FAQ - ARTHROSCOPY
FAQ - FOR SHOULDER ARTHROSCOPY
Q. When Shoulder Arthroscopy Is Recommended?
Shoulder arthroscopy is recommended if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.
Common shoulder arthroscopic procedures include:
- Rotator cuff repair
- Bone spur removal- subacromial decompression
- Removal or repair of the labrum-Bankarts/SLAP repairs
- Repair of ligaments
- Removal of inflamed tissue or loose cartilage
- Repair for recurrent shoulder dislocation
- A torn or damaged biceps tendon
Less common procedures - nerve release, fracture repair, and cyst excision can also be performed using an arthroscope.
Q. Surgical Complications with shoulder arthroscopy?
Complications following arthroscopy are very rare.
- Infection rates tend to be very low
- Stiffness after surgery -frozen shoulder, and prolonged rehabilitation
- very rarely, complications like further damage to the joint or damage to the nerves or blood vessels in or around the area of the operation
Q. What are the details of the shoulder arthroscopy?
Most people receive general anesthesia before this surgery or you may have regional anesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain in this area. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.
First, your surgeon will examine your shoulder with the arthroscope. Your surgeon will:
- Insert the arthroscope into your shoulder through a small incision. The arthroscope is connected to a video monitor in the operating room.
- Inspect all the tissues of your shoulder joint and the area above the joint -- the cartilage, bones, tendons, and ligaments.
- Repair any damaged tissues. To do this, your surgeon will make 1 - 3 more small incisions and insert other instruments through them. A tear in a muscle, tendon, or cartilage will be fixed. Damaged tissue may need to be removed.
Your surgeon may do one or more of these procedures during your surgery:At the end of the surgery using the arthroscope, your incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and what repairs they made.
If surgeon is not able to justify the treatment with arthroscopy, then he may change to open procedure to complete the job
Q. What after the shoulder arthroscopy?
Recovery can take anywhere from 1 to 6 months. You will probably have to wear a sling for the first week. If you had a lot of repair done, you may have to wear the sling longer.
When you can return to work or play sports will depend on what surgery was performed. It can range from 1 week to several months.
Q. When can I return to work?
You may be able to return to sedentary job 2-4 weeks following surgery. For job requiring overhead activity you may not be able to return to work for 3-6 months.
Q. what about post surgery rehabilitation?
For many procedures, especially if a repair is performed, physical therapy may help you regain motion and strength in your shoulder. The length of therapy will depend on the repair that was done.
Q. When can I return to overhead activity?
You will be able to return to full overhead activity 2 months following surgery with the assistance of physical therapy.
Q. Is it normal to have numbness around my shoulder following surgery?
You may experience some numbness on the outside of your shoulder, this occurs when making the incision damaging nerves. This usually goes away with time.
Q. When can I shower/bathe following my rotator cuff repair?
Avoid showering or bathing until your incision is completely dry.
FAQ - ACL REPAIR
Q. What is Arthroscopy Surgery?
Arthroscopic surgery is a very commonly performed orthopedic procedure over major joints like knee, shoulder; ankle etc for diagnostic / therapeutic purpose .it is routinely a day care procedure. It is performed under regional anesthesia, with the use of fine instruments like cannula, probe, scope, camera and light source.
Q. What are the joints that can be viewed with an Arthroscope?
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist.
Q. what is there in knee arthroscopy?
Knee arthroscopy is used for:-
Diagnostic purposes -biopsy, visualization of joint in unexplained joint pain
Therapeutic Purposes- ACL, & PCL, reconstruction, Menisectomy, Meniscus tear repair, loose body removal, synovectomy etc.
Q What Is the ACL?
The ACL is one of the two main crossed ligaments in the middle of the knee joint that connects the femur (thigh bone) with the tibia (shin bone). It controls the rotation of knee and prevents giving out of the knee with pivotal motions of the leg.
Q. What are the confirmatory tests for ACL Tear?
Very often Patients history of sudden giving away during sport activity and after that repeatedly during any pivoting movement is the most confirmatory sign of ACL tear.Doctor will further confirm laxity by performing few tests, Further on MRI of knee joint is must to confirm the ACL tear isolated or associated with any other ligament injury like PCL, Meniscus, Collateral ligaments.
Q. How Does the Physician Know That the ACL Is Completely Torn?
It does not matter whether the ligament is partially or completely torn.If the knee is lax, as can be measured by clinical examination, the ACL is not functioning to protect the knee against pivotal motions. The MRI can determine if the ligament is completely torn, but cannot differentiate the degree of laxity.
LAXITY IS THE INDICATION FOR SURGERY THAN PARTIAL/ TOTAL TEAR.
Q. What are the chances of any associated injury with ACL tear?
After the initial injury, there is a 50% chance of damage to the meniscus.In the acute situation, the meniscus tear may be repaired. In theChronic situation, the incidence of meniscal tear is 75%, and the torn portion of the meniscus usually has to be removed.
Q. What are Treatment Options for ACL Injuries?
Initially physiotherapy and muscle strengthening exercises are tried in non- sports persons and even after good trial if sensation of giving away still persists than arthroscopic ACL repair is done.
Q. What are the indications for ACL repair?
You only need to have an ACL reconstruction if you are physically active in pivotal sports such as basketball, volleyball, or soccer. Only approximately 10% of patients who have injured their ACL can return to these sports without an ACL reconstruction. Some patients can use a brace, modify their activities, and resume sports without surgery. The best option for the young, pivotal athlete is to have a reconstruction to prevent episodes of giving way because of ACL laxity. With each reinjury, there is risk of further damage to the meniscus and articular cartilage.
Q. What If I Have an ACL Tear with giving away / locking of knee and I Continue Pivoting Sports?
The patient will probably suffer repeated giving way Episodes, accompanied by pain and swelling. During sports and later on routine daily activites and In the long term, this will cause meniscus tear & wearing of the inside of the knee (osteoarthritis). The patient who wants to carry on with vigorous pivoting sports should have an operation to reconstruct the knee.
Q. when can a patient return back to sports after surgery?
Averagely four to six months, but sometimes, it may take as long as one year to fully return to a pivotal sport.
Q. When can a patient join the job back after surgery?
Light duty / table job can be joined at 2-3 weeks if the job involves physical activity, it will take three to four months or until your legs are strong enough.
Q. When Can the Patient Start Driving After Surgery?
Driving can be resumed when weight bearing is comfortable. This Usually is sooner when the left knee is involved.
Q Is physiotherapy needed after surgery?
Yes, a specially designed program is must in guidance of physiotherapist to reduce the pain and swelling, regain range of motion, and increase the strength of the muscles.
Therapy may have to be modified based on the individual's progress Through the weeks of rehabilitation.
Q. Which Graft Is Better?
Grafts routinely used are the Semitendinosus or the Patellar Tendon Success of surgery depend on the technique of placing the graft in the correct position, the fixation of the graft and the postoperative rehabilitation. Dr Satpal prefers semitendinous graft in all his patients excepts in athletes who wish to go back to sport early. . The patellar tendon graft is used for the athlete The earlier return to activities is based on the faster healing of the bone-to bone healing of the patellar tendon graft when compared to the tendon to-bone healing with the hamstring graft. The latter may take as long as three months to heal.
Q. What about Synthetic Grafts?
Synthetic materials are not routinely used to substitute for the ACL because of the higher incidence of failure. These materials are indicated in special situations, such as multiple ligament injuries or some reoperations.
Q. What About the Allograft?
The allograft is obtained from a cadaver, so a minimal risk of disease transmission exists. In addition, the graft takes longer to incorporate and often has tunnel enlargement as a result. Long-term results have shown more failures.
Q. Is Knee brace required after surgery?
Hinged locked specialized braces are required for next 1 month to protect the graft until it heals to the bone.
Q. What Are the Potential Complications of ACL Surgery?
The complications that may occur after ACL reconstruction are those that are related to any surgical procedure such as infection and deep venous phlebitis (i.e., blood clot in the calf).
The complications specifically related to the operation are loss of range of motion, anterior knee pain, persistent pain and swelling, and residual ligament laxity because of graft failure.
An injury to the nerves or blood vessels after this type of surgery is extremely uncommon.
FAQ - FOR MENISECTOMY
Q. What are the symptoms of meniscus tear?
- Joint line tenderness and effusion
- Symptoms are frequently worsened by flexing and loading the knee, activities such as squatting and kneeling are poorly tolerated
- Complaints of 'clicking', 'locking' and 'giving way' are common
- Functionally unstable knee
- Symptoms are frequently worsened by flexing and loading the knee, activities such as squatting and kneeling are poorly tolerated because of stiffness and pain
Q. How does the meniscus tear?
Typically an athlete or active individual tears a meniscus with a twisting injury. Younger athletes often suffer more significant injuries than do older adults. Often older athletes will note feel pain with such injuries. Occasionally older patients do not remember a specific injury at all.
Q. What is Arthroscopic menisectomy?
When meniscus tear is in the nonvascular area and symptomatic than with the use of arthroscopic instruments like scissors and shaver , the surgeon cuts out the torn portion of the meniscus and leave a stable rim.
Q. What's the difference between a partial meniscectomy and a total meniscectomy?
Meniscectomy refers to the removal meniscus in the knee. Total removal takes the entire meniscus out. This includes surfaces all the way around the knee joint--front, side, and back. Partial meniscectomy is the removal of less than half of the meniscus only the significant tear piece. The edge of the cartilage around the rim of the knee joint is left in place.
There are differences in the results of partial and total meniscectomies. Without the meniscus, the joint space narrows and more stress is placed on the knee. Long-term studies show some functional changes as well.
Q. What is the future effect of menisectomy/ Does removing part of the meniscus lead to long-term problems later in life?
The meniscus acts as a shock absorber, so, removing part of it would lead to more stress on the articular cartilage and bones. While there is no way to predict if patient will develop later arthritis or how quickly, it is a potential concern.
Despite this concern for long-term wear on the articular cartilage and subsequent arthritis, the inner torn fragment probably provides little protection to this cartilage either. Plus the pain is unlikely to improve without trimming that part out. Therefore patients often undergo surgery to relieve pain and get back to activities even if they could develop degenerative problems in later years or decades.
Q. What is the risk associated with the procedure?
As such there is no major or common complication known with the procedure. Rare complications known are, the blood vessels and nerves around the knee may be injured causing numbness or weakness in the leg below the knee. There is a risk of deep vein thrombosis, a condition in which a blood clot forms within a deep-lying vein. There is a rare risk of infection and bleeding.
Q. Could the pain from a meniscus tear go away on its own?
Some meniscus tears are not painful. Unfortunately, it is difficult to predict whether a patient with a painful meniscus tear will get relief of that pain from ice, rest,NSAIDS, or physical therapy.
Q. What are the differences in meniscal repair and menisectomy?
Only the outer 1/3rd of the meniscus is vascular, or receives blood. Therefore, this is the only portion of the knee which can actually heal itself. Tears that are in the outer 1/3rd of the meniscus, and which are relatively new, are typically the best candidates for a MENISCAL REPAIR. In this case the surgeon will go in and actually suture the torn pieces together, immobilizes the knee so that it can’t be moved for several weeks after the surgery. The benefit of this procedure is that the biggest portion of meniscus is preserved and , if successful patient’ll have complete meniscus in the future. But rehabilitation is much lengthier, often taking up to 6 months to get back to full recovery.
In contrast, for older injuries or in tears that occur within in the inner 2/3rd’s of the meniscus, a partial meniscectomy is generally performed. In this case the surgeon will go in and remove the torn segments, and then attempt to smooth out the remaining portions of the meniscus. The benefit here is that patient will return back to routine activities very quickly; on the down side, patient will lose some of the shock-absorbing capacity at the joint, leaving patients at increased risk of long-term knee issues such as arthritis.
Q. How would one should expect the progress after mensiectomy ?
- Full weight bearing or bearing weight as tolerated immediately after the meniscectomy
- Passive and active range-of-motion exercises begin immediately postoperatively and quadriceps strengthening exercises
- Crutches are usually required for 2-3 days until the patient is able to fully put his/her body weight on the knee without significant discomfort
- Return to full daily activities usually at 4-6 weeks, providing full range of motion has been regained
- Athletes may return to full athletic activities when normal quadriceps muscle tone has recovered and range of motion is full and pain-free.
FAQ - JOINT REPLACEMENT
FAQ - TOTAL HIP REPLACEMENT
Q.Who develops hip arthritis?
Hip arthritis typically affects patients over 50 years of age. It is more common in people who are overweight, and weight loss tends to reduce the symptoms associated with hip arthritis. There is also a genetic predisposition of this condition, meaning hip arthritis tends to run in families. Other factors that can contribute to developing hip arthritis include traumatic injuries to the hip and fractures to the bone around the joint.
Q.What are the common symptoms of hip arthritis?
Hip arthritis symptoms tend to progress as the condition worsens. Often patients report good months and bad months or symptom changes with weather changes. This is important to understand because comparing the symptoms of hip arthritis on one particular day may not accurately represent the overall progression of the condition.
The most common symptoms of hip arthritis are:
- Pain with activities.
- Limited range of motion.
- Stiffness of the hip.
- Walking with a limp.
Q. What is the treatment for hip arthritis?
Treatment of hip arthritis should begin with the most basic steps, and may progress to surgery.
Probably one of the most important, yet least commonly performed treatments. The less weight the joint has to carry, the less painful activities will be.
Limiting certain activities may be necessary, and learning new exercise methods may be helpful.
Use of a cane or a single crutch is the hand opposite the affected hip will help decrease the pressure on the arthritic joint.
Strengthening of the muscles around the hip joint may help decrease the burden on the hip. Preventing atrophy of the muscles is an important part of maintaining functional use of the hip.
Anti-inflammatory pain medications (NSAIDs) are prescription and nonprescription drugs that help treat pain and inflammation.
Joint Supplements (Glucosamine)
Glucosamine appears to be safe and might be effective for treatment of osteoarthritis, but research into these supplements has been limited.
Q. When total hip replacement is advised?
Joint replacement surgery is recommended by doctors when there is severe hip pain and loss of function and there is no help from oral medication in relieving the pain. Prior to operation, doctor makes use of X-rays to look at bones and cartilage in Hip area for seeing if these are damaged and ensuring that the resultant pain is not because of any other reasons.
Q. What is Cemented THR?
These are attached to existing bone with cement that acts as glue and attaches artificial joint to bones.
Q. What are Uncemented Joints?
These are attached using porous coating designed to allow bone to adhere to artificial joint. Over a period of time, there is a growth of new bone that fills up openings in porous coating, thus attaching joints to bone.
Q. The type of anesthesia of General or Regional Anesthesia?
For joint replacement surgeries, the doctor often uses regional anesthesia. But at times seeing the overall health of patients and their marked preferences, the operation can also be carried out under general anesthesia.
Q. What is the Post Surgery care that needs to be taken?
Patients who have undergone Hip Replacement are administered intravenous (IV) antibiotics and medicines for controlling blood clotting and pain for around a day after surgery. The initial few days requires taking medicines as prescribed by the doctor including pain killers that would decrease over the time. However, there may be the need to take anticoagulant medicines for several weeks after the surgery has been performed.
Q.What is the Rehabilitation procedure?
- The rehab process post hip replacement surgery starts next day after the surgery.
- Exercises are started under supervision of the team and accompanying physiotherapist.
- Pt is allowed to sit on side of the bed/chair on next day of surgery.
- Gait training is begun on second post op day or according to patients compliance.
- Initially partial wt bearing walking with help of walker is allowed and gradually shifted to crutch / cane support, continued for 6 weeks, after which full weight bearing is allowed.
Q. How well does the Surgery Works-life of the implant?
People having undergone hip replacement surgery feel less pain than pre-surgery stage and are able to successfully resume daily activities. With the passing days, patients would probably be able to do handle daily activities more easily as joint start moving better.
The overall lifespan of the hip implant depends on factors as:
- Lifestyle of the patient (how much stress is put on a joint).
- The weight of the patient (overweight patients tend to put extra stress on joints).
- How well new joint and bones mend together.
Q. What are the Risks or complications Involved in this surgery?
Risks Involved at Surgery and Post Operative Recovery Stages:-
- Blood clots- DVT
- Infection in surgical wound/in the joint that may be treated with antibiotics or if found deep in joint, the removal may require more surgery including removal of artificial joint
- Nerve injury that may cause numbness or difficulty in moving a muscle
- Problems related to wound healing especially for patients having rheumatoid arthritis and diabetes
- Deposits of bone (Myositis ossificans) in soft tissues around hip joint that may decrease motion range of the hip
- Hip dislocation post surgery
- Difference in leg lengths which are usually very small and do not cause any pain or functional issues
- Risks carried through general anaesthesia procedure especially for people who have had recent heart attack as well as those having chronic lung, liver, kidney, or heart disorders
- Loosening of artificial hip joint parts.
- Infection around the implant.
- Fracture of bone.
- Implant breakage.
- Bone loss.
- Loosening of prosthesis.
- Wearing away of joint tissues.
Further, X-ray studies also help in diagnosing fractures of hip/dislocated prostheses.
FAQ - TOTAL KNEE REPLACEMENT
This section provides a brief introduction to knee replacement. It is meant to provide basic information. Check with Dr Satpal about more comprehensive resources, patient education materials. & details about the procedure.
Q- What causes knee pain?
There are many different causes of knee pain, including injury, arthritis and infection.
Q- Is there a cure?
It depends on the problem. Some knee pain can be treated through rehabilitation, medication, intra-articular steroid injection, splintage & other cases may require surgery.
Q- How common is knee replacement surgery?
Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.
Q- Is Total Knee Replacement for You?
The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon.
Q- When Surgery Is Recommended?
There are several reasons why your doctor may recommend knee replacement surgery.
- A knee that has become bowed as a result of severe arthritis.
- Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
- Moderate or severe knee pain while resting, either day or night.
- Chronic knee inflammation and swelling that does not improve with rest or medications.
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy,splintges,knee braces or other surgeries.
Q- What is the ideal age for surgery?
There are no absolute age or weight restrictions for total knee replacement surgery. Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
Q. Home Planning before surgery?
Several modifications can make your home easier during your recovery.
- Safety bars or a secure handrail in your shower or bath.
- Secure handrails along your stairways.
- A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation.
- A toilet seat riser with arms, if you have a low toilet.
- A stable shower bench or chair for bathing.
- Removing all loose carpets and cords.
- A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery.
Q. How to extend the Life of Your Knee Implant?
Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following all doctors instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.
Q .What is the recovery time?
Everyone heals from their surgery at a different pace. In most cases, however, patient will be restricted to using a walker or crutches for 1 month after operation. Patient will then be allowed to advance to a cane outdoors and no support around the house for several weeks... By about 3 months, one can walk without a limp... There may be continued improvement in muscle strength and endurance for 6 to 12 months after surgery. Patient will gradually return to normal function without any assistance.
Q. When will my staples be removed?
Approximately 12 to 15 days post-operatively.
Q. How long do I need to keep a bandage on my incision?
Till the stitch removal
Q. When should I wear the knee immobilizer? When can I discontinue it?
Routinely knee immobilizer is not required. it is only applied to those patients who had correction of severe deformity pre-op to prevent reappearance of contractures.
Q. When can I shower (get incision wet)?
Routinely advised after stitch removal
Q. How long will I be on pain medication?
Initially strong oral pain medications are prescribed for 7-10 days.Patient do require off & on some low dose pain relieving medication for about 2-3 months
Q. Do I need physical therapy?
Yes! The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually 5-7 days /week)... Your therapist will keep your surgeon informed of your progress.
Q. How often should I use the CPM (Continuous Passive Motion) machine?
It is used as part of physiotherapy to those patients who have difficulty in bending the knees after the surgery.
Q. What exercises should I do?
You will be instructed by physical therapist on appropriate exercises and given a list to follow. In general, swimming and a stationary bicycle are good exercise options. What positions should I avoid? Avoid using a pillow or towel roll behind the knee for any length of time.
Q. Can I lift weights?
Generally not for the first 2 months.. Use light weights to begin with, and increase gradually as strength & balance improves in legs.
Q. I am constipated, what should I do?
It is very common to have constipation postoperatively. This may be due to a variety of factors but simple laxative/stool softener may be used.
Q. When can I drive?
It is permitted only after the patient can walk without support and patient has developed good quadriceps and hamstrings strength.
Q. When can I return to work?
If your work is primarily sedentary, you may return after approximately 1 to 2 months. If your work is more rigorous, you may require up to 3 or 4 months before you can return to full duty.
Q. When can I travel?
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots. During the first 2 months after surgery, you should not travel for extended periods as that would interfere with your physical therapy.
Q. Will I be stopped at security check at airports? Do I need a doctor's note?
Yes you may be stopped by the metal detector machine. It is advisable to carry doctors prescription /implant sheet or fit to fly with you.
Q. What activities are permitted following surgery?
Activities permitted following total knee replacement include walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.
Q. What activities should I avoid?
With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, avoid high-impact activities such as running, jogging, jumping, or other high-impact sports such as, downhill skiing, and vigorous racquet sports such as singles tennis or squash for the rest of life after surgery.
Q. What about sex?
In the months following surgery, patients are generally advised to take it easy and modify their positioning to keep pressure off of the joint while it's healing. As always, it is best to consult with your doctor about what's safe for your particular condition
Q. Can I drink alcohol?
Advised to quit alcohol for 2-3 months.
Q. How long should I use compression stockings for?
These should be used for the first few weeks in order to help reduce swelling and improve circulation. They should be worn while out of bed and removed for sleeping.
Q. Should I use ice or heat?
Ice should be used for the first several weeks, particularly if you have a lot of swelling or discomfort.
Q. Can I sit cross-legged?
In Indian scenario on floor squatting / sitting cross-legged is avoided.
Q. Can I go up and down stairs?
Yes. Initially, you will step up with your non-operated leg when going up stairs and step down with your operated leg when going down stairs. As your leg gets stronger, you will be able to perform stairs in a more regular pattern (about 1 month).
Q. What should I expect after knee replacement?
More than 90% of people after total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform activities of daily living.
Q. How to protect the Knee Replacement?
- Avoiding repetitive heavy lifting.
- Avoiding excessive stair climbing.
- Maintaining appropriate weight.
- Staying healthy and active.
- Avoiding "impact loading" sports such as jogging, downhill skiing and high impact aerobics.
- Consulting your surgeon before beginning any new sport or activity.
- Thinking before you move.
- Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses.
- Avoiding excessive bending when weight bearing, like climbing steep stairs.
- Not lifting or pushing heavy objects.
- Not kneeling.
- Avoiding low seating surfaces and chairs.
- See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays, usually once a year.
Q. Normal Things about Your New Knee?
- Clicking noise with knee motion.
- Skin numbness on the outer (lateral) part of your knee.
- Swelling around the knee and/or lower leg.
- Warmth around the knee.
- "Pins and needles" feeling at or near the incision.
- Dark or red incision line.
- Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.
- Increased bruising.
Q. Abnormal/Alarming signs after TKR?
(Call the doctor immediately if you experience any of these).
- Increasing redness, particularly spreading from the incision.
- Increasing pain and swelling.
- Fever (>101° F).
- Persistent drainage from your wound.
- Calf swelling or pain, particularly associated with ankle motion.
- Ankle swelling that does not decrease or resolve overnight.
- Bleeding gums or blood in urine/stool.
Q. Possible Complications of Surgery?
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, DVT,, Implant problems, Continued pain, Neurovascular injury occur in fewer than 2% of patients. Add on Major medical complication do increase the severity of known complications.
FAQ - FRACTUR & TRAUMA
Q. What is a fracture?
A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:
- Open fracture (compound fracture): occurs when the broken bone breaks through the skin in the leg.
- Closed fracture (simple fracture): the bone is broken but the skin is still intact.
Q. What are the sign & symptoms of fracture?
Signs and symptoms of a fracture include:
- Swelling or bruising over a bone.
- Deformity of an arm or leg.
- Pain in the injured area that gets worse when the area is moved or pressure is applied.
- Loss of function in the injured area.
- In compound fractures, bone protruding from the skin.
Q what emergency steps to be taken before shifting a patient of suspected fracture?
- First-aid - Depends on type & location of fracture
- For open fractures -Control bleeding before treatment
- Dress the wound with antiseptic solution
- Check the breathing , pulse, conscious status
- Calm the person
- Examine for other injuries-head, chest , abdominal etc.
- Immobilize the injured limb in splints/ supports to prevent abnormal movements.
- Apply ice to reduce pain / swelling
- Shift patient to nearest hospital & pre-inform that hospital about the arrival of injured patient.
- Massage the affected area.
- Straighten the broken bone.
- Move without support to broken bone.
- Move joints above / below the fracture.
Q. What are the different types of fractures called?
- Greenstick fracture: A portion of the bone is broken, causing the other side to bend (this resembles what would happen if you tried to break a branch from a tree: it cracks on one side but stays partially intact on the other side).
- Buckle or torus fracture: One side of the bone bends (buckles) upon itself without breaking the other side
- Comminuted fracture: A bone has broken into more than two pieces. Comminuted fractures often require surgery.
- Growth plate fractures: Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities Growth plate fractures are unique to pediatric patients.
- Stress (hairline) fracture: Tiny cracks in the bone usually caused by overuse or repetitive stress-bearing motions. These are common in children who take dance or run track.
- Non-displaced: the bone cracks or breaks but stays in place.
- Displaced fracture: ends of the broken bone come out of alignment. In a displaced fracture, surgery is usually needed to realign bones.
Q. How are fractures in children different from fractures in adults?
A child's bone differs from adult bone in a variety of ways:
- Flexible bones: A child's growing bones are bendable and resilient, which means they tend to buckle or bend a lot before breaking. This is the reason for the unique fracture patterns seen in children and not in adults. "Greenstick" and "buckle" fractures are two examples.
- Faster healing: Children's bones are also surrounded by a thick layer of connective tissue (periosteum) that defends the bone against injury and harm. This tissue also produces blood supply to the area of a fracture. The body uses this supply of blood to replace damaged cells. Periosteum in adults tends to be much thinner, resulting in a slower healing process.
- Vulnerable growth plates: Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities. In performing surgery on broken limbs in children, surgeons must consider and account for these growth plates.
Q. Which fractures are treated by plaster casting?
Undisplaced fractures or fractures with least chances of displacement.
Q. How long is the plaster cast applied over limbs?
Duration of cast treatment varies with the configuration, location and involvement of weight bearing limb .It is generally applied for 3 -6 weeks.
Q. Can I bear weight over leg cast?
Only after consulting treating orthopedic surgeon.
Q. which fractures are to be operated upon?
- Displaced fractures.
- Comminuted fractures.
- Displaced epiphyseal injuries.
- Intraarticular fractur.
- Early mobilsation is required.
- Fractures with neuro-vascular injuries.
- Displaced old conservatively treated fractures.
Q .what is the right time of surgery in fractures?
Earliest , as delay may lead to more blood loss, increase in swelling & compartment pressure and might lead to sudden neuro- vascular deficits.
Q. Should I have to bring all old X rays or to have fresh x ray on every visit?
Always bring complete documents and all concerned X-rays on each visit. If required doctor might ask you to get fresh X ray afterwards.
Q. I am outside Delhi & I wish to shift my patient to your set up for treatment?
You first inform Dr Satpal about the details of the patient and after consulting him, patient can be shifted in well equipped ambulance maintaining well splintage of the injured limb.
Q. Do pain & swelling persist after surgery also?
Yes, swelling in the injury region & distally do persist for long duration after surgery but it gradually improves with movements of the limb. Pain at the fracture site decrease as it unites.
Q. What is nonunion, what are the sign and symptoms of nonunion?
A fracture is said to be nonuniting if it doesn’t show any sign of union in X-rays or pain & abnormal mobility still persist till 6 months after the injury.
Q. what is the line of management of nonunion of fractures?
Non union can be due to improper fixation, no growth potential at fracture ends, gap at fracture site, chronic medical conditions etc. It needs repeat surgery in form of bone grafting & refixation, along correction of any medical illness.
FAQ - SPINE SURGERIES
FAQ - SPINE FRACTURES
Q. What is a spinal fracture?
Fractures to the bones in your spine (vertebrae) are called spinal fractures. They are also referred to as vertebral compression fractures (VCFs), or simply, compression fractures. Spinal fractures occur as a result of bone loss resulting from conditions like osteoporosis.
Q. Are spinal fractures difficult to diagnose?
About two-thirds of all osteoporosis-related spinal fractures aren't diagnosed primarily because: Patients with spinal fractures may have mild, or very little discomfort, Patients may consider back pain a normal part of aging or Patients may not realize the importance of proper diagnosis.
Q . What are the signs and symptoms of an acute vertebral compression fracture?
An acute fracture occurs suddenly, such as from a fall. You may not have any signs and symptoms with a mild fracture, or you may have any of the following:
- Back pain that gets worse when standing up or walking. The pain goes away when you lie still.
- Muscle spasms in your back.
- Pain when the fracture area is touched.
- Problems passing urine, or having bowel movements.
- Sudden, severe, and sharp back pain.
- Sudden weakness in your arms or legs.
Q. What are the signs and symptoms of a chronic vertebral compression fracture?
A chronic fracture has signs and symptoms that last longer than two months. You may have any of the following:
- Depression (deep sadness) and trouble sleeping.
- Your abdomen (stomach) looks larger than normal.
- Kyphosis or lordosis. These are conditions that cause your spine to curve, making your back look rounded or curved.
- Loss of feeling or weakness in your legs or arms.
- Loss of height.
- Mild back pain.
- Trouble breathing and shortness of breath. You may have trouble bending, reaching, lifting, climbing steps, or walking.
Q. Why should I be concerned about spinal fractures?
Just one spinal fracture can increase your risk for another spinal fracture to 3-5 times more than it was before the initial fracture occurred. This risk increase occurs because the broken bone (vertebra) affects the distribution of weight along the spinal column. Misalignment brought on by a fractured vertebra places more stress on adjacent vertebrae.
Q. What are the psychological effects of spinal fractures?
Medical complications, depression, anxiety, and lowered self-esteem. The alterations in lifestyle that accompany severe kyphosis can profoundly affect well-being and cause feelings of isolation and sadness
Q. Who is at risk for an osteoporosis-related fracture?
The International Osteoporosis Foundation estimates that 40% of women and 15% of men over the age of 50 will have one or more osteoporosis-related fractures in their remaining lifetime. Long-term use of medications such as corticosteroids can weaken bone, making it more susceptible to fracture. Medical treatments like chemotherapy and radiation therapy have been shown to cause bone loss. Finally, lifestyle choices and genetic factors can adversely affect bone density.
Q. How does normal back pain compare with the pain from a spinal fracture?
A complete physical exam, together with an X-ray and/or magnetic resonance imaging (MRI), can help your doctor differentiate between pain caused by a spinal fracture or pain caused by other disorders.
Q. What can happen if a spinal fracture isn't diagnosed and treated?
If One spinal fracture is not diagnosed on time and treated accordingly can lead to resulting in kyphosis (curvature of the spine).
Q. What are the investigations performed in spinal fractures?
Neurological tests: The doctor will also evaluate the patient's neurological status. This includes testing the ability to move, feel, and sense the position of all limbs. In addition, the doctor will test the patient's reflexes to help determine injury to the spinal cord or individual nerves.
Imaging tests: this may include x-rays, computed tomography (CT ) scans, and magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic and lumbar spine.
Q. what are the Treatment plan of spine fractures?
The treatment plan for a fracture of the thoracic or lumbar spine will depend on:Other injuries and their treatment &The particular fracture pattern. Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.
Flexion Fracture Pattern
Nonsurgical treatment. Most flexion injuries (compression fractures, burst fractures) can be treated in a brace for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post injury problems.
Surgical treatment. Surgery is typically required for unstable burst fractures that have:
- Significant comminution (fracture fragments).
- Severe loss of vertebral body height.
- Excessive forward bending or angulation at the injury site.
- Significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord.
These fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture. Decompression involves removing the bone or other structures that are pressing on the spinal cord. This procedure is also called a laminectomy.
Extension Fracture Pattern
The treatment plan for extension injuries will depend on:
- Where the spine fails.
- Whether the bones can be fit together again (reduction) using a brace or cast.
Nonsurgical treatment. Extension fractures that occur only through the vertebral body can typically be treated nonsurgically. These should be observed closely in a brace or cast for 12 weeks.
Surgical treatment. Surgery is usually necessary if there is an injury to the posterior (back) ligaments of the spine. In addition, if the fracture falls through the disks of the spine, surgery should be performed to stabilize the fracture.
Rotation Fracture Pattern
Nonsurgical treatment. Transverse process fractures are predominantly treated with gradual increase in motion, with or without bracing, based on comfort level.
Surgical treatment. Fracture-dislocations of the thoracic and lumbar spine are caused by very high-energy trauma. They can be extremely unstable injuries that often result in serious spinal cord or nerve damage. These injuries require stabilization through surgery. The ideal timing of these surgeries can often be complicated. Surgery is sometimes delayed because of other serious, life-threatening injuries.
Q. Complications with spine fractures?
Complications associated with fractures of the thoracic and lumbar spine.
Blood clots in the legs - DVT, which may develop from immobility. These clots can travel to the lungs and cause death (pulmonary embolism). Pneumonia and pressure sores are also common complications of spinal fractures.
There are also specific surgical complications, including :Bleeding, Infection, Spinal fluid leaks ,Instrument failure, neurological deficit ,Nonunion ETC
Q. How is a Osteoporotic fractures vertebral compression fracture treated?
If you have a mild fracture, you may need to rest in bed for a short time. You may need to wear a back brace for 8 to 12 weeks. A brace may decrease your pain, and help your vertebrae heal. You may need to use a cane or walker. You may also need any of the following:
- Bisphosphonates: This medicine can help you keep the bone strength that you have, and may help your bones get stronger.
- Calcitonin: This medicine helps strengthen your bones. It can decrease the pain of a VCF when it is caused by osteoporosis. It can also decrease your risk of getting another fracture.
- Hormones: Parathyroid hormone may be given to certain women to increase bone density, and decrease the risk of fractures. Certain women may be given the hormone estrogen to treat osteoporosis. Medicine called estrogen receptor modulators increase bone density and can help prevent fractures.
- Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and swelling.
- Pain medicines: You may be given medicine to decrease the pain caused by a compression fracture.
- Supplements: You may need to take calcium and vitamin D to help strengthen your bones.
- Occupational therapy: Occupational therapy (OT) teaches special skills for bathing, dressing, cooking, eating, and driving. A therapist may help you choose tools to use, and suggest ways to keep your home or workplace safe.
- Physical therapy: These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
- Other therapy: therapist may use radiotherapy, heat or ice packs, or massage to relieve muscle pain. Exercises to stretch your back muscles, biofeedback, deep breathing, and relaxation therapy may also help.
- Surgery: You may need surgery if your pain, weakness, or numbness does not go away after using other treatments. Surgery may make your spine more stable, and help decrease pressure on your spinal nerves caused by the fracture.
- Vertebroplasty: Bone cement is placed into the fractured vertebrae.
- Kyphoplasty: A balloon is placed in the fractured vertebrae. Bone cement is put inside the space made by the balloon.
- Open surgery: Open surgery returns bones to the right place by putting them together using wires, pins, plates, or screws.
Q. What else can I do to help prevent a vertebral compression fracture?
- Do not smoke cigarettes, cigars, and pipes. For women, smoking increases your chance of early menopause, and lowering estrogen, which increases your risk of osteoporosis.
- Check bone mineral density every 2 years
- Keep your home safe. Have enough light so you can see clearly. Leave a light on at night to help you find your way to the bathroom and kitchen. Place carpet down in the bathroom instead of hard flooring. Hard flooring is slippery if it gets wet. Secure carpeting to the floor around all edges. Remove throw rugs, or secure them with double-sided tape, or special backing. Ask your caregiver for more information on how to prevent falls in your home.
- Use a cane or walker when you are walking if you feel imbalance. This will decrease your chance of falling.
- Use medicines to prevent or treat osteoporosis.
- Wear shoes with rubber bottoms. This will help prevent falls.
- When picking things up, bend at the hips and knees. Never bend at your waist only. Use bent knees and your leg muscles, not your back as you lift the object. While lifting an object, hold it close to your chest. Try not to twist, or lift anything above your waist.
Q. How can I sleep better when I have a VCF?
- Avoid using a waterbed as it does not support your back well.
- Sleep on a firm mattress. You may also put a one-half to one inch piece of plywood between the mattress and box spring.
- Sleep on your back with a pillow under your knees. This will decrease pressure on your back. You may also sleep on your side with one or both of your knees bent, and a pillow between them. You may also try lying on your stomach with a pillow under you at waist level.
Q. Call DR Satpal if:
- You have back pain and you think you may have a compression fracture.
- Worsening symptoms or difficulty with controlling your bladder and bowel.
FAQ - Microdisectomy
Q. Post operative care and instructions?
- Keep your dressing dry and clean for 7 days after surgery to prevent infection. Leave dressings intact unless damp or ooze present from wound.
- You may shower if you cover the incision with plastic wrap to keep it dry. A shower chair can be used if needed, otherwise use a special non-slip mat.
- It is important if you have a low toilet, to consider loaning a plastic extension, or over the toilet seat.
- Wear back support provided for you at the hospital as instructed.
- Change position regularly, do not lie in one position for too long (you will get stiff and sore).
- Take pain medication regularly as prescribed and advised. (Do not keep taking pain medication unless you really need it once the pain of the operation has worn off).
- No stooping, bending or twisting of your back. Keep your back straight and bend your knees using your thigh muscles.
- No sitting in soft chairs or sofas that allow your back to curve. Sitting may be uncomfortable, so limit your time sitting in a chair (20-30 minutes).
- Sit and stand straight, do not sit slouched or leaning over to one side in a chair.
- No stretching to reach high cupboards or shelves.
- No jogging. Short, frequent short walks are better than long walks.
- No lifting, housework or yard work during the first six (6) weeks or until allowed by your doctor.
- No driving or long car journeys until consulting with your surgeon at the first post-operative visit.
Q-what are the Guidelines for Physical Activity after Surgery?
- Light activities such as walking may be started on the day of surgery. Your physical activities should progress gradually by alternating activity with rest.
- Plan for short, regular walks with rest periods.
- Each day increase your walking distance on a gradual basis.
- Once your sutures have been removed and the wound has completely healed (usually 2-3 weeks post-operation) you may go swimming (mainly just walking in the pool and a little gentle swimming. (No pool games or diving in.)
- Sexual activity is permitted within the bounds of your comfort. Consult with your surgeon.
- Discuss returning to work during your doctor’s appointment.
Q. When to Call Doctor?
if you Experience Any of the Following Symptoms:
- If you feel warm or chilled, take your temperature. Call your doctor with a temperature of 38.3 °C or above.
- Increasing redness and swelling at the incision site.
- Changes in the amount, appearance, or odour of drainage from your incision.
- New or increased changes in sensation/presence of numbness in extremities.
- Severe pain that is not relieved by medication and rest.
Q. What are the risks of this operation?
|Nerve injury||Damage to the nerve whilst removing disc(1%)|
|Cauda equina syndrome||Damage to the central nerves in the spinal canal, going to bowel, bladder and sensory functions (including sexual sensation).|
|Fluid leak||Small tear in the nerve sheath allowing leakage of cerebrospinal fluid Dural tear (cerebrospinal fluid leak). This occurs in 1% to 2% of these surgeries. It does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.|
|Infection||Contamination during surgery or, rarely, late infection via the blood. Which can lead to long term pain in the back if the disc itself is involved.|
|Recurrent disc||Persistence of small pieces of disc within the disc space - could come out later The aim of the operation is not to completely remove the disc, but to remove the parts which are trapping the nerve and causing the pain. The emptying of the disc space is always only partial. There is, therefore, the risk of further disc material coming out of the space at a later date, but this is a rare complication (5-10%).|
Q. what is the Postoperative Care?
Follow-up care for a microdiscectomy usually includes a combination of the following:
- Pain management. Immediate post-operative pain can be managed with a combination of non-steroidal anti-inflammatory drugs. Ice may also be applied to the back to decrease pain within the first 48 hours after surgery.
- Stretching program. To minimize tethering of the nerve root by scar tissue, gentle stretching exercises should be done in the early postoperative period. Scar tissue in and of itself is not painful, but if it tethers the nerve root short as the patient heals this can result in chronic pain. The stretching should be done about 5 to 6 times a day for 6 to 12 weeks, since this is the time period in which the scarring occurs. It is generally advisable to do the stretching exercises frequently and gently. Stretching too hard may result in pain, and one should only take the stretch to the point of pain to avoid inflaming the nerve. If a patient feels too much pain after surgery to do any stretching, it would be wise to wait until he or she is more comfortable.
- Back strengthening exercises. After the soft tissue has healed (usually 2 to 3 weeks after surgery), it is important to start back strengthening exercises.There are a wide variety of possible exercises to achieve the desired results, and it is important to choose exercises that are safe and well tolerated so that they will be done on a regular basis. About 15 minutes of appropriate stretching and strengthening exercises per day is advisable for the first one to three months.
Q. What is the chance of a successful outcome?
A microdiscectomy is 85% to 95% successful in relieving pain in the buttocks and leg. Pain relief is typically quite rapid, although in specific instances, it may take six to eight weeks for the nerve to calm down. If a nerve has been pinched for a long time, the success rate is rarely 100% as there is usually some residual mild tingling, weakness, or pain, all of which are fairly tolerable.
Q. What am I allowed to do when I go home?
We generally advise people to take it easy for the first couple of days.
You will be able to take care of yourself, go up and down stairs, and move around based on your own comfort level. For the first six weeks you should not put any unnecessary stress on your back.
During the first few weeks following discharge, we encourage you to begin walking for one half hour to two hours each day in divided intervals. You should walk slowly enough so pain does not flare up in your leg. The nerve is generally quite sensitive after surgery and intermittent leg pain similar to your pre-surgical pain is common. The pain should calm down quickly if you decrease your activity level.
At the six-week mark, you may be enrolled in a structured physical therapy program to include core strengthening and neutral spine exercises. You will also be allowed to begin low-impact aerobic activities (e.g. elliptical training, recumbent bicycling, swimming, etc.) at this time point.
Three months after surgery, you can begin higher impact aerobic activities such as running, jumping, and non-contact sports.
Six months after surgery, you will be free to participate in any physical activity (including contact sports and activities) without restriction.
Q. When can I return to work?
Each situation is unique and should be discussed with your physician prior to surgery. In general, most patients return to work about one to two weeks after a microdiscectomy.
FAQ - Spinal fusion
Q. what are the contraindications for posterior fusion procedure?
- Severe post operative peri-neural scarring or severe arachnoiditis.
- Previous bilateral transforaminal approach with root fibrosis.
- Large dural tears and equina root herniations.
Q. What are the advantages of posterior fusion procedure?
Nerve decompression is easily done with the posterior approach and placement of pedicle screws as well as trans foraminal intervertebral lumbar fusion is possible without having to manipulate nerves or the thecal sac. This is one of the less dangerous procedures. The fusion rate ( and success rate of the operation) is high ± 92%. Deformities can be corrected
Q. What are the ways to assure a successful fusion?
Likelihood of fusion is increased with good stability of the bones that need to be fused. Axial compression stability is added anterior by use of the cage that is placed via the Trans foraminal L1-5 and the PLIFapproach L5-S1. Rotation, side bending and flexion extension stability is created by posterior pedicle fixation segmentally over the vertebra that requires fusion. The pedicle fixation is placed under compression, forces to enhance stability further.
Q. What is the need for fusion and fixation in chronic mechanical bachache?
Mechanical instability of the spine may result from a several causes, including degenerative disease, trauma, or cancer. If the degree of instability is excessive the structural integrity of the spine will be compromised. This decreased stability can produced pain during normal activities, a condition known as mechanical low back pain. The pain is typically confined to the lower back, hips, and thighs. If a significant degree of instability exists or conservative measures fail, the structural integrity of the spine is restored through a spinal stabilization surgery. The operative procedure, known as a fusion and fixation, is intended to eliminate the movement across the unstable portion of the spine and reduce the production of pain. Long-term stability is achieved through the growth of a bony bridge between the unstable bones, known as a fusion.
Q. what changes lead to degenerative instability of spine?
With normal aging the discs gradually collapse, the facet joints thicken and ligaments lose their elasticity and stabilizing ability. These various gradual changes in the spine lead to a loss of space for the nerve elements (spinal stenosis) since degeneration has a tendency to lead to settling between vertebrae (sometimes also shifting, such as in spondylolisthesis) and thereby narrowing of the spinal canal and neuroforamen at the affected levels (usually lower lumbar spine).
Q What if you do nothing?
If you do not have an operation, your pain is likely to continue and may get worse over time. If you have weakness or numbness, this may also get worse.
Q. Who should have it done?
If you have numbness and weakness (neurological symptoms) or difficulties passing or controlling your urine, you should have an operation.
Q. Surgical Procedure in posterior fusion for instability of spine?
The procedure is performed under general anesthesia. A midline incision is made in the lower back overlying the area of instability. Soft tissue is dissected off the back of the spine to expose the unstable spinal segments. A lumbar laminectomy is typically performed to decompress the neural elements. Once the neural elements are free, the spinal stabilization procedure is performed. The bone to create the fusion is harvested from the iliac crest (a part of the hip bone) through the same or separate incision. Using bony landmarks & fluoroscopy the entry site and trajectory of the pedicle screws is identified and the screws are inserted. These advanced imaging techniques allow more accurate screw insertion. The harvested bone is then transplanted across the unstable spinal segments. The pedicle screws are then connected with metallic rods providing immediate stability. The operative site is then sutured closed in multiple layers.
Q. list of known Risk and Complications with decompression & fusion?
- Excessive bleeding causing shock,
- Injury to the dura causing cerebrospinal fluid leakage or meningitis.
- Delayed wound bleeding, haematoma formation and wound infection.
- Problems in wound healing or persistent scar discomfort.
- Loosening or breakage of internal fixation device.
- Failure of bone union.
- Problems with iliac crest bone graft donor site such as wound infection,
- Recurrence or deterioration of the original spine condition.
A. Cervical spine surgery
- Injury to the vertebral artery causing stroke.
- Injury to the cervical cord or nerves causing neurological damage, in extreme case may lead to tetraplegia, double incontinence and breathing difficulty
B. Thoracic spine surgery
- Injury to the lung causing pneumonia or pneumothorax.
- Injury to the thoracic cord or nerves causing neurological damage, in extreme case may lead to paraplegia, double incontinence and breathing difficulty
C. Lumbosacral spine surgery.
- Reflex slowing of bowel movement causing abdominal distension and vomiting.
- Injury to the spinal nerves causing neurological damage, in extreme case may lead to paraplegia and double incontinence.
Q. Any Alternative Treatment?
Conservative treatment including physiotherapy and occupational therapy Physiotherapy or osteopathy can help reduce back pain, but does not usually reduce leg pain or weakness. Result depends on individual patient and disease
Q. what is the duration of surgery?
The total surgery time is approximately 2 to 4hours, depending on the number of spinal levels involved.
Q. What After the Procedure? Post op regime of spinal decompression and fixation?
The recovery period varies from case to case but on average is 6-12 weeks. Most patients are usually able to go home 3-5 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger. During this time we encourage people to walk as much as possible, lie as much as possible but to only sit for limited periods (20-30 minutes). Walking, swimming, aerobic classes are all very suitable only after doctors permission but please avoid contact sports,
Patients are issued a soft or rigid lumbar corset that can provide additional lumbar support in the early postoperative period, if necessary.
The wound area should remain covered with a gauze bandage secured in place with tape. The area should be kept clean and dry. The bandage should generally be changed every 7 days.
Shower / Bath
Body sponging to be preferred for initial 10-15 days till stitch removal. But if patient wish to take bath than , keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area.
Patients are refrain from driving for 4-6 weeks, longer if still in pain after surgery.
Return to Work and Sports
Patients may return to light work duties as early as 2-3 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 3 months after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at only one level may return to heavy lifting and sports activities when the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.
Doctor's Visits and Follow-Up
Patients will return for a follow-up visit to see the doctor approximately 12-14 days after surgery. The incision will be inspected. The incision will be inspected and the stitches or staples will be removed.
FAQ - Vertebroplasty
Q. what is Vertebroplasry?
Vertebroplasty is a minimally invasive, day care procedure used to treat vertebral compression fractures caused by painful osteoporosis and metastatic tumors. During vertebroplasty, A local anesthetic is used to numb the affected area of the patient's spine, where the surgeon inserts one or two needles guidance through a small incision in the patient's skin. Under under C- arm, the surgeon inserts the needles into the fractured vertebra through pedicals and slowly injects a small amount of bone cement into the vertebra at fracture site. The bone cement hardens quickly. The patient is kept for observation for a few hours following the procedure. In rare cases, the patient is kept overnight for observation. Vertebroplasty can prevent further collapse of the vertebra, height loss and spine curvature.
Q. What are the indications of vertebroplasty?
- Patients with persistent back pain(refractory to medical management) caused by vertebral compression fractures are potential candidates for vertebroplasty.
- Cases with multiple pathological vertebral fractures.
- Progrssive kyphosis >20 degre in subacut vertebral fractures.
- Chronic painful vertebral comprssion fractures with non union.
Q. How can vertebroplasty help me?
In most patients, vertebroplasty provides immediate improvement in pain related to vertebral compression fractures. Many patients return to their normal activities within only a few days of having the procedure, and few patients continued pain reduction months and years later.
Q. How long does vertebroplasty take?
Each vertebral procedure takes about half an hour, so treatment of multiple vertebral fractures takes longer. Patients typically spend two to three hours following the procedure in a comfortable observation area to be sure there are no complications or side effects.
Q. What is the success rate?
Most patients report significant pain reduction within a few hours of the procedure. Studies report over 90%(2) and higher success rates for significantly relieving pain associated with vertebral compression fractures. Patients are able to return to their normal activities within a few days.) The success rate and potential complications depend upon each patient's health and other factors. You should discuss these risks and complications with your doctor.
Q. What are the long-term effects of bone cement?
There are no known detrimental long-term effects.
Q. What cement material is used?
polymethylmethacrylate cements with barium mixed into it , for Adequate opacification in order to perform the procedure safely.
Q. Is vertebroplasty covered by Medicare or private insurance?
Percutaneous Vertebroplasty is a covered by most of the insurance companies or TPA's .Rest it depends on terms and conditions of your policy. Our Hospital TPA department will provide you help to process from claim.
Q. When should one contact the doctor immediately after vertebroplasty?
- Your procedure area becomes red, warm, and swollen.
- You have drainage from the area your procedure was done.
- You are unable to move one or both of your arms.
- You are unable to move one or both of your legs.
- You are urinating less than usual, or not at all.
- You suddenly cannot think clearly.
- You suddenly feel lightheaded and have trouble breathing.
- You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
Q. What is the Difference between a Kyphoplasty and a Vertebroplasty?
Vertebroplasty is procedure for minimal compression, as aim is to reduce pain. Kyphoplasty is a procedure for 70- 90 % loss of height. That involves inserting a small balloon at the point where the vertebra has collapsed. The balloon is inflated to raise the bone and then cement is injected into the space. This procedure hopes to restore some amount of height loss.
Q. How successful is vertebroplasty?
Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.
Q. What are the risks or complications?
Vertebroplasty is a very safe procedure with few risks or complications. Rarely cement may leak from the fracture site and may lead to some neurological injury either due to the heat of cement setting or to pressure effect.
Q. Will vertebroplasty treat or prevent loss of height?
After a vertebra has fractured, there is typically a loss of only 20 percent to 30 percent of the height of the bone. But over several weeks, compression may progress and the vertebra flattens out, until eventually there's a 70 percent to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis in individuals who already have these conditions.Vertebroplasty is procedure for minimal compression, as aim is to reduce pain. Kyphoplasty is a procedure for 70- 90 % loss of height, which involves inserting a small balloon at the point where the vertebra has collapsed. The balloon is inflated to raise the bone and then cement is injected into the space. This procedure hopes to restore some amount of height loss.
FAQ - CLINIC APPOINTMENT
Shishodia Orthopaedic Centre
Important instructions for patients.
- Please bring all prescription papers & investigation reports on every visit.
- Pl. inform Doctor if you are suffering from any medical illness/drug allergy/pregnancy/on any prolong medication.
- To avoid inconvenience, purchase prescribed medicines from chemist in Shalimar Bagh/near by.
- for any telephonic conversation with Dr. call between 9pm to 9.30pm
- Medical certificate will only be issued to patients taking treatment at this clinic. No certificate will be issued for court purpose.
- Never mix alternative medicine / treatment with the prescribed treatment.
- If you wish to use Medi claim/insurance, inform the doctor in advance.
- Collect your X ray films within 15 days between 6pm to 9pm only.
- All females / senior citizens/ kids are supposed to be accompanied by relatives/ friends.
- All Orthotic items are available in the clinic: - walker, walking stick, knee cap, ankle support, cervical support, cervical collar, L-S belt, wrist band etc.
Q. What are your clinic / practice hours?
- 9.00 am to 1.00pm, Monday to Saturday. By appointment only .
- 6.00 pm to 9.00 pm, Monday to Saturday, Walk-in in the private Clinic.
- Sunday & Holidays only Emergencies.
- Any special appointment on this days are to be taken 2 days before.
Q. What documents should I bring along on visiting the doctor?
Remember to bring the following:
- Old treatment documents- doctors prescription, list of medication in the past, old investigation original films(X rays, CT, MRI) / reports etc Insurance information.
- If you have had surgery elsewhere, please bring a copy of your operation report. If you wish to avail insurance facility, than bring, --TPA Card, ID Proof, Policy of last 2 years.
- Referral Letter (if required)
Q. How to cancel an appointment?
Telephone during business hours. Please cancel at least 1 day ahead so that your appointment time can be allocated to another patient who is seeking treatment.
Q. What are the parking facility?
You can drop the patient at the gate of clinic & park your vehicle outside the lane of clinic. Wheel chair facility available for patients
Q. Any Ambulance service available?
Ambulance on demand can be arranged for transferring patients on nominal rates.
Q. Any investigation facility available?
Collection and booking of laboratory investigation. X-ray facility available.
Q. Any lodging facility for Outstation patients?
On patients demand, in advance can be arranged in near by areas. Associated cost will be informed.
Q. What are the physiotherapy facilities available at clinic?
At present no physiotherapy available in house. Home physiotherapy can be arranged.
Q. What should I do in Emergency?
Call on ph. no.- 08860337212 / 9313616024 or reach to the Fortis Hospital Shalimar Bagh Emergency and ask them to contact DR. Satpal team members.
FAQ - INDIAN PATIENTS OUTSIDE DELHI
Q. How can we contact / book appointment for Dr. Satpal ?
In Emergency- either call on mobile no:- 08860337212 / 09313616024 or drop sms on this mobile no. In non-emergency- book your appointment online.
Q. What if we want to contact/ consult Dr Satpal before shifting our patient to his centre?
You can consult Dr Satpal on video calling online. You can book this by filling the form in “online Consultation” section.
FAQ - OSTEOPOROSIS
Q.What is Osteoporosis?
Osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium. Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily.
Q.What are the risk factors for Osteoporosis?
- Older age (age 65 and older)
- Gender : While women commonly lose 30-50% of their bone mass over their lifetimes, men lose only 20-33%. Women have more incidence of Osteoporosis.
- Race : Caucasian and Asian women are most at risk for the disease, but African American and Hispanic women can get it too.
- Figure Type : Women with small bones and those who are thin are more liable to have osteoporosis.
- Family history of an old-age fracture
- Weight less than 60 kg
- Hormonal Deficiencies
Women - Events associated with estrogen deficiencies are the primary risk factors for osteoporosis in women. These include:
- Menopause prior to age 45 ( Early menopause) :-Women who stop menstruating early because of heredity, surgery or lots of physical exercises may lose large amounts of bone tissue early in life.. Within 5 years after menopause, the risk for fracture increases dramatically. Fractures occurring during this period are more likely to occur in the wrist or spine than the hip, but their occurrence is a strong predictor of later severe osteoporosis and hip fracture.
- Surgical removal of ovaries.
- Missing periods for 3 months or longer
- Never having given birth
- Anorexia nervosa, (an eating disorder), bulimia or extreme low body weight can affect the body's production of estrogen
Men - Low levels of testosterone increase osteoporosis risk. Certain types of medical conditions (hypogonadism) and treatments (prostate cancer androgen deprivation) can cause testosterone deficiency.
- Life long low calcium intake
- Excess alcohol consumption
- Minimal weight bearing exercises
- Vitamin - D deficiency
- Medical conditions - Rheumatoid Arthritis, chronic diseases, thyroid diseases, steroid therapy for long time, alcoholism, diabetes, hyperthyroidism, epilepsy, chronic liver or kidney disease, Crohn's disease, celiac disease, scurvy, leukemia, cirrhosis, gastrointestinal diseases, vitamin D deficiency, lymphoma, hyperparathyroidism, and rare genetic disorders such as Marfan and Ehlers-Danlos syndrome.
Q.Dietary changes that can prevent or must for the treatment of Osteoporosis?
- Eat beans, lentils and Soya products which are natural source of estrogens (females).
- Reduce fat intake or saturated dairy products
- Drink enough fluids
- Increase intake of fiber
- Avoid additive, preservatives and chemicals such as artificial sweeteners
- Reduce intake of caffeine
- Reduce alcohol
- Avoid excess intake of sugar
- Ask doctor for weight reduction and a suitable diet for that.
- Eat diet rich in calcium and vitamin – D
Q.Diet rich in calcium and vitamin – D ?
|Milk (skim, 2 percent, or whole, 8 oz [236 mL])||300|
|Yogurt (6 oz [168 g])||250|
|Orange Juice (with calcium, 8 oz [236 mL])||300|
|Tofu with calcium (1/2 cup [113 g])||435|
|Cheese (1 oz [28 g])||195 to 335 (hard cheese = higher calcium)|
|Cottage cheese (1/2 cup [113 g])||130|
|Ice cream or frozen yogurt (1/2 cup [113 g])||100|
|Soy milk (8 oz [236 mL])||300|
|Beans (1/2 cup cooked [113 g])||60 to 80|
|Dark, leafy green vegetables (1/2 cup cooked [113 g])||50 to 135|
|Almonds (24 whole)||70|
|Orange (1 medium)||60|
Others :- Eat brown rice, Oats, Fruits and vegetables etc.
There are only a few foods that are good sources of vitamin D, so vitamin D supplements are often recommended unless you are exposed to sunlight on your skin regularly
Suggested dietary sources of vitamin D are listed below.
|Food||International Units(IU) per serving||Percent DV(Daily Value)*|
|Pure Cod liver oil, 1 Tablespoon (Note: most refined cod liver oils today have the vitamin D removed! Check your label to be certain.)||1,360||340|
|Salmon, cooked, 3½ ounces||360||90|
|Mackerel, cooked, 3½ ounces||345||90|
|Tuna fish, canned in oil, 3 ounces||200||50|
|Sardines, canned in oil, drained, 1¾ ounces||250||70|
|Milk, nonfat, reduced fat, and whole, vitamin D fortified, 1 cup||98||25|
|Margarine, fortified, 1 Tablespoon||60||15|
|Pudding, prepared from mix and made with vitamin D fortified milk, 1/2 cup||50||10|
|Ready-to-eat cereals fortified with 10% of the DV for vitamin D, 3/4 cup to 1 cup servings (servings vary according to the brand)||40||10|
|Egg, 1 whole (vitamin D is found in egg yolk)||20||6|
|Liver, beef, cooked, 3½ ounces||15||4|
|Cheese, Swiss, 1 ounce||12||4|
*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for vitamin D is 400 IU for adults.
Daily Adequate Intake of Vitamin D
|Birth to 13 years||200 IU|
|14 to 18 years||200 IU||200 IU||200 IU||200 IU||200 IU|
|19 to 50 years||200 IU||200 IU||200 IU||200 IU||200 IU|
|51 to 70 years||400 IU||400 IU|
|71 + years||600 IU||600 IU|
Follow your Doctors advice on calcium and Vitamin.-D supplements.
Q. What are the Symptoms of Osteoporosis?
Frequently Osteoporosis is diagnosed for the first time, when an old age-geriatric patients presents with acute unexplained debilitating localized bone pain or chronic generalized bone pain.
Very often, these pains on investigation are diagnosed as fracture of vertebra (compression fractures), hip forearm or any other bone fractures with or without minor trauma such as bending forward, lifting, jumping or falling from standing position etc.
Pain, disfigurement, and debilitation are common in the latter stages of the disease. Early spinal compression fractures may go undetected for a long time, but after a large percentage of calcium has been lost, the vertebrae in the spine start to collapse, gradually causing a stooped posture called kyphosis, although this is usually painless.
In old age, the increase risk of falling, along with impaired eyesight, collapse due to transient loss of postural tone with or without loss of consciousness lead to often multiple fractures .Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with gait or balance disorders, are most at risk.
Q. What are routine Investigations for Osteoporosis?
(A)DEXA (Dual-energy X-ray absorptiometry)
DEXA is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30-40-year-old), healthy adult women reference population. This is translated as a T-score. But because bone density decreases with age, more people become osteoporotic with increasing age. The World Health Organization has established the following diagnostic guidelines:
|Category||T-score range||percentage of young, healthy women|
|Osteopenia||−2.5 < T-score < −1.0||14%|
|Osteoporosis||T-score ≤ −2.5||0.6%|
|Severe Osteoporosis||T-score ≤ −2.5 with 1+ fragility fracture(s)|
The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under 50 years of age should not be made on the basis of densitometric criteria alone. It also states, for premenopausal women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone.
- Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down type-I collagen protein, an important constituent in bones. Prepared antibodies can recognize the resulting fragment, called a neoepitope, as a way to diagnose osteoporosis.Increased urinary excretion of C-telopeptides, a type-I collagen breakdown product, also serves as a biomarker for osteoporosis.
- CTX markers
- P1NP markers etc
Quantitative CT differs from DEXA in that it gives separate estimates of BMD for trabecular and cortical bone and reports precise volumetric mineral density in mg/cm3 rather than BMD's relative Z score.
QCT's advantages: it can be performed at axial and peripheral sites, can be calculated from existing CT scans without a separate radiation dose, is sensitive to change over time, can analyze a region of any size or shape, excludes irrelevant tissue such as fat, muscle, and air, and does not require knowledge of the patient's subpopulation in order to create a clinical score (e.g. the Z-score of all females of a certain age).
QCT's disadvantages: it requires a high radiation dose compared to DXA, CT scanners are large and expensive, and because its practice has been less standardized than BMD, its results are more operator-dependent. Peripheral QCT has been introduced to improve upon the limitations of DXA and QCT.
Quantitative Ultrasound has many advantages in assessing osteoporosis. The modality is small, no ionizing radiation is involved, measurements can be made quickly and easily, and the cost of the device is low compared with DXA and QCT devices. The calcaneus is the most common skeletal site for quantitative ultrasound assessment. The method can be applied to children, neonates, and preterm infants, it is expected that quantitative ultrasound will be increasingly used in clinical practice but this can give mor of fals high readings. It cannot replace DEXA.
Q. What is the Medical Treatment for Osteoporosis?
Medicines prescribed for prevention of osteoporosis
Hormonal therapy :-
- Raloxifen - selective estrogen receptor modulator.
- Estrogen Replacement Therapy - Remains a good treatment for prevention of osteoporosis, but is not recommended yet unless other indications for its use are present, as well. There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause.
- Testosterone -In hypogonadal men, testosterone has been shown to give improvement in bone quantity and quality.
Bisphonates :- Are effective in preventing fractures of the vertebrae, non vertebral bones and hips when taken for three to four years.
Teriparatide (a recombinant parathyroid hormone)has been shown to be effective in treatment of women with postmenopausal osteoporosis.
Calcium and vitamin D decrease the risk of non vertebral fractures in those with postmenopausal osteoporosis by about 18%. High intake of vitamin D reduces fractures in the elderly.
Q. What are the Benefits of exercise for people with osteoporosis?
A sedentary lifestyle, poor posture, poor balance and weak muscles increase the risk of fractures. A person with osteoporosis can improve their health with exercise in valuable ways, including :
- Reduction of bone loss
- Conservation of remaining bone tissue
- Improved physical fitness
- Improved muscle strength
- Improved reaction time
- Increased mobility
- Better sense of balance and coordination
- Reduced risk of bone fractures caused by falls
- Reduced pain
- Better mood and vitality.
Q. What factors are to be considered while deciding on an exercise program?
Always consult with your doctor, physiotherapist or health care professional before you decide on an exercise program. Factors that need to be considered include :
- Your age
- The severity of your osteoporosis
- Current medications
- Your fitness and ability
- Other medical conditions such as cardiovascular or pulmonary disease, arthritis, or neurological problems
- Whether bone density or falls prevention are the main aims of your exercise program
- A combination of weight-bearing aerobic and muscle-building (resistance) exercises is best, together with specific balance exercises.
Q. Recommended exercises for people with osteoporosis?
Exercises that are beneficial for people with osteoporosis include :
- Weight-bearing- it means that feet and legs support the body weight, eg – walking, dancing, stair climbing.
- Walking as little as 3- 5 miles /half an hour of moderate exercises five times a week are good for the body.
- Resistance Exercises - it means working against the weight of another object. It helps in osteoporosis, it strengthens muscle and builds bone like using free weights such as dumbbells and barbells, elastic band resistance, body-weight resistance or weight-training machines.
- Flexibility Exercises to improve joint flexibility, posture, balance and body strength like- yoga, stretches, Tai chi etc.
Ideally, weekly physical activity should include something from all three groups.
Swimming and water exercise
Swimming and water exercise (such as aqua aerobics or hydrotherapy) are not weight-bearing exercises, because the buoyancy of the water counteracts the effects of gravity. However, exercising in water can improve cardiovascular fitness and muscle strength. People with severe osteoporosis or kyphosis (hunching of the upper back) who are at high risk of bone fractures may find that swimming or water exercise is their preferred activity. Consult with your doctor or health care professional.
Even though walking is weight-bearing exercise, it does not have a major impact on bone health, muscle strength, fitness or balance unless it is carried out at high intensity such as at a faster pace, for long durations (such as bushwalking) or incorporates challenging terrain such as hills. However, for people who are otherwise inactive, walking may be appropriate as a safe way to introduce some physical activity.
Q What Exercises to avoid for people with osteoporosis?
A person with osteoporosis has weakened bones prone to fracturing. Activities to avoid include :
- Exercises that increase the risk of falling.
- Exercises that require sudden, forceful movement unless introduced gradually as part of a progressive program.
- Exercises that involve loaded forward flexion of the spine such as abdominal sit-ups
- Exercise that requires a forceful twisting motion, such as a golf swing, unless accustomed to such movements. This motion can put Osteoporotic patient to risk of spine / hip fractures.
- Running, jogging, and jumping may put stress on the spine, may lead to fractures in weekend bones so should be avoided or gentle weight bearing exercises like walking, dancing, gardening etc. Can be tried.
Q. The amount of exercise permissible for people with osteoporosis?
The exact amount of exercise required for people with osteoporosis is currently unknown. However, research indicates the following may be beneficial:
- 45 minutes to one hour of aerobic activity two to three times per week.
- Resistance training (such as weight training with dumbbells, barbells or rubber tubing) two to three times per week. Each session should include exercises to strengthen the lower limb, trunk and arm muscles. Each exercise should be performed eight to 10 times.
- Balance exercises need to be performed at a level that is challenging to your balance and should be performed for a few minutes at least twice a week. Note, for safety reasons, always make sure you can hold on to something if you overbalance.
- Include stretching exercises to promote flexibility.
- Exercise needs to be continued long term to achieve reductions in fracture rates.
Q Advice for people with osteoporosis?
Regular exercise should be considered an essential part of any osteoporosis treatment program along with medication and lifestyle changes.
Treating Orthopedic Doctor and physiotherapist will decide the right and suitable exercise program for each case and self decisions may be hazardous to health.