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Joint Replacements

Orthopaedics & Joint Replacements

Conditions We Treat

Hip

Hip Arthritis

When patients complain of hip pain, arthritis is one of the most significant causes. With arthritis, the pain is progressive (with time the pain increases). Treatment options include physical therapy, pain killers, corticosteroid injections, orthotics and surgery. The patient must refrain from high-impact activities that worsen the condition. This may become crippling if left untreated.

Osteonecrosis

Being a condition that can cause excruciating pain, it is a result of the blood supply to the femur being stopped. Cells need oxygen to survive, and in its absence they die. The hip joint, as a result, may suffer damage leading to chronic arthritis.

Hip Fractures

One of the more common hip conditions that is prevalent among the older population (above 50 years), its incidence increases further in the over 65 years age category. In older people, hip fractures can result from just a trivial fall, but the good news is if the person is otherwise healthy, with timely treatment and rehabilitation, a normal life can be restored.

Other Painful Hip Conditions

  • Bursitis: Liquid sacs called bursae are present in between tissues. Their purpose is to facilitate ease of movement and reduce friction. When this bursa gets infected, or inflamed a condition called bursitis results, which is characterized by hip pain.
  • Tendinitis: Bones and muscles are attached to each other by tendons. Due to overuse, the tendons might get sore, resulting in hip pain.
  • Muscle Strain: The hip joint is reinforced by muscles and tendons. When these are overworked, they get strained, causing hip pain.
  • Hip Labral Tear: The hip joint is cushioned by a layer of cartilage around the socket (Acetabulum). This is called the labrum. The labrum helps in keeping the thigh bone and socket together. A tear in this cartilage causes hip pain.
  • Cancer: Cancers can either originate in the hip, or they can spread to the hip from other parts. These can cause hip pain or result in fractures (Pathologic Fractures).

Knee

Knee Arthritis

The knee is the most common joint that is afflicted with arthritis. Arthritis can affect any joint in the body, causing pain and inflammation. When the knee is affected, daily activities like walking become painful. Arthritis can be controlled with proper treatment.

Fractures

In the front part of the knee, is the kneecap (patella). An injury to the kneecap in the form of an accident or a fall can cause it to crack or break. This is called a kneecap fracture and the pain from this fracture is felt immediately. Tibia and femoral fractures are major injuries and can lead to serious problems, if not attended to properly. They require immediate treatment.

Deformity Correction

Misalignment of the legs can occur due to conditions like knock knees and bow legs. In these conditions, the legs will not be straight and will look visibly deformed. The pressure borne by the knees in such cases will result in pain. Surgical correction can rectify this condition to relieve pain and give a better appearance as well.

Knee cap Pain (Patella Femoral)

Medically known as the patella femoral pain syndrome, the pain in this case can be felt anywhere around the kneecap. Being a condition common in teenaged girls, it prevents activities like running, climbing stairs, etc.,

Anterior Cruciate Ligament (ACL) Injury

The thigh bone and shin bone are connected by many ligaments. One sturdy ligament present inside the joint is called the anterior cruciate ligament. When this ligament tears (which mostly occurs during sporting activities) severe knee pain and inflammation will result. Treatment can vary as per the injury’s severity.

Other Painful Conditions and Instability

  • Meniscus Tear: The knees are cushioned by cartilages called meniscus. This cartilage can tear when a sudden force acts to twist the knee. This condition is called a meniscus tear and can be treated either conservatively or surgically depending on the injury.
  • Femoral Neuropathy: When the femoral nerve of the leg is affected by conditions like diabetes, arthritis, etc. it leads to the debilitation of the nerve. This can weaken the knees and lead to knee buckling.
  • Plica Syndrome: Plica syndrome is an inflammation of the medial plica (abnormal band of tissue in the knee) which causes knee pain and buckling.

Foot and Ankle

Fractures

Ankle fractures that are commonly encountered in young and old alike are caused by a sudden twisting movement of the foot, falls and sporting activities. Foot fractures may be caused by a fall from a height or when heavy objects are dropped on the foot. Pain while walking and inflammation are the symptoms. Treatment depends on the type and severity of fracture.

Dislocations

An ankle dislocation is usually the result of a forceful injury which causes the bones in the ankles to separate. Characterized by severe pain, visible deformation may also be observed. Diagnosed with an x-ray, the immediate line of treatment would be to restore the bones to their original position (Closed or Open reduction).

Arthritis

The feet and ankle too can be affected by arthritis. By conducting physical examinations and analysing a person’s gait, the doctor will come to a conclusion on the exact part of the foot which is affected. Proper diagnosis and treatment can cure the problem.

Deformities

The deformity may be present in the form of a flat foot (with no arch), a significantly abnormal arch, deformed toes, etc. If they do cause a problem, initially splints or orthoses with exercises help. If persistent, surgery can be performed to overcome it and restore functionality.

Other Painful Conditions

  • Bunions: Here, the big toe juts out when the tendons and ligaments do not support it properly. Being painful when the foot is fitted into narrow footwear, the condition can be overcome with orthotics and comfortable footwear. If the condition is painful, medication or surgery may be needed.
  • Achilles Tendinitis: The heel bone is connected to the calf muscles by the Achilles tendon. Overworking the tendon by running (more than what it is used to) or by performing high-impact activities injures it. Treatment involves a combination of rest, graded physiotherapy, medications and footwear modification.

Shoulder

Arthritis

Shoulder arthritis is the wear out of the cartilage inside the shoulder joint. Manifesting as shoulder pain, stiffness in the shoulder and reduced range of movement of the shoulder, it can be treated by non-invasive as well as invasive techniques. Non-invasive methods include physical therapy, icing the area, and medications.

Fracture

The scapula, the clavicle, and the humerus are the bones that make up the shoulder. Any of these can sustain a break. While they all cause shoulder pain with swelling and reduced range of shoulder movement, they also have signs unique to each of them. X-rays, CT scans, and MRIs are used to diagnose the condition. Icing the area, physiotherapy, medicines and arm slings (to immobilize the area) might help. Surgery may be needed in some type of fractures only.

Shoulder Dislocation and Instability

The shoulder joint detaches from the socket, and as a result the shoulder becomes unstable. While genetic predisposition is a cause, other causes include injury and overuse. Frequent dislocations increase instability. Patients are advised to refrain from activities that might cause dislocation along with icing and pain medications. Surgery is necessary for recurrent dislocations.

Frozen Shoulder

Medically called adhesive capsulitis, frozen shoulder is the result of the connective tissue around the shoulder thickening and reducing movement. Diabetics and people whose shoulder movement is restricted (eg. Following injury) are more prone to frozen shoulder. Physiotherapy helps along with injections to alleviate pain. In very rare cases, surgery might be needed.

Rotator Cuff Tears

The rotator cuff refers to the muscles and tendons that play a key role in connecting the upper arm with the shoulder. Symptoms of rotator cuff tear are pain at night time and pain even when the shoulder is at rest. Carrying and lifting things might also cause pain. Performing the same motion repeatedly is a common cause of rotator cuff tear. Falls, injuries, etc. are other possible causes.

Other Painful Conditions

  • Bursitis: The bursa (the sacs filled with fluid) around the shoulder that aid in movement get inflamed and cause shoulder pain.

Elbow

Fractures

The ulna is one of the bones in the forearm. The tip of the ulna (near the elbow) ends in the olecranon, which protrudes slightly and is unprotected by muscles and soft tissue. Hence, this part is susceptible to fractures and breaks/cracks relatively easily with a blow. Olecranon fracture can be treated with splint or surgery depending on the severity.

Dislocation

The radius, the ulna and the humerus form the elbow joint. When these three bones get displaced from the joint, it is called an elbow dislocation. Fall on an outstretched hand usually is the cause. Painful and visible to the naked eye, complete elbow dislocations are quite easy to diagnose. Partial dislocations will need a physical examination and diagnostic tests for confirmation.

Arthritis

Arthritis in the elbow could be osteoarthritis or rheumatoid arthritis. With osteoarthritis, reduction in the cushioning cartilage around the elbow joint causes the elbow bones to rub against each other. Injuries and overuse are the common causes.

Rheumatoid arthritis is an autoimmune condition wherein the body joints are attacked by the body’s own immune system. When both elbows are affected, rheumatoid arthritis is the usual cause.

Tennis Elbow, Golfer’s Elbow

Racquet sports like tennis, badminton, etc., which require a tight grip and swinging movement can exert a lot of pressure on the tendons on the outer part of the elbow. This condition is called a tennis elbow and it might cause pain while lifting objects, fisting the hand, raising the hand, etc. Golfer’s elbow is alike tennis elbow, except in this the tendons in the inner part of the elbow are affected. These can occur even in a person who does not play sports or games. Physical examination with imaging tests help confirm the conditions.

Other Painful Conditions

  • Cubital Tunnel Syndrome: Constriction of the ulnar nerve in the elbow can cause pain, loss of sensation and weakness in the elbow.
  • Ruptured Biceps Tendon: The biceps has tendons at both its ends with one tendon attaching to the shoulder and the other tendon attaching to the elbow. A trauma to the tendon can cause it to tear partially or completely resulting in a ruptured biceps tendon.

Hand and Wrist

Fractures

The bones of the hand and wrist may break due to road accidents, a bad fall, high-impact sports, etc. When the patient is already suffering from osteoporosis, the probability of sustaining a fracture is more. Immediate treatment is of importance as the bones might not heal properly otherwise. The symptoms include pain in the hand, swelling, and in some cases the hand is visibly deformed. A physical examination along with an x-ray is done for diagnosis. Surgery will be done under anaesthesia to realign the bones.

Arthritis

When arthritis affects the hand, performing daily activities might become difficult. Symptoms include pain which increases with hand movement. The pain is also more on waking up in the morning. As arthritis progresses, the pain also increases. X-rays, blood tests at times, are done for diagnosis. The condition’s severity as assessed on tests will determine the treatment. Treatment can be invasive or non-invasive. There are various surgical treatments too which can be done depending on individual conditions and joints involved.

Carpal Tunnel Syndrome

The median nerve runs through the arm, through the carpal tunnel in the wrist till the fingers. When this median nerve is compressed, the hands might experience a tingling sensation, or they might completely lack sensation. This is called the carpal tunnel syndrome, and it has many possible causes that range from diabetes and pregnancy to rheumatoid arthritis. What begins as a tingling sensation may aggravate to pain and the inability to hold objects properly. Early treatment is important for recovery. Treatment options include immobilizing the hand, performing stretching exercises, pain medication, and surgery as the last resort.

Trigger Finger

When bending the finger, the finger gets locked in bent position and straightens with an audible snap accompanied by pain. This is called trigger finger. Overuse of the fingers and hand, performing the same movement repeatedly and inflammation of the tendons can result in trigger finger. Pain on getting up in the mornings, pain while gripping objects and straightening fingers are the other symptoms. There are no specific tools to diagnose this condition; a physical examination is what will help the doctor in diagnosis. Rest, immobilization, physiotherapy, and pain medications will help treat the condition. Surgery when done for unresponsive individuals gives dramatic relief.

Other Painful Conditions

  • Cubital Tunnel Syndrome: When the ulnar nerve is pinched, cubital tunnel syndrome might result. When the elbow is subjected to a lot of weight, this condition manifests. Surgical and non-surgical treatment options are available.

Musculoskeletal Tumors

Benign Tumours of the Bone

Just like in other parts of the body, tumours can form in the bones and muscles too. These tumours can be benign or malignant.

Benign tumours occur in any age. The tumour may be felt as a lump and may also be accompanied by pain. Sometimes, its presence is discovered accidentally while taking an x-ray for a fracture. The fracture may have been a result of the tumour’s growth. It is best to surgically remove the tumour.

Bone Metastasis

In bone metastasis, cancer from other parts of the body spreads to the bones. The cancer does not originate in the bone. When the cancer affects the bones, it can form small holes in the bone. As a result, the bone gets weakened. This is called osteolysis, and the possibility of fracture increases when bones are thus affected. Radiotherapy, chemotherapy, pain management and surgery are the treatment options.

Others

Pelvic and Acetabular Fractures

Usually sustained in an accident or because of a fall from height, pelvic and acetabular fractures require prompt treatment. For senior citizens though, even a relatively insignificant fall can result in this fracture if their bones are already weak. The complicated anatomy of the pelvis makes this a challenging condition to treat. The pelvis holds up the upper body, and the acetabulum refers to the part of the pelvis that connects to the femur. These fractures usually are accompanied by injury to the surrounding tissues and nerves. The surgeon will decide on a surgical or non-surgical option depending on individual conditions.

Bone Infection (Osteomyelitis)

When the bone is infected, either as a result of infection spreading from far away tissue or by infection originating in the bone itself, the condition is called osteomyelitis. In the latter case, a wound or open injury might expose the bone to germs and result in the condition. Fever with pain and inflammation at the site of infection are the usual symptoms. Smokers and diabetics are at an increased risk of contracting this condition, and hence they should take care to avoid cuts in feet, which may lead to osteomyelitis.

Geriatric Orthopaedics – Fragility Fracture

When a fracture is sustained by a fall from standing height or less, this is usually because the bones are already weak. This kind of fracture is called a fragility fracture and is common among older citizens. With a fragility fracture, surgical intervention is recommended so that the patient can regain mobility as quickly as possible. Quick recovery is all the more important as in some cases immobility can lead to various complications. Post-surgery, methods to prevent future fractures need to be implemented.

Periarticular Fractures

Fractures that occur in or in close proximity to a joint are called periarticular fractures. Extreme pain and inability to move are characteristic of these fractures. Treatment is complicated because of the anatomical nature of these fractures. Though they can occur anywhere in the body, parts of the leg are more common sites for these fractures. Since they are close to the joints, accurate treatment is necessary.

Periprosthetic Fractures

In a periprosthetic fracture, the bone breaks or cracks near the implant that has been placed already. These types of fractures are becoming increasingly common these days. They might be caused by weak bones, bone infection, and pressure on the bone. Women are more at risk than men.

Post-Surgical Problem Fractures (Malunion and Non-union)

In a malunion, the bone heals after a fracture, but its positioning is not right. As a result, the limb may seem twisted/ bent or reduced in length. When pain persists after fracture treatment, malunion is a possible cause. Surgical intervention may be required to correct it.

Non-union refers to the fractured part’s inability to mend. Even for months after the fracture, healing does not take place. For a fracture to heal well, it needs to be held in proper position with adequate blood supply. When blood supply is not enough, non-union can result.

Orthobiologics

Orthobiologics are substances that are found in the human body that promote healing. So, surgeons make use of these to enhance the healing process. Bone grafts, stem cells, platelet rich plasma, etc. are all examples of orthobiologics.

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