WHAT IS SPONDYLOLISTHESIS? Conversation between patient & Dr Raghava

 

in conversation with Dr Raghava Dutt Mulukutla, Orthopedic Surgeon and Chief of spine surgery

Q. Doctor I am suffering from back and leg pain and I am told that my vertebra has slipped forward.

A. You are suffering from a condition called spondylolisthesis. Here one of the vertebra slips forwards over the vertebra below.

Q. How does this happen?

A. There are a number of reasons for this. This could result from anomalies in the spine at birth, some in early childhood and some due to fractures and various diseases and conditions of spine.

The two most common varieties

1. the first variety, when the vertebra slips forwards between 4-6 years of age. This may cause back pain or leg pain during childhood or during adulthood. Sometimes due to extra weight of pregnancy, women come to doctors with back pain and this condition is then diagnosed

2. the second variety is one which is somewhat common in females at about the age of forty. This is due to degeneration (wear and tear) and is more common in women who are overweight.

Q. What are the treatment options for this condition

A. Most patients get better with physiotherapy and medication. Once the pain subsides it is important to start exercise programmes to strengthen back and abdominal muscle. Walking, sports, yoga, swimming all help.

Q. Do I require surgery?

A. Only if the pain does not subside with physiotherapy, restricted activity for a few weeks followed by exercises etc. Surgery is more beneficial in those who suffer from leg pain rather than back pain alone

Q. What is the type of surgery that is done?

A. In children and young adults sometimes repair of the defect in the vertebra .is done to prevent back pain.Mostly screws and rods are placed in the spine and the vertebra that has moved forwarded is brought back to its original position. Cages are also used to maintain the reduction and restore the height between the vertebrae. Fusion is routinely done .

Q. How long do I need to take rest? And what are the precautions to be taken after surgery

A. You will be out of bed 2nd or 3rd day after surgery. You need to stay in hospital for 4-5 days. You will be in ICU for a day. You will be given a brace to support your back for a few weeks.

Q. When can I get back to work?

A. You need 6 weeks time for light duties and 3 months for heavy work.

Q. Do I need to undergo lot of physiotherapy?

A. You hardly require any physio. A few months after surgery physios will teach you a set of exercises which are very easy to follow and can be done at home.

Q. How painful is the procedure?

A. The procedure is not that painful and you will be given adequate pain relief medication after surgery

Q. can I play games and sports after surgery?

A. Swimming, yoga ,sports are all beneficial. You will be told how to lift weights and also given a set of exercises to strengthen your back.

Q. Will surgery affect my married life?

A. Not at all . You can have a normal married life and women can have babies and undergo normal deliveries

 

BLOG – Dr Udai Prakash at the Arthrex Surgical Skills Lab – LATEST INNOVATIONS IN ADVANCED KNEE ARTHROSCOPY at Arthrolab, Germany

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.

knee-arthroscopy-1

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.

 

knee-arthroscopy-2 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.

BLOG – HEALTHY EATING by Dr Deepa Agarwal, Nutritionist/ Dietician

Every now and again many of us resolve to improving our health habits and promise ourselves to eating healthier. Follow these tips to treat yourself to healthy eating.

1. Don’t deprive yourself.

Aim to eat nutritious foods your body loves 80 percent of the time. Use that other 20 percent to treat yourself a bit.

2. Graze healthfully.

Tide yourself over between meals with healthier snacks. Whether your thing is sweet or savory, crunchy or chewy, there are plenty of options for snacking smart.

3. Eat fresh produce all year long.

Find out which fruits and veggies are in season even in the winter and stock up at the store and farmers’ markets. Eating fresh means eating the tastiest and most delicious produce around.

4. Indulge smarter.

Chocolate-dipped strawberries? Choco-Nut popcorn? Yes, please. Lower sugar doesn’t have to mean less deliciousness.

5. Understand emotional eating.

There is a link between how we feel and how we eat, particularly when it comes to stress.  Figuring out what kind of eater you are and whether you look to food to comfort you in times of anger, boredom, stress, or sadness will help you formulate a plan for making different decisions when faced with those emotions.

6. Make holidays, birthdays, and special occasions a little healthier.

Holidays and special occasions are always a good reason to enjoy delicious food. Luckily, there are plenty of ways to celebrate without going overboard.

7. Be mindful at meal times…

Staying tuned in to what you’re eating (as opposed to the phone or TV) is a great way to eat until you’re full, but not beyond. Being relaxed and mindful can also help you heed fullness cues.

8. …But don’t overthink it.

Recent research shows that the more time we take to think about whether or not we should eat something, the more likely we are to find a reason to justify eating it.  Checking in with yourself about your mood and are great habits to have, but remember to trust your gut.

9. Start the day right.

Studies suggest that eating a healthy breakfast is linked to sustained weight loss and weight management, particularly when that breakfast is nutritious and fiber-rich and high in protein.

10. Use the buddy system.

Having a partner with the same healthy-eating ambitions has been shown to help both people reach their goals.

What you eat can impact every aspect of your life from your mental health to your sleep and relationships. So go ahead and wholeheartedly commit to developing healthier eating habits this year. Set goals that are simple and tangible. Make time to meal plan to set yourself up for success. But above all else, believe in yourself. This is your year. You can do this!

Dr Deepa Agarwal, is Consultant Nutritionist at Udai Omni Hospital. She has an experience of 10 years having completed MSc and PhD in Clinical Nutrition.

To consult Dr Deepa Agarwal, please email enquiry@udaiomni.com

Book an appointment

Joint Replacement Surgery – Hip & Knee

By Dr. Udai Prakash
Dr.Udai Prakash is a consultant orthopedic and joint replacement surgeon at Udai Clinic Orthopedic Centre,Hyderabad.He holds an experience of over 21 years, his expertise include joint,hip and knee replacement surgery.


Hip and knee replacement surgery has a dramatic effect on patients’ lives. It is generally recommended if conservative measures have been ineffective or are likely to be ineffective. Most patients are able to go back to their former active lifestyle as their pain is relieved and mobility restored. Age is not a bar to joint replacement surgery. Modern materials and techniques have largely overcome the problems of wear and loosening of the implant. This brief introduction to joint replacement surgery will give you a flavour of the different types of joint replacements of the hip and knee performed by our surgeons.

Total Hip Replacement 

Total hip replacement is probably the most successful operation performed by any surgeon of any specialty.

Total Hip Replacement

It involves replacing both the acetabulum and the femoral head components of the ball and socket joint. It is indicated in painful conditions of the hip such as osteoarthritis, rheumatoid arthritis, avascular necrosis and certain fractures and in a vast majority of cases it results in a dramatic improvement in the quality of life. Modern hip replacements are made of materials like titanium or high grade stainless steel and contain bearings such as ceramics, cobalt-chrome and highly cross-linked polyethylene that make them very durable. Age is not generally a concern when considering someone for a hip replacement as long as they have the right level of fitness and the operation is done for the right indication. The probability of most good hip implants surviving 10 years is over 90%.

Total Knee Replacement 

Total Knee ReplacementKnee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. This is a well established procedure giving consistently good outcome with long term results often matching and sometimes exceeding those of total hip replacement. In general, the surgery consists of resurfacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button. Functionally, most patients get back to their formal lifestyle including most non-impact leisure activities like golf.

Unicondylar Knee Replacement

Unicondylar Knee ReplacementThis is an excellent procedure for limited arthritis or the knee. Usually performed through a smaller incision than total knee replacement, only the part of the knee that is diseased is resurfaced. The joint therefore feels and behaves more like a normal knee. Recovery is rapid and the patient is often discharged within 2 -3 days of surgery.

Hip Resurfacing

Hip ResurfacingHip Resurfacing is an alternative to hip replacement surgery in some patients. It is a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. There is no long stem placed down the femur so it is more like a natural hip and may allow patients a return to many activities. It seems the ideal option for young individuals with severe hip osteoarthritis who are likely to outlive any prosthesis that they receive and who are keen to carry on with an active lifestyle. In the unlikely event of the resurfacing failing many years down the line the bone stock that has been preserved in the first instance makes the revision in most cases almost as easy as doing a primary hip replacement. According to the Australian Registry data for 2009, performance of hip resurfacing for men under 65 years of age is better than total hip replacement.

Revision Hip and Knee Replacement

Revision Knee ReplacementRevision Hip ReplacementPrimary hip and knee replacements do fail in time for a number of reasons. Revising them is highly specialised surgery requiring extensive training and access to sophisticated equipment, implants and hospital facilities. In most cases the old prosthesis is removed and replaced with a new implant. The surgery is often long and the risk of complications is higher than after a primary operation. Patients tend to spend the first 24 to 48 hours after the procedure in the high dependency unit. Surgery may involve the use of ultrasonic devices to remove the old cement used for fixation of the prosthesis, bone graft and/or custom made implants. Identifying failing joint replacements and performing the revision early is crucial for a successful outcome and therefore a regular follow-up by an orthopaedic surgeon is advisable for all patients carrying a hip or a knee replacement.

Frequently Asked Questions

  1. When is joint replacement surgery recommended?
    The reasons are many. Most patients with severe hip or knee pain as a result of advanced arthritis may be candidates for joint replacement. Joints can also get damaged due to previous injury or infection. There are many more indications including congenital disorders, childhood disorders leading to arthritis in later life, avascular necrosis etc.
  2. How long do joint replacements last?
    On average a hip or knee replacement has a 90% chance that it will survive 10 years and a 80% chance that that it will last 20 years if done by a well trained surgeon at a specialist hospital. The survival is highly dependent on the quality of surgery and the implant used.
  3. What are they made of?
    Modern joint replacements are made of many different materials – these include Cobalt-Chrome alloy, surgical grade stainless steel, titanium. Your surgeon should be able to give you more information depending on what joint you are having replaced. All joint replacements done at Udai Clinic are imported at the moment.
  4. How long will I need bed rest for?
    You will almost never need any bed rest. The aim of the surgery is to get you out of bed as soon as possible after surgery. You will need intensive physiotherapy during the recovery phase of 6-8 weeks.
  5. How long will I stay in the hospital?
    On average a patient after joint replacement will stay between 5-7 days in the hospital.
    Following complex joint replacement, the stay may be longer.
  6. Will I be able to sit on the floor?
    Many patients can sit on the floor after joint replacement surgery whether it is the hip or the knee. However, your surgeon will guide you on this depending on what you are having done and the complexity of the surgery. Kneeling might be difficult after knee replacement surgery. Again, the quality of surgery is the key. If done well and if the patient is motivated, most activities of daily living are possible.
  7. Can I ride a scooter or drive a car afterwards?
    Most patients can start driving after about 6 weeks but please discuss this with your physiotherapist or your surgeon.
  8. At what age is joint replacement recommended?
    Joint replacement can be done at any age. Most patients are between 55 – 80 years of age but the range can be from teenage to over 90 years. As long as the patient is reasonably fit, joint replacement can be done. Your doctor should be able to advise on this.

If it helps, please share!

Spine Surgery in hyderabad

BLOG – OH MY BACK! by Dr Raghav Dutt Mulukutla, Chief of Spine Surgery

If you are one of the few lucky ones who have not yet suffered from low back pain, do not be too happy. Second only to common cold, low back pain is increasing in incidence the world over.  Almost 80-90% of population  is affected by this problem in urban areas and  is the commonest cause of  absenteeism from work for people under 45 years of age in the Western World.

Most of us suffer for a few days to weeks and in some it becomes a chronic problem with umpteen visits to various specialists, homeopaths, ayurvedic  massage treatments, acupuncture, magneto therapy, reiki etc.

In India friends, neighbours, barbers, medical shop owners, grand mothers  are all specialists… they  have their own special remedies to offer and stories to tell. And of course that consultation with the foreign doctor – when I went to USA……… and the stories go on!

Who is at risk?

Almost 90%  have a mechanical reason for their back pain, and in 10% various diseases and disorders are responsible for low back pain. Many risk factors have been identified  :  lifting weights  beyond a workers physical capability, repeated bending and twisting in awkward positions , prolonged sitting especially in slouched position  is well known to produce low back pain. Obesity, cigarette smoking, lack of physical exercise, weak abdominal and back muscles  are some of the very potent factors  in causing low back pain.

What causes back pain?

The very fact that we are born as humans – our upright posture places tremendous stress and strain on the back.

  1. bad posture
  2. prolonged sitting : IT industry/ executives
  3. weak abdominal and back muscles
  4. weak bones ( osteoporosis )
  5. smoking
  6. driving 2 wheelers with bad shock absorbers
  7. over weight
  8. lack of exercises during and after pregnancy
  9. un-accustomed bending forwards and lifting weights

Let’s get to know some of the common conditions that cause low back pain:

The slipped disc: The human spine consists of individual bones called vertebrae separated by  discs-  which simply put  is a  jelly surrounded by fibrous tissue. When the discs get damaged or degenerated, it slips backwards and presses on the spinal cord and nerves causing pain in the lower  back or along the leg – known typically as sciatica.

Non surgical management: 

Over 90% of patients with slipped discs do not require surgery and get better with rest, physiotherapy and medication. You do not have to sleep on floor or hard beds. A firm bed is all that is required,  and rest for more than one week is not advisable. There is no need  for strict bed rest and you can move about  if pain permits.  Exercises should be commenced after the pain subsides and your physiotherapist would be the best person to teach you the exercises  to strength the back  and  abdominal muscles.

The surgery

Traditional surgeries such as laminectomy have no place in the management of disc prolapse. Surgeries such as Fenestration, Microscopic surgery or  Endoscopic microdiscectomy(Key hole surgery) offer the best results. The minimally invasive surgeries do not weaken the back muscles  and return to work is much quicker.

Spinal stenosis:

As we get older , the spinal canal  gets narrowed  due to arthritis and degeneration of tissues in the spine-resulting in pressure on the nerves. Typically  the patient may experience  low back pain, buttock pain and leg pain. Patients find it difficult to walk for long distances and have to rest after  walking for a few minutes. He/she can resume walking once the pain subsides. Majority of the patients get better with change in life styles, physiotherapy and epidural steroid injections in to the spinal canal. Modern surgical techniques once again give lasting relief  in those who do not get better  with non operative treatments.

Spondylolisthesis: This is slipping of one vertebra over the other, resulting in pressure on the nerves and again is responsible for back pain and sciatica. In those who do not get better with non operative measures, surgery offers good relief from pain.

Osteoporosis:  Again a common condition in women, is responsible for significant back pain and vertebral fractures. Exposure to sunlight, physical exercise, balanced diet,  go a long way in managing this problem. In those who suffer from fractures, minimally invasive procedures such as vertebroplasty – which is injection of synthetic material (bone cement) under local anaesthesia gives excellent results.

Other conditions: Curvature of spine (hunch back-scoliosis, TB, cancers and tumors and a variety of disorders can affect a human spine. Prompt consultation  and investigations would  help in diagnosis and treatment.

Who should be consulted for spine surgery?

Orthopaedic  surgeon or  Neuro surgeon? That is the doubt in almost everyone’s mind. Traditionally both operate on Spines.Today we have a sub-speciality  – Spine Surgery. Spine surgeons are specially trained to perform spine surgeries and it would not be too long  when Neuro surgeons would be operating only on Brain and Orthopaedic Surgeons on bone and joints and  Spine surgeons alone would be performing Spine surgeries.

Information on the Internet: Beware! Not all information on the net is accurate and current. Newer technologies that appear on the net, are like fashions that keep changing and  are industry driven.

Are spine surgeries safe?

Spine surgery is complicated and needs expertise. One need not worry too much about the complications and a well planned and well executed surgery in an understanding and cooperative patient gives excellent results.

Is there an age limit?

No! Today spine surgeries are performed in infants. Age certainly is no bar.

The second opinion?

When in doubt take a second opinion. But seeing too many doctors is quite confusing.

For a healthy back

  1. Correct your posture – do not slouch
  2. Get out of your chair every 20 minutes- stand or walk for a few minutes
  3. Getting out of chair is more important than buying expensive chairs
  4. Exercise regularly: yoga/walking/swimming/sports
  5. Quit tobacco

Dr.Raghava Dutt Mulukutla is  consultant orthopaedic and chief spine surgeon at Udai Omni Hospital. He has an experience of over 35 years, his expertise includes spinal deformity surgeries, scoliosis and back pain management.

To consult Dr Raghava Dutt Mulukutla, please email enquiry@udaiomni.com

Book an appointment

Total-and-compartmental-300x180

BLOG – TOTAL KNEE REPLACEMENT versus PARTIAL KNEE REPLACEMENT by Dr Udai Prakash, Orthopaedic Consultant Hip and Knee specialist

If you have been recommended a knee replacement then you may be a candidate for a partial (uni compartmental) knee replacement.You may be a good candidate for a partial or uni compartmental knee replacement if your arthritis is confined to a single compartment of the knee.

Your knee is divided into three major compartments: The medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patella femoral compartment (the front of the knee between the kneecap and thigh bone).

Partial Knee Replacement

In a partial knee replacement, only the damaged compartment is replaced with metal and polyethylene (a surgical grade plastic). The healthy cartilage and bone in the rest of the knee is left alone.

Total Knee Replacement is also a highly successful procedure. More than 600,000 knee replacements are performed in the US annually and this number is set to reach 4 million by 2030. Similarly, in India it is thought that over 30,000 are being performed annually and this number is increasing by 15% annually.

Partial knee replacement numbers are much smaller as not all patients are suitable for this type of conservative surgery and not all knee surgeons are trained in performing this surgery.


Dr Udai Prakash, is chief joint replacement surgeon at Udai Omni. He has over 20 years of experience and specialises in primary and revision hip and knee surgery.

To consult Dr Udai Prakash, please email enquiry@udaiomni.com

Book an appointment

BLOG – WAYS TO GET RID OF YOUR BACK ACHE by Dr Raghava Dutt Mulukutla, Orthopaedic Consultant & Spine specialist

Top ways to get rid of your back ache


1. Reduce your weight

      • Cut off that fat from your diet
      • Less weight on your spine means less pain

2. Get out of that chair

      • Change the way you work, not your job
      • Get up every 20 minutes. Either just stand up or take a few steps

3. Exercise

      • Regular exercise tones up your back muscles
      • Healthy muscles take the stress and strain and protect your spine

4. Quit Smoking

      • Stop smoking. It damages your spine
      • Avoid all tobacco products

5. Consult a Physiotherapist

      • Core strengthening exercise programmes are very helpful
      • Get advise on how to sit/lift weights/posture etc.
      • Learn stretches

6. Use a desktop

      • Use large desk top monitors, and they should be at eye level
      • Do not use laptops and tablets at work places. Restrict their use

8. Have a healthy body & mind

      • Keep diabetes, cholesterol (lipid profile ), blood pressure, thyroid and other medical conditions in good control
      • Avoid excessive worry about back pain


9. Physical activity

      • Brisk walking/ swimming / yoga /sports are essential for a healthy back
      • Indulge in physical activity that you like and enjoy


10. If nothing works

 

      • See a spine surgeon

Dr. Raghava Dutt Mulukutla is Consultant Orthopaedic and Spine Surgeon. His expertise includes spinal deformity surgeries, scoliosis and back pain management. Here he advises on that lingering backache that one needs to get rid off.

To consult Dr Raghava Dutt Mulukutla, please email enquiry@udaiomni.com

Book an appointment

 

Back Pain: Treatment and Care

Back Pain: Treatment & Care

By Dr. Raghava Dutt Mulukutla, Consultant orthopedic and spine surgeon. He holds an experience of over 32 years, his expertise include spinal deformity surgeries, scoliosis and back pain management.

“If you are one of the few lucky ones who have not yet suffered from low back pain,do not be too happy. Second only to common cold, low back pain is increasing in incidence the World over. Almost 80-90% of population is affected by this problem in urban areas and is the commonest cause of absenteeism from work for people under 45 years of age in the Western World. Most suffer for a few days to weeks and in others it becomes a chronic problem with umpteen visits to various specialists,homeopaths,Auervedic massage treatments, acupuncture, magnetotherapy,Rieki etc. In India friends, neighbours, barbers, medical shop owners ,grand mothers are all specialistst have their own special remedies to offer and stories to tell. And of course that consultation with the foreign doctor – when I went to USA……… and the stories go on!

Who is at risk?

Almost 90% have a mechanical reason for their back pain, and in 10% various diseases and disorders are responsible for low back pain. Many risk factors have been identified : lifting weights beyond a workers physical capability, repeated bending and twisting in awkward positions , prolonged sitting especially in slouched position is well known to produce low back pain. Obesity, cigarette smoking, lack of physical exercise, weak abdominal and back muscles are some of the very potent factors in causing low back pain.

What causes back pain?

The very fact that we are born as humans – our upright posture places tremendous stress and strain on the back.

  • bad posture
  • prolonged sitting : IT industry/ executives
  • Weak abdominal and back muscles
  • weak bones ( osteoporosis )
  • smoking
  • driving 2 wheelers with bad shock absorbers
  • over weight
  • lack of exercises during and after pregnancy
  • un-accustomed bending forwards and lifting weights

 

Let’s get to know some of the common conditions that cause low back pain:

THE SLIPPED DISC: The human spine consists of individual bones called vertebrae separated by discs- which simply put is a jelly surrounded by fibrous tissue. When the discs get damaged or degenerated, it slips backwards and presses on the spinal cord and nerves causing pain in the lower back or along the leg – known typically as sciatica.

Slipped Disc
Arrow pointing to the slipped disc, pressing on the spinal cord

Non surgical management:

Over 90% of patients with slipped discs do not require surgery and get better with rest, physiotherapy and medication. You do not have to sleep on floor or hard beds. A firm bed is all that is required, and rest for more than one week is not advisable. There is no need for strict bed rest and you can move about if pain permits. Exercises should be commenced after the pain subsides and your physiotherapist would be the best person to teach you the exercises to strength the back and abdominal muscles.

The Surgery

Traditional surgeries such as laminectomy have no place in the management of disc prolapse. Surgeries such as Fenestration, Microscopic surgery or Endoscopic microdiscectomy(Key hole surgery) offer the best results. The minimally invasive surgeries do not weaken the back muscles and return to work is much quicker.

SPINAL STENOSIS: As we get older , the spinal canal gets narrowed due to arthritis and degeneration of tissues in the spine-resulting in pressure on the nerves. Typically the patient may experience low back pain, buttock pain and leg pain. Patients find it difficult to walk for long distances and have to rest after walking for a few minutes. He/she can resume walking once the pain subsides. Majority of the patients get better with change in life styles, physiotherapy and epidural steroid injections in to the spinal canal. Modern surgical techniques once again give lasting relief in those who do not get better with non operative treatments.

SPONDILOLYSTHESIS: This is slipping of one vertebra over the other, resulting in pressure on the nerves and again is responsible for back pain and sciatica. In those who do not get better with non operative measures, surgery offers good relief from pain.

OSTEOPROSIS: Again a common condition in women, is responsible for significant back pain and vertebral fractures. Exposure to sunlight, physical exercise, balanced diet, go a long way in managing this problem. In those who suffer from fractures, minimally invasive procedures such as Vertebroplasty : which is injection of synthetic material (bone cement) under local anaesthesia gives excellent results.

OTHER CONDITIONS: Curvature of spine (hunch back-scoliosis, TB, Cancers and tumors and a variety of disorders can affect a human spine. Prompt consultation and investigations would help in diagnosis and treatment.

Who should be consulted for spine surgery? 

Orthopaedic surgeon or Neuro surgeon? That is the doubt in almost everyone’s mind. Traditionally both operate on Spines.Today we have a sub-speciality – Spine Surgery. Spine surgeons are specially trained to perform spine surgeries and it would not be too long when Neuro surgeons would be operating only on Brain and Orthopaedic Surgeons on bone and joints and Spine surgeons alone would be performing Spine surgeries.

Information on the Internet: Beware! Not all information on the net is accurate and current. Newer technologies that appear on the net, are like fashions that keep changing and are industry driven.

Are Spine Surgeries safe?

Spine surgery is complicated and needs expertise. One need not worry too much about the complications and a well planned and well executed surgery in an understanding and cooperative patient gives excellent results.

Is there an age limit?

No! Today we perform spine surgeries on infants to aged persons and age certainly is no bar.

The second opinion?

 When in doubt take a second opinion. But seeing too many doctors is quite confusing”

For a healthy back

Correct your posture – do not slouch
Get out off your chair every 20 minutes – stand or walk for a few minutes
Getting out of chair is more important than buying expensive chairs
Exercise regularly –  yoga/walking/swimming/sports
Quit tobacco

Joint Replacement Surgery- Primary or Revision Hip/ Knee

By Dr Udai Prakash, Chief Joint Replacement Surgeon.

Hip and knee replacement surgery has a dramatic effect on patients’ lives. It is generally recommended if conservative measures have been ineffective or are likely to be ineffective. Most patients are able to go back to their former active lifestyle as their pain is relieved and mobility restored. Age is not a bar to joint replacement surgery. Modern materials and techniques have largely overcome the problems of wear and loosening of the implant. This brief introduction to joint replacement surgery will give you a flavour of the different types of joint replacements of the hip and knee performed by our surgeons.

Total Hip Replacement 

Total hip replacement is probably the most successful operation performed by any surgeon of any specialty.

Total Hip Replacement

It involves replacing both the acetabulum and the femoral head components of the ball and socket joint. It is indicated in painful conditions of the hip such as osteoarthritis, rheumatoid arthritis, avascular necrosis and certain fractures and in a vast majority of cases it results in a dramatic improvement in the quality of life. Modern hip replacements are made of materials like titanium or high grade stainless steel and contain bearings such as ceramics, cobalt-chrome and highly cross-linked polyethylene that make them very durable. Age is not generally a concern when considering someone for a hip replacement as long as they have the right level of fitness and the operation is done for the right indication. The probability of most good hip implants surviving 10 years is over 90%.

Total Knee Replacement 

Total Knee ReplacementKnee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. This is a well established procedure giving consistently good outcome with long term results often matching and sometimes exceeding those of total hip replacement. In general, the surgery consists of resurfacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button. Functionally, most patients get back to their formal lifestyle including most non-impact leisure activities like golf.

Unicondylar Knee Replacement

Unicondylar Knee ReplacementThis is an excellent procedure for limited arthritis or the knee. Usually performed through a smaller incision than total knee replacement, only the part of the knee that is diseased is resurfaced. The joint therefore feels and behaves more like a normal knee. Recovery is rapid and the patient is often discharged within 2 -3 days of surgery.

Hip Resurfacing

Hip ResurfacingHip Resurfacing is an alternative to hip replacement surgery in some patients. It is a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. There is no long stem placed down the femur so it is more like a natural hip and may allow patients a return to many activities. It seems the ideal option for young individuals with severe hip osteoarthritis who are likely to outlive any prosthesis that they receive and who are keen to carry on with an active lifestyle. In the unlikely event of the resurfacing failing many years down the line the bone stock that has been preserved in the first instance makes the revision in most cases almost as easy as doing a primary hip replacement. According to the Australian Registry data for 2009, performance of hip resurfacing for men under 65 years of age is better than total hip replacement.

Revision Hip and Knee Replacement

Revision Knee ReplacementRevision Hip ReplacementPrimary hip and knee replacements do fail in time for a number of reasons. Revising them is highly specialised surgery requiring extensive training and access to sophisticated equipment, implants and hospital facilities. In most cases the old prosthesis is removed and replaced with a new implant. The surgery is often long and the risk of complications is higher than after a primary operation. Patients tend to spend the first 24 to 48 hours after the procedure in the high dependency unit. Surgery may involve the use of ultrasonic devices to remove the old cement used for fixation of the prosthesis, bone graft and/or custom made implants. Identifying failing joint replacements and performing the revision early is crucial for a successful outcome and therefore a regular follow-up by an orthopaedic surgeon is advisable for all patients carrying a hip or a knee replacement.

Frequently Asked Questions

  1. When is joint replacement surgery recommended?
    The reasons are many. Most patients with severe hip or knee pain as a result of advanced arthritis may be candidates for joint replacement. Joints can also get damaged due to previous injury or infection. There are many more indications including congenital disorders, childhood disorders leading to arthritis in later life, avascular necrosis etc.
  2. How long do joint replacements last?
    On average a hip or knee replacement has a 90% chance that it will survive 10 years and a 80% chance that that it will last 20 years if done by a well trained surgeon at a specialist hospital. The survival is highly dependent on the quality of surgery and the implant used.
  3. What are they made of?
    Modern joint replacements are made of many different materials – these include Cobalt-Chrome alloy, surgical grade stainless steel, titanium. Your surgeon should be able to give you more information depending on what joint you are having replaced. All joint replacements done at UDAI OMNI are imported at the moment.
  4. How long will I need bed rest for?
    You will almost never need any bed rest. The aim of the surgery is to get you out of bed as soon as possible after surgery. You will need intensive physiotherapy during the recovery phase of 6-8 weeks.
  5. How long will I stay in the hospital?
    On average a patient after joint replacement will stay between 5-7 days in the hospital.
    Following complex joint replacement, the stay may be longer.
  6. Will I be able to sit on the floor?
    Many patients can sit on the floor after joint replacement surgery whether it is the hip or the knee. However, your surgeon will guide you on this depending on what you are having done and the complexity of the surgery. Kneeling might be difficult after knee replacement surgery. Again, the quality of surgery is the key. If done well and if the patient is motivated, most activities of daily living are possible.
  7. Can I ride a scooter or drive a car afterwards?
    Most patients can start driving after about 6 weeks but please discuss this with your physiotherapist or your surgeon.
  8. At what age is joint replacement recommended?
    Joint replacement can be done at any age. Most patients are between 55 – 80 years of age but the range can be from teenage to over 90 years. As long as the patient is reasonably fit, joint replacement can be done. Your doctor should be able to advise on this.
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