HKS Clinic

Hi,

I am Dr. Hitesh Kubadia, Orthopedist. I will talk about the queries being asked about knee replacement.

Q1: How long my replaced knee lasts?

Ans: The knee should last for almost 15-20 years if you are taking good care of it. It also depends on the patient's moving activities. If a patient is in sports, it will not last for a long.
 

Q2: How long will it take for me to be back to the normal routine?

Ans: It is major surgery. The body takes time to adapt it. With minimally invasive surgery, it takes less time. But I would say that within a few days, the patient is able to take a round of their compound. They are able to go to the market and come back. Maximum time is required for 6-12 weeks to live a normal life. But yes, the patient may suffer from a little pain because the body is accepting the new joint. There is a bit of swelling around the knee. It causes some burning sensations around the knee. These are all the normal process of healing. They all settle down over a period of time.


Q3: Patients ask when I would be able to sit down and use Indian toilet?

Ans: I would never suggest my patients do those activities on a routine basis but doing once a while will not cause much harm. But if a patient is doing this activity continuously, the life of the knee will become much small. That is why it is never suggested to do these activities.

Q4: Patients ask, can I postpone my knee replacement with alternative methods, non-surgical methods.

Ans: Yes, osteoarthritis is a debilitating disease. It is a degenerative disease which happens with the age. Yes, there are times when we try to protect the knee. When we fail to give pain-free treatment then we talk about knee replacement. Physiotherapy in such cases helps a lot. Body muscles are very important to be strong. So, they decrease the load of the knee. And causes less degeneration around the knee. Sometimes, we also inject certain gels in the knee and helps the knee for the frictionless movements. And that also helps in causing less pain around the knee. These are a few methods tried in early and moderate arthritis. It is only when these methods actually do not help the patient to get enough pain relief in their daily routine. Then we talk about replacement.

Hi,

I am Dr. Hitesh Kubadia, Orthopedist. I will talk about the problem of the shoulder joint. Patients tell me that they have frozen shoulder. They may have frozen shoulder but what I have seen that it is not frozen shoulder in a few of the cases. What they have is called subacromial. They have some swelling in between 2 bones. Because of this, the movement of the shoulder gets restricted. This causes a lot of pain. This reduces the movement of the shoulder. This can be easily diagnosed in the clinical examination. Very rarely we need to do an MRI scan. We insert an injection in the joint which helps in reducing the swelling and pain.

The moment pain is reduced, the shoulder starts moving comfortably. Another common problem is of shoulder dislocation. The shoulder is a kind of a socket joint. It has a ball and a socket. The shoulder is a very versatile joint and requires a lot of movement. The socket is very shallow. To increase the depth, the tissue is called liberal tissue. Something will get teared then the only shoulder will come out. And when we put the shoulder back to its place, tissue also goes at its place. So, it becomes common for the shoulder to get dislocate again and again. Every time when shoulder gets dislocated, there is no damage causing in the ligaments. So, what is recommended?

We impair the tissue and then it is back to its place. This is done arthroscopically. When tissue is back to its origin, it prevents the shoulder from coming out. Another common problem we see in the older age group is the tear in the rotator cuff. Now, what is it? It is a very common pathology. A rotator cuff is a group of muscles. When tender tear, it actually goes back and comes and lies between the 2 bones. Again it causes pain. Being a very important stabilizer of the shoulder, taking out the shoulder becomes very difficult. So, what is to be done as it causes a problem in the routine activity. These are the common pathology are seen around for shoulders and they have a very good system of the treatment. So, treatment helps in decreasing the pain.

Thanks!

Hello,

 I am Dr. Hitesh Kubadia, orthopaedic and the joint replacement surgeon in Mumbai and I am here to talk about a common surgery which is done in orthopaedics called the total hip replacement. There are lot of myths and there are lot of questions about this surgery. I thought I will answer a few of them. Like in the knee joint, when the non-surgical methods fail to give relief for knee pain and we think about knee replacement. Similarly, for a hip joint problems, when the non-surgical method like medications, physical therapy and drugs fail to give relief and a person finds it difficult to get on with his day to day activities and activities of daily living, that is when a surgical option can be thought about. First let's understand about the hip joint. Hip joint is a big, large ball and socket joint of the lower limb, which connects the pelvis to the lower limb. And being a large joint and it is a being a weight bearing joint, any problem with the joint can cause pain.

Common most common problem with the hips are seen are osteoarthritis, rheumatoid arthritis, avascular necrosis of the femur, fractures of the neck of femur these are all very common problems about the hip which can make a life very disabling for the patient. These are the few conditions where you know hip joint replacement may become very necessary for the patient to continue with his day to day activities. First let's understand what the hip joint is made up of. Hip joint has a socket which is the acetabulum part of the pelvis and a ball and a ball and a ball on the femoral side which articulates with the acetabulum and has a smooth glistening surface which is called the articular cartilage and which causes friction-less movements. Any problem with this cartilage or any avascular necrosis of the head of the femur causes this cartilage to denude and over a period of time causes a lot of wear and tear and this wear and tear causes a lot of friction friction full movements across the hip joint and causes pain.

This is simply nothing but osteoarthritis of the hip joint. All these common problems are normally first treated non-surgically with medications, with physical therapy, with physical aids like a cane or a walker. But when these modalities stop giving enough relief to the patient in their day to day activities like walking, get going up and down the stairs, getting in and out of the chair or getting in and out of the car even. So, these are very activities of daily living and when these start getting affected in day to day activities, then a surgical option should be thought about. Total hip replacement is one of the most consistent methods of giving you pain relief and has become the gold standard and and almost all these hip problems, it has become the most consistent way of giving patient pain relief and getting him back to routine activities and living. It has now become pretty safe also with the advent of modern-day anaesthesia, with modern day techniques of surgical approaches so it has become very very safe today. So, what is done in a total hip replacement? Total hip replacement is a surgery where the damaged part of the hip joint is replaced by a metallic prosthesis. Okay. So, it is formed of 2 as the hip is formed of 2 components: the socket and the ball. Similarly, the components of the prosthesis are also of 2 things.

One is the socket which has a metal shell and has a plastic or a ceramic liner to it and has a femoral stem which goes into the hollow part of the femur and gets fixed into it. And has a ball, which is either a metal or a ceramic head liner. So, these when they are attached to to each other, and this causes friction less movements. There are various types of prosthesis which are available today. They can be cemented, they can be uncemented. When this that is up to the surgeon's discretion what is best for the patient and looking at the X-rays, looking at the physical examination of the patient, we very often conclude what would be best for the patient. In today's niche, the trend is more towards cementless fixation having a scratch fit into the bone of the patient and they are they seem to be working longer than the cemented versions. And also, there are other things which come into consideration is the liners which we use.

You know nowadays there are enough reports across the world that the liners of ceramic with polyethylene or ceramic on with a with a ceramic liner, they seem to be having much less wear over a longer period of time and probably will last for a very very long time for the patient. There are enough reports which suggest they may even last beyond 20-25 years too. I hope this information was useful to you.

Hi!

This is Dr. Hitesh Kubadia, I’m an orthopedic and joint replacement surgeon, specializing in minimally invasion joint replacement surgeries using the muscles sparing approach. I also do a lot of partial knee replacement i.e. called a unicompartmental knee replacement which is the next thing in trying to preserve as much as natural tissue as possible.

I’m here to explain something about osteoarthritis of the knee which is a very common problem faced by lot of elderly population and it disabled them in day to day life. These are the small models of the knee here so that I can explain it to you all and you all can understand what is the actual problem here. Now if you look at this is the knee model so if you look at the knee the knee is made up of a lower portion of the femur and upper portion of the tibia, so this is covered by a cartilage here, this blue thing which is marked up here is the cartilage and this is a very smooth glistening surface which allows for frictionless movement across the knee. OK.

As we age as we creates strains in this cartilages, these cartilages develop some bumps in their surfaces. So this surface doesn’t become as smooth as it once was. As we age as the friction keeps on increasing with a period of time this gets worn out completely. So much so that the underline bone gets starting visible and this causes tremendous frictions on your movement and causes pain. As people still pull on and then what happen this all the 3 compartments of the knee, the medial compartment, the latter compartment and the front compartment and the inner compartment the outer compartment and the compartment which is in the front all get worn out.

.So this causes pain and disability and pain for the patient and effects the day to day activities of life. Osteoarthritis has various forms of treatments, initially, everything is nonsurgical so when you try all those non-surgical methods to relief so that your life continues with lot of more than ease. But when these non-surgical methods like injections in the knee or physical therapy and injections in the knee start failing to give you enough relief then we need to think about surgical options.

So when we see on the x-ray on the clinically examine the patient and we see only one compartment of the knee which is damaged and the other part of the knee is very healthy it makes sense to do only you know change only that compartment of the knee which is actually causing the problem for the patient. So what is done here, as you look at this model is the friction between only in this compartment of the knee the other compartment of the knee is nice and smooth so what is done is only this compartment is changed. So what is changed with is you just resurface the area which is actually damaged and the resurface the lower portion that is damaged so which we removed this portion of the lower portion of the tibia and what is replaced by a small alloy of cobalt chrome and other cobalt chrome alloy at the plate this plate and medical grey plastic is inserted between the two surfaces and this movement becomes more than glistening over the period of time.

So this gives relief and gives fantastic relief again this is a minimally invasive surgery and since all the ligaments and the part of the knee is preserved and they are natural and they are glistening so the feel of the knee is much more natural and we have now enough reports across the world. These things lasting for even 20 years there is actually slowly passing the results of a traditional total knee replacement. We just spoke about the partial knee replacement but when we see the arthritis is confined to all the three compartments so this is no point in changing only the one part of the knee so that’s we come to the total knee replacement. So that’s what gives the patient long-term relief.

Again this done through a minimally invasive approach, muscle sparing approach so that the recovery time is much faster and much shorter. Right! So here we look at this model see this the whole knee is damaged the inner compartment the outer compartment the whole knee is damaged. So what is done here? Again resurfacing part so only the damaged portion of the cartilage and bit of bone is removed like this and we changed the whole thing off, and this is replaced with a cobalt chrome allow base plate and a medical grey plastic. Again on the femur side again cobalt chrome alloy which is fitted across. This is fitted to the bone with bone cement and this gives you lasting movements and comfortable movements across life. If you are or your family members face knee pain or hip pain in day to day life and they need a consultation with me they are most welcome to contact us through HKS Clinic or through lybrate.com