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Category Archives: Orthopaedics

Mild Sports Injuries Can Lead To Crippling Arthritis

Dr (Prof) Raju Vaishya

Mild sports injury is a major concern for players whose sports career spoil due to injuries. However most sports injuries are mild and temporary, with no long-term effects. Minor sprains and bruises or overuse injuries treated properly may be nuisances but do not necessarily cause any permanent problems. Some injuries, however, may lead to crippling arthritis later in life, but new techniques like Autologous Chondrocyte Implantation (ACI), help young people who suffer from arthritis or knee damage due to sports injuries or accidents, by growing cartilage tissue in the affected area, allowing for a complete recovery.

Autologous Chondrocyte Implantation (ACI) has recently become available in India, where near normal chondrocytes (cartilage cells) are developed, which can then be implanted to treat the damaged cartilage has been catching on. Many young people are opting for this procedure. A number of such surgeries have been performing in India. This surgery is a good option because it allows young people to get back to sports quickly and they can resume normal activity in 7 to 9 months. The treatment he claims is effective because good cartilage cells are taken, harvested and cultured and used to replace the damaged cartilage.

These good cells grow on the damaged cartilage cells by stimulating near normal cells and making the affected area as good as new.

There are a few different methods to prevent sports injuries. The first is proper conditioning. When someone is poorly conditioned or fatigued, the muscles do not protect the joints, and an injury is more likely. It is important for athletes at any level to be properly conditioned for their sport, not only with regards to stamina but also strength and flexibility. Proper nutrition and hydration also come into play. The next aspect of prevention is proper form and technique in the specific sport, assured in part by following the rules of the game. Finally, certain sports offer protective equipment, and this may be of benefit in injury prevention. Once an injury has been sustained, there are still measures that may prevent arthritis. Avoiding strenuous or demanding activities may decrease the chances of arthritis. In many cases, as in the torn ACL, the problem can be surgically corrected, restoring proper mechanics and thereby hopefully preventing arthritis.

The more common way a sports injury leads to arthritis is when a ligament or supporting structure is damaged, causing abnormal mechanics in the joint. This greatly increases the stress on the articular surface, which over time, wears out and causes arthritis. One of the most known examples of this type of this injury is in the knee. With the increased attention of media to the injuries sustained by star athletes, most people have heard of an ACL injury.

 Is President of  Arthritis Care Foundation  & Senior Consultant Orthopaedic & Joint Replacement Surgeon at Indraprastha Apollo Hospitals, New Delhi. Dr. Raju Vaishya is a specialist in sports injuries, who has performed many such surgeries.

Obesity and Sedentary lifestyle are Principal cause behind early Arthritis & Knee Damage

By Vinod Kumar

Experts warn vicious cycle of inactivity and unbalanced diet flare the overweight kids up for arthritis as adult. According to experts  the effects of obesity put children at risk of long-term foot, leg and back problems.

While Childhood Arthritis (juvenile arthritis) is considered a rare disorder, the incidence is rising and doctors of the city blame obesity to be one of the major contributors. City doctors are shocked to discover that the school going children are also suffering from bone disorders like arthritis and osteoporosis. While there are many reasons for the kids to be obese, including hormonal issues, but being overweight is strongly connected to diet and inactivity inform the experts.

“Our hips and knees bear five to seven times our body weight. These little frames aren’t supposed to be carrying 50 to 60 kg of body weight. The heavier the child, the bigger the pressure on the joints and cartilage, and that can be painful. It sets up their soft tissue for inflammation.” Informed Dr. (Prof.) Raju Vaishya, Founder President of Arthritis Care Foundation (ACF) and senior consultant, orthopaedic & joint replacement surgeon at  Indraprastha Apollo Hospitals. Obesity causes an increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation, said Dr. Vaishya.

According to senior dietitian & nutritionist Dr pallavi Vaishya, “if your child complains of joint pain, swelling or stiffness in one or more joints for a period of six weeks or longer, seek medical attention as early diagnosis and treatment is necessary to prevent permanent joint damage. The inactivity related to watching TV and playing video games have a significant impact on childhood obesity. Poor eating habits also lead to diets deficient in calcium and vitamin D – important nutrients for growing bones,”

“The diagnosis of knee osteoarthritis is occurring much earlier. Obesity and knee injuries may be helping to drive the increase in knee Osteoarthritis among younger people. Injuries to the knee have been linked with an increased risk of knee arthritis.   “More knee replacements are being performed in younger population than before due to obesity, sedentary lifestyles & other forms of arthritis,” said Dr. Raju Vaishya.

According to Dr. Vaishya, Over the last few years, the volume of joint replacement procedures has increased dramatically—and the percentage of joint replacement in patients who are younger than 65 years have seen marked increase.

Dr. Raju Vaishya said that it is a common misconception that autoimmune diseases (AIs) affecting joints, such as rheumatoid arthritis (RA), only affect the elderly. Statistics show that both the young and active can also suffer from these debilitating conditions.

“Patients must not lose hope. Treatment has improved significantly and newer therapies and methodologies including the very exciting biologic disease modifying drugs and procedures like arthroscopy and joint replacements have made a tremendous impact on our ability to treat the various Arthritis. With the help of these therapies, patients are now able to live a fuller, healthier and more active life no matter what their age. They can still reach for the stars and realize their dreams.” said Dr (Prof) Rohini Handa, senior consultant, rheumatology, Indraprastha Apollo Hospitals.

“As the number of younger patients with arthritic knees increases, the emphasis should be given to prevention, and improvements in surgical techniques and implants will lead to better long-term outcomes when joint replacement is performed,” said Dr. Handa.

According to Dr, Raju Vaishya now a day’s arthritis of the knee and other joints is striking at younger ages but shedding a few pounds if you’re overweight may reduce your risk. As people become more aware of the facts around joint pain they are more inclined to seek help.

“Many people believe that only the elderly suffer from arthritis but I treat patients of all ages in my practice. Often they are misdiagnosed because some doctor’s rule out the possibility of a patient having some form of arthritis as they are too young, and the elderly don’t seek treatment as they believe there is nothing that can be done,” explains Dr. Handa.

According to Dr. Pallavi Vaishya, “ a program of exercise & taking precautions has reduced pain and improved mobility by as much as 50 percent in those with knee arthritis. A good physical activity programme is possible for people of all abilities, sizes, ages and attitudes.  An effective self-management plan should include a plan to stay active, as well as medication, balance between rest and recreation, a healthy diet, and joint protection techniques.”

Detecting Rheumatoid Arthritis Early Crucial

Message On World Arthritis Day

Dr. Raju Vaishya

Rheumatoid arthritis is a chronic, autoimmune disease in which the body’s immune starts attacking the body itself by attacking healthy joints causing inflammation of the tissue that protects them. That results in swelling, pain as well as discomfort. If there is pain and inflammation in small joints is persisting for a few weeks and if it is associated with morning stiffness lasting over 45 minutes to one hour, there is a high probability that the patient is harbouring rheumatoid arthritis.

If not diagnosed in time, deformities like crooked fingers, weakening of muscles of hands, which causes inability to pick and grasp things, weakening of joints like elbows and shoulders makes lifting difficult for the affected and the person can be bed-bound if the lower extremities are affected. RA is not just an illness of the joints, it can affect lungs and blood vessels also.

Though rheumatoid arthritis is not curable but it can be effectively controlled and managed like we do with any other chronic disease, diabetes for instance. It is advisable to not resort to pain killers for relief. There are specific medicines to manage rheumatoid arthritis. But if this disease is left to worsen for long, treatment gets increasingly difficult, so catching this disease young is the right way to avert this situation.

Mutated genes may make you more susceptible to the disease. You can be more prone to rheumatoid arthritis if you are a woman. Family history, cold temperatures, humidity, or certain foods such as meat, foods containing saturated fat etc. can all trigger the disease.

However there is no cure for RA but medication can reduce joint inflammation, relieve pain and slow or prevent the joint damage. Occupational and physical therapy can help protect joints from further damage. Certain exercises can keep your joints flexible.

 Is a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation.  Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions. He has more than 150 published articles in various International and national peer-reviewed medical journals and has been regularly invited to give lectures, chairing sessions,etc. in Orthopaedic conferences around the world. He has been awarded for the best paper publication on nu¬merous occasions by Delhi Orthopedic Association and Apollo Hospitals. His work was recognized in the Limca book of records in 2012, 2013 & 2015 for do¬ing bilateral Total Knee Replacement in 93 years old gentleman, bilateral Total Knee Replacement in the oldest couple in a single sitting, ACL reconstruction on oldest man.

Osteoporotic Fracture Risk In Urban Indian Population

Dr.Raju Vaishya

Osteoporosis is one of the impending epidemics as the population around the world ages. It is usually considered a “silent disease” until a fracture occurs. Osteoporotic fractures are defined as fractures associated with low bone mineral density (BMD) and include clinical spine, hip, forearm and shoulder fractures. Based on 2001 census approximately 163 million Indians are above the age of 50; this number is expected to increase to 230 million by 2015. Even conservative estimates suggest that of these, 20 percent of women and about 10-15 percent of men would be osteoporotic. The total affected population would, therefore, be around 25 million and the figure can increase to 50 million. Osteoporosis leads to nearly 9 million fractures annually worldwide.

There have been studies around the world for prevalence of osteoporosis and its related risk factors but there have been limited studies which discuss the incidence of risk factors and osteoporosis in the Indian population. In this study, the incidence of osteoporosis and the associated clinical risk factors was studied in the urban Indian population of New Delhi. Bone mineral density of 445 individuals (223 males and 222 females) using qualitative ultrasound was assessed. The patients were also questioned regarding the presence of the various clinical risk factors as per the FRAX tool of WHO. The incidence of osteoporosis was found to be very high in the urban Indian population of New Delhi.

There is an urgent need for a comprehensive national program to screen for osteoporosis in India. More care and attention should be targeted towards elderly, especially the ones with the risk factors as discussed here to prevent the future epidemic of osteoporosis.

Recently, a WHO scientific group proposed that the 10-year probability of fracture calculated using information on clinical risk factors.The FRAX tool developed by the WHO is used in assessment of both clinical fracture risk and BMD. The risk of fracture is cal­culated in men or women from age, body mass index (BMI) computed from height and weight and independ­ent risk variables comprising; a prior fragility fracture, parental history of hip fracture, current tobacco smok­ing, long-term use of oral steroids, rheuma­toid arthritis, other causes of secondary osteoporosis and daily alcohol consumption of 3 or more units daily.

Information on age and Clinical Risk Factors was obtained using a standardized questionnaire administered face to face. The community out-reach programme was organized by the efforts of an NGO (Arthritis Care Foundation) in this study. The senior citizen forum and the resident welfare associations in the areas of central and east Delhi were contacted and those who volunteered for the camp were included in the study. Fourteen camps were organized in total and every third person attending the camp was included in the study. The study duration of the study was from October 2012 to March 2013. This study was conducted in Sukhdev Vihar, Ishwar Nagar, Sarita Vihar, Jasola, Kalkaji, East of Kailash, New Friends Colony, Maharani Bagh, Lajpat Nagar – I,II,III,IV, Nizzamuddin and Mayur Vihar. The cluster of subjects mainly belonged to the middle and upper class.

The 445 individuals in this study were in the age group of 38 years to 68 years (mean: 59.68 years). There were 223 males and 222 females in this study. Females were found have the significantly high incidence of osteoporosis. A very high incidence of osteoporosis (69%) was found in the studied population, with about 69% and only 31% people had normal BMD scores. It was found that the association of parent history of fracture, rheumatoid arthritis and secondary osteoporosis was associated with high incidence of osteoporosis.

The major osteoporotic fracture risk ranged from 0.70% to 25% and the risk of hip fracture ranged from 0 to 21%. The number and percentage of the population needing treatment were out of a total population of 445 was 113 (25.39%).

The problem of osteoporosis will soon be of greater importance in developing countries due to the increase in life expectancy. Identification of patients who are at risk of developing osteoporosis and adequate treatment can prevent long-term morbidity due to osteoporotic fractures. Unfortunately, osteoporosis receives low attention in the primary health care programs in most underdeveloped and developing countries where most population is largely unaware of the serious complications associated with osteoporosis.

The ideal management of osteoporosis is two-pronged, 1) by minimizing the risk of acquiring the disease by modification of individuals’ lifestyle to combat related risk factors and 2) by identification of patients at high risk to reduce future fractures. Many risk factors, some are modifiable (like low BMD, steroid intake etc.) and others non-modifiable (like advanced age, personal and parental history of fracture) are associated with osteoporosis.

When the risk factors are studied in the context of the Indian population, some points are worth mentioning. The average age at menopause has been reported to be slightly lower than the average Caucasian female. This decreased exposure to estrogen in a female in her lifetime is a major risk factor for osteoporosis. There are other described modifiable risk factors which have been associated with the low BMD in the Indian population. The most important factor is the low dietary intake of calcium and vitamin D. The causes of poor dietary intake of calcium include a large vegetarian population and the absence of government guidelines regarding fortification of food. Moreover, due to the increasing costs of dairy products, a large population is unable to afford them. An increased intake of phytates in the Indian diet (in chapatti) as another major contributing factor for the poor absorption of dietary calcium. Even though India is a sun-rich company, still a large population is vitamin D deficient. The causes of vitamin D deficiency include the use of traditional dresses like sari, burqa which limit the direct exposure of the skin to the sun. Other contributing factors include highly pigmented skin and overall low sun exposure.

The 10-year probability of MOF and HF was significantly associated with higher age and female gender. Parent history of fracture, presence of secondary osteoporosis and rheumatoid arthritis were also significantly associated with a 10-year probability of HF and MOF. Similar results were found in null by some authors in other populations30,31,32.  The results are consistent with results published in literature where a null significant association between risk of osteoporosis and such variables was found30,43. This present study can be generalized to upper and middle class of an urban population.

Steroid intake was not found to be significantly associated with lower T-scores. The reason for this could be the selection of a possible “healthy cohort”. The cohort attending our health camps were a comparatively healthy population as depicted by only 15 total patients found to be using steroids. We were also unable to find a significant association between alcohol intake and smoking with T-scores.

We found a very high incidence of osteopenia and osteoporosis in the urban Indian population. Out of the population studied, 25.39% of the population needed treatment on the basis of FRAX score. Significant association of sex, parent history of fracture and secondary osteoporosis was identified in the present study whereas alcohol and steroid intake was not found to be statistically associated with the low T-scores. This study may predict a future epidemic of hip and major osteoporotic fractures in the aging population of India and might pose a serious challenge to the health planners. There is an urgent need for a comprehensive national program to screen for osteoporosis in India. We propose that more care and attention should be targeted toward elderly and especially postmenopausal female with respect to preventive measures. Further research and studies regarding fracture rates, the null component of osteoporosis, and evaluation of the applicability accuracy and feasibility of universal use of FRAX in Indian population are needed. 

Dr. (Prof.) Raju Vaishya , a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation.  Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions. He has more than 150 published articles in various International and national peer-reviewed medical journals and has been regularly invited to give lectures, chairing sessions,etc. in Orthopaedic conferences around the world. He has been awarded for the best paper publication on nu¬merous occasions by Delhi Orthopedic Association and Apollo Hospitals. His work was recognized in the Limca book of records in 2012, 2013 & 2015 for do¬ing bilateral Total Knee Replacement in 93 years old gentleman, bilateral Total Knee Replacement in the oldest couple in a single sitting, ACL reconstruction on oldest man.

 

Advancement In Joint Replacement Surgery

Dr Raju Vaishya

Until a few decades ago, a diagnosis of arthritis was deeply discouraging to patient and doctor alike. While most kinds of arthritis are chronic and can’t be cured,  one doesn’t have to face a life of pain. One can live a normal life, with arthritis.  Today, though researches haven’t found a cure for most arthritis, there is  an array of prescription drugs to help with more serious kinds of arthritis, including several new drugs for rheumatoid arthritis. In severe cases of joint damage, surgery can help restore joint function and mobility. There are now new, conventional and alternative treatments, the benefits of self-help programmes, plus treatment specific to the different types of arthritis.

In recent years there has been some revolutionary advances in joint replacement surgery. Till recently the joints, which were commonly replaced were that of knee joints and hip joints. Now the other parts of body can also be replaced as that of shoulder, elbow, wrist, finger and ankle joints.

It has been observed that Asian bones are not only small but also more fragile as compared to European and American bones. This discovery has led to better joints, which are better replicates of original joints and their life span has also increased to 20 to 25 years. The improvement in the designs & materials used in artificial joints have contributed to increase the life span of these joints. Some new bearing surfaces, like metal on metal, ceramic on ceramic & development of cross linked poly ethylene has shown to increase the life of these joints by reducing the wear rate & providing an efficient low friction artificial joint surfaces. Hence, it is now possible to implant these joints even in younger patients with crippling arthritis.

Contemporary Total Knee Replacement (TKR) which is currently one of the most frequently performed orthopaedic surgical procedures, has developed over the past 30 years. Although the goal of TKR is simple, the means of accomplishment are complex as surgeons & engineers strive to design a prosthetic joint that will function like a human knee. Success of the procedure not only is dependent on the skills of the surgeon & his team, but is also coupled with the design of the implant & instrumentation. A scientific sound design must be complemented by easily used instruments & a technique that assumes accuracy & reproducibility.

Total Joint Replacement (TJR)  represents a major advance in the management of severe, crippling arthritis. More than 5,00,000 patients undergo Total Joint Replacement each year, in USA alone. Joint replacement surgery not only relieves the pain & suffering of a crippling arthritic, but give a new lease of life to the joint & improves the quality of life tremendously.

Although  the procedure is among one of the most successful in Orthopaedic Surgery, the debate continues as to the best treatment option regarding TKR. Newer types of joints like Unicompartmental, Mobile bearing, High flex knees, Hybrid Hips, Hip Resurfacing, Metal on Metal & Ceramic on Ceramic implants have been introduced for use recently.

Not only there have improvements in the materials, designs & instrumentation of joint replacement surgery, but new techniques of replacing joints using small cuts (Minimally Invasive Surgery or MIS), computer assisted navigation surgery, & robot assisted surgery are becoming popular, as they are likely to provide more accurate placement of artificial joints with minimum of discomfort to the patient.

The future  of joint replacement  surgery is bright in India. The number of total joint repalcements being done in India is increasing at a rapid rate in the recent past. Total Joint Replacement surgery has come here to stay forever, as it has proved worldwide over in the last 3 decades, through its excellent results.  A great amount of research is being carried out to further improve both the materials used in the replacement parts and in their design to make them function smoothly and as ‘normally’ as possible. With more trained personnel available in time to come & lower cost of prosthesis would certainly help in making the TJR to become extremely popular treatment option.

Arthritis Care Foundation (Regd) is a registered society working towards helping people in India, who are suffering with arthritis & related problems. The main objectives of the organization is to spread knowledge about arthritis, organize free camps for patients suffering from Arthritis & Osteoporosis & to help the patients who need specialist consultations, walking aids , medicines & surgery.

President, Arthritis Care Foundation &
Sr Consultant Orthopaedic & Joint Replacement Surgeon
Indraprastha Apollo Hospitals, New Delhi