, exposure of enough of our skin to sunlight for adequate amount of time is essential. Otherwise we rely on the food sources.

When we move up in our class of society, we tend to believe that the food would be rich in all these vitamins and hence we would not need supplements.

However moving up in the class of society also entails living in air conditioned houses, leaving for work in Cars, and not getting enough sunlight.

Surprisingly, Vitmain D testing among this class of middle and upper class citizens reveal that the deficiency is rife and needs attention.

We also found that some of the patients have toxic levels of Vitamin D as they are consuming the so called health foods in abundance.

All you need is enough sunshine in our life!



Many singers have written and sung on sunshine in our life

Dont let the sun go down on me as George Michael and Elton John!

There is enough sunshine outside in India but let it shine on us at least half an hour a day.

I am told that the darker you are, more sun needs to shine for our Vitamin D

Remember Vitamin D is called SunShine Vitamin as there are sunshine States in US and Australia



Warm Regards

Chockalingam

Useful links, kindly keep visiting this blog and i shall keep updating.

These are sites which i found informative and able to pass on the message in a simple illustrated method

Site on road safety

http://www.speedorsafety.com/driver-advice/

The two second rule in driving

http://www.rotr.ie/rules-for-driving/speed-limits/speed-limits_2-second-rule.html

Traffic signs in India

http://www.indiandrivingschools.com/road-traffic-signs-signals.html

Diet and Exercise

http://www.health.gov/dietaryguidelines/dga2000/document/contents.htm

Does your child have flat foot, read on

http://orthoinfo.aaos.org/topic.cfm?topic=a00046

Happy surfing and be safe in cyber and real life

Warm Regards

Chockalingam