Wednesday, 11 March 2015

Avascular necrosis of the hip - treatment in Nagpur

The original article can be read at

Various causes of hip arthritis are age related wear and tear, rheumatoid arthritis, ‘avascular necrosis’ of the hip etc. ‘Avascular necrosis’ means death of the head of femur bone because of loss of blood supply.
Sickle cell disease, alcohol consumption, prolonged treatment with medicines called as steroids, fracture of the hip etc are most common causes of avascular necrosis of the hip joint. Some rare & unknown diseases can cause avascular necrosis of the hip as well.

Sickle cell disease is very common 
in and around central India.
Even though in India, arthritis of the knees is more common than the arthritis of the hip, in Central India especially around Nagpur region, there is higher prevalence of hip arthritis because of sickle cell disease.

The original article can be read at

Hip and knee are the most significant joints that are affected by arthritis. Every time we perform our day to day activities like walking, standing, getting up from a chair or bed etc all our body weight is always transmitted through our hip & knee joints. Therefore in patients with arthritis of hip and knee there is severe pain even in normal day to day activities. There can also be shortening of the lower limb.

Beware of long term 
steroid medications
Pain leads to restriction of activity and loss of freedom leading to disability (handicap) and dependence. Patients having advanced arthritis cannot do simple activities like walking, sitting, getting up from a seat due to pain. As the disease progresses, they cannot go outside the confines of the four walls of their home even for simple activities like shopping, buying milk or vegetables. In the advanced stages of arthritis even household activities like going to toilet, cleaning, washing, wearing socks or tying shoe laces evoke pain leading to serious disability and dependence on others like spouse, family members, servants or neighbours.

Arthritis of hip joint.
Various treatment options available for hip arthritis include pain-killer medications and joint preserving surgeries in the early stages. In the advanced stages only a hip joint replacement can help the patient get relief from pain and regain normal movement. Hip joint replacement is so effective and popular surgery all over the world that, in an online poll hip replacement was voted as the single most significant medical discovery of the 20th century.

Hip arthritis in an 18 yr old
patient of sickle cell disease
Pain, loss of motion, restriction of activity, difficulty in walking, unequal leg lengths. Dependence on others, permanent disability, loss of confidence are other outcomes of this disease process.
  • Pain not controlled
  • Stiffness (loss of motion)
  • Disability
  • Restriction of day to day activities
Hip replacement surgery is performed primarily for pain relief and also to regain independence and ability to do day to day work.

The original article can be read at

Wednesday, 4 March 2015

Knee pain & Knee Replacement Surgery in Nagpur

For original article visit

  • Pain not controlled by medicines
  • Stiffness (loss of motion)
  • Instability
  • Disability
  • Restriction of day to day activities
TKR surgery is performed principally for pain relief. Although the range of motion of the knee may improve following surgery, this is not the primary aim of the surgery and extra motion should be regarded as a bonus
The damaged bearing surface of the knee joint (articular cartilage) is replaced by metallic prosthesis (made up of cobalt-chromium or titanium), which articulates with a polyethylene bearing. These prosthetic components are fixed to the bone using bone-cement or rarely using coated components onto which bone grows. The right decision about appropriate prosthesis for a particular patient is made.
Total knee replacement is a major surgical procedure with very high success rates. However, like any other surgical procedure it is also associated
with some risks, which are uncommon, but must be kept in the mind.

For original article 
For more detailed information

Tuesday, 24 July 2012

Urban Indians Are Physically Inactive.

The average British national is reportedly among the most inactive person on this planet. This revelation was made by one of the most prestigious medical journal, The Lancet, last week. Indians have been praised by the same study for being among the least inactive people.

But should this be a cause for celebration? Hardly. The study seems to have looked at India as a whole; the rural-urban divide seems to have been blurred. The rural Indian who walks miles to get his ration or water supply or to consult a doctor has been considered alongside urban Indians who in comparison seems pampered with metro rail networks and corporate hospitals.

A study done in a school in Greater Mumbai shows why urban India should be as worried as Britain about physical inactivity. The study done by Dr Aashish Contractor of Asian Heart Hospital in Mumbai's Bandra area showed that while 14 per cent of the schoolchildren who were studied were overweight, most of them didn't walk enough. The study counted the number of steps that children would need to take as per their Body-Mass Index to be classified as physically active.

Dr Contractor's research showed that 88 per cent of the boys and 85 per cent of the girls in that school failed to take the 15,000 steps per day and 12,000 steps per day respectively needed of 12-year-olds.

This lack of physical activity leads to obesity among children and eventually leads to chronic diseases such as hypertension, diabetes or cardiac diseases. The Lancet study showed that 5 million people die
due to physical inactivity every year. This is the same number of deaths caused by smoking. Urban Indians, who are as fond of their couch-seat in front of the television sets as they are of junk food,
need to wake up to the stay-fit mantra.

Sunday, 1 July 2012

Surgery is no "magic wand", but it does get disabled people back on their feet again

‘Surgery makes you walk but it’s no magic wand’

Priyangi Agarwal, TNN Jun 26, 2012, 05.55AM IST
    "When I recall my pre-surgery days, I feel that life was as difficult as living with a disability!" This is how, Premlata Devi, an elderly who underwent knee replacement surgery described her pain. But what is it that actually leads to such acute crippling of the knees? Experts blame arthritis as the chief cause of trouble. According to the Arthritis Foundation of India (AFI), "Most forms of arthritis can be divided into osteoarthritis, rheumatoid arthritis and gout."
    AFI literature shows that osteoarthritis typically strikes the weight bearing joints such as knees, hips and back joints besides hands and spine. It is a progressive disease that mostly affects the knee. Rheumatoid Arthritis is an autoimmune disease (a condition in which body's own immune system becomes its enemy and tends to cause a disease). It causes chronic inflammation of the joints and sometimes the tissues around the joints. Gout, which is also known as the crystal induced arthritis, is an arthritic condition that occurs when uric acid crystals accumulate over the joints. Gout can affect joints in the big toe, ankle, foot, hand, wrist and elbow besides the knee. In rare cases, it may affect shoulders, hips or spine. "Problems such as pain and disability arise in all the three conditions mainly due to degeneration of joints," explained, Prof RN Srivastava, faculty, orthopaedic department, CSMMU. "Pain induced by damaged ligaments and parts of the knee is most felt in case of knees, which bear the maximum body weight," he stated adding, "The painful destroyed knee affects a person's day to day living in simple activities such as standing, sitting, walking, and others."

    Before Surgery - Disabled
    The worn, diseased or damaged surfaces of the knee joint can be removed and replaced with artificial surfaces in a surgical procedure known as Total Knee Replacement (TKR). "The surgery has helped many people return to a normal life," said Dr Srivastava. In the words of Premlata, "Knee replacement surgery made me walk after years, but it is no magic wand." Her observation is extremely important. "Patients should not aspire for overnight changes in their lifestyle. The surgery may make them walk but after sustained sessions of physiotherapy. Pre-operative counselling plays an important role here. It helps in setting up realistic targets for patients," said Dr Sanjai Srivastava, who regularly takes up arthroplasty.
    After Surgery - able to walk

    Experts suggest that disease can surely be delayed if not totally prevented. "Ageing, lack of nutrition and physical activity, vitamin D deficiency, obesity, hereditary and socio-economic factors are some causes behind degeneration of cartilage," they said.

    Friday, 15 June 2012

    Injections ineffective for knee arthritis: study

    NEW YORK | Tue Jun 12, 2012 3:22am IST

    NEW YORK (Reuters Health) - Injections of the lubricating substance hyaluronic acid may be little help to people with knee arthritis, researchers reported Monday.

    Hyaluronic acid exists naturally in the fluids that bathe the joints, where it acts like a shock absorber and lubricant. People with osteoarthritis -- the common, "wear-and-tear" type of arthritis -- seem to have lower-than-normal levels.

    So one treatment for arthritis patients is to get injections of hyaluronic acid directly into the affected joint, a therapy also known as viscosupplementation. In the United States, it's been approved since 1997 for knee arthritis only; in Europe, it's been used longer and for more types of arthritis.

    But a new research review, published in the Annals of Internal Medicine, finds the benefits may be minimal for aching knees.

    Looking at 89 past clinical trials, researchers found that overall, viscosupplementation did seem to bring pain relief to some knee arthritis sufferers -- as compared to "sham" injections or no treatment.

    But when they focused on 18 larger trials (with at least a couple hundred patients), there were only "clinically irrelevant" effects, according to the researchers.

    On top of that, they report, the injections can carry side effects like swelling and inflammation in the joint soon after treatment.

    "We don't have evidence that viscosupplementation works, but it is associated with an increased risk of adverse events," said Dr. Peter Juni from the University of Bern in Switzerland, who worked on the study.

    "That is not very reassuring," Juni told Reuters Health. He and his colleagues recommend that the injections "be discouraged" for people with knee arthritis.

    But an orthopedic surgeon not involved in the study said hyaluronic acid injections should still be an option for at least some patients.

    "I think patient selection is key," said Dr. Joseph Bosco, from the NYU Langone Medical Center in New York.

    The injections are more likely to help someone with mild to moderate knee arthritis and "no big pieces of cartilage floating around in the joint," according to Bosco. (Osteoarthritis occurs when the cartilage cushioning the ends of the bones begins to break down.)

    Bosco also pointed to the limitations of the new study.

    It's what researchers call a "meta-analysis," which means the results of different studies are pooled together. The issue, Bosco said, is that the individual studies differ from each other -- in how they are done, the specific hyaluronic acid formulations and characteristics of the patients.

    "I think it's difficult to make an overarching comment on the use of hyaluronic acid, based on this," Bosco said.

    In general, the evidence on hyaluronic acid is not high-quality, according to Dr. John Richmond, who chaired the committee that devised the current treatment guidelines on knee arthritis from the American Academy of Orthopedic Surgeons.

    But he agreed the therapy should remain an option. "It's a reasonable way to manage pain" for at least some people, Richmond, also the head of orthopedics at New England Baptist Hospital in Boston, said in an interview.


    In the early stages of knee arthritis, people may be able to go with non-drug options alone, like exercise or, if needed, weight loss. And pain relievers such as acetaminophen might help.

    But when that no longer works, people often arrive at a place where they are "stuck," Richmond said.

    Most commonly, they turn to non-steroidal anti-inflammatory drugs (NSAIDs) -- painkillers like ibuprofen, naproxen and the prescription drug celecoxib (Celebrex).

    But both Richmond and Bosco pointed out that regularly using those drugs has significant downsides, such as stomach irritation in some people.

    Injections of cortisone, which fight inflammation, can bring a temporary reprieve. But those should not be done repeatedly, Richmond said.

    The final resort is surgery to replace part or all of the damaged knee joint. But, Richmond and Bosco said, that may not be appropriate for younger, more active people.

    "Hyaluronic acid is no panacea," Bosco said. But, he added, "I think it should be kept in physicians' armamentarium" against knee arthritis."

    In the U.S., the injections are approved for knee arthritis that cannot be managed with non-drug tactics and simple analgesics like acetaminophen or topical rubs.

    When they work, the injections -- which involve anywhere from one to five separate shots, depending on the formulation -- offer only temporary pain relief. You might feel better for a few months, then need a repeat round of shots.

    Based on what's known so far, repeated rounds of treatment appear safe, Richmond said.

    But that gets pricey. With all costs and fees considered, one round of treatment approaches $1,000, according to Richmond. (In the U.S., Medicare and many private insurers will at least partly pay.)

    As for safety, some studies in the current review looked at "serious adverse events" -- including life-threatening conditions or problems severe enough to land someone in the hospital.

    Only eight studies actually described those events, which were more common in viscosupplementation patients -- 26 suffered serious problems, versus 14 patients in the untreated groups.

    But those "events" included cases of cancer, cardiovascular disease and musculoskeletal disorders. And Bosco and Richmond both doubted those problems could be pinned on hyaluronic acid injections.
    The trials typically lasted four months. Attributing something like cancer to the injections "doesn't make a whole lot of sense," Richmond said.

    Juni said there is an "unfortunate" lack of both safe and effective options for people with knee arthritis. But he also urged people with the condition to "not be too pessimistic."

    He said the basic approaches to knee arthritis, like exercise therapy and losing excess weight, can help ease symptoms in many people, if they stick with them.

    The study was funded by the Arco Foundation, a private research organization.

    SOURCE: Annals of Internal Medicine, online June 11, 2012.