A MultiDisciplinary Approach… Knee and Joint Replacement Surgeries

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HEALTH MET WITH THE ENTIRE TEAM AT THE RECENT LAUNCH OF THUMBAY HOSPITAL’S NEW ORTHOSPINE CENTER IN DUBAI TO UNDERSTAND MORE ABOUT HOW KNEE AND JOINT REPLACEMENT SURGERIES HAVE CHANGED DRAMATICALLY IN THE PAST 20 YEARS.

A HOLISTIC APPROACH
Orthopedics has changed in the past 20 years, tells Specialist Orthopedist Dr. Amit Arvindbhai Shah, explaining, “Before, the patient was treated AFTER the problem occurred, while now it is about prevention. As our lifestyles have changed with an increase in obesity rates, and now as orthopedic experts, we need to be able to assess a patient and predict these potential problems in advance before they happen in the future.” Dr.Gopal Shukla, Specialist Neurosurgery, further explains that the spine unit aims to offer a complete range of solutions for spinal ailments starting from simple posture related backaches to instrumentation for complex spinal deformities. The armamentarium includes minimal access procedures like microdiscectomies and endoscopic disc excision

LIFELONG COMMITMENT
In fact, in orthopedics, they are caring for humans from birth to death, reveals Dr. Mohammed Ahmed Refai Farag Sanad, Pediatric and Deformity Correction Orthopedic Specialist. “This journey in life may include developmental problems or congenital deformities, which require to be checked; this is the pediatric sector,” he says. “Next, there is adolescence in which sports injuries, trauma, movement, and some rheumatoid disease may begin now.”

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ACHES AND PAINS
Nowadays, there is an increasingly dramatic increase in muscular pain and even newborn babies can be affected; all of which Rheumatology Consultant Dr. Mohammed Hanafy Mohamed Ahmed Salama points out is related to rheumatology. For arthrodesis in the knees and hip, most patients have underlying rheumatic disease May/June 2017 18 which causes a destruction of the joints in the form of rheumatoid arthritis, systemic lupus, ankylosing spondylitis, psoriatic arthritis, fracture of the spine hand and hips, secondary metabolic bone disease (osteoporosis), and many other rheumatic disorders. All of these require preoperative management by a rheumatologist, to control their disease activity, and check their medications which may delay healing as well as medication that may lead to post-operative complications. Also, a rheumatologist has a role after recovery from surgery to control diseases and prevent further joint destruction.

KNEE AND JOINTS REPLACEMENT
The most common reasons for bone degeneration, highlights Specialist Orthopedist Dr. Pulate Avinash Murlidhar, are obesity, a sedentary lifestyle, and not consuming a healthy diet. Other than that, there are diseases; some people may have in-built congenital problems, some may have suffered in an accident, or there may be a rheumatological disease.

THE PROCEDURE
Dr. Rajesh Garg, Specialist Orthopedic and Joint Replacement Surgeon, has successfully performed thousands of joint replacement surgeries on patients ranging from ages 35 to 97. However there is still a spike in patients for knee joint replacements at age 60 to 70 years, typically because of the aging phenomenon- “wear and tear”. He reiterates, “Often times in the past, as a patient got older in age, he/ she assumed the knee pain was due to aging when it was actually knee arthritis, but mistakenly assumed as a symptom of aging.” Also, sometimes a person may have a cartilage injury for which they used painkillers to alleviate the May/June 2017 19 pain instead of getting it properly treated. This can lead to arthritis further down the line, or it may be genetic, or a post collagen muscular disorder or some other form of arthritis which affects the joints.” Typically Dr. Garg and the team will replace the joint only and only if there is no other means or mode of relieving pain in that knee joint. “So, if a patient has knee arthritis and has tried all other modalities of treatment including pain killers, lifestyle modifications, braces, injections, and joint debridment with knee arthroscopy, yet still the knee pain is disrupting daily activities, then we educate and suggest the patient go for knee replacement surgery,” he states.

RECOVERY

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Today, knees joint replacement surgeries are much more improved in the hands of a good surgeon with the best implants and the latest infrastructure, than it was before, points out Dr. Garg. He adds, “Now the post-operative period has almost become pain-free with better analgesic control by the highly professional anesthetist team.” “For early recovery, we ask the patient to start moving his limbs as soon the patient regains their senses in their lower limbs from effect of the anesthesia, and make them stand within 24 to 48 hours and walk with a help of walker. On an average, the patient stays with us in our hospital for 4 to 5 days and upon discharge, the patient is independent enough to take care of his activities of daily living. A predesigned physiotherapy protocol is followed for each patient from day 1 and on an average, a patient requires 4 to 6 weeks of good effective rehabilitation period for better results.”

TEAM WORK
Performing a joint replacement for a patient is total teamwork, explains Dr. Avinash; from the fitness of the patient to the point of surgery and later physiotherapy requirements. He explains, “Although replacement surgery is a broad perspective, because every knee/ joint replacement is different for every patient, everything is totally individualized to that particular patient because some patients may have deformities, some have the inability to move due to pain, some may have severity due to arthritis, so it’s all according to these factors that a surgery will be done.”

THE IMPORTANCE OF PHYSIOTHERAPY
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The role that physiotherapy plays in the patient’s prognosis is paramount and Dr. Avinash maintains that it is actually something that is done from start to finish in their department. Further elaborating, Dr. Mohammed Ahmed Refai Farag Sanad explains, “After surgery, our patient is shifted for physiotherapy to complete the job. If we stop post-surgery, the patient can actually lose 50 percent of the result.”

Further elaborating, Krishnakali Mondal, Physiotherapy Consultant explains, “Surgery or not, we always have to assess the patient.” For example, if there is a patient who is undergoing joint replacement, before the operation, the physiotherapist needs to carefully and thoroughly assess the muscular strength, joint range of motion, gait, or any other abnormalities of this patient since flexibility and strength is required for joint replacement. “We need to assess how much strength the muscles have and the success of the surgery will depend upon the condition of the muscles,” she tells, “we also check the posture and the difficulties he/ she may face. Once a knee or joint replacement is done, the physiotherapist immediately begins to check that the muscles adapt with the body and the patient gets back to normal activities gradually”

CREDITS:
Dr. Rajesh Garg
Specialist Orthopedic and Joint Replacement Surgeon
Dr. Pulate Avinash Murlidhar
Specialist Orthopedic
Dr. Mohammed Hanafy Mohamed Ahmed Salama
Rheumatology Consultant
Dr. Mohammed Ahmed Refai Farag Sanad
Pediatric and Deformity Correction Orthopedic Specialist
Dr. Amit Arvindbhai Shah
Specialist Orthopedic
Dr. Gopal Shukla
Specialist Neurosurgery
Krishnakali Mondal
Physiotherapy Consultant
Divyashree Uchil
Physiotherapy

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