Dr. R.K.Sharma, Senior Consultant & Joint Replacement surgeon at Indraprastha Apollo Hospital talks about the ABC of Arthritis at length.
Degenerative Arthritis is the fate of mankind, only the extent of involvement differs from one individual to other. Its severity increases with the advancing age. It affects different individuals differently. Arthritis is a reality, which needs to be understood and accepted. Changes in joints are taking place without being visible to your eyes; hence accepting them is little difficult. The cartilage of the joint, which is well congruent in younger years, becomes eroded and irregular as the age progresses. This may also happen because of the rheumatic disease or as a result of fracture through the joint. The body reacts to this change and thus excess bone formation take place, thus Osteophytes are formed. These are soft eburnated bony spicules within the joint; synovial fluid is collected and joint becomes swollen.
Taking painkiller tablets and denying the problem is not a solution. Painkillers are temporary methods. Their excess intake exposes you to the risk of gastric ulcer and the much serious problem of kidney damage. Singh et al have reported in American journal of medicine (105) 1998 that 1,07000 patient are admitted annually for medicine related intestinal complication as a result of pain medicine intake. All pain-relieving tablets cause kidney damage for sure and prolonged use may damage kidneys irreparably, thus forcing one to go for repeated dialysis and Kidney transplant.
To avoid such complication one can go for the most effective treatment. i.e. Knee Replacement surgery. Technique called multimodal technique for the control of pain following knee surgery includes “local infiltration analgesia” (LIA), minimally invasive surgery, respect for the soft tissue intraoperatively. LIA is mixture of sensorcaine ketorolac, and adrenaline into the tissues around the surgical field to achieve satisfactory pain control with little physiological disturbance. The technique allows virtually immediate mobilization and earlier discharge from hospital.
After consistent effort for a long time, we have devised a multimodal approach for doing reasonable painless surgery. It starts right from OPD, as this is first interaction with the patient. The patient is educated properly, regarding surgery and rehabilitation protocol. We believe that if patient are well informed in advance, the pain perception goes down or threshold increases.
In this particular surgery, we cut the link of brain with the pain. With this the patient doesn’t feel the pain and recovers fast. We follow the principle, that vicious cycle of painless period should not be disrupted at any point of time, because once the pain stimulus is established in brain, then it is difficult to abolish.
A dedicated, highly trained pain management team regularly attends the patient for their pain management with all the modern equipment like PCA pumps, Epidural Analgesia etc. for maximum patient satisfaction. The main aim of surgery is to get relieved of the pain and disability caused due to the knee ailment, however the time of recovery varies from patient to patient.
Common symptoms of knee arthritis are pain, swelling, locking and instability of knee joint. Stretching of ligaments leads to instability. Commonly encountered arthritis is Degenerative Arthritis, Rheumatoid Arthritis, Sero-negative Arthritis, Gouty Arthritis and posttraumatic arthritis.
The non-operative treatment of arthritis knee starts with awareness about arthritis, use of wedges in shoes and only occasional pain relieving medicines. Amongst pain relieving medicine NSAIDs (brufen, voveron, nimulid, etc,) are best avoided. Paracetamol is a safer painkiller. First step methods are weight reduction and precautions like avoiding squatting, kneeling or sitting on floor. Stair climbing should be minimized. Weight reduction is an important strategy. Physiotherapy is important as strong knee muscles reduced the strain on the joint cartilage. Heat therapy and IFT/ultra sound are method of physiotherapy, which help reducing swelling of the inflamed joint. You need to take arthritis serious when discomfort start in walking or taking stairs, when you need regular pain medicine, when you become over weight, when pain shuffles from one knee to other.
You should consider surgery when arthritis is moderate to serve and when joint wear is demonstrable by X rays. This is visible by weight bearing X rays of knee joint. The final decision of surgery has to be taken by you, your family and your surgeon. Our vision need to be broadened, reality of aging has to be accepted and if needed treatment must be undertaken. Our mission should be to make aging graceful for all. Arthritis is a manageable challenge, a planned and judicious treatment is important and early initiation is the key to success.
How much pain I will have after surgery?
Post surgery pain in our cases is almost negligible, owing to the pain relieving techniques like continuous never blocks, infiltration of special pain relieving cocktail into your joint, oral pain medications, PCA (Patient Controlled Analgesia), ice packs, leg exercise and minimally invasive surgical technique. During the operation, the cause of your pain is removed. However, you can accept your joint and wound to be somewhat sour for up to 12 weeks after your surgery. This discomfort will steadily decrease over time as your body heals. Most people find that the pain is negligible by 3 months.
How successful is the operation?
In terms of reducing pain and increasing function significantly without complications, numerous studies have reported that almost all knee replacement have been successful.
How long will I spend in hospital?
All patients recover at different rates. On average, patients go home within 3 to 5 days after having the operation done. Due to ongoing improvement in patient care, hospital stays are getting shorter.
How much improvement will I have after my operation?
The amount of knee bending required to do most activities of daily living is achieved in all cases. Many of my patients are able to have calf touching the thigh movement possible and are able to sit cross-legged. However post surgery movement of knee also depends upon what movement is possible in your knee before surgery.
What can most joint replacement patients do immediately after being discharged from hospital?
You should be able to walk with a walking aid without the assistance of another person. You should be able to get in and out of bed, in and out of chair and on and of the toilet without the help of another person. You should also be able to dress or bathe yourself within the use of assistive devices. You should be able to bend your knee at least 90 degree or more. You are expected to continue the exercise you were taught on daily basis for general well being.
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