Dr Udai Prakash is organising THE HYDERABAD OSTEOTOMY COURSE, on 2nd June at Taj Deccan to help knee surgeons share their wealth of experience in all aspects of knee osteotomy surgery, rehabilitation and dealing with complications.
Osteotomy means “cutting of bone in such a way so as to re-align it in its correct position”. There are many instances when a surgeon may offer an osteotomy as a course of treatment. For example:
- Bow legs or knock knees in children and young adults
- Straightening of man-united fractures
- Alleviate pain in arthritis of joint
- Correction of mal-tracking or recurrent dislocation of patella
- Correction of various congenital deformities etc
There has been a resurgence of interest in the use of osteotomy for alleviating pain in the knee due to arthritis. This procedure avoids or postpones knee replacement surgery or simply can be thought of as an alternative to knee replacement.
Many young adults also have deformities in their legs which could give them an awkward gait as well as prevent them from taking part in active sports. These deformities can also make them very socially conscious about the appearance of their legs. Many young girls with deformities are brought to us by parents anxious about their marriage.
The course has a mix of national, international and local faculty with a wealth of experience in this technique. There will be a live surgical demonstration and series of talks and discussions.
The course is targeted towards the young knee surgeon keen to develop an interest in this technique. Experienced surgeons will also gain from this course and will have a chance to network and learn the nuances of this surgery from experts.
For More Details : Click Here
Ankylosing Spondylitis (AS) is a condition most commonly affects young males. It is known to cause stiffness in spine and hip joints. Importance of hip involvement in AS has been recognised as a commonly disabling problem, whereas involvement of other joints like shoulder is less frequent and less severe. In contrast to the classical changes of AS in the spine the changes in hip does not lead to formation of new bones, but it results in an erosive disease, which destroys the joint. These changes start occurring fairly early on in life, and total hip replacement is often the therapy of choice in this difficult clinical situation.
In the early stages, ankylosing spondylitis is likely to cause:
- pain in the lower back in the early morning which eases through the day or with exercise
- pain in the sacroiliac joints (the joints where the base of your spine meets your pelvis), in the buttocks or the backs of your thighs.
- Hip involvement usually comes on gradually, and although the pain often is felt in the groin area, it can sometimes be felt in other areas of the body, such as the knees or the front of the thigh
In advanced stages
- Lower back and neck stiffness resulting in bending and twisting of torso and neck
- Fusion of hips(Hip Ankylosis)
In the past, surgical fusion of the hip was performed to reduce the pain but at the cost of losing movement at the hip joint. Numerous studies now have however proven that total hip replacement in hip ankylosis is the most favourable line of treatment. It provides patient with pain relief , near normal movement of the hip joint and perfectly normal walking pattern.
At Udai Omni, total hip replacement for a fused or ankylosed hip has a long history of over ten years. To date, we have had a 100% success rate with no failures. This is a technically demanding procedure but if done well, the results are extremely gratifying as one can see in the example seen below:
A 33 year old software engineer came to us in 2009 with a fused right hip that resulted in a very awkward gait. He was obviously very conscious of his disability that affected his social life as well as his work. He had been to see many orthopaedic surgeons but could never get the confidence that he would walk normally again. During my annual visit to Udai Omni hospital from the UK, this young man consulted me and agreed to get his surgery done by me. Within six weeks, he could walk independently without a limp and eventually got back to his passion of swimming.
Video of patient swimming!
Update on Joint Replacement Surgery
Joint replacement surgery has come a long way over the last six decades. The most common joints that are being replaced across the world are the knee, hip, shoulder, elbow and ankle in that order. In the USA over 700,000 knee and around 400,000 hip replacements are done annually. These numbers are expected to rise exponentially to over 4 million procedures by 2030. The data in India is not very robust but estimates vary between 100,000 – 200,000 knee replacement procedures. Hip replacement numbers are substantially less. Indians seem genetically more predisposed to knee arthritis compared to their counterparts in the West. The most common indication for knee replacement is osteoarthritis. In contrast, Indians seem well protected against osteoarthritis of the hip which is very common in the West. The most common indication for a hip replacement in India is Avascular Necrosis because of injudicious and rampant use of steroids by medical practitioners.
Indications for a knee replacement include :
- Rheumatoid arthrits
- Post traumatic arthritis
When is a knee replacement advisable? I generally advise surgery in patients who have advanced arthritis when conservative measures have failed to control the pain and disability. Age should not be a criterion for advising a knee replacement.
There are two types of knee replacements : Total Knee Replacement and Partial Knee Replacement. Partial Knee replacements are done by surgeons who are trained in the procedure. Most surgeons perform a total knee as a standard procedure for osteoarthritis whether it involves a single compartment or not. At Udai Omni, we perform partial or unicompartmental knee replacement if the arthritis is limited to one compartment. About 40% of our knee replacement procedures are partial. The benefits of partial knee replacement include:
- early recovery
- fewer complications like MI and DVT
- ability to sit on the floor and climb stairs
- natural feel of the joint rather than a feeling of a lump of metal in the knee
- ability to take part in leisure sports and activities
The success rate or survivorship of knee replacements in general are very good. Overall we are seeing a 90% survivorship at 20 years.
Many different types of implants are available. A standard implant made of cobalt chrome alloy and a polyethylene spacer is sufficient for over 90% of the patients. A ceramic coated implant like the “bionic gold” or “oxinium” prosthesis is advisable for those with allergy to artificial jewellery. There is no evidence that these implants perform better than a standard implant.
The most common indication for a total hip replacement in India is Avascular necrosis of the femoral head. Other indications include rheumatoid arthritis, post traumatic arthritis, sequelae of childhood conditions like dysplasia, infections, Perthes’, SCFE etc.
Age is not a concern these days with advent of better materials and designs. Many patients in India tend to be young – in their 20s and 30s.
Floor activities: Traditionally, patients with hip replacements were told not to perform any activities on the floor. With better designs now available in India, a good competent surgeon should allow their patients to sit on the floor for various washroom activities and other activities like eating, praying etc. Many patients with a hip replacement get back to a normal lifestyle which can also include gentle sporting activities like badminton, table tennis, golf, trekking etc.
There are essentially two types of hip replacements – cemented and uncemented. Both perform equally well although the tendency is to do uncemented hips in the younger people. The bearing – ie the ball and the socket lining are the key for long term success. Ceramic heads and liners are generally recommended in the young and a metal head with polyethylene line may be suitable for the middle aged to elderly.
Survivorship and success of most standard hip replacements has improved significantly over the last few decades. Now, over 90% of our patients can expect their hip to survive 20 years. I would imagine this figure will get better as we follow our patients up in the future.
Enhanced Recovery after joint replacement:
Success of joint replacement, whether it is the hip or the knee depends on many factors. A well trained experienced surgeon is the key. However, other factors like patient engagement, physiotherapy and pain management are also extremely important.
At our hospital, we provide multi modal analgesia with the help of our expert anaesthetists to mobilise the patient within a day of surgery and discharge them home within 3 days on average. With advent of ambulatory selective nerve blocks and judicious use of oral and injectable analgesics, our patients mobile early and their VAS (visual analog score) for pain out of 10 is usually between 2-4. Knee and hip replacement need not be a painful experience any more.
Surgery and joint replacement for advanced arthritis is going be around for a long time to come. There is no procedure or medicine to reverse advanced arthritic changes and deformity, whether it is the hip or the knee. No stem cell procedure or cartilage regenerative procedure will help in this regard. Media and pharmaceutical industry have a long track record of influencing the patient who would obviously prefer conservative procedures over surgery.
Industry is working on improving the performance of the implant by improving the coating and bearing materials.
Preventing arthritis by keeping oneself active and lean may be the best solution to prevent future arthritis and this avoid surgery.
Biological replacement from either ones own tissue or animal tissue is still a distant dream but a lot of work is being done across the world.
On the eve of World Osteoporosis Day, doctors pointed out at an alarming rise in the number of osteoporosis patients. Almost every other person over the age of 50 years is likely to suffer from osteoporosis, they said.
According to International Osteoporosis Foundation, one in three women and one in five men aged 50 years and over will suffer an osteoporotic fracture. Osteoporosis makes bones weak and fragile so much so that they can break even after a minor fall, a bump, a sneeze, or a sudden movement. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.
“Old people may not be fit for surgery and therefore, suffer pain forever,“ said Dr Udai Prakash, director and specialist in joint replacement, Udai Omni Hospital for Advanced Orthopaedics and Trauma. Osteoporosis is however, preventable and starting early is helpful.“The best thing that can be done to prevent osteoporosis is to exercise regularly as it helps keep the bone strength intact. Adequate sun exposure and calcium rich foods can help prevent it,“ said Dr Rajkiran Dudam, consultant Rheumatologist, Star Hospitals. Read More
I was recently in Munich to update himself in the latest technology in knee ligament reconstruction. The Arthrex surgical skills lab is equipped with the latest arthroscopic wet and dry lab simulators and is stocked with a complete inventory of the latest instrumentation and implants.
The exposure certainly gave me the edge in offering my patients the latest surgical options in knee ligament surgery.
The knee has several ligaments that can get damaged after sports injuries and accidents. These include the ACL (anterior cruciate ligament), the PCL (posterior cruciate ligament), MCL (medial collateral ligament) etc.
Without surgical reconstruction many young patients can never get back to sports and an active lifestyle. The knee becomes vulnerable to getting worn out (arthritis) at a younger age than average.
Early and expert ligament reconstruction can help young people get back their former active lifestyle and delaying surgery can result in damage to other structures within the knee. It’s like a loose hinge on a door, if not repaired early can result in other hinges coming loose.
Knee arthroscopy procedures (keyhole surgery) have advanced many fold in the last few years. This was an opportunity for surgeons like myself interested in knee surgery to update themselves.
The experienced faculty from around the world conducted practical demonstrations in some of the most advanced arthroscopic (keyhole) procedures for ligament and meniscal injuries of the knee.
This is the latest in Anterior Cruciate Ligament reconstruction using the all inside technique which would give a patient less post -operative pain and a quicker recovery.
Dr Ved Prakash handing over blankets to Sub Inspector Naidu (Abids). These were distributed to the homless in the Nampally /Abids area this winter which has been exceptionally harsh.