Friday, June 15, 2012


Most patients with advanced knee arthritis are still looking for that elusive cure. They are unable to accept that they need surgery. They strongly believe that something or someone somewhere can solve the problem with some magic medicine. They will keep trying fancy treatments like acupressure, rope therapy, braces, etc. The list goes on and on.
In all joints like the knee, the bone ends are covered by a smooth lining called cartilage. Cartilage ensures smooth, painless knee movements. Damage to the cartilage marks the beginning of arthritis. In advanced cases the cartilage lining is completely eroded. The bone below the cartilage gets exposed and bone starts rubbing on bone. This leads to severe pain. The real problem here is that cartilage does not regenerate or grow back. No matter what you try or which medicine you take, the original cartilage doesn’t come back. As the disease progresses and more and more cartilage is lost, the leg starts getting deformed at the knee. This makes matters worse. A crooked leg condemns the patient to more pain and disability. This pain can never go till the cartilage comes back and the leg becomes straight. Both these goals are impossible with non operative treatment!
So why does knee replacement work when everything else is failing? To understand this we need to understand the history of knee replacement. Researchers, scientists and doctors worldwide were struggling to solve the issue of arthritis since centuries. Initially they tried to replace the cartilage with other substances from the patient’s body like fat, fascia etc. But none of the structures they used had the qualities of cartilage and they would breakdown very fast and the procedure would fail. Then in the 60’s a genius called Sir John Charnley made a few landmark discoveries. He invented an extremely strong plastic called high molecular weight polyethylene. This plastic resembled cartilage very closely. The friction between this plastic and metal was as low as between two bones lined by natural cartilage. In addition to its fantastic friction properties, this plastic was also extremely strong. The other landmark discovery was of bone cement. This cement anchored the artificial joint to natural bone so strongly that the union lasted many years. These two discoveries changed the face of replacement surgery. Sir John Charnley designed an artificial hip joint which lasted 10 to 15 years. This was the first successful replacement. Using these landmark discoveries scientists started working on knee replacement. Finally after many attempts they achieved success and durable artificial knee joints were designed.   
Knee replacement works because it achieves both the desired goals. Cartilage is replaced by a strong and durable ‘cartilage like’ plastic. Furthermore the deformity is completely corrected after the surgery. As the damaged cartilage is replaced, the patient gets complete relief of pain. And as the leg becomes straight, this relief lasts many, many years. 
So does knee replacement work? Yes! It is one of the most successful surgeries of modern medicine. But it is a complicated surgery. To work it has to be done properly. The surgeon has to learn the technique and spend an adequate time in training. A well trained, experienced surgeon will do a good job almost every time. Infection is a constant threat to any surgery. In replacement surgery, infection can ruin everything. So in addition to a good surgeon, you need a good operation theatre.
These two factors are the reason, this surgery fails. An inadequately trained surgeon in a poor operation theatre is a recipe for disaster. Because of these issues, this wonderful surgery has earned a bad name.
 Instead of avoiding surgery because of fear which stems from a lack of awareness, I encourage patients to educate themselves regarding the pros and cons of this surgery and gain benefits.
What you KNEEd to know...
What is knee replacement?
Knee replacement is a surgery in which around 1cm of diseased bone and cartilage is removed and replaced by artificial metallic caps. The new joint surface restores normal joint movements and eliminates pain.
When is a patient ready for knee replacement?
1.       When pain is unbearable and constant
2.       When walking even short distances takes a lot of time and effort
3.       When the patient needs a walker or stick support to walk
4.       When the patient stops going out of the house for recreation, work or to attend social functions in fear of pain
5.       When deformity or limp becomes very severe
What are the advantages of this surgery?
1.       Complete relief of pain
2.       Complete correction of deformity
3.       Patient walks independently without help of a stick
4.       Patient can walk as much distance as he/she desires
5.       Patient can climb stairs
How long will a knee replacement last?
Knee replacement typically lasts for 15 to 20 years after which it may become loose and need a revision surgery.
How long will a patient have to be in bed after a knee replacement?
A patient usually walks within a couple of days after the surgery. The patient is able to go to the toilet on his/her own whilst in the hospital itself.
Is this surgery painful?
Most patients experience postoperative surgical pain. This pain can nowadays be well controlled with modern pain management techniques.
How long is the recovery?
Most patients need 1 – 2 months to recover completely and experience a pain free joint
What are the complications of this surgery?
Infection is the most feared complication. With modern theatre setup and discipline, infection rate is less than 0.6%. All other complications are rare.
Armed with this knowledge, the arthritic patient need not suffer anymore!

Knee Replacement at concessional rates at Inamdar Hospital, Pune

Tuesday, June 05, 2012

The Ultimate Vaccine

We all know about vaccines. A vaccine is any preparation used to confer immunity against a specific disease.  It’s an amazing discovery of medical science and a very appealing concept indeed. You take the vaccine and you will be protected from the illness forever. As soon as a new born baby is born, parents are rushing to the doctor to get him/her vaccinated.
Wouldn’t it be wonderful if there was a vaccine for blood pressure or diabetes? Or a vaccine for knee arthritis or spondylitis?
What if I tell you that there is such a vaccine? And it’s not a new invention. It’s been around for some time. And better still, it’s free! Would you believe me?
Believe it or not, it’s true. Such a vaccine does exist! .... Unfortunately we have forgotten about it. This vaccine is EXERCISE!
Imagine that you have just bought a new expensive car or jewellery that you have been wanting for a long time. You will look after it well. The car will be cleaned and serviced regularly. The jewellery will be kept carefully in a box. Your body is a gift from God! Close your eyes and ask yourself, have you been good to your body? Have you looked after it? If you don’t maintain your car, it will give you trouble. It won’t run properly. But still most people will look after their cars far better than they will care about their own bodies. A bad car is an inconvenience, but a bad body means suffering!!
A healthy body is crucial to be able to enjoy life. All the money in the world is a waste, when you don’t have health. Without health, you cannot enjoy your new car or house or your vacation. And at times it is too late. You cannot even buy health. So how do you vaccinate your body against disease? How do you look after this beautiful gift?
Prevention is better than cure. If you don’t want to suffer with ill health and disease, you have to act now. Physical fitness with exercise is the best way to avoid lifestyle related illnesses like blood pressure, heart disease and diabetes. And it only works if you do exercise regularly throughout life.
As young people we get busy with work. We want to work hard so that we earn and secure our future. Many of us get obsessed with work. We lose track of priorities and we lose perspective. What is the point of working so hard and abusing your body? You may or may not end up becoming very rich, but you definitely will end up with a lot of illnesses. So all the hard earned money is then spent to become better and many times in spite of the money spent, you remain ill.
So my sincere request to young people is to not lose the wonderful days of their youth in work. Everything should be in moderation which is true also for work. Work is important and everyone has to work but draw your limits. The human body is not designed to work 24/7. Earn a little less but enjoy it by remaining healthy. Extra money earned is useless as it is at the cost of health.
What type of exercise should we do? There are three basic types of exercise. The most important exercise is aerobic exercise. Aerobic exercise is any activity that increases your heart rate (you can hear and feel your heart beating fast) and your breathing rate (panting). Regular aerobic exercise is the best vaccine against lifestyle disorders. Everybody cannot do aerobic exercise. Especially if you are a heart patient, you need to check with your doctor before starting aerobic exercises. Those who are not accustomed to aerobic exercise should start slowly. Eventually one should increase to the recommended 30 to 40 minutes of aerobic exercise daily. Some examples of aerobic exercise are brisk walking, jogging, running, cycling, swimming and rowing. Aerobic exercises have become famous as ‘cardio’ exercises in modern gyms. While doing exercise, it is important to remember to go to the next level of difficulty, just like a student progresses to the next grade or standard in school. Cycling is a safe exercise for those suffering from knee pain.
The next exercise is Yoga or stretching exercises. These exercises are good for the health of joints and they are a vaccine for arthritis and spondylitis. Yoga exercises ensure that all joints move through their complete natural range of motion.
The third type of exercise is individual muscle strengthening exercises. These are exercises which ‘body builders’ do. Strong muscles protect joints from damage. Most people do not need to use weights. Anti gravity muscle endurance exercises are sufficient.
Many patients ask me if yoga is enough. All three types of exercises are important. So yoga on its own is not enough. Yoga will complement aerobic exercise to give you a better result.
Many patients tell me that they are working in the office or the kitchen all day and that is enough exercise! Physical work is better than sleeping in bed but it is poor exercise. Work generally results in exertion and exhaustion rather than exercise. Those who exercise regularly develop enough stamina so they can work harder, faster and more efficiently without getting tired.
Moreover exercise comes with pleasant side effects! People who exercise feel a sense of pride and satisfaction like the proud owner of a new diamond set. This translates into a positive energy in their daily lives. So they work better, they maintain better relations with their loved ones and they are more happy.
If you are one of the people who says ‘I don’t have the time for exercise’ then I feel sorry for you. If there is time to eat, if there is time to sleep, if there is time to pray, if there is time to watch television or read a newspaper then there can be time for exercise. It is a question of priority and commitment.’ Where there is a will there is a way’  
The worst enemy of exercise is laziness. It is an enemy of many things. There is no glory in laziness. We have to fight this enemy in every living moment of our lives!
So my dear readers, if you want the gift of good health then you have to work for it. Get up and get going and grab that vaccine!