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Birmingham Hip Resurfacing

What is Hip Resurfacing
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What is Hip Resurfacing?



Provided by Wockhardt Hospital
Brought to you by Healthbase



Hip ResurfacingHip Resurfacing or Surface Replacement Arthroplasty is a bone-conserving alternative to conventional Total Hip Replacement (THR). Unlike THR, hip Resurfacing does not involve the removal of the femoral head and neck nor removal of bone from the femur. Rather, the head, neck and femur bone is preserved in an effort to facilitate future surgery should it be necessary and to enable the patient to take advantage of newer technology or treatments in the future. The current generation of hip Resurfacing devices utilize a metal bearings have demonstrated a much higher level of wear resistance as well as reduced bone loss and inflammatory tissue reaction about the hip joint as compared to metal-polyethylene bearings.

Hip Resurfacing is anatomically and biomechanically more similar to the natural hip joint resulting in increased stability, flexibility and range of motion. Further, dislocation risk is virtually eliminated. Higher activity levels are typically achieved with less risk. These benefits are realized because the head diameter that results from Resurfacing is very similar to the patient's normal head diameter and these larger head sizes are typically much larger than the femoral balls utilized in conventional THR.

Advantages of Hip Resurfacing:

  1. Allows the patient to squat and sit on the floor safely

  2. Allows a normal range of movement and sporting activities after operation

  3. Sacrifices only the diseased bone and preserves normal bone

  4. Restores the normal structures of the hip

  5. More natural feel after surgery

  6. Early rehabilitation

  7. Easy to revise if needed

  8. Less risk of dislocation

  9. No leg length alteration


Know the physiology of Human Hip

The normal hip joint consists of a ball rotating inside a socket. The ball is called the head of the femur and the socket in the pelvis is called the Acetabulum. The surface of the femoral head and the acetabulum (i.e. the ball and the socket) is covered by a protective layer of cartilage ( the white lining seen in the pic). This makes the joint smooth and reduces friction during movements. It covers and protects the bone like the rubber of a car tyre.

Any condition that damages the Cartilage will lead to pain, dysfunction and eventually arthritis. Cartilage can get damaged due to a number of reasons including Injury, Infection, Ankylosing Spondylitis, Avascular Necrosis ( loss of blood supply to bone), Rheumatoid Arthritis, Osteoarthritis, Developmental problem like bone Dysplasias, slipped upper femoral epiphyses etc.

Frequently Asked Questions  

  • Is this a minimally invasive?

  • Do I need blood transfusion during the surgery?

  • Is it a very painful operation?

  • When do we remove the stitches and is it very painful?

  • How long do I have to stay in hospital?

  • When can I start walking and climbing stairs after the operation?

  • Do I need lots of physiotherapy after surgery?

  • Will I be able to sit on the floor after surgery?

  • What is the ASR/BHR?

  • What is the advantage of Hip Resurfacing over conventional total hip replacement?

  • Are there any implants used ?

 

Is this a minimally invasive?
This operation can be done by a minimally invasive approach and the invasion can be kept to less than 10cms. The operation also involves minimal damage to bone.

 

Do I need blood transfusion during the surgery?
We generally do not need blood transfusions during the operation.

 

Is it a very painful operation?
Pain control techniques and minimal injury to soft tissue and bone during surgery help to keep the patients comfortable in the post operative period.


When do we remove the stitches and is it very painful?
Absorbable sutures are used. These need not to be removal. The patient does not have to follow up for up to 60 years after discharge from hospital.

 

How long do I have to stay in hospital?
Local patients are discharged four days after the operation, but overseas patients may have to stay for 8-10 days after surgery.

 

When can I start walking and climbing stairs after the operation?
Most patients start walking with support on the second postoperative day after removal of the drain. Our team of physiotherapist takes you through a standardized protocol of mobilization and stair climbing is achieved before discharge.

Do I need lots of physiotherapy after surgery?
The amount of physiotherapy needed depends on the condition of your joint and muscles before the operation. Most patients do not need much suppressed physiotherapy.

  Will I be able to sit on the floor after surgery?
Yes, this surgery will allow you to do that safely unless another problem prevents it.  

What is the ASR/BHR?
Hip resurfacing or surface replacement arthroplasty uses specialized implants that are fixed into the bone .Two international companies sell such implants in India at present.

a)Smith and Nephew (MMT) ? (BHR)    Birmingham Hip Resurfacing.
b)Johnson and Johnson ? (ASR) Articular    Surface Replacement.

What is the advantage of Hip Resurfacing over conventional total hip replacement?
Conventional Total Hip Replacements usually consist of a long metal component that is fixed into the femur (thigh bone) articulating with a polyethylene cup cemented into the pelvis.

Conventional hip replacements sacrifice a large quantity of normal bone. The very nature of fixation of these implants causes progressive bone loss due to stress shielding. The problem of bone loss gets compounded by osteolysis due to polyethylene debris from the cup. All these reduce the bone stock and make any future revision procedures difficult. The polyethylene cups gradually thin down due to wear and need replacing. The head of the femoral component is small in diameter, so as to reduce friction at the cost of stability. This increases the risk of hip dislocation i.e. hip coming out of joint

Problems with Conventional Total Hip Replacement:

  1. Bone loss

  2. Increased risk of dislocation

  3. Cannot squat or sit on the floor without the risk of dislocating the hip

  4. Range of movement is less

  5. Cannot safely indulge in sporting activities

  6. Revision Surgery difficult

  7. Feels less like a normal natural hip

  8. Possibility of change in leg length after surgery

 

Are there any implants used?
Modern techniques allow us to replace the diseased human hip with artificial implants which ensure near normal movements and function. Huge advances have been made in terms of the materials, the method of fixation and structure of these implants. The purpose of all these changes is to increase the longevity, reduce complication rate and improved function after surgery. Hip Resurfacing (bone conserving hip replacement (BHR), surface replacement ) with a metal-on-metal articulation is another step in this direction.


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Hip Resurfacing vs Hip Replacement


How is Hip resurfacing Surgery more beneficial to Total Hip Replacement?

Hip resurfacing is better than THR (total hip replacement) because generally after THR, one cannot sit on the floor, squat, or lead a very active, hectic life or play sport. THR can also dislocate. Hip Resurfacings hardly ever dislocate and activity levels are excellent after resurfacing. It should last even longer than THR and with a far far better lifestyle than THR. If Resurfacing fails at any stage, THR can be easily done.

Is Hip resurfacing Surgery only for young patients?

Not really, it can be done in elderly patients as well with good outcomes, provided they still have good bone density. This can be advised by our specialist doctors after reviewing your X-Rays. Please get X-Rays of your affected hip done - AP and Lateral views and send upload it in your account at Healthbase's My MedReports page (after login).

How would I determine if I am a candidate for this procedure without traveling abroad?

Once our specialist doctor looks at your Hip X rays and medical reports, it can be made clear if you are an appropriate candidate for resurfacing surgery. If possible please get the x ray by email from your radiology Lab or photographed at photo lab and upload it in your account at Healthbase's My MedReports page (after login). If you need help in digitizing or scanning of your medical reports, please contact Healthbase customer support.

Information about Hip resurfacing versus hip replacement procedure

Hip resurfacing or surface replacement arthroplasty is a bone-conserving alternative to conventional total hip replacement (THR). Unlike THR, hip resurfacing does not involve the removal of the femoral head and neck; hence the head, neck and femur bone is preserved in an effort to facilitate future surgery to enable the patient to take advantage of newer technology or treatments in the future. The current generation of hip resurfacing devices utilizes a metal-metal bearing. Metal-metal bearings have demonstrated a much higher level of wear resistance as well as reduced bone loss and inflammatory tissue reaction about the hip joint as compared to metal-polyethylene bearings. Hip resurfacing is anatomically and biomechanically more similar to the natural hip joint resulting in increased stability, flexibility and range of motion. Further, the dislocation risk is virtually eliminated. Higher activity levels are typically achieved with less risk. These benefits are realized because the head diameter that results from resurfacing is very similar to the patient's normal head diameter and these larger head sizes are typically much larger than the femoral balls utilized in conventional THR. This surgery is less invasive and rehabilitation after the operation is quicker. Patients are encouraged to be active after surgery as this improves the bone stock. Birmingham Hip Resurfacing technology, is a much advanced technical procedure than conventional total hip replacement. As a novel procedure, it demands an experienced surgeon who can thoroughly understand the responsibility of performing hip Arthroplasty on young active patients.

To keep pace with this changing and demanding scenario, we have a highly experienced Opthopaedic Surgeon - Dr. Kaushal C Malhan, in our clinical team. He brings with him tremendous orthopaedic training from the U.K. Dr. Malhan is responsible for establishing a regional Birmingham Hip Resurfacing Center at Wockhardt Bone & Joint Hospital in Mumbai, one of its kind in India. Patients from India and even from neighboring countries can benefit from the remarkable rewards of this procedure. Register to get FREE quote. Registration at Healthbase is simple, easy and free.

Conventional total hip replacements usually consist of a stemmed femoral component that is fixed into the femoral canal using cement articulating with a polyethylene cup cemented into the pelvis. There are several conventional total hip replacement systems that have been proven to work well in elderly inactive patients. In Hip replacement surgery thigh bone is generally removed which leads to the loss of large quantity of normal bone. All these reduce the bone stock and make any future revision procedures difficult. They work less well in the younger patients with poorer survival. They do not allow full unrestricted activity and can dislocate.

BHR is more advanced then the conventional hip replacement surgery. It has changed the lives of many young arthritics worldwide. For some of the hip joint problems/diseases like Avascular Necrosis, Hip Dysplasia with Secondary Arthritis, Old Perthes Diseases, Ankylosing Spondylitis and Young Age Osteoarthritis - BHR is proving as an effective solution.

Unlike Traditional hip replacement surgery the amount of bone removed is much smaller. During the surgery the joint is removed and resurfaced with a round femoral cup and metal acetabular socket. There is no risk of limb length changes at operation. Rehabilitation is much faster. The joint is then lubricated by the hip's natural fluid. In BHR, preservation of bone stock at the time of operation and less stress shielding makes it easy to revise the surgery, if needed. This procedure helps in sacrificing only the diseased bone and acetabular socket preserves normal bone.

The advantages of BHR over the conventional hip replacement surgery

  • Removes only unhealthy bone and replaces it with a metal on metal articulation.
  • It preserves the normal bone of the hip
  • patients can squat, sit cross-legged without the risk of dislocation
  • Everlasting
  • based on 35-year history in Birmingham of metal on metal implants.
  • Excellent restoration of full function.
  • Femoral head remains viable after BHR surgery.
  • It does not sacrifice normal bone during primary surgery.
  • Activity restriction not required after surgery, as there is hardly any risk of dislocation.
  • Patient can indulge in full sporting activities without risk of dislocation.
  • Patients have gone back to sports like competitive Judo and Squash after surgery.
  • Overall 99% success rate
  • ideal option for the younger or more active patient.
  • No dislocation in more than 2000 BHR procedures done in Birmingham.
  • Many adolescent patients have had the procedure with excellent results.
  • Procedure can be done soon after skeletal maturity.
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Top Total Knee Replacement
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Total Knee Replacement



Provided by Wockhardt Hospital
Brought to you by Healthbase



Your knees work hard during your daily routine, and arthritis of the knee or a knee injury can make it hard for you to perform normal tasks. If your injury or arthritis is severe, you may begin to experience pain when you are sitting down or trying to sleep.

Sometimes a total knee replacement is the only option for reducing pain and restoring a normal activity level. If your and your doctor decide a total knee replacement is right for you, the following information will give you an understanding about what to expect.

A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.

The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients. Correct rehabilitation following surgery significantly improves outcomes.


Implant Components


Medical Tourism - Healthbase - Total Knee ReplacementIn the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface.

The femoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits.

The patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.


Advantages of Total Knee Replacement


Medical Tourism - Healthbase - Total Knee Replacement ImplantThe most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around a month's time. The patient regain a normal lifestyle and mobility with significant improvement in quality of life.


Exercise Program and Physical Therapy/ Rehabilitation after Knee Surgery


Knee replacement surgery is a complex procedure, and physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times.

Your knee rehabilitation program begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness, maximize post-operative range of motion, and get you ready for discharge.


When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven't used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours.

Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy. You will work with physical therapy until you meet the following goals:

1. Independent in getting in and out of bed.
2. Independent in walking with crutches or walker on a level surface.
3. Independent in walking up and down 3 stairs.
4. Independent in your home exercise program.

Your doctor and therapist may modify these goals somewhat to fit your particular condition.

In your physical therapy sessions you will walk, using crutches or a walker, bearing as much weight as indicated by your doctor or physical therapist. You will also work on an exercise program designed to strengthen your leg and increase the motion of your knee.

Your exercise program will include the following exercises:


Medical Tourism - Healthbase - Quadriceps Setting
Quadriceps Setting
The quadriceps is a set of four muscles located on the front of the thigh and is important in stabilizing and moving your knee. These muscles must be strong if you are to walk after surgery. A "quad set" is one of the simplest exercises that will help strengthen them.

Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.

You may start doing this exercise with both legs the day after surgery before you go to physical therapy. The amount of pain will determine how many you can do, but you should strive to do several every hour. The more you can do, the faster your progress will be. Your nurses can assist you to get started. The following diagram can be used for review.

 

Terminal Knee Extension
Medical Tourism - Healthbase - Terminal Knee ExtensionThis exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint.

Lie on your back with a blanket roll under your involved knee so that the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.

 

Knee Flexion
Medical Tourism - Healthbase - Knee FlexionEach day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.

In addition, your therapist may add other exercises as he or she deems necessary for your rehabilitation.

 

Straight Leg Raising
This exercise helps strengthen the quadriceps muscle also.
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times.

Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.

 

Use of heat and ice

Ice: Ice may be used during your hospital stay and at home to help reduce the pain and swelling in your knee. Pain and swelling will slow your progress with your exercises. A bag of crushed ice may be placed in a towel over your knee for 15-20 minutes. Your sensation may be decreased after surgery, so use extra care.

Heat: If your knee is not swollen, hot or painful, you may use heat before exercising to assist with gaining range of motion. A moist heating pad or warm damp towels may be used for 15-20 minutes. Your sensation may be decreased after surgery so use extra care.

 

Long-Term Knee Rehabilitation Goals
Once you have completed your knee rehabilitation therapy, you can expect a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.



Guidelines at Home - What happens after I go home?

 

Medication

  • You will continue to take medications as prescribed by your doctor.

  • You will be sent home on prescribed medications to prevent blood clots. Your doctor will determine whether you will take a pill (Warfarin or coated aspirin) or give yourself an injection. If an injection is necessary, your doctor will discuss it with you, and the nursing staff will teach you or a family member what is necessary to receive this medication.

  • You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, call your doctor.

Activity

  • Continue to walk with crutches/walker.

  • Bear weight and walk on the leg as much as is comfortable.

  • Walking is one of the better kinds of physical therapy and for muscle strengthening.

  • However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles.

  • If excess muscle aching occurs, you should cut back on your exercises.

Other Considerations

  • For the next 4-6 weeks avoid sexual intercourse. Sexual activity can usually be resumed after your 6-week follow-up appointment.

  • You can usually return to work within two to three months, or as instructed by your doctor.

  • You should not drive a car until after the 6-week follow-up appointment.

  • Continue to wear elastic stockings (TEDS) until your return appointment.

  • No shower or tub bath until after staples are removed.

  • When using heat or ice, remember not to get your incision wet before your staples are removed.


Your Incision

 

Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the staples are removed in three weeks.

 

Prevention of Infection

 

If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the knee area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement. You will be given a medical alert card. This should be carried in your billfold or wallet. It will give information on antibiotics that are needed during dental or oral surgery, or if a bacterial infection develops.


Frequently Asked Questions

 

  • Who is a candidate for a total replacement?

  • What are the risks of total knee replacement?

  • When do I return to the clinic?

  • Should I have a total knee replacement?

  • Who develops a more severe or an earlier arthritis?

  • When can I return home?

  • What measures should be taken after the surgery/operation (Post operative instruction)

  • What activities should I Avoid after Knee Replacement?

Q 1 Who is a candidate for a total replacement?

 

Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure is performed in younger people.

The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:

  • You have daily pain.

  • Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.

  • You have significant stiffness of your knee.

  • You have significant instability (constant giving way) of your knee.

  • You have significant deformity (knock-knees or bowlegs).

Q 2 What are the risks of total knee replacement?

 

Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung.

Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:

  • some knee pain

  • loosening of the prosthesis

  • stiffness

  • infection in the knee

A few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.

 

Q 3 When do I return to the clinic?

 

Even if everything is fine, it is advisable to return every three years after the surgery for a review.


Q 4 Should I have a total knee replacement?

 

Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you. All your questions should be answered before you decide to have the operation.

 

Q 5 Who develops a more severe or an earlier arthritis?

 

One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding.

Another form of Arthritis is Inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD's), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist.

Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.


Q 6 When can I return home?

 

You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.

 

Q 7 What measures should be taken after the surgery/operation (Post operative instruction)

 

The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery.

Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.

Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.

Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery. Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside.

  • Resuming other normal household activities, such as sitting and standing and walking up and down stairs.

  • Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.


Q 8 What activities should I Avoid after Knee Replacement?

 

Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.

You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.



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Top Unicondylar Knee Replacement
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Unicondylar Knee Replacement



Provided by Wockhardt Hospital
Brought to you by Healthbase



Most people are aware of the total knee replacement surgery. This involves replacing the unhealthy surface of the entire knee joint with metal and plastic implants. It is a very successful operation with good long term results. However a large percentage of patients have arthritis limited to one part of the joint alone. Replacing the whole joint in these patients is overkill and unnecessary.

Medical Tourism - Healthbase - Normal Knee vs Arthritic Knee' ALIGN=RIGHT HSPACE=5 WIDTH=265 HEIGHT=203 BORDER=0><FONT FACE=Many middle aged men and women develop osteoarthritis of the knee. Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.

In this operation only that part of the knee, which is unhealthy, is replaced. The normal surfaces are left alone. This operation has several advantages over total knee replacement surgery.

  • It can be done through a very small incision.

  • It is minimally invasive and hence tissue damage is far less.

  • The patient gets complete pain relief and the implant lasts long

  • The knee feels more natural as ligaments are preserved

  • Range of movement is full and it allows squatting and sitting crosslegged

  • Post operative hospitalization is reduced and return to normal is much faster than total knee replacement surgery.

Dr. Kaushal Malhan is a Joint Replacement and sports surgeon at the Wockhardt hospital. He was the first surgeon in India to do the mobile bearing oxford unicompartmental knee replacement and has been in the forefront in the field of full bending knee replacement surgery.

 

Medical Tourism - Healthbase - Preop and Postop knee x-rays

Preop xray of Dr Malhan?s
patient showing affection of only half the knee joint

Postop xray after surgery




Medical Tourism - Healthbase - Total Knee Replacement vs Unicompartmental Knee

One of the many overseas patients Dr Malhan has operated at Wockhardt hospital.

He is squatting 10 days after unicondylar knee replacement surgery

 

Frequently Asked Questions

 

  • What is unicondylar arthroplaty, or partial knee replacement?

  • What are the advantages unicondylar arthroplasty?

  • How is it different from total knee replacement?

  • You mentioned recovery is faster. What does that mean?

  • What does the surgeon do during a unicondylar arthroplasty?

  • How do I know if I am a candidate for this surgery?

What is unicondylar arthroplaty, or partial knee replacement?

Partial knee replaces only the area of the knee that is worn out, sparing patients the more medically complicated and involved total knee replacement surgery.

 

What are the advantages unicondylar arthroplasty?

With a partial knee replacement, there is a dramatically shorter recovery time due to less surgical trauma, less scarring and fuller range of motion.


How is it different from total knee replacement?

During total knee replacement, surgeons typically make a 7 to 8-inch incision over the knee, patients stay in the hospital for approximately four days, and there is a recovery period of up to three months. During minimally-invasive partial knee surgery, a part of the knee to be replaced through a small, 3-inch incision. There is minimal damage to the muscles and tendons around the knee and the required hospital stay is up to two days. The recovery period is about one month.

 

Medical Tourism - Healthbase - Total Knee Replacement Patient

 

You mentioned recovery is faster. What does that mean?

Patients often walk unassisted within a week or two of the operation. Even those who have both knees done at once are able to walk without the assistance of a walker or cane fairly quickly.


What does the surgeon do during a unicondylar arthroplasty?

When a knee replacement is performed, some bone and cartage are removed using precise instruments to create exact surfaces to accommodate a metal and plastic prostheses.

 

How do I know if I am a candidate for this surgery?

Candidates for this surgery are generally younger, more active patients. The partial knee replacement allows for symptoms of pain or discomfort. The procedure allows younger patients to buy time before they need a full knee replacement. The procedure is also effective for older patients if they have disease localized to one half of the joint.



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Top Shoulder Replacement
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Shoulder Replacement



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Medical Tourism - Healthbase - Shoulder ReplacementSimilar to other joint replacement procedures, shoulder replacement surgery is generally done to address persistent pain that is not controlled by non-surgical therapy. Less commonly, poor shoulder motion may also be a reason for replacement surgery.

Medical Tourism - Healthbase - Shoulder Replacement ImplantThe shoulder is a ball-and-socket joint, with the top of the arm bone (humeral head) fitting into a socket known as the glenoid. Muscles and tendons, such as the rotator cuff, help hold the joint in place. Surgery involves replacing the humeral head and the glenoid with artificial components. The humeral head replacement is generally made from a metal alloy, while the glenoid component is made from polyethylene plastic. The new components may be anchored by cement or press-fit into place so that the bone grows in around them.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

 

Rehabilitation

 

Arthritic shoulders are stiff. One of the major goals of total shoulder replacement surgery is to relieve much of this stiffness. However, after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. This early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery. Driving a car is not allowed for 6 weeks after surgery.

Here are some "do's and don'ts" for when you return home:

  • Don't use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.

  • Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.

  • Don't overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.

  • Don't lift anything heavier than a glass of water for the first 6 weeks after surgery.

  • Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.

  • Don't participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.

  • Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.
    Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function

Frequently Asked Questions

 

What are the symptoms to detect Shoulder Replacement?

 

Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night's sleep. The patient's shoulder may make grinding or grating noises when moved. Or the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.

 

How do I know if I am ready for shoulder replacement surgery?

 

Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.


How long is the recovery following shoulder replacement surgery?

 

Hospital stays vary from one to three days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.

Most physicians will begin some motion immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

 

What are the symptoms of severe arthritis of the shoulder?

 

Common symptoms of shoulder arthritis include:

  • Pain with activities

  • Limited range of motion

  • Stiffness of the shoulder

  • Swelling of the joint

  • Tenderness around the joint

  • A feeling of grinding or catching within the joint

Can rehabilitation be done at home?

 

In general the exercises are best performed by the patient at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

 

When can I return to ordinary daily activities?

 

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.


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Birmingham Hip Resurfacing Papers

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Birmingham Hip Resurfacing (BHR)
History, Development & Clinical Results


Hip Resurfacing Today


Hip Resurfacing Today Bringing everything together
Hip Resurfacing can work Hybrid Hip Resurfacing components Development of porous in growth surface - Porocast Tm Metallurgy - Improving on the past Finishing Technologies
"The human mind accepts a new idea about as graciously as the human body accepts a foreign protein" Atrributed to Wilfred Trotter, Consultant Surgeon, University College Hospital, London

Hip Resurfacing can work
It seemed to us that all the theoretical advantages of the hip resurfacing concept could be realised when thin metal shells were used as the articulating parts. However, this would require precision engineering for manufacture of the metal-on-metal bearing with expertise virtually lost following the abandonment of metal on metal total hip replacements in the 1970's, and a quality fixation that would be durable in young active patients.
Birmingham Experience of Metal on Metal Hip Resurfacing Design of the hip resurfacing started in 1989 and the first implantation was performed in February of 1991. Over the next three years, three methods of fixation were employed on both the acetabular and femoral sides to determine optimum fixation. It was clear at the end of this pilot study that hydroxyapatite cups were best, and cemented femoral components were best.42


Hybrid fixed resurfacing components (Fig. 37)
A limited range of three acetabular components with hydroxyapatite coating on a largely smooth surface and three femoral components designed for fixation with cement were manufactured and inserted from March 1994. The early results with this implant were most satisfactory, but because of the limited range we could not treat very small or very large patients, nor could we deal effectively with significant acetabular dysplasia, and dysplasia is a common prob- lem in these young patients.
Towards the end of 1996 a small number of patients with recently inserted Hybrid resurfacings reported a grating noise. This new complication could not be explained either by the Surgeons or the manufacturer, and there was no alternative but to withdraw this implant from the market-place pending further investigation. Subsequent investigation showed that the introducer holes for the cup introducer instrument had inadvertently been malpositioned. (Fig. 37 & 38) This meant that with introduction of the component at surgery, burrs could be raised on the articular surface giving rise to noise. Happily, the noise from these patient's hips settled quickly and all patients have continued to function well. It was clear however that redesign of the implant system would be necessary so that a new cup introducer instrument could be employed, ensuring that there was no risk of damaging the articular surface with cup insertion. (Fig. 38)


Since re-design of the implant was required because of the introducer problem, the opportunity was taken to markedly expand the range of sizes available (four cups increased to 23 cups) so that the extremes of patient sizes could be dealt with effectively. (Fig. 39) A dysplasia system was developed so that patients with severe acetabular dysplasia could be treated, and we decided to enhance the socket fixation. (Fig. 39)
It should be emphasised however, that we have not encountered any problem with socket fixation in the original Hybrid components except in severe dysplasia, but contemporary work indicated that hydroxyapatite on a smooth surface might not prove durable in the long term as hydroxyapatite does get resorbed.26 Hydroxyapatite on a porous surface has the advantage of encouraging early bone ingrowth. When the hydroxyapatite disappears, then enduring biological fixation continues with bone ingrowth in the porous network.
It was clearly important to maintain continuity and commonality as far as possible in all other aspects of this project. To this end the design team remained the same, Finsbury Ltd, the casting house, Centaur Precision, remained the same, the hydroxyapatite supplier, Plasma Biotal Ltd, remained the same as did the clinical development team, D.J.W. McMinn FRCS and R.B.C.Treacy FRCS. Only the finishing technologies changed significantly, to those developed by Finsbury Ltd, which were not available elsewhere but which al- lowed us much better dimensional control of the bearing surface geometry.



Development of porous ingrowth surface ? PorocastTm
It is known from clinical practice that conventional methods of producing a porous surface (plasma spray titanium and sintered beads) have a weak mechanical link to the substrate material (Fig. 40) and the coating not infrequently displaces.
Particles can become lodged in the articulating parts and act as a third body.(Fig. 41) It was considered that this would be particularly detrimental to a metal on metal articulation, so a much more robust porous coating had to be developed.
Sintered beaded acetabular cup showing weak bead junctions. (Fig. 40) 1 year retrieval of polyethylene liner showing embedded plasma spray titanium particles displaced from uncemented cup shell. (Fig. 41)



In addition, we wanted to faithfully reproduce the metal- lurgical microstructure and chemistry of the McKee and Ring metal on metal hip arthroplasties which had given such good bearing durability. (Fig. 42) Ring bearing microstructure showing rich carbide content x100 (Fig. 42)
It was discovered that the heat of sintering required to apply conventional sintered beads had a deleterious effect on the metallurgical microstructure and caused carbide depletion. Since carbides are the extremely hard ceramic-like particles in this high carbon chrome co- balt material responsible for wear resistance, any dimi- nution of the carbide content could not be considered benign. Furthermore we noted that the processes of Hot Isostatic Pressing (HIP) and Solution Heat Treatment (SHT) commonly employed in manufacturing technology to eliminate microporosity and improve strength also had a deleterious effect on the microstructure by causing profound carbide depletion. (Fig. 43) It has been shown that such carbide depleted metal performs poorly as a metal/metal articulating surface. 43,44,45,46 Carbide depletion following HIP + SHT x100 (Fig. 43)





Birmingham Hip Resurfacing showing porous ingrowth surface. (Fig. 44)
BHR components during casting process.
Ceramic coating of wax forms
Porocast Tm is a cast-in porous (Fig. 45) surface and the beads are integral with the substrate metal. This was a joint development between Centaur Precision Castings (a division of Doncaster Industries Plc), and Midland Medical Technologies Ltd. In addition to the very considerable work that had to be undertaken in the development of the porocast process, the de- velopers also had to satisfy the requirement that all the implants were porosity free. This then ob- viated the requirement for Solution Heat Treat- ment and Hot Isostatic Pressing as a post-cast heat treatment which, of course, would carbide deplete the metallurgical structure. Section through BHR cup showing Porocast Tm. x50 Beads are integral with substrate metal, rich carbide content.(Fig. 46)




Finishing Technologies (Fig. 47)
It was clear that some of the early McKee/Farrar failures were due to poor manufacturing.
In the modern era of metal on metal joints the highest possible technology is employed to achieve near perfect bearings. In the case of the Birmingham Hip Resurfacing, roundness to within two microns is achieved, an order of mag- nitude improvement on the conventional THR. (Fig. 47-49) Surface roughness is well within the ISO standard for conventional THR. (Fig. 48) (Fig. 49)

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ACL Reconstructions New Zealand, Auckland

 

Orthopaedic conditions and procedures information:

Arthroscopic surgery or arthroscopy

Minimally invasive orthopedic surgery

Avascular necrosis (AVN) - causes, symptoms, diagnosis, treatment, surgery, cost

ACL Repair and ACL Reconstruction surgery

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Hip arthroplasty

Arthroscopic shoulder acromioplasty

Shoulder replacement surgery

Shoulder arthroscopy surgery

Rotator cuff repair surgery

Carpal tunnel syndrome

Carpal Tunnel Release Surgery Patient Experience

Tendinitis or tendonitis

Achilles tendonitis

De Quervain`s tenosynovitis

Trigger finger

Ankle fusion surgery

Bunion removal

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Knee arthroscopy

 

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We offer over two hundred medical, dental and cosmetic procedures in various categories: Orthopedic procedures such as hip replacement, Birmingham hip resurfacing, artificial knee replacement, rotator cuff repair, knee surgery; Cardiac and Vascular procedures like heart bypass (multiple coronary artery bypass graft or CABG), aortic aneurysm repair, heart valve repair, heat valve replacement, angioplasty, RF Ablation; Spinal procedures such as spine fusion, laminectomy, disc replacement; Weight-loss procedures like gastric bypass, lap band, gastric sleeve; Eye procedures like LASIK; Cosmetic and Plastic surgery procedures such as breast augmentation, face lift, rhinoplasty (nose surgery), liposuction; Dental procedures such as orthognathic surgery, dental bridges, dental implants, dental crowns; dental veneers; and hundreds of other procedures in the departments of Urology, General surgery, Wellness and many more. The savings are up to 80% of typical US hospital prices.

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