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Medical Blog

Arthroplasty

R.B aged 78 years complained of knee pain following slip and limitation of certain activities. She underwent total knee arthroplasty using fixed bearing Johnson & Johnson(USA) prosthesis. She was happy as the pain was gone and she was able to resume her normal social life again.

Sikha Basu aged 62 years underwent staged bilateral total knee arthroplasty at Belle Vue Clinic and is happy following her surgery and has already resumed her regular and social life.

Trauma

Distal Radial Fracture

58 years old female patient S.B had a fracture of distal radius after a fall on the roadside. She underwent plate osteosynthesis as she was shecduled for a holiday in the US shortly. Her quick recovery made it possible for her to embark on the US trip.

47 year old male labourer R.G sustained a critical femur fracture after a fall from a truck. Plate osteosynthesis with bone graft of his metaphyseal defect allowed him to resume his work gradually.

Savita Rangta 65 year old female patient sustained a 32 AL closed fracture of proximal shaft of left femur following a fall at home. She was treated to a synthes A2FN nail and was able to walk from the 4th day after surgery.

She is doing well and is thankful for the surgery.

35 year old male labourer had a fallfrom the top of a lorry and was unable to walk following the incident. He underwent screw osteosynthesis using MIPO techniques and was able to resume his work over a period of weeks.

S.G a young male aged 25 years sustained a Doyles type 4 B mallet finger surgery. He was treated with extension block technique and was splinting for further 6 weeks. He recovered fully after the procedure.

R.B, a female patient aged 88 years old sustained a fractured neck of femur, right side, after a fall inside the house. She was managed with screw osteosynthesis within 8 hours of her injury and gradually resumed weight bearing with crutches after the second day of surgery.

T.K a male patient aged 58 years sustained a road accident prior to admission here at Belle Vue Clinic. He underwent plate osteosynthesis using a lateral approach with perfect reconstruction of his fractured joint line. Despite being diabetic, he is recovering fast and walking without support almost 2 months after surgery.

D.P male patient aged 59 years old sustained a fracture of the proximal humerous right sided in a road accident. He underwent plate osteosynthesis using a standard Delto pectoral approach. He is recovering with physiotherapy and has resumed his work about a month following his surgery.

R.K aged 49 years sustained a badly committed fracture of his left clavicle. He was operated cosmetically and was completely pain free after doing plate osteosynthesis

S.R aged 65 years sustained a transcervical fracture neck of femur of her left hip. In situ fixation was achieved and she started walking after 2 days of surgery.

Young lady non alcoholic aged 32 years, was suffering from groin pain left side more than that of the right hip for the past 3 months. Gradually progressive pain enhanced on walking. She had received steroids for meningitis in the past in a short bolus dosage.Successfully treated with core decompression and autologous osteoblast grafting cultured from her own iliac crest. Pain significantly improved and she is being encouraged progressive weight bearing.


Joint Replacement- Patient Education

Dr. Debabrata Kumar Consultant Joint Replacement &Orthopaedic surgeon
MBBS, D.Ortho (IPGMER& SSKM Hospital)
DNB (Orthopaedic surgery – New Delhi)
Fellowship in Joint Replacement (Singapore)
Fellowship in Foot surgery (France)
Attached to Belle Vue Clinic & Kolkata Police Hospital

This guide is designed to give you the important information you need to achieve the best outcome from your joint replacement surgery. This guide is your workbook. It discusses:

  • How to prepare for your upcoming surgery
  • What to expect before, during, and after surgery and during your hospital stay
  • What to expect and what to do to continue your successful recovery at home
What is Arthritis?

Why Does My Knee Hurt? In the knee joint, there is a layer of smooth cartilage on the lower end of the femur (thigh bone), the upper end of the tibia (shin bone), and the undersurface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis develops when the smooth cartilage wears away. The knee can then become stiff, swollen and painful. Eventually, the cartilage can wear down to the bone and the bones can rub against one another, causing more pain.

Overview of Total Knee Replacement

The knee joint is the largest joint in the body. It is the “hinge” joint of the leg. It’s the joint that allows the leg to bend and straighten. The knee joint is located at the meeting point of the thigh bone (femur) and the shin bone (tibia). The knee cap (patella) covers the area where the two bones meet. During total knee replacement surgery, the damaged part of your knee is removed and replaced with an implant. Implants are made of various materials: stainless steel, titanium, chrome, cobalt, or polyethylene. Bone cement may also be used in the repair. The choice of implants varies from person to person. Factors considered are your age, activity level, body type, and the amount and strength of your bone and bone tissue. Your surgeon will choose the implant that is best suited for your needs and lifestyle. During total knee replacement surgery, a relatively thin amount of bone is removed from the end of the thigh bone, the top of the leg bone, and the underside of the kneecap. This creates bone surfaces that allow the implant to have a good fit. Most of the major ligaments and tendons of the knee are left in place so that the knee can bend and straighten, yet remains steady in position from side-to-side and front-to-back.

Overview of Total Hip Replacement

The hip joint helps us keep our balance and supports our weight in all of its movements. The upper end of the leg bone (femur) has a rounded head (femoral head) that fits into a socket (acetabulum) in the pelvis to form the hip joint. During total hip replacement surgery, the damaged part of the hip is removed and replaced with implants, called components. Your surgeon selects the components that are best for you based on your age, activity level, and body type.

Preparing for Surgery

Exercise

Exercising, up to the day before your surgery, helps improve your strength, range of motion and endurance. This helps lead to a successful outcome and recovery. Talk with your surgeon about a referral to physical therapy if you would like help developing an exercise program. In addition, see the exercises at the end of this guide.

Why is exercise so important for your recovery?
  • Strengthening exercises for the hip or knee joint improves recovery.
  • Upper body conditioning exercises help reduce muscle soreness and fatigue caused by the use of a walker crutches, a cane, or other aids.
  • A walking or water exercise program increases endurance, flexibility, and overall strength
Circulation Exercises

Although swelling is a normal response after surgery, circulation exercises help control swelling and prevent more serious complications, such as blood clots. Review and learn the circulation exercises (see Physical Therapy section) before surgery to make them easier to perform after your surgery.

Diet and Nutrition

Healthy eating and proper nutrition before your surgery aids the healing process.

  • Drink plenty of fluids and stay hydrated.
  • Eat more fiber to help avoid constipation (often caused by pain medications). Foods that contain fiber include corn, peas, beans, avocados, whole wheat pasta and breads, broccoli, almonds.
  • Eat foods rich in iron, such as lean red meat, dark green leafy vegetables, raisins, and prunes.
  • Eat foods high in Vitamin C to help your body absorb iron. Foods that are high in vitamin C include oranges, cantaloupe, and tomatoes.
  • Make sure you are getting enough calcium, which is needed to keep your bones strong. Foods that are high in calcium include milk, cheese, yogurt, dark leafy greens, and fortified cereal.

Eat light meals, especially the day before surgery. The combined effects of anesthesia and your medication may slow down your bowel function. This can cause constipation after surgery.

Smoking and Alcohol Use Smoking

Smoking causes breathing problems, increases the risk of medical complications, and slows recovery. Smoking also increases the risk of infection and blood clots after surgery. If you smoke, we encourage you to quit at least a few weeks before surgery.

Alcohol Use - Before surgery, it is important to be honest with your health care providers about your alcohol use. Tell your health care provider how many drinks you have per day (or per week). This information helps determine if you are at risk for alcohol withdrawal or other alcohol-related problems that could occur after surgery and affect your recovery. We are here to help you prepare and recover from your surgery as quickly and safely as possible. Diabetes Guidelines and Blood Glucose Management Managing your blood glucose is always important, but it is extremely important before surgery. In fact, managing your blood glucose before surgery can help reduce the risk of problems after surgery, such as infection and other complications. Surgery can affect your blood glucose control in many ways. Stress before and after surgery can cause your body to release hormones that may make it more difficult to manage blood glucose levels. Surgery can also affect your normal diet, and may change your usual medication routine. Your diabetes will be managed throughout the entire surgical process, starting with a thorough review during the pre-operative testing and continuing through the post-op period.

Medications

Some medications thin your blood, increase the risk of bleeding after surgery, or interfere with healing. These medications may need to be stopped before surgery. If you take medications that contain aspirin, anti-inflammatories (such as ibuprofen, naproxen), blood thinners (such as warfarin,) or arthritis medications, ask your surgeon when to stop taking these medications. Because blood-thinning medications affect clotting and bleeding, these medications (plus all your other medications) will be reviewed with you either at your pre-admission visit or by your surgical team.

Home Safety Preparation

Setting up your home for your return before you have surgery will help keep you safe, make your life easier, and aid in your recovery. Listed below are suggestions for preparing your home for a safe recovery.

Traffic pattern

Move obstacles

such as throw rugs, extension cords, and footstools – out of your walk way. Create a wide, clear path from your bedroom to your bathroom and kitchen so you can easily move about with a walker or crutches.

Bathroom

Ask an occupational therapist how to adapt your bathroom to meet your needs during recovery. You will likely need an elevated toilet seat or commode and a shower chair.

Sitting

Sit in chairs that keep your knees lower than your hips. Choose a firm, straight-back chair with armrests. A dining room chair may work if you don’t have other chairs. Add a foam cushion or folded blanket if you need to raise yourself up, but avoid sitting on a soft pillow. Also, avoid sitting in rolling chairs or recliners.

Children and Pets

Small children and pets can pose a safety hazard. Small children may need to be taught how to interact with you in ways that keep you safe. If you have pets, make arrangements to keep pets in another area of the house when you arrive home.

Access to Items

To avoid reaching or bending, keep frequently used items within easy reach, especially in the kitchen, bathroom, and bedroom, for example, food, medications, phone. It’s a good idea to carry a cell phone or portable phone with you at all times during your recovery.

Stair climbing

It’s okay to climb stairs without assistance, if you are able. However, you may need help with climbing stairs when you first get home. Consider installing handrails or make sure existing handrails are secure.

Laundry and cleaning

Get help with cleaning and laundry. Have a few weeks’ of clean clothes available.

Adaptive or Durable Medical Equipment (DME)

A walker, crutches, or cane are standard equipment used by all patients recovering from joint replacement surgery. It is highly recommended that you contact your insurance company to find out what is covered under your policy.

For patients with hip replacements, an elevated toilet seat or bedside commode may be needed for safety. Both provide increased height, while the bedside commode also has arms and can usually fit directly over your home toilet. It may also fit in the shower.

Below is a list of suggested items that can make your life easier and keep you safe. Most of the items can be found at a medical supply store or at pharmacies, home improvement stores, or thrift stores. These items should be purchased before your surgery, however before buying; we suggest you talk to either a physical or occupational therapist about your specific needs.

Before Your Surgery

Pre-Admission Testing

A pre-operative work-up is mandatory for all joint replacement patients. At this visit, you will be asked about your medical history, previous surgeries, illnesses and current state of health. You will also undergo a series of tests, such as lab work, urinalysis, nasal swab, X-ray, EKG and / or stress test.

The Day Before Surgery

Do
  • Remove nail polish.
  • Shower and wash your hair the night before. Bathing helps reduce the amount of bacteria on the skin and may lessen the risk of infection after surgery. Use the antibacterial soap provided and follow the instructions.
  • Sleep in clean pajamas or clothes.
  • Sleep on freshly laundered linens.
  • Get a good night’s sleep – it’s important to be well-rested before surgery.
Do Not
  • Do NOT eat or drink anything after the time you were instructed; ice chips, gum, or mints are NOT allowed.
  • Do NOT use lotions or powders.
  • Do NOT shave before surgery.
  • Do NOT shower the morning of your surgery

The Day of Surgery

On the day of surgery, you must remember several important things:
  • Take only the medications you have been told to take; take them with a small sip of water.
  • Comply with the strict instructions about food / beverage consumption
  • Do not wear make-up or jewelry.
  • Do not take insulin unless otherwise instructed.
  • Do not take your oral diabetes medication (pills) on the morning of your surgery.
When You Arrive
  • You will be asked to empty your bladder
  • Any glasses, contacts, hearing aids, or dentures will be removed before surgery and returned after surgery.
  • Advanced directives will be noted.
  • You will have your vital signs checked (Vital signs are your heart beat rate (pulse), breathing rate, body temperature, and blood pressure).
  • Your operative site will be prepped and the surgeon will review the procedure.
  • An intravenous (IV) line will be started to give you fluids and medication.
The Surgery

Your surgery takes about one to three hours to complete. While you are in the operating room, your loved ones may wait in the surgical waiting room. The surgeon or representative will speak with your family while you are recovering.

Your Hospital Stay

After your stay in the PACU, you will be moved to a nursing unit that specializes in the care of patients with joint replacements. Some patients, for various other reasons, are moved to another nursing unit. It is normal to drift in and out of sleep until the anesthesia completely wears off. Because it’s important to rest as much as possible, we encourage friends and family to limit their visits.

REMEMBER

Do not get out of your bed without assistance. Although getting up on the day of surgery aids in your recovery and helps prevent complications. You MUST not do so without assistance. Within 24 hours after arriving to your hospital room you will receive a visit from a physical and/or occupational therapist to begin mobility exercises.

You may also receive a visit from:

  • Your surgeon, resident, fellow or physician’s assistant
  • A medical doctor
  • An anesthesiologist or nurse anesthetist
  • Your Specialty Care Coordinator

A physical therapist or nurse will help with bedside activities. Also, remember to perform the circulation exercises at the end of this guide.

Recovery/Rehabilitation Process

Physical therapy and occupational therapy after your joint replacement surgery are critical parts of your recovery, as well as to help you regain range of motion and strength. Although you may feel significant pain during and after your therapy sessions, it is necessary for your recovery.

Your physical therapist will teach you how to:

  • Lay in your bed in comfortable positions.
  • Move from sitting to standing
  • Walk with an assistive device (a walker, crutches, a cane).
  • Comply with hip and knee precautions.
  • Perform a home exercise program on your own.
  • Walk up and down stairs with an appropriate assistive device.
Total Joint Precautions

Knee

  • Do not pivot or twist your operated leg.
  • Do not kneel or squat.

Hip

Note: Precautions may vary, depending on the surgical approach. Your surgeon and therapist will discuss your specific precautions. General precautions are as follows:

  • Do not bend your operated leg beyond a 90 degree angle.
  • Do not pivot or twist your operated leg.
  • Do not cross your operated leg or ankle.
Your Hospital Discharge

Planning starts the moment you decide to have surgery. One of the first things you need to do is arrange a ride for the day of your discharge. Most patients are ready to be discharged from the hospital one to three days after surgery; however, specific criteria must be met. You will be discharged from the hospital when:

  • Your medical condition is stable.
  • You are able to eat and urinate.
  • Your pain is controlled with oral pain medication.
  • Your home is prepared for your safety.
  • You successfully met physical and occupational therapy goals.
The First 48 hours at Home

No matter how much you prepared for your homecoming, it will be an adjustment. You will likely experience anxiety and question whether you were discharged too early. This is a normal feeling, so relax and focus on your recovery. Also expect a visit from the physical therapist or occupational therapist within 48 hours of discharge.

Continued exercise at this early stage is important to achieve the best outcome with your new joint replacement. Based on your needs, your therapy may be continued at home or in an outpatient setting of your choice. You will be given an exercise program to continue exercising at home.

Weeks 1 to 6 at Home

During the first six weeks after discharge, you should be making progress week by week. Most patients are eager to report their progress at follow-up visits and are ready to move to the next level in their recovery. Most patients can accomplish the following during the first six weeks after total joint replacement:

  • Walk without help on a level surface with the use of walker, crutches, or cane as appropriate.
  • Climb stairs as tolerated.
  • Get in and out of bed without help.
  • Get in and out of a chair or car without help.
  • Shower using a tub bench once staples are removed – as long as there are no issues with the incision.
  • Resume your activities of daily living including cooking, light chores, walking, and going outside the home. You should certainly be awake and moving around most of the day.
  • Some patients return to work before the first follow-up visit. This is approved on an individual basis and should be discussed with your surgeon.
Icing and Elevation

After a joint replacement, swelling is expected. Swelling can cause increased pain and limit your range of motion, so taking steps to reduce the swelling is important. Continue using ice packs or some form of cold therapy to help reduce swelling. For knee replacement, you may use pillows to elevate; however, it’s important to elevate the entire leg, down to the ankle. Never put a pillow only behind your knee so your knee is in a bent position. Your knee should be straight when elevated.

Diet

Resume your diet as tolerated and include vegetables, fruits, and proteins (such as meats, fish, chicken, nuts, and eggs) to promote healing. Also, remember to have adequate fluid intake (at least 8 glasses a day). It is common after surgery to lack an appetite. This may be the result of anesthesia and the medications. Proper nutrition is needed for healing. During the healing process, the body needs increased amounts of calories, protein, vitamins A and C, and sometimes, the mineral zinc. Eat a variety of foods to get all the calories, proteins, vitamins, and minerals you need. If you have been told to follow a specific diet, please follow it. What you eat can help heal your wounds and prevent infection and potential complications. If you’re not eating well after surgery, contact your healthcare provider about nutritional supplements.

Diet Resume your diet as tolerated and include vegetables, fruits, and proteins (such as meats, fish, chicken, nuts, and eggs) to promote healing. Also, remember to have adequate fluid intake (at least 8 glasses a day). It is common after surgery to lack an appetite. This may be the result of anesthesia and the medications. Proper nutrition is needed for healing. During the healing process, the body needs increased amounts of calories, protein, vitamins A and C, and sometimes, the mineral zinc. Eat a variety of foods to get all the calories, proteins, vitamins, and minerals you need. If you have been told to follow a specific diet, please follow it. What you eat can help heal your wounds and prevent infection and potential complications. If you’re not eating well after surgery, contact your healthcare provider about nutritional supplements.

Weeks 6 to 12 at Home

This period after joint replacement is a time of continued improvement. You will probably notice an increase in energy, a desire to do more activities, and a noticeable improvement in your new joint. Please keep in mind that every patient is different and will improve at different pace. If you are not happy with the pace of your recovery, please contact your surgeon’s office to discuss your concerns.

Walking

After your six-week follow-up visit, you will likely start using a cane to walk and move about. Use the cane until you return for your 12-week follow-up visit. Walk with the cane as much as you want as long as you are comfortable. Back to Work Many patients return to work after the six-week follow-up visit.

Tips to remember for returning to work include:

  • Avoid heavy lifting after you return to work.
  • Avoid standing or sitting for long periods of time.
  • Avoid activities such as frequently climbing stairs or climbing ladders.
  • Avoid kneeling, stooping, bending forward or any position that puts the new joint under extreme strain.
  • Expect a period of adjustment. Most people return to work with few problems. However, you may find the first several days very tiring. Give yourself time to adjust to work again and gradually this should improve.
Continue Exercise Program

Continue to exercise. Many patients stop working with physical therapy during this time. However, exercising is the most important activity to increase strength and leads to the best outcome. Work or home activities should not replace your exercise program.

Three Month Follow-Up

You will see your surgeon for another follow-up visit about 3 months after surgery. We encourage you to resume normal activities both inside and outside the home.

Six Months and Future Follow-Up Visits

Your next appointment is six months after surgery, then once a year unless told otherwise. These appointments give you a chance to discuss any concerns about your total joint replacement or other joints in which symptoms may develop.

33year old Man suffering from severe right hip pain and not able to walk well for 6months. He had been advised Total Hip replacement surgery but he wanted to save his natural hip. Only way possible was try a Vascularised fibular graft in the head of femur to establish a Functional hip joint. This surgery is not practised in Eastern India and was performed for first time at Bellevue by Dr Ujjwal K Debnath, Consultant Orthopaedic Surgeon.