Category Archives: Surgery

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

The Oxford knee is an artificial joint utilizing the mobile bearing system.

The Oxford procedure can be very successful for treatment of osteonecrosis of the knee, as this process typically destroys a very limited area of the knee. Replacing this with a partial knee replacement, with the remaining knee structures intact, is often one of the best strategies for treatment

The Oxford knee appears to have the best track record. If you follow the links on my website, information regarding statistics and studies can be found on the Oxford website.

An Oxford medial unicompartmental knee replacement has been shown to have over 95% survival of the implant at 10 years, if appropriate screening was done prior to the surgery. “Screening” means that it was ascertained that the lateral compartment was preserved and that the cruciate ligaments were intact. This compares to the best total knee results. Furthermore, it appears that if a revision is necessary, i.e. in the 5% of patients that develop a problem during the first 10 years, taking a unicompartmental knee replacement out and replacing it with a total knee replacement is less of an operation and has better results than taking a total knee replacement being replaced by another total knee replacement.

Therefore, the strategy utilizing a smaller prosthesis, i.e. unicompartmental knee replacement, as the first procedure, is predicted to give similar outcomes and better revision options than using a total knee replacement as the first procedure. It minimizes “burning your bridges”.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

A wrist fusion can be a very effective operation for controlling pain in an arthritic wrist. Arthritis can arise as a consequence of a number of conditions, including trauma, generalised wear and tear arthritis, inflammatory arthritis, such as those caused by rheumatoid arthritis or psoriasis.

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

Arthritis can occur in a wrist as a consequence of a fracture that may have gone into the joint and healed with a step, causing localised wear and tear. Arthritis can occur as a generalised wear and tear process, with increasing age. Arthritis can occur as a consequence of inflammatory joint disease such as rheumatoid arthritis or psoriatic arthritis.

Patients often complain of pain and a decreased range of movement in the wrist. Painful actions include lifting and bending the wrist. These can be quite painful. Restricted range of movements can affect patients, with inability to perform common day-to-day tasks.

Generally speaking the arthritic wrist is swollen and has a restricted range of movement.

There are two main types of fixation for wrist fusions. The first is a contoured plate that is held across the back of the wrist joint, with screws into the bone to secure fixation. The surgeon will carefully remove the remaining articular cartilage from the wrist joint to allow the bone to completely solidify underneath the plate. The second type of fixation is a pin that is passed across the wrist joint (usually down through the middle knuckle joint). This second type of fixation is often performed for patients with rheumatoid arthritis.

If a plate fixation is used and the fixation is solid often no post-operative immobilisation is required, and patients are advised to move their fingers as soon as possible. Swelling is common after such a surgery and it is highly advisable to elevate the hand for the first few weeks after surgery. If a pin fixation has been used, then often this is supplemented with plaster of Paris for four to six weeks until the underlying bones have solidly united.

These, generally speaking, can be well tolerated with a plate fixation within the first two to three weeks. Heavy loading activities should be avoided until the bone has completely solidified.

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Ankle Arthritis is a condition where the ankle joint cartilage becomes degenerated. The ankle cartilage, which is supposed to be a smooth gliding surface, becomes eroded, coarse and stiff. The ankle joint can become enlarged and full of bone spurs. The ankle joint is responsible for up and down motion of the foot, and is made up of the two leg bones (tibia and fibula) and one foot bone (talus). Ankle arthritis can be painful and interferes with everyday life.

Patients with ankle arthritis have varying degrees of symptoms, which often correlate with the extent of the arthritic degeneration. Typically the symptoms involve pain, swelling and stiffness. Arthritic pain may flare after periods of inactivity (such as getting out of bed in the morning, or after a standing up after a sitting for a while). As the joint loosen up with activity, the pain may decrease as the day progresses. The pain may be deep and intense to superficial and achy.

Movement of an arthritic ankle joint can result in a clicking or grinding sensation, medically known as crepitus. In more advanced cases, the ankle joint develops bone spurs (aka arthritic bone spurs) – which is the body’s mechanism for blocking the painful arthritic motion.

Patients with ankle arthritis seek treatment for some, if not all, of the following reasons: pain, interfering with simple walking, affecting activities, grinding sensation in ankle, enlargement of the ankle, swelling, and/or a change in the structural architecture of the ankle and/or foot.

Depending on your overall health, symptoms and severity of the ankle arthritis, treatment can be conservative and/or with surgery.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

When non-operative treatments have failed to control the pain and the pain is:

• Moderate to severe
• Constant/ all the time
• Affecting sleep
• Stopping you from carrying out activities of daily living

Trapeziectomy’s are normally performed as day case surgery under a general anaesthetic or a regional block (where the arm is made numb using an injection). You will be sent home with dressings or a POP on and be seen by the consultant in 2/52 to remove the dressings. At this point you may be seen by a hand therapist who will:

• Provide a splint to be worn as protection as your thumb heals
• Give exercises to help you re-gain movement in your thumb
• Give advice on what kind of activity you should/shouldn’t be performing
• Give advice on strengthening your thumb

Things to consider before having a Trapeziectomy:

• Risk of infection through surgery
• Risk of nerve injury/ neuroma. A small nerve running through the region of where the surgeon is operating can be damaged during surgery. It may form a painful spot on / near the scar (a neuroma)
• Rehabilitation can take between 4-12 months
• Results from trapeziectomy vary depending on may different factors i.e. the individual, other health problems, severity of arthritis, etc.
• 80% of patients experience decrease in pain following surgery, 15% experience little or no change in pain and function and 5% are worse than before they had surgery
• Risk of problematic scar tissue. After the operation there is a risk that you may have problems with scarring, including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement
• Risk of problematic scar tissue. After the operation there is a risk that you may have problems with scarring, including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Success is difficult to assess. The most important factor relates to your expectation of success. Total joint replacement is one of the most successful operations when performed in the right patient. While total joints have seen great advancement they are still not better, than your native joint prior to arthritis. 98% of patients will answer yes to the following three questions 1 year after surgery:

• Are you glad you had the surgery?
• Did it fulfil your expectations?
• Would you do it again?

There will be individual variations in recovery time. Most will be able to walk without an assist device (crutches, cane, walker) in a few weeks and return to normal function by 3 months. Wearing in and improvement may occur over the first year.

While some centers are attempting to make joint replacement an outpatient procedure (I do offer outpatient arthroplasty procedure in appropriate candidates), I feel most patients will require 1-2 days of hospitalization. Pre-existing medical conditions (heart problems, diabetes, hypertension, kidney problems, pulmonary problems) may lengthen your hospital stay. Patients will be discharged home when their pain is well controlled on oral medications and they have been cleared by physical therapy.

Most will be discharged home and participate in an outpatient physical therapy program. Most insurance programs do not recognize total joint replacement as criteria for admission to a rehabilitation facility unless extenuating medical conditions exist. If social or health issues prevent discharge home, you may be transferred to a skilled nursing facility with therapy. Please note that if you are considering a rehabilitation unit after surgery, it would be advisable to visit prior to surgery.

For surgery on the right leg it is recommended that you not drive for 4 weeks. You may drive thereafter if you feel comfortable applying enough force to brake suddenly and you are no longer taking narcotics for pain control. For left leg surgery, you may drive as soon as you feel comfortable and are no longer taking narcotics.

As soon as you feel comfortable. It is recommended that you stretch and walk each hour during long trips to prevent blood clots in your legs (deep venous thrombosis).

For a sedentary job (ex. Deskwork) you may return in 2-4 weeks. For more labor intensive work you should plan on at least 3 months. Average time to return to work across all jobs is just under 9 weeks.

You may return to all low-impact activities when you feel comfortable (walking, golf, swimming, bicycling, skiing). You should avoid high impact activities such as running and jumping.

The literature reports a 0.5-1% chance of requiring additional surgery each year. So at 10 years, 90-95% are functioning normally and at 20 years 80-85% remain normal. After 20 years the success declines more rapidly. There is promising data that the newer components may exceed these expectations.

Knee replacements rarely notice any real or functional differences. For hip replacements a leg length discrepancy may occur requiring the use of a shoe lift. The chance of this occurring is increased by a prior leg length difference, severe hip arthritis, and/or severe back issues. For hip replacements, achieving stability of the hip joint super-cedes exact equalization of leg lengths.

I feel it is very beneficial to see or at a minimum notify your primary physician to ensure that your health status is optimized prior to surgery. If you do not have a primary physician then we will assist you in obtaining one for evaluation.

Ordinarily no. If however you suspect you have a dental infection, have poor dental hygiene, or have not had a dental check up in 12 months then it would be advisable to proceed with a formal dental examination.

Complication rates vary. The most important risk of complications is related to the health status of the patient. Patients with health issues are at greater risk of complications. Some of the most important include, but are not limited to; diabetes, heart disease, pulmonary disease, kidney disease, rheumatoid arthritis, vascular disease and obesity. Diabetics should have optimum blood glucose control and those whose HbA1c are elevated will likely be postponed. A patient who is found to have active infections or illnesses should delay surgery until the issue is resolved. The risk of infection at our facility is below the national average. A national average being between 1-2%.

Ultimately that decision is made between you and the anesthesiologist. I however, strongly recommend you consider a spinal anesthetic. Spinal anesthesia is associated with less blood loss, lower risk of blood clots, lower risk of stroke, less post-operative nausea, less pain, and faster recovery (many of these claims are debated).

Most patients receive a Foley catheter that remains in place until the day after surgery. There are some rare exceptions.

Having IV access for the first day is important for the rapid administration of medications. The patient will receive IV antibiotics 1 hour prior to surgery and usually no longer than 24 hours after surgery.

National statistics are 12% need for transfusion for knee replacements and 19% for hip replacements. Our facility employs tactics to decrease the need for blood transfusion. Our transfusion rate is well below 5%. We can usually identify who might require a transfusion before surgery (persons who are anemic prior to surgery or who have more complicated medical or surgical issues).

I prefer starting out with narcotics and then decreasing their use based on patient comfort. I have had patients not use narcotics, but it is very important that the patients pain be well controlled so that they may participate and progress with therapy. Playing “catch up” on pain control is not ideal. Some patients do react poorly to narcotics and final pain medication treatment will be tailored post-operatively. Patients who have been on narcotics leading up to surgery may experience increased difficulties with pain control.

Once a waterproof dressing is applied you may shower. Typically the day after surgery. You should keep a dressing on the incision for at least 1 week.

Typically 3-4 weeks after surgery. I favor closer to 4 weeks just to be on the safe side.

Often I use an absorbable suture placed below the skin and Dermabond (super glue for the skin) on top and therefore there are no sutures/staples to remove. If, however, your skin condition required sutures/staples they are typically removed by 10-14 days.

It is common to require pain medication for up to 2-3 months. Initially you will be taking a narcotic. You may choose to switch to an over-the-counter medication such as ibuprofen or acetaminophen as soon as you are comfortable. Most discontinue narcotic by 4-6 weeks. Requiring narcotics beyond 3 months is unusual.

For knee surgery the duration is 10-14 days. For hip surgery the duration is 21-35 days. I typically use Xarelto which is an oral pill. It is easy to monitor and administer and has a very high safety margin. The medication is expensive, but it is necessary. An alternative is an injectable anti-coagulant but it too is expensive.

Coumadin (Warfarin) is a much cheaper option but is difficult to manage and requires regular blood draws to monitor its effectiveness. I typically reserve its use for persons who are on it for another reason. Recently the AAOS has demonstrated that Aspirin therapy may be safe in select individuals, but I feel our elevation precludes its routine use. I do recommend patients consider Aspirin 325mg daily after completing the Xarelto or other chosen agent for 60 days unless you have a contraindication to its use. Your specific anti-coagulant and duration of use will be based on your risk of developing clots against your risk of having a bleeding event.

If you are taking coumadin you should avoid alcohol. Only very modest consumption should occur if you are taking narcotics (I do allow for a glass of alcohol when in the hospital). Beyond this, you may consume in moderation at your own discretion.

I no longer recommend iron post-operatively as its benefit has been called into question and it can contribute to constipation, which is common after surgery and while taking narcotics.

Initially, ice is most effective at reducing swelling. After 2 weeks you may use whichever makes you most comfortable.

I prefer the use of the compressive stockings (TED hose) until the first postoperative visit (2 weeks). After discontinuing, if your ankles swell, then you should use them until this normalizes. For long trips they are recommended for 3 months following surgery.

I recommend going upstairs leading with your non-operative leg and going down stairs lead with your operative leg. “Good leg up, bad leg down.” This will be taught to you by our therapy team.

As a matter of habit I use formal therapy, but in select situations you may not need therapy. Initially they may need to come to you until you are able to present to an outpatient program. Therapy can be essential to short and long term improvement. Typical duration 6-8 weeks.

For knee replacement and anterior hip replacement as soon as you are comfortable. For posterior hip replacement you should wait for at least 6 weeks and focus on your hip precautions.

It is not uncommon. Factors such as pain, narcotic usage, increased dependency on others, and limitations in mobility can contribute to mild depression. These feelings usually subside as you recover. If these feelings are pervasive or persistent please bring them up to me or your primary physician.

This is a very common complaint. Over-the-counter Benadryl or Melatonin may be effective. If not you may require a prescription medication.

It is very common. A stool softener (Colace over-the-counter) is recommended. Drink plenty of water. Our hospital provides a post-operative plan to assist with constipation. It is very important that if you have painful constipation that you cease all narcotic consumption and notify us or present to an emergency department. If a long acting narcotic is prescribed it is the first agent that should be stopped until constipation is improved.

Wallet cards indicating surgical implants are no longer recognized. You will have to inform the security officer of your surgery and may be asked to demonstrate the incision so wear appropriate apparel. Over 1 million total joint replacements are performed each year, so you are not alone.

Avoid any invasive procedures for 6 weeks after surgery. For simple dental cleaning, antibiotics are not required. For invasive procedures it has been recommended to take antibiotics prior to the procedure for 2 years after surgery. The most recent update states antibiotics are not required unless the patients immune status is compromised. I recommend antibiotics for dentistry of any form for the first two years and then at patient discretion. If your dentist has a recommendation, then you should take that into consideration as well.

Simple “nicks” do not require antibiotics, but if you have an injury that is obviously infected or requires medical assistance then you should seek medical attention and notify the provider that you have a joint replacement. Viral conditions do not require antibiotic coverage. If you have a bacterial infection you should consult your primary physician.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors.

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.

Patients with rheumatoid arthritis may require surgery of the metatarsals.

The time required to be off work will vary with the demands of the person’s job. A minimum of one week off work would be advisable with the patient staying at home with the foot elevated above the heart.

You can most definitely choose hotels as per your convenience to you and your budget.

You can talk to the doctor and satisfy all your medical queries. You can also send us your queries for answers from the top doctors

To know about the procedure of getting an Indian Medical Visa, please go to our website where you will find all the details regarding the initial procedure. You can also send us a query regarding the same.

Many hospitals in India have language translators to help you communicate better and effortlessly with the doctors and medical staff.