Disc Herniation

What is

Disc herniation occurs when an intervertebral disc degenerates and deteriorates, causing the inner nucleus to leak into a weakened area on the outside of the disc.

The weak point in the outer nucleus of the intervertebral disc is directly below the spinal nerve root, so a herniation in this area can put direct pressure on nearby nerves or the spinal cord.

Therefore, herniated discs are sometimes a cause of radiculopathy, which encompasses any disease that affects the nerve roots of the spine.

Dr Ashu Consul, best orthopaedic in Dwarka, consultant at Venkateshwara Hospital, adds that, initially, herniated discs can be confused with the following pathologies: “piriformis syndrome, facet arthropathies, deep gluteal syndrome, peripheral neuropathies, muscle trigger points and, in more severe cases, tumors”.

Causes

The vertebrae of the spine are separated by discs that cushion movement and leave space between the vertebrae. In the same way, they allow their movement, which makes it possible to bend down or stretch out.

In addition, the vertebrae of the spine protect the spinal cord that comes from the brain and runs down the back to the lower back. The discs fulfill a very important function of cushioning and distribution of loads and any damage to them can be serious if not treated quickly.

The disc can move out of place, that is, herniate, or rupture due to injury or stress. This can cause excess pressure on the spinal nerves resulting in pain, numbness or weakness in the patient.

Normally, herniated discs are located in the lumbar region, with the second most affected area being the cervical discs (the neck).

Symptoms

A cervical disc herniation can cause pain in the neck, which in turn can radiate to the arm, shoulder, or can cause numbness or tingling in the arm or hand. Sometimes the pain can be dull, constant, and difficult to locate.

In addition to this pain, the symptoms of herniated discs are the following:

• The first sign that the patient has a herniated disc is pain in the arms and neck. If numbness or tingling occurs it may indicate that the problem is more serious.
• Typically, the patient complains of sharp, cutting pain, and in some cases, there may be a prior history of episodes of localized pain, present in the back and radiating down the leg.
• The episode of pain may come on suddenly or be heralded by a tearing or snapping sensation in the spine.
• When the pain starts slowly, it can worsen after the patient spends a long time sitting, standing, at night, when sneezing, coughing or laughing.
• Weakness is also a common symptom that affects the leg or arm and may require excessive effort to move them.
• Usually, the numbness or weakness goes away over a period of several weeks or months. 

Prevention

According to Orthopaedic in Dwarka, “exercising regularly and appropriately is important. Also avoiding leading a sedentary lifestyle, being overweight and smoking helps prevent this type of back pathology. Finally, avoid unnecessary risks such as lifting heavy objects, improperly bending or twisting the lower back, or sitting or standing in the same position for many hours and in an unergonomic way.

Types

There are three degrees:

• Disc protrusion: when the nucleus pulposus has not yet come out of the annulus fibrosus, it is therefore weaker and gives way in its structure. This is the first stage of a herniated disc.
• Disc herniation: the material of the nucleus pulposus is ejected from the limits of the annulus fibrosus.
• Disc extrusion: the exit of the disc material is violent and breaks the posterior common vertebral ligament, leaving free fragments in the vertebral canal. 

Diagnosis

To diagnose a herniated disc, the orthopaedic doctor in Delhi will carry out a medical examination of the spine, arms and lower extremities. Depending on the region where the patient's symptoms are located, the orthopaedic in Delhi will look for possible numbness or loss of sensitivity.

In addition, he will test your muscle reflexes, which may have been affected and slowed down or even disappeared. He will also study the patient's muscle strength and the shape of the curvature of the spine. 

On the other hand, the patient may also be asked to sit, stand or walk, bend forward, backward or sideways and move the neck, shoulders or hands.

Diagnostic tests that can verify the existence of a herniated disc are:

• An electromyography that will determine which nerve root is affected and where it is compressed.
• A myelography to specify the size and location of the hernia.
• An MRI that will show if there is pressure on the spinal cord.
• Finally, an X- ray of the spine may also be performed to rule out other injuries that cause cervical or back pain.

Treatments

The first treatment given to patients with this condition is short rest and pain medication, followed by a period of physiotherapy session with physiotherapist in Dwarka. In most cases, almost immediate recovery occurs, but in other cases medication or injections may be required.

In the case of corticosteroids, they are usually administered, above all, non-steroidal anti -inflammatory drugs to control pain and also muscle relaxants. 

Injections into the area of ​​your back where the herniated disc is located can help control pain for a few months. In addition, these injections greatly reduce the swelling of the disc.

The last option is microdiscectomy, considered as the surgery that is used to relieve pressure on the nerve root and allow the nerve to recover more effectively. This type of intervention does not entail great difficulty, since it is usually enough with a small incision and one night of admission. 

Regarding the therapeutic approach to herniated discs, Orthopaedic in West Delhi states that "one of the most important advances has occurred in the increased precision of diagnostic tools, which has made treatment much more effective and specific, both in management conservative as in the surgical. From the surgical point of view, the trend is towards minimally invasive, what we commonly know as microsurgery, so that the tissues suffer the least negative impact after the surgical intervention”.

At what age do herniated discs usually appear?

“Disc herniation can appear at any age, since its causes are multifactorial. Although, it begins to be more frequent in the range of 30 to 50 years of age. And they are more prevalent after the age of 50, where it is estimated that more than 80% of the population begins to show disc degeneration”, says orthopedic in Delhi.

Hip Osteoarthritis Treatment

Hip arthrosis, also called coxarthrosis, belongs to a group of diseases called chronic degenerative diseases, that is, diseases that progressively evolve, affecting certain areas or tissues of the body.

In the case of osteoarthritis of the hip, there is progressive wear and tear of the cartilage of the hip joint.

This disease is also characterized by bone neoformation in the region where there was joint wear. These neoformed structures are popularly called parrot beaks.

Risk Factors for Hip Osteoarthritis

It is not known for sure why certain groups develop hip arthrosis, but it is known that some situations tend to increase the probability of developing this degenerative disease.

Among these factors are previous diseases of the hip, such as epiphysiolysis, in addition to septic arthritis, congenital dislocation, femoroacetabular impingement, rheumatism, fracture sequelae, as a result of previous surgeries, etc.

This pathology usually affects older people. In the case of previous diseases in the hip, it is called the pathology of secondary hip arthrosis. It is estimated that in the population over 65 years of age approximately 12% have symptomatic osteoarthrosis.

Symptoms

The main symptom of hip arthrosis is pain, located in the groin area. But the patient may report other symptoms such as difficulty performing simple movements such as bending down or bending, as well as joint stiffness and crepitus.

Other symptoms are pain in the buttocks area and the pain may be present even after a period of rest, especially at night.

Difficulty performing simple activities such as walking, climbing stairs, sitting or crossing the legs is present in cases of coxarthrosis.

As coxarthrosis is a progressive disease, the signs and symptoms also have a progressive evolution, that is, they can start in a very mild and little limiting way, but progress to intense and very limiting.

Thus, the first signs of coxarthrosis include joint stiffness, which starts bothering more in the morning, but tends to disappear during the day. In these cases, the limitation of movement is quite small.

With the passage of time and the evolution of the disease, joint involvement also increases and, as a result, the stiffness becomes greater and tends not to disappear during the course of the day. Even the pain can even radiate to other places, such as the lumbar spine, for example.

Rest no longer helps to improve the condition and the patient begins to feel pain in any location or position, feeling very uncomfortable even when lying down or standing still.

The consequence of this is that the patient increasingly decreases the level of movement and when he moves, he limps, trying to transfer the load to the other side of the body that does not present the pathology.

Although this seems like a temporary solution, it actually only worsens the situation, as it leads to muscle weakness in the leg and buttocks, which are extremely important musculature for hip protection.

Thus, it is important that a professional is sought when the first symptoms appear, so that the diagnosis is established and a good treatment plan made, precisely to prevent the natural progression of the disease from occurring.

Diagnosis of Osteoarthritis of the Hip

The diagnosis of this pathology is the responsibility of the orthopaedic doctor in Dwarka. Unfortunately, many patients are slow to seek medical help, believing that the pain and the situation will spontaneously improve, which is not the case with a degenerative disease.

Clinical evaluation is essential, with the professional collecting information about the pain history and medical history of that patient. In addition, some functional exams to check the patient's muscle capacity in the region are performed.

It is important to check the muscle condition of the leg, buttocks and thigh, to establish the degree of evolution of the disease.

Imaging tests may be ordered, such as X-rays and MRIs. These exams are important to be able to assess the degree of involvement of the joint surface.

The exam of choice for diagnosing hip arthrosis is the AP radiograph of the pelvis, also called pelvic panoramic, and the lateral view of the affected joint.

The other imaging tests are important when the orthopaedic doctor in Delhi wants to eliminate other possible causes of the problem.

The reduction of the joint space, as well as the presence of bony prominences in the region, are factors that are investigated with the analysis of the image exams.

Treatment of Hip Osteoarthritis

For the treatment of coxarthrosis, it is important to point out that not all cases require surgery, and conservative treatment is an excellent alternative that should be considered because of its positive results.

However, in some cases, depending on the level of joint involvement, surgery becomes unavoidable.

Conservative treatment for hip osteoarthritis

The approach should always be individualized and geared to the patient's lifestyle and expectations about treatment.

Depending on the degree of pain presented by the patient, the orthopaedic in Dwarka may prescribe appropriate analgesics and anti-inflammatory drugs to reduce the acute pain. This is part of conservative treatment.

Physiotherapy in the Conservative Treatment of Hip Arthrosis

Physiotherapy in Dwarka is also indicated for pain reduction, since there are physiotherapeutic techniques that are quite suitable for acute pain.

Among these physical therapy techniques, we can highlight electrothermophototherapeutic resources, such as laser, TENS and ultrasound.

Other techniques include myofascial release and joint mobilizations.

From the reduction of pain, it is possible to focus on a second moment of conservative treatment with the support of physiotherapy in Delhi, seeking muscle strengthening and range of motion.

Activities such as water walking and water activities (hydrotherapy) can also be quite helpful.

At first, the exercises should start without movement, only isometric contraction. Then, with light contraction, then with manual resistance, elastic resistance and finally, resistance with weights.

Appropriate muscle strengthening for patients with coxarthrosis prevents the progression of the disease, as it makes the musculature absorb the necessary load from the patient's activities, preventing this load from being transferred to the compromised joint region.

The result is an improvement in the patient's physical condition, with reduced pain and improved functional and movement capacity.

Surgical Treatment for Osteoarthritis of the Hip

In some cases, due to the degree of involvement of the hip joint, the surgical indication ends up being the best option for the patient with coxarthrosis.

When there is a very large involvement of the joint region or in cases where conservative treatment has failed, the surgical option can be offered to the patient.

It is worth remembering that every surgical process has risks and that the patient will still have to undergo a long physical therapy rehabilitation after the surgery.

Therefore, orthopaedic in Delhi explains to the patient that, although the results of the surgery can be positive, physical therapy rehabilitation is essential.

The most indicated surgery for cases of hip arthrosis is arthroplasty or hip replacement in Delhi, but the indication of the surgical procedure will depend on several factors, such as the patient's age, etiology, degree of activity and range of motion.

In addition, it is important to check whether the disease is present in only one hip joint or in both.

Surgical procedures can be divided into three types:

- Osteotomies and arthroscopies: change the position of the hip bones;
- Fusion of the hip joint, called arthrodesis;
- Replacement of the hip joint with a prosthesis (arthroplasty).

Obviously, the most invasive surgical procedure of the three described is the replacement of the hip joint with a prosthesis. There is no rule, but in general, less invasive procedures are recommended in early cases.

Arthrodesis is now considered a disused technique. Arthroplasty, on the other hand, is considered one of the greatest successes in medicine in terms of surgery and there has been a lot of progress not only in the surgical technique but also in the materials to be placed as prostheses.

Even so, arthroplasty is indicated for the most severe cases of joint destruction.

Patellar Instability or Patellar Dislocation

 

What is Patellar Instability or Patellar Dislocation?

The patella, formerly known as the kneecap, is the front bone of the knee, responsible for transmitting the strength of the thigh muscles. In some situations, this bone can move out of its normal location, called patellar instability or patellar dislocation, explains the orthopaedic in Delhi.

If the patellar dislocation occurred for the first time, it is called a primal patellar dislocation. From the second episode, it is called recurrent patellar dislocation.

What are the symptoms of patellar instability?

When a patellar dislocation occurs, there is severe pain and an inability to mobilize the knee. It is possible to see and feel that the patella has moved out of place.

Most of the time, the patella comes back into place on its own almost immediately. Rarely, a doctor needs to put it in place with a knee extension maneuver.

After a patellar dislocation, there may be a feeling of insecurity with the knee, even without the patella clearly moving out of place. This sensation is called a patellar seizure. It is a very uncomfortable symptom, which can interfere with normal activities, says the orthopaedic in Dwarka.

How and why does patella dislocation occur?

Patellar dislocation can occur from trauma, such as a blow or twist to the knee, or without trauma, in a common movement of the joint.

Some people have knee features that favor patellar dislocation. Among the main ones are:

• High patella
  • The patellar tendon is longer, which makes the patella rest on the knee in a higher position, decreasing the bony socket at the beginning of knee flexion.
• Increased patellar tilt
• Femoral trochlea dysplasia
  • The groove on the femur where the patella fits can be shallower than normal, completely flat, or even convex.
• Increase of the “Q” angle
  • “Q” angle is formed by the direction of traction of the thigh musculature and the direction of traction of the patellar tendon.
• Patients with valgus knees (knees in, or in “X”)
• Ligament laxity is also more predisposed.

What is the medial patellofemoral ligament?

The medial patellofemoral ligament is the structure that prevents dislocation of the patella. When the patella is displaced, it is injured or loosened.

When the patellar dislocation is treated without surgery, what is expected is that this ligament will heal. In the surgical treatment of patellar dislocation, reconstruction of the medial patellofemoral ligament is performed in most cases, explains the orthopaedic surgeon in Delhi.

Learn more about patellar dislocation treatments below.

How is patellar instability diagnosed?

The diagnosis of patellar instability is made through a careful assessment of the patient’s clinical history and physical examination, complemented with imaging tests.

The main test to be evaluated is magnetic resonance imaging, which shows indirect signs of dislocation, injury to the medial patellofemoral ligament, and the anatomical changes that favor instability. In addition, MRI is essential to look for cartilage lesions. Other tests, such as radiographs in special positions and computed tomography, are useful for evaluating the shape of the knee and predisposing factors, states the orthopaedic in west Delhi.

How is patellar instability treated without surgery? In what situation is he indicated?

In the case of a patient with an episode of patellar dislocation, both non-surgical and surgical treatment are possible. The decision for one or the other must be individualized, after a detailed discussion between the patient and the orthopaedic surgeon in Dwarka.

Non-surgical treatment involves immobilization for a period, followed by rehabilitation focused on exercises to strengthen and control the thigh and hip muscles. The goal of successful non-surgical treatment is the absence of new episodes of dislocation and patellar apprehension, the feeling of discomfort or buckling caused by instability, explains the orthopaedic surgeon in Dwarka.

In which cases is surgery indicated?

Situations that indicate treatment with patellar dislocation surgery are:

• Recurrent episodes of dislocation (recurrent patellar dislocation)
• Association with cartilage injuries
• Symptoms of apprehension getting in the way of normal activities

Patients with a single episode of dislocation, although they can be treated without surgery, can also opt for surgical treatment. Surgery has the advantage of a lower chance of re-displacement or seizure symptoms for activities, says the orthopaedic surgeon in west Delhi.

What are patellar instability surgeries like?

According to the orthopaedic surgeon in Delhi, there are several procedures available for patellar instability, which are chosen according to the characteristics of each patient, and there may be a combination of procedures. This concept of individualized treatment is known as à la carte treatment, influenced by the French school.

These are the most common procedures performed for patellar dislocation.

• Reconstruction of the medial patellofemoral ligament
  This ligament is the main restrictor of patellar dislocation, and its reconstruction is indicated in almost all cases. It is a graft from the patient’s own tendon to remake the ligament.
• Lateral release (or release)
  Release of structures that hold the patella on the side or outside, when there is excess tension. Can be done openly or arthroscopically (video surgery)
• Tibial tuberosity osteotomy
  A cut is made in the tibial bone to reposition the point where the patellar tendon attaches. This transfer allows for patellar realignment or patellar height correction.
• Trochleoplasty
  Correction of the shape of the femoral trochlea, the groove where the patella rests on the femur.
• Treatment of cartilage injuries
  When cartilage injuries also exist, these may also need specific treatment.

How is the postoperative period and rehabilitation?

Postoperative care depends on the technique used. They usually involve a period of support with crutches and a knee brace. However, from the beginning, it is already allowed to put the foot on the floor and remove the immobilizer to move the knee in most situations. Rehabilitation includes restoring knee mobility and restoring strength and control of the musculature of the thigh, hip, and trunk.

10 Common Signs and Symptoms of Hip Wear

 

Hip wear (hip arthrosis) is a very frequent and limiting problem. It is the aging of articular cartilage that is responsible for free joint movement and pain-free. When the cartilage is worn out, the hip joint can no longer move freely and bear load, causing pain and movement restriction.

About 10% of the population over 45 years has hip wear with painful symptoms and almost 30% of the population has changes in hip wear on imaging tests such as radiography or MRI, says the orthopaedic in Delhi.

Common Symptoms

If you have a suspected hip wear, these are 10 most common Signs and Symptoms, which may indicate an evaluation with the hip surgery specialist. 

1. Pain in the groin area.

Pain in the groin region, or anterior region of the hip is perhaps the most common feature of the hip that is worn. This occurs by the characteristic of innervation of the joint that occurs by the same nerve roots that inners the groin region and anterior face of the thigh.

Pain in the groin area can occur because of other diseases, but it is very characteristic of the hip that has its cartilage worn out, states the orthopaedic in Delhi.

2. Stiffness of the hip joint. Loss of mobility.

One of the signs that a joint is worn is the loss of its function, which is precisely the ability to move the joint without pain.

When a joint is worn out, it ignites, and movement begins to cause pain. The result of this is that the patient himself begins to move the joint less as a way to protect himself from pain.

Thus, soft tissue structures such as capsule, muscles and tendons are retracted further reducing joint mobility, explains the orthopaedic doctor in Delhi.

3. Pain for lifting from low chairs or toilet.

Another striking feature of patients with hip arthrosis is the difficulty of getting up from low chairs and from the toilet.

This occurs because at the time of elevation, there is a sudden increase in load and pressure in the hip joint, which if worn out, will lead to a worsening of the pain, says the orthopaedic doctor in Delhi.

4. Claud gait, or “limp” gait.

The perfect functioning of the hip joint is essential for a balanced and pain-safe gait. When the hip is worn out, movement and change of loads on damaged cartilage can cause pain.

An immediate reflex is the decrease in the range of motion of the joint during gait and shortening of the pitch during the gait step on the worn hip.

All this gait movement in order to reduce the pain, ends up causing the “limp gait” or clauaudicante gait, explains the orthopaedic in Dwarka.

5. Pain to crouch and put on the shoes.

As much as it sounds like a simple activity, putting on simple shoes gets harder and harder for those who have hip arthrosis.

This occurs because the movement of putting on the shoes implies a large flexion of the hip and increased load on the joint, even if the patient is still.

A good alternative for patients who have hip arthrosis and pain to put on shoes, is to replace shoes with shoelaces with sneakers or shoes of the type “moccasin” that do not need to be tied, suggests the orthopaedic in Dwarka. 

6. Pain to go up and down stairs and to get in and out of the car.

This complaint is very common in patients with advanced hip arthrosis. With the progression of wear, pain is worse in activities with hip flexion with load and rotational movements, says the orthopaedic doctor in Dwarka.

Everyday activities such as going up and down stairs and getting in and out of the car get more difficult, requiring the support of the hands and the other member to be executed.

7. Feeling of locking, clicking, or crackling of the hip.

In many cases of hip wear, there may be detachments of cartilage fragments and inflammatory process in the joint (synovite).

These factors cause noises called clicking, or the famous “crek crek”, explains the orthopaedic doctor in Dwarka.

8. Decreased ability to walk and use supports

The hip is fundamental for a correct efficient and pain-free gait movement. Hip wear in a load area prevents perfect joint slippage and causes pain at the time of limb support.

This leads to a decrease in the patient’s ability to walk who needs to stop after a few steps for pain relief or the need to use supports such as crutches or walking, explains the orthopaedic in west Delhi.

9. Decrease in sexual activity.

Hip wear can reach many patients with active sex life. This can be a big problem because pain and limitation of movements can decrease the willingness to have sex (libido) or impair the sexual act due to the accentuated symptoms, says the orthopaedic in west Delhi.

10. Discouragement to carry out daily activities.

Hip wear is a progressive and limiting problem. It is very difficult to assimilate the loss of function and quality of life that it causes.

The constant pain and limitation for small daily activities greatly affects the psychological of patients. It’s very difficult to live with that.

When the pain is strong and the discouragement is very strong, it is good to remember that there is always the solution of the surgery. Look for a reliable specialist orthopaedic doctor in west Delhi! 

How many of these symptoms do I need to have to have surgery?

There is no specific number of symptoms that define the exact time of performing hip prosthesis surgery.

The higher the number of symptoms and the higher the intensity of them, the greater the chance of a hip replacement surgery in Delhi by a synthetic prosthesis.

Everything About Knee Replacement

THE KNEE JOINT

Joints are the areas where bones meet, and movement occurs. The knee joint is made up of the femur above and the tibia below. The two bones are separated by cartilage that acts as a cushion and allows movement.

REASONS FOR SURGERY

The reasons for total knee replacement surgery in Delhi are: severe pain, loss of mobility, or deformity of the knee. Symptoms may be due to osteoarthritis, rheumatoid arthritis, or trauma among others.

Osteoarthritis, commonly called "wear and tear," is the most common cause for a total knee replacement.

ABOUT KNEE REPLACEMENT

The knee joint is made up of the ends of the thigh bone (femur) and the shin bone (tibia). These bones normally slide over each other with ease because they are covered by soft cartilage. If an injury damages the cartilage or is worn away by arthritis, for example, it can make the joint ache or stiff.

Generally, a new knee joint improves mobility and decreases pain, although your new knee will not be able to bend as much as a normal knee joint.

Depending on the condition of your knee joint, they will replace part or all of your knee joint. A total knee replacement is more common.

Artificial knee pieces can be made of metal and / or plastic, and a knee replacement can last up to 20 years.

WHAT ARE THE ALTERNATIVES?

Knee replacement surgery in Delhi is generally recommended only if nonsurgical treatments, such as physical therapy and exercise, taking medication, or using physical support devices such as a cane, no longer help decrease pain or improve mobility.

Alternative surgical procedures include arthroscopy in Delhi (if the arthritis is not very severe) or osteotomy (in which the leg bones are cut and put back). You may have already had these procedures before your knee replacement.

The surgeon will explain your options.

PREPARING FOR A KNEE REPLACEMENT

The orthopaedic surgeon in Delhi will explain how to prepare for the operation. For example, if you smoke, they will ask you to stop smoking, as this increases your risk of chest and wound infection, which can delay your recovery.

Typically, you must stay in the hospital for about five days, and the surgery is performed under general anesthesia. This means that you will be asleep during the operation. Otherwise, if you prefer, the surgery can be performed under epidural or spinal anesthesia. This type of anesthesia completely numbs from the waist down, and you will remain awake during the operation.

If you are going to have general anesthesia, you will be asked to fast. This means that you should not eat or drink, normally, for about six hours before general anesthesia. However, it is important to follow the instructions of your anesthetist.

In the hospital, the nurse can check your heart rate and blood pressure and do a urine test.
Your surgeon will explain to you what will happen before, during, and after the procedure, and any pain you may have. This is your opportunity to understand what will happen, and it may be helpful to prepare questions about the risks, benefits, and other alternatives to the procedure. This will help you stay informed so that you can give your consent if you are asked to sign a consent form to carry out the procedure.

You may be asked to wear compression stockings on your unaffected leg to prevent blood clots from forming in your veins (deep vein thrombosis, DVT). You may need an injection of a blood-thinning medicine called heparin in addition to, or instead of wearing, compression stockings.

WHAT HAPPENS DURING A KNEE REPLACEMENT?

Generally, a knee replacement in Delhi takes about two hours.

The orthopaedic in Delhi will make a single cut (10 to 30 cm long) in the front of your knee. You will push the kneecap to the side to reach the knee joint. The surgeon will remove the worn or damaged surfaces from the end of the femur and the top of the tibia. Typically, he will remove the anterior cruciate ligament and may remove the posterior cruciate ligament. For support, the best orthopaedic in Dwarka will not remove the collateral ligaments. It will shape the surfaces of the femur and tibia to fit the artificial knee joint and then fit the new joint over both bones.

Sometimes the back of the kneecap is replaced with a piece of plastic. This is known as patella lining.
After placing the new joint, the surgeon will close the wound with stitches or clips and cover it with a bandage. The surgeon will place a tight bandage on your knee to help minimize swelling.

WHAT SHOULD I EXPECT AFTER

You will need to rest until the anesthesia wears off. After epidural anesthesia, you may not be able to feel or move your legs for several hours.

You may need pain relievers to ease any discomfort when the anesthesia wears off.

You may have an intermittent compression pump attached to special pads on your lower legs for the first day or so. By inflating the cushions, the pump encourages healthy blood circulation and helps prevent a DVT. You can also have a compression stocking on your unaffected leg. This helps maintain circulation.

A physiotherapist in Dwarka (a movement and mobility specialist) will visit you daily to guide you through exercises that will help you recover.

You will stay in the hospital until you can walk safely with the help of a cane or crutch. When you can go home, you will need to ask someone to drive you.

Before you go home, the nurse will give you recommendations for caring for your knee and a date for your follow-up appointment.

How long it takes for the sutures to disappear will depend on the type used in the surgery. However, for this procedure they usually go away in about six weeks. Nonabsorbable sutures and clips are removed 10-14 days after surgery.

RECOVERING FROM KNEE REPLACEMENT SURGERY

If necessary, you can take an over-the-counter pain reliever, for example acetaminophen or ibuprofen. Follow the instructions in the patient information leaflet that comes with your medicine, and if you have questions, ask your pharmacist.

Physical therapy exercises are an indispensable part of your recovery, so it is essential that you continue to do them for at least two months.

You will be able to move around your house and go up and down stairs. For a few weeks, some everyday activities, such as shopping, will be difficult for you to do. You may need to use a cane or crutches for about six weeks.

You may be asked to wear compression stockings at home for several weeks.

When resting, raise your leg and support your knee to help prevent leg and ankle swelling.

Depending on the type of work you do, you may be able to go back to work after six to 12 weeks.

Follow your surgeon's recommendations for driving. You should not drive until you are sure that you can brake in an emergency without discomfort.

WHAT ARE THE RISKS?

Knee replacement surgery in West Delhi is a common and generally safe procedure. However, in order to make an informed decision and consent, you must be aware of the possible side effects and risk of complications associated with this procedure.

Side effects

These are the unwanted, though mostly temporary, effects of successful treatment; for example, feeling dizzy as a result of general anesthesia.

Your knee will hurt and be swollen for up to six months.

You will have a scar on the front of your knee. You may not have sensation in the skin around the scar. This may be permanent, but it should get better in two years.

Complications

Complications are problems that occur during or after the operation. Most of the people are not affected. Possible complications from any operation include unexpected reactions to anesthesia, excessive bleeding, or clot formation, usually in a vein in the leg (DVT).

Complications specific to knee replacement are rare, but include:

• Wound or joint infection Antibiotics are given during and after surgery to prevent this complication.
• Unstable joint. The knee joint may loosen and may require surgery to correct it.
• Damage to blood vessels or nerves. It is usually mild and temporary.
• Scar tissue. Scar tissue formation can limit movement. You will likely need another surgery to correct it.

 

Hip arthroscopy in athletes: eliminate exercise pain

Every athlete who suffers from hip pain usually faces a very similar journey: when the first symptoms appear, they start conservative treatment with anti-inflammatory drugs and painkillers. When the pain improves a little, they try to return to activity. After a little while, they are in pain again.

But when drug treatment no longer has any effect and the pain starts to impair sports practice or even the performance of simple routine activities, what can amateur and high-performance athletes do?

The first step is to seek an orthopedic in Delhi specializing in the hip, who will be able to perform a thorough evaluation. Only after that, treatment will start based on the cause of the injury, that is, try to treat the problem at its root instead of just treating the pain.

The imbalance of strong structures around the hip joint, such as tendons, ligaments and bursae are the main cause of hip pain in those who practice sport. This happens because the hip makes an important connection between the legs and the trunk. Any slight alteration can generate instability and injury.

While many athletes have no indication for surgery, for others, performing a surgical procedure, such as hip arthroscopy in Delhi, is the best option to restore quality of life, sports performance and prevent an injury from becoming chronic, or even progress to cartilage wear.

Hip arthroscopy for athletes

Problems such as hip injuries are closely linked to the practice of sports such as running, cycling, volleyball, tennis, football, dance, artistic gymnastics and other sports.

In the recent past, a large number of young people with hip pain during physical activity did not have a correct diagnosis and some cases progressed to wear and tear. The orthopaedic doctor in Delhi acted as a spectator of the worsening of the joint injury, without being able to interfere with the inevitable.

Today, it is known that many of these young athletes had a disease caused by a change in the fit of the frame, called femoroacetabular impingement.

Athletes with this type of hip injury are the main beneficiaries of hip arthroscopy surgery in Delhi.

Considering the limitations in sports performance imposed by the hip injury, the procedure is a great treatment option for femoroacetabular impingement with labrum injury, as it is capable of correcting the anatomy of the joint socket.

Today, there are several studies that demonstrate that the rate of return to sport after arthroscopy is above 90%. The rehabilitation phase after hip arthroscopy in athletes lasts about 6 months, and may vary for each case.

How hip arthroscopy works in athletes

Hip arthroscopy is a minimally invasive surgery, in which 1 to 2 cm incisions are made in the hip to place cameras and specific instruments used to repair cartilage and adjust the hip bones.

The performance of arthroscopy in athletes is indicated mainly for those who have excess bone in the hip joint, have pain and limitation of movement. These patients are usually adults between 20 and 40 years of age who practice physical activity.

Hip arthroscopy in athletes, when recommended, is a great solution to eliminate pain and return to physical exercise.

A common mistake made by many athletes is accepting hip pain as part of their routine and continuing to practice sports even without a proper diagnosis.

Many patients live with hip problems for years and seek treatment only when the pathology is preventing them from performing movements.

Having medical follow-up from a hip specialist orthopedic in Dwarka will ensure that the athlete has adequate treatment from the start, preventing the injury from progressing and requiring more invasive treatments.

Faced with the persistence of symptoms, look for a specialist orthopaedic surgeon in Delhi!

Patellar Tendinitis

 

What is patellar tendinitis?

One of the most common knee tendinitis or knee tendinopathies are those that result from inflammation of the patellar tendon.

The patellar tendon attaches proximally to the lower pole of the kneecap (or patella). This sesamoid bone transmits the pulling force of the quadriceps muscle, allowing mobilization of the knee joint. Distally, the tendon insertion zone is located in the region of the anterior tuberosity of the tibia.

Both insertions can be the site of inflammation and pain in the anterior (or rarely lateral) region of the knee, explains the orthopaedic in Delhi.

Causes of patellar tendinitis

Knee tendinitis is an injury that is very often associated with high-intensity sports training, especially one that requires repeated pushing movements (“jumper’s knee”).

Therefore, knee tendinitis of this type occurs mainly in sports that involve jumping (volleyball, handball, basketball, etc.).

However, knee tendinitis can also develop in occasional exercisers or in patients who do not exercise at all, says the orthopaedic in west Delhi.

Symptoms of Knee Tendonitis

The main signs and symptoms are pain in the anterior region of the knee, which worsens when jumping or running and which is sometimes accompanied by edema (swelling).

Knee pain is sometimes so intense that it can cause lameness and difficulty walking, states the orthopaedic in Dwarka.

Diagnosis of patellar tendinitis

The diagnosis of patellar tendinitis is made clinically, namely the type and location of pain, the clinical history of practice of certain modalities, as well as the analysis of auxiliary diagnostic tests such as: Knee X-Ray, Knee Ultrasound and the Magnetic Resonance Imaging (MRI) of the knee.

In case of doubt about the diagnosis or difficulties in overcoming the symptoms, you should consult your orthopaedic doctor in Delhi.

Complications in patellar tendinitis

In more severe cases of patellar tendinitis, namely those with a longer duration, the chronic inflammation can lead to progressive weakening of the tendon, with the appearance of micro-tears and eventual evolution to a complete and total tear of the patella.

Is patellar tendinitis curable?

Yes, there is a cure, the prognosis depending on a series of factors such as the time of evolution and intensity of symptoms, athlete’s biotype / weight, knee morphology, type and intensity of the sport practiced, explains the orthopaedic in Dwarka.

Age also decisively affects recovery time, being obviously shorter in younger athletes.

Find out below how to treat patellar tendinitis.

Treatment of knee tendonitis (patellar)

The treatment of all knee tendinitis in general always involves conservative measures, such as resting, applying local ice, systemic or topical anti-inflammatory drugs (or remedies).

Physiotherapy is always an essential part of this treatment, allowing to speed up recovery and rapid return to sport.

Infiltration with PRP ‘s is considered in the literature as having a local analgesic effect and improving the regeneration process.

In cases that are very resistant to these treatments and that cause great functional disability, infiltration with corticosteroids should be carried out with consideration given the increased risks of tendon rupture, especially when applied multiple times.

SURGERY FOR TENDONITIS OF THE KNEE (PATELLAR)

Surgery (or operation) for the treatment of these types of pathologies is always a last resort, says the best knee surgeon in west Delhi.

The surgical procedure consists of debridement of the degenerated tissues, opening the lower pole of the patella and, if necessary, reinserting any areas of tendon rupture, explains the best knee surgeon in west Delhi.

Due to the risks of possible complications, namely the complete rupture of the tendon, postoperative recovery must always be very cautious, respecting the healing timings of the tissues involved and under the supervision of specialist orthopaedic surgeon in Delhi and Physiatry.

Knee Arthroscopy For Knee Injuries

What is knee arthroscopy?

Knee arthroscopy is a minimally invasive procedure that allows access and treatment of injuries that affect the various structures of said joint. For this, 2 or 3 small incisions of less than one centimeter are made that allow access to the joint.

Most knee surgeries that do not involve the placement of a prosthesis are performed with a complete or partial approach with knee arthroscopy in Delhi. It is the technique of choice to address many injuries because it allows a better and greater visualization of the joint. In a non-aggressive way, all the points of the knee can be accessed to clean the cartilage, small perforations of the bone that lacks cartilage (microfractures), stabilize the cartilage and apply substances or elements that allow the cartilage to regenerate (plasma rich in platelets or stem cells).

Likewise, knee arthroscopy is also used as support for other open techniques, since it improves the diagnosis and prognosis of the patient's injury, as it is less aggressive.

The arthroscopy in Delhi can be performed under local, regional or general anesthesia, depending on the injury and the patient. The anaesthesiologist will decide the best method for the patient, as long as he suffers as little as possible.

Why is it done?

Knee arthroscopy is used to solve knee injuries. Thus, meniscus injuries are one of the most common pathologies and, thanks to arthroscopy, it is possible to preserve most of the menisci, since the resection is not complete but partial. Meniscal sutures and the possibility of transplanting the meniscus with knee arthroscopy are common techniques that allow better protection of the cartilage of the joint.

Another of the most dangerous injuries related to sports practice is the rupture of the anterior cruciate ligament. If this is injured, it causes instability in the knee that makes it impossible for the patient to perform practically any sport. If the instability continues, it can damage surrounding structures, such as the menisci and cartilage. Hence, it is necessary to reconstruct the anterior cruciate ligament with grafts, accessing the joint through arthroscopy.

On the other hand, cartilage injuries (chondroplasties, osteoarthritis or osteochondritis) are also very common. Preserving the cartilage will also preserve the joint, avoiding wear and tear on the knee.

What does it consist of?

The orthopaedic in Delhi will make the small incisions in the knee to be able to access it. He will first fill the knee joint with a sterile solution and remove any cloudy fluid. This way he will be able to see the joint clearly and in detail.

The orthopaedic in Dwarka will then insert the arthroscope (a very thin device with a camera on the end) into the knee. This device sends the images to the television monitor, so that the surgeon can see all the structures in detail. Through the other holes, the surgeon will introduce the surgical material that will allow him to address the injury and repair the damaged structures.

It is a procedure that usually does not last more than an hour. After that, the patient will be transferred to a rehabilitation room and will be able to leave the hospital after two hours, more or less.

Preparation for knee arthroscopy

Before surgery, the patient must undergo a complete physical examination so that the specialist can assess their health and any anomaly that may interfere with the arthroscopy. Likewise, the patient must inform the orthopaedic surgeon in Delhi of the medication he takes, so that he can tell him which ones he should stop taking before the intervention. Some complementary preoperative tests will also be carried out, such as magnetic resonance imaging, electrocardiogram or blood tests.

Care after the intervention

Recovery after arthroscopy is faster than conventional open surgery. However, the advice of the specialist must be followed so that the knee recovers correctly.

It is normal for the patient to experience swelling in the days after the intervention, so it is recommended that the leg be elevated during those first days after the surgery. Also, the application of ice will relieve pain and reduce inflammation.

The incisions should also be healed, keeping them clean and dry. The orthopaedic in West Delhi will tell the patient when they can shower or change the bandage.

On the other hand, shortly after the intervention, the patient must begin rehabilitation exercises with a Physiotherapist in Dwarka, who will establish a program appropriate to the patient and the injury. This will help restore motion and strengthen your knee muscles.

Alternatives to this treatment

The alternative to knee arthroscopy in West Delhi will be conventional open surgery, which is currently only used in more serious cases, in which a prosthesis must be placed. Any other technique will suppose a greater invasion in the knee and a worse postoperative period.