Treating knee pain in the young -
Biological Cell Therapy, the new frontier:
Treating knee pain for younger people, between the ages of 15 to 55, poses the biggest challenge. Primary osteoarthritis is uncommon below
age of 30 years, secondary arthritis due to previous trauma or sports injury is not so uncommon. Damage to the articular cartilage in the
knee due to an injury or sudden impact may affect millions of people world-wide, but treatment is hampered by the fact that in adult life,
articular cartilage is limited in its ability to regenerate. Therefore treating such injury leading to arthritis of the younger person
becomes more challenging.
What is cartilage?
Cartilage is the most vital structure of the knee joint, that help to prevent the grinding of two bony surfaces.
What is the answer to treat cartilage injury?
ACI(Autologous Chondrocyte Implantation) technique appears most promising, due to its ability to generate hyaline type cartilage, which
is more durable.
How is ACI performed?
Healthy knee cartilage is harvested from the non weight bearing area of the affected joint. In a high tech cell culture lab, these cartilage
cells are re-grown in multiplication over five weeks. In the second stage, cells are injected into damaged area covered by bone membrane
What is new in cartilage implantation?
MACI (Matrix Induced Autologous Chondrcyte Implantation) is a current advanced innovative technology over previous method described.
This uses collagen membranes and Tisseel fibrin sealant to attack the chondrocyte seeded scaffold and fill the cartilaginous defect
Hips: ALL NEW AGAIN
Osteoporosis, the degenerative joint disease that usually sets in with age, causes pain, not only to the person suffering from it, but
also to the family of the patients. Seeing someone close to you hobble with every step can be agonising. Especially of there’s nothing
you can do to take the pain away. But there is, Studies have shown that new disphosphonate drugs can cure osteonecrosis of the hip, a
debilitating disease that could only be cured by surgery earlier.
Total hip replacement and total knee replacement surgeries are no longer necessary.” In the past few years, doctors have made possible
the option of surface replacement--- surgery where the surface of the joint is ‘capped’, ”says Dr. Sanjay Agrawal, consultant orthopaedic
at Breach Candy and PD Hinduja Hospitals, and specialist in joint replacement surgeries. “This preserves a large portion of the natural
bone. And just in case the patient needs a revision surgery in a few years, natural bone is easier to work with.
New instruments, surface finishing materials and computerisation are now being used in surgery of he joints. “Technology now allows the
patient full range of movement with minimal damage to the bone. The patient has the ability to do things that were impossible earlier.”
Says Dr. Agarwala. Sitting cross-legged and squatting are just a few of the things a patient is not forbidden any more. “ This also
offers greater longevity of the joints, ”he adds.
Osteoporosis cure in once-a-day pill?Tested on rodents, New Drug completely Rebuilds Bones Chicago
: a once-a-day pill helped completely rebuild bone in rodents with server osteoporosis, a finding that could lead to a new class
of drugs to treat the brittle-bone disease in humans, US researchers said.
The team tested a compound that blocks the production of the serotonin hormone produced in the gut in mice and rates with a severe form
of the disease and found they completely recovered their bone density.
“If you break the bone, it looks like a normal bone,” said Gerard Karsenty of Columbia University Medical Centre in New York, whose study
appears in the Journal nature Medicine.
Using the findings, he said the team is working to develop this type of treatment for human patients with osteoporosis, in which bones
become fragile and porous. Increasing the risk of fracture.” There is an urgent need to identify new, safe therapies that can increase
bone formation on a long-term basis,” Karsently said.
The study builds on prior research conducted by the same team that found that the chemical messenger serotonin-when released by the
gut-inhibits bone formation.
Serotonin is most commonly known for its role in the brain as a chemical messenger but 95% of the serotonin in the body is produced
in the gut as a way to regulate bone formation, Karesenty said. ”we thought that if we could inhibit the synthesizing of serotonin
in the gut, it could be a way to treat osteoporosis, ”he said.” Luckily for us, there are a couple of inhibitor of gut-derived serotonin
that do not affect the synthesis of brain-derived serotonin.”
The team tested a compound that blocks the production of serotonin in the gut in mice and rats with osteoporosis.” Indeed, when you
deprive the system of serotonin in the gut, consistent with the human genetic data, what you see in mice or rats is that you correct
completely the osteoporosis,” Karsenty said .
He said the drug had already been tested in people in early safety studies.
“This molecule is given once a day orally. Obviously it is very attractive. There are very few molecules that can induce bone formation.
Beer is good for Bones’
London: Beer is a significant source of dietary silicon, a key ingredient for increasing bone mineral
density, and hence a moderate consumption may help fight osteoporosis.
An international team has carried out the study and found that beer is rich in silicon—a mineral found in barley, a key ingredient in
the beverage---- which survives the brewing process as orthosilicic acid. And, according to the study, it’s silicon which helps strengthen
bones and prevent osteoporosis, a disease that is characterized by low bone as well as the deterioration of bone tissue.
Lead researcher Charles Bam-forth of California University was quoted by the British media as saying,” Beer containing high levels of
malted barely and hops are richest in silicon. It’s the husk of barely that’s rich in this element,While most remains during brewing,
significant quantities are none the less extracted into wort and survive into beer” .
Bone Lengthening procedure puts him on his feet again
Mumbai: Kalyan resident Chanrakant Kothere never believed doctors who told him three years ago that he
would not be able to walk properly again. It was perhaps his positive belief that led to a near-complete cure—a bone-lengthening procedure
known as the IIizarov technique and a subsequent operation over the lasted over nine months.
Kothere, who had met with a road accident while going to Alibaug on a bike, suffered multiple fractures on his right leg, resulting in a
limp and extensive pain.
“Some doctors suggested an amputation after the initial treatment,” said Shobha kothere, wife of Chandrakant. But the couple was determined
that he would walk without a stick---sooner than later. In the interim, the fracture on Kothere’s right leg caused a bow leg appearance.
He was “Shorter” by almost three inches on his right side.
“He resumed work, but came back twice with a fracture that needed plastering. How long could we go on? Said Shobha. That is when Shobha
went to Wockhardt Hospital in Mulund in January this year to meet a doctor for a cure. At Wockhardt, the doctors decided to conduct the
surgery in two stages. “In the first stage., We cleared the infected bone and aligned the leg using a ring shaped IIzarov External
Fixator,” said Dr. Sachin Bhonsale, consultant orthopedic surgeon at Wockhardt. The screws were turned—1 mm a day – to facilitate
lengthening. “It took four months for the bone tissues to grow. That is when we performed the second stage of attaching a titanium
rod and screws,” the doctors said.
The significance of the case lies in the fact that even after three years of the fracture, a procedure to transport the bone and fix
the joint was successful.
Doc up & running after cell therapy
Dying Hip Joint Repaired With Cultured Cells
A 25-year-old Ratna girl doctor could be the first in India to be treated for avascular necrosis using cell therapy.
Avascular necrosis is a disease in which the tissues of the hip joint die because of lack of blood supply. The top of femoral head
(the ball portion of the ball and socket joint) collapses as a result and begins to flatten. The most common treatment of this disease
is complete hip replacement.
But 25-year-old Suhas Khanavilkar deicided to take a chance—with a new therapy. Instead of surgery, he only needed an implant of bone
cells cultured from his own bone marrow.
“Ten months ago, I suddenly stared experiencing pain in both my hips while walking. I neglected it for a long time, but there came a
time, when a cracking sound came from my hip joint whenever I sat down or stood up. CT and MRI scans showed that the head of my thigh
bone had become uneven. The left side was still better. But the right hip was so painful the joint even fractured,” said Suhas’ Dr.
Gauresh Palekar, Suhas ‘doctor, says the therapy, which was performed eight months ago, was possibly the first in India.
Satyen Sanghavi, chief scientific officer of ‘Regrow’, a Lonavala-based cell therapy services company, said it was a five-week –long
procedure. “First 10 ml of Suhas’s bone marrow was taken form his posterior bone. This was sent to our lab in Korea where it was cultured
into bone cells. Around 10,000 stromal cells were separated from the bone marrow, which were then cultured into 50 million osteoblasts
In November, the bone was pushed back into its original place, and the inside was filled with calcium cement, and a mixture of cultured
bone cells and fibrin gel. “The calcium cement turns into bone within a year. The gel is used to keep the cultured bone cells in place,”
said Dr Palekar, who runs a clinic in Girgaon.
Although Suhas walked with the help of crutches for three months after the surgery, today, he walks runs and climbs stairs just as earlier.
“Drug treatment of avascular necrosis helps preserve the disease bone till nature can take over and restore the bone, Stem cells, however,
will hasten this procedure. Still, it is too early to say if it will be successful,” said Dr. S Agarwala orthopedic surgeon with Hinduja
Hospital. Dr. Vijay Shetty, orthopedic surgeon with Hinduja Hospital. Dr. Vijay Shetty, orthopedic surgeon with Hiranadani Hospital
says,” We need to look at long-term results before we can start doing it on every patient.”
Chronology of An Implant
Avascular Necrosis (AVN) occurs in the hip joint, when the top of the femoral head (the ball portion) collapses and begins to flatten
due to the stoppage of blood supply.
• 10 ml of bone marrow is taken from the pelvic bone
• In the lab, around 10,000 stromal cells are separated from the marrow.
• These are cultured into osteoblasts (bone cells)
• In a span of five weeks, these are expanded into 50 million cells
1 Due to lack of blood supply, the bone tissues die
2The bone starts collapsing and flattens inwards
3The bone is pushed back in its normal position and is filled with a calcium and bone cells mixture.
• Prolonged use of alcohol/steroids
• Working in extreme atmospheric conditions
• Injury, fracture or dislocation of the hip joint
• Most known cases of AVN are idiopathic (where cause is unknown)
Stem cell therapy saved his cricketing career
Mumbai: a dying cricketing career and four surgeries later, stem cell therapy came to the rescue of budding cricketer Ankit Parasher.
Repeated wear and tear in the playground wear and tear in the playground damaged his left knee to such an extent that his performances
on filed had hit rock bottom.
21-year-old Parasher, state level player from Madhya Pradesh, had been suffering from Osteochondritis Dissecans (OCD)-a condition in
which cracks appear in the lining of the knee joints. Gradually, blood supply to the affected area got disrupted and fragments of the
affected bone and its covering of cartilage loosened up and some even got detached.
A common orthopedic procedure, arthroscopy, performed twice on him, also failed to yield any results. “It affected my performance on
the field as I would be in pain after every match.” Said Parasher, who is going to be back in action next month after a break of more
than a year.
If not for the stem cell therapy, there was little doctors could have done to revive his career. Orthopaedic surgeon Dr. Anant Joshi,
who specialises in sports injuries, went ahead with a procedure called chondron. In this procedure, patient’s own healthy cartilage
tissue is harvested, stem cells are cultured from the tissue and implanted in the affected area, he said.
The stem cells, which were harvested from Parasher’s 67mm of cartilage tissue, tool around 4 weeks to culture. Once the cells were formed,
they were injected in his affected left knee joint. The results were visible in six months. Said Joshi.
The treatment could also mean boon to sportsperson who suffer from repeated injuries, said Joshi, who is also an advisor to the Board of
control for Cricket in India (BCCI). “Before cartilage cell treatment, we had very limited options to treat sportsmen,” said Joshi.
Joshi, however, cautioned that this therapy may not hold much promise for arthritis, or conditions requiring joint replacement.
Osteoporosis drug overuse narms limbs:
Drugs used to treat osteoporosis—the brittle bone disease—could make limbs easier to bone disease—could make limbs easier to break if
used for too long, new studies have found. According to two studies—presented at the annual meeting of the American Academy of Orthopedic
Surgeons in New Orleans---overuse of the a drugs upsets the mineral and crystalline structure of bone, causing weakness that can lead to
fractures, Scientists found that bisphosphonates improve quantity. at the expense of quality. Although the medicines helped preserved
bone, over time they appeared to impair its structure.
TAKE CARE OF YOUR BONES
Osteoporosis is affecting millions of women, Zeenia F Baria asks experts more about this disease
Are you aware that Osteoporosis is an illness that is affecting millions of women across the globe? This disease usually targets people
after the age of 45 and is more common in post menopausal women. Often called the silent disease because bone loss occurs without
symptoms, there is an urgent need for more awareness of osteoporosis.
According to Consultant Orthopaedic, Joint Replacement and Hip Resurfacing Surgeon, Dr Sanjeev Jain, people may not know that they have
osteoporosis untile their bones become so weak that a sudden strain, bump or fall causes a hip fracture or a vertebral collapese. "Pain
and weakness all over is a common symptom.Unfortunately, in many cases, the first real 'symptom' is broken bone. Loss of height, with
the gradual curvature of the back, (caused by vertebral compression fractures) may be the only physical sign of osteoporosis," says
Dr.Jain. The best ways to prevent it and to protect your bones is to do exercises that help in strenthening bones. "Building bones
through adequate calcium intake and exercises when you are young is an investment that will pay off years later with a reduced risk
of hip and other fractures. An inactive person should start these exercises slowly and gradually increase the intensity.
Brisk walking, jogging, climbing stairs are especially good. Muscle building exercises are not recommonded for people with osteoporosis.
In pregnant, lactating, nursing, post-menopausal women and in men and women over 65 years, the requirement of calcium and vitamin D
increases. Vitamin D can be obtained from eggs, liver or even spending about 15 minutes in the sunshine is good. Apart from calcium,
Vitamin D,K,B6,B12 and minerals like magnesium, zinc, manganes and silicon are also important in strengthening bones. To prevent
menopausal bone loss, estrogen replacement therapy, calcitonin, bisphosphonate, parathyroid hormone therapy and other medications
should be considered," he says.
Orthopaedic and Joint Replacement Surgeon, Dr Dilip D Tanna, says that the human body forms bones until the age of 35 years after which
new bone formation is negligible. "This remains our highest bone mass. Post 35 years our bone mass remains steady untile 45-50 years
after which it gradually begins to lose bone mass due to menopause. Most women lose around one per cent of their bone mass each year
post menopause. Osteoporosis can be detected only over a period of time with a few tests. Include a lot of calcium rich alternatives
in your diet. These include dry beans, such as black-eyed peas, kidney beans and black beans, turnip greens, collard greens, broccoli,
sardines, tofu and fortified orange juice. Almonds, sunflower and sesame seeds ae also a rich source of calcium,"
Consultant Orthopedic Surgeon, Dr Sanjay Agarwala, concludes saying that osteoporosis isn't always hereditary."There can be a
predisposition mediated through hormonal lack. The peak bone mass i.e. the amount and quality of bone is genetically linked. However,
environmental factors and personal habits determine the final quality of bone. On needs to replenish stores of calcium and vitamin D
and at times consider hormones that can makes bones grow. One can prevent this illness by going in for weight bearing exercises during
young age and maintaining the intake of calcium and vitamin D," says Dr Agarwala.
Never in vein
Many who suffer from varicose veins think there is not cure for this problem But this is a misconception.
There are several instances of people silently suffering from varicose veins unable to find a cure or learn how to handle them. Also,
when the pain and disease recurs despite treatment, patients are under the impression that varicose veins are not curable. But this is
Payal Shah, who lives in the U.S. had suffered from various veins for five years. She tried several treatments but found only
temporary relief. While travelling to India, on the 14-hour flight, she experienced tremendous discomfort and pain in her legs
and her ankle was red, swollen and painful. Soon her ankle, was a pool of blood; a varicose vein had ruptured and was bleeding
heavily. The first-aid on flight controlled the bleeding and on landing, she was brought to hospital. The bleeding varicose veins
were treated with a combination of laser and scleriotheraphy treatments, where the affected vein was destroyed from within. The
results were very effective; not only did bleeding stop within 24 hours, but Payal also found a permanent cure.
What are varicose veins? Why do they occur? Varicose veins are swollen and enlarged veins, which are usually blue or dark purple
and may appear lumpy, bulging, or twisted in appearances. They can occur in any part of the body but generally appear on the legs.
With awareness being low, patients are often unaware of advanced treatments that can give permanent relief. Often patients tend to
take what they do with fever. Take a Crocin for the pain. This does not help treat the underlying main cause. If left untreated for
long, varicose veins can cause long-term damage. The patient may not be able to walk in the long run, or the vein may burst and cause
bleeding and wounds that may not heal.
Various veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows smoothly back to
the heart and is prevented from flowing backwards by a series of tiny valves, which open and close to let blood through. If these
valves weaken , or are damaged, the blood flows backwards, and collects in the vein, eventually causing it to be varicose.
There are several reason why they might just suddenly appear. Varicose veins tend to be hereditary. If your mother or grandmother had
them during pregnancy, you news is that they tend to get better after delivery.
In another case, a 31-year-old store manager working on his feet most of the day suffered from ulcer that would not heal for a few
years. Northing worked despite several kinds of treatment. Finally he top was treated with a combination of laser and surgical
treatment, which is the best form of treatment for young patients. He recovered completely in four weeks.
So what are the most effective treatments available? The type of treatments depends on your general health and the size, position,
and severity of your varicose veins. The most effective method is endovenous laser along with hook phlebectomy. Other available
treatments include use of compression stockings, sclerotherpy, which is usually suitable for people who have small to medium-sized
varicose veins. This involves a special chemical being injected into the veins and then seals then closed. Surgery may be required
when large varicose veins need to be removed.
The other option is endovenous laser treatment where a narrow tube, known as catheter, is inserted into the vein using an
ultrasound scan . A tiny laser is then passed through the catheter and positioned at the top of the varicose vein. It emits
short bursts of energy, heating the vein up and sealing it closed. The laser is slowly pulled along the vein using the
ultrasound scan as a guide, allowing the entire length of the vein to be closed.
Total Knee Replacement surgery-A Patients Perspective
A patient taking a decision to undergo knee replacement goes through a big turmoil and apprehension. These is always an anxiety and fear
factor related to its s success. Several questions to be answered prior to decision making. Postoperative painful physiotherapy,
prolonged recovery, worsening of condition prior to surgery and safety having one or both side surgery is major reasons govern myths
about this wonderful operation.
Result of surgery is excellent provided there is prior understanding of problem, acceptance of surgery and its results and co-operation
for post suirgery physiotheraphy program. With advance post operative pain management program there is negligible or no pain after
knee replacement in today’s time.
Complimentary to pain management is minimally invasive knee replacement. Here operation incision is very small with least damage to
muscles and tissues during surgery and hence pain factor is negligible or even not there. This all contributes to over all stay after
surgery to 2 to 3 days.
There is always a high degree of expectation from surgery, particularly related to gaining more bending after knee replacement with
Indian cultural and social background. Newer design of knee implants and special surgical technique provides this needed complete bending
for sitting cross legged position. I have performed more than 800 surgeries using this design if implant with excellent expected results.
Since both, knees are severely involved in most of the patient, there is always a swing in the mind to have one side or both side
surgeries done, both sides—Bilateral Knee Replacement can be done vey safely in medically cardiac fit and motivated group of the
patients. Main advantages are one time anesthesia. Surgery, recovery and physiotherapy. Current technology using computer navigation
helps surgeon to align joint and implant to highly accurate, precise and desired position to have excellent long term results. After
total knee replacement there is improved quality of life through greater independence & far superior mobility.
Arthritis Learn about your condition
Each year world Arthritis Day focuses on a different aspect of living with arthritis. This year, the 'Let's Work Together' theme
considers the challenges of work, be it paid employment, voluntary work or work at home supporting a family. Arthritis is India's
number one ailment. Over 50 per cent of the population have arthritis in one or more of their joints. By the time one is 75 years
old, there is an 80 per cent chance that one has developed arthritis somewhere, particularly in the larger joints such as the hip
or the knee.
Challenges of work
Arthritis can affect people when they are in the best of their ability to contribute to their family, society and the nation. It not
only affects an individual who has developed the disease, but also affects his/her relatives, friends, work colleagues and others,
who must provide support for those have it. Quality of life plummets, income can fall.
Let's work together
For arthritis of any form, surgery is usually undertaken reluctantly. It is better, often safer, to manage the condition without an
operation, if at all possible. It is perfect to have worries and questions about arthritis. Therefore it is very important that people
who suffer from arthritis should:
* Learn as much as possible about their condition
*Find new ways to cope with physical limitations
*Ask for help when needed
*Share frustrations and successes with family and friends
*Use honest, open communication
*Keep a sense of humour
Working together as a team can make all the difference.
Hip fracture turns fatal for the olderly and burns holes in pocket
When The Bone Deteriorates
A study by Arthritis Foundation of India says that hip fractures are fast becoming a big killer in India. Over 10% of the patients who
had hip fracture, died within a year of injury.
The most common reason for fractures is osteoporosis, a disease in which bones become fragile and more likely to break. If not prevented
or left untreated, it can progress painlessly until a bone breaks. These fractures, occur typically in hip, spine and wrist.
Hard, outer bone becomes brittle with age
Soft spongy bones suffer loss of collagen (protein tissue) and calcium, increasing risk of fracture
Risk (%) of bone fracture
One in two women will sustain at least one fracture by age 75- a far higher proportion then men
AGE AND HIP FRACTURE
The risk of hip fracture increases with age. One reason may be the increased weakness of the upeer thigh bone.
EXERCISE CAN HELP
These kinds of exercise put weight on femoral neck and strengthen bone:
Where break happens
Effect of aging:Outer bone thins on upper side of thigh bone, or femur, thickens on under side
Impact point: with a sideways fall, which is most common in older people
The break:Neck at upper end of femur
India is home to 300 m pople suffering from osteoporosis
Most hospitalisations for hip fractures are in people oler then
Gradual loss of density, with age, weakens bones, and makes old people susceptible to hip fractur
Finding Your feet
New surgical procedure offers arthritis patients increased mobility with a metal-free ankle implant made from natural collagen;
technology avoids the risk of rejection...
Patients suffering from severe arthritis now have an option for total ankle replacement that offers increased mobility and pain
relief without permanent metal implants. Pioneered by Daniel K Lee at the University of California San Diego (UCSD), this technique
could offer arthritis sufferers the world over a non-metal, biological ankle replacement.
For years, patients have had the option of total joint replacement in the hips, knees and ankle with titanium and other metal devices.
While the imploants are well-suited for hips and knees, metal replacements for the ankle show a high level of failure and unwanted
complications such as metal collapse and breakage.
Also, once an ankle is replaced with metal, options for revision surgery are little to none. Statistics point that over 100 million
adults-approximately 1 in 5- report doctor-diagnosed arthritis. As the world's population ages, these numbers are likely to increase
sharply, and a good proportion of suffering adults will have limited activity as a result.
Nearly two-third of people with arthritis are younger than 65.
"Up until now, patients have had two options for replacing their ankle joints: metal implants or fusion of the joints', said Lee,
director of foot an dankle surgery at UCSD Medical Centre."Now there is an option that actually restores the ankle with a biologic
material that is similar to the collagen found in cartilage."
Lee, who is a foot an dankle surgeon, said that surgeons in a two-hour, minimally-invasive surgical procedure could remove the damaged
cartilage around the ankle joint through a four-centimetre incision.
The collagen material can then be moulded into the joint where it adapts to the contour of the patient's ankle.
"Unlike a metal device, the advantage to this material is that the implant can be customised in size and contour for every patient's
individual need', said Lee.
The biologic material-proceed from either human or animal collagen sources-has been used for more than 10 years in plastic and abdominal
surgery and heart valve replacement. Since it is non-allergenic and sterile in nature, there is no risk of rejection or need for the
patient to take immunosupressors.
To allow the material to integrate fully with the ankle joint, a temporary external device is used to stabilise the joint area while
keeping it "distracted" or open for a period of four to six weeks.
Attached by small pins, the cylinder-shaped device serves as a shock system to keep the joint free from friction and movement untile
healing is complete. The device is then removed entirely, thus keeping the patient's ankle free from any metal parts.
"Within three weeks after surgery, we see an incorporation of tissue onto the damaged cartilage," said Lee."The idea here is to avoid
fusion of the ankle and to add longevity to the joint. We want to give patients as much mobility as possible so they can get back to
the activites they love the most."
Lee's has already used his procedure on various patients, with ages ranging between 30-85. Robert Adams, 82, a retired professor,
received the ankle replacement after repeated attempts at physical therapy.
"My ankle collapsed on me," said Adams. "I didn't like the idea of a fusion with no motion or opening up my ankle for a metal device.
Following this surgery, I no longer have sharp or stabbing pains. I am continuing to improve an dcan get around better."
This novel technique for ankle replacement and results of a study will be described in lat 2008 in the Journal of Foot & Ankle
A retirement plan for baby boomers
* 62 per cent of people aged 50, 64 years report having at least one chronic condition such as hypertension or diabetes.
*8.6 million people have multiple chronic diseases.
*37 million people are projected to have multiple chronic disease by 2030
*46 million people suffer from arthritis.
By the year 2030...
*Six out of 10 boomers will have over one chronic condition.
*One out of four boomers will live with diabetes and one out of two will have arthritis.
*20 per cent of the population will be over 65 (compared with 13 per cent today).
Your body, as it ages....
Changes in our health are inevitable as we get older. But while doctors tell us to focus on the basics-eat right, exercise and keep
cholesterol an dblood pressure in check- is there more that we need to know about staying well as we age?
For Your Brain: Stimulation and Exercise:
People may worry about heart disease and diabetes, but they downright dread Alzhemier's disease, a recent survey found.
For good reason. One in eight adults over 65 is affected by the disease. Those who are spared know they may end up with the burden of
caring for a parent or a spouse who is affected. A few drugs can slow down the disease but do not cure it.
Studies show that older people who've maintained their mental acuity tend to be socially connected, with relatives, friends and community.
Seeking out stimulation through in scientists recommend eating a Mediterranean-style diet, including fish and nuts, antioxidant-rich
fruits and vegetables , olive oil and possibly some red wine.
For Your Mouth: Regular Brushing and Cleaning
Dental cavities are not good news, but hey may be among the smaller problems. The advice is familiar: Brush and floss regularly, use
fluoride mouthwsh, limit snacks and sweet drinks, visit the dentist twice a year. There are two more serious problems, common dental
diseases that can lead not only to loss of teeth but also to loss of life: periodontal disease and oral cancer.
Periodontal disease-a chronic bacterial infection of the gums that destroys the bone and tissues that hold the teeth- is the leading
cause of tooth loss in adults. Oral cancer is the second serious dental problem. Smoking and alcohol abuse are the major causes, but
25 per cent of oral cancers appear in people who have never smoked or drunk to excess.
For your Heart:Change of diet is the way:
Most people think heart-healthy living involves sacrifice. Give up your favourite foods. Break a seat. Lose weight. But some of the
best things you can do for your heart do not involve deprivation or medication. Simple changes in the foods you eat can rival medication
in terms of the benefit to your heart.
Even so, many people are not getting the message. Just a few small changes-eating more fish, vegetables, nuts and fibre-can have a major
impact on your risk for heart problems. For some people, drinking moderate amounts of wine may offer additional benefits. It's hard to
believe that such simple food changes can make a meaningful difference, but data from hundreds of studies show they can.
For Your Back: Your Backache Heals Itself
Back pain is one of the most common physical complaints, so it's no surprise that treatments for it have multiplied over the years. But
the effectiveness of virtually every pharmaceutical or surgical remedy, however, has been questioned. And for all the money sufferers
spend on doctor visits, hospital stays, procedures and drugs, backs are not improving.
The mystery begins with the first doctor's visit. The exact cause of back pain is never found in 85 per cent of patients. It is little
wonder then that doctors fall back on trational approaches, like exercise or counselling. The reality is that most people with back
pain heal on their own, slowly, with out major intervention.
For Your Waist: 'Where'Beats'How much'
The size of your waist can tell you far more about the state of your health than the number on a bathroom scale. Many studies suggest
that it is not how much you weigh but where studies suggest that it is not how much you weigh but where you carry your weight that
matters most to your health.
A large waist means you are more likely to have fat around your heart, liver and muscles, and it signals that you should be screened
for other problems, like high cholesterol.
Losing even a little weight can have a big effect. If you have a large waist, your first goal should be to stop gaining weight Exercise
and improving the quality of the food you eat will lower your for heart, even if you never lose inches.
For your Bones: Find out if you're at Risk:
While osteoprosis and hip fractures are major health concerns for some people, the challenge is finding out who is at risk and who is
not. Most of us have normal aging bones that are not going to break-about 85 per cent of women never fracture a hip.
Most people have enough bone to start with, so the bone loss of aging is not a big problem. But for some, the decline in density is
rapid, as their bones become porous and fracture risk increases.
Many woman also receive diagnoses of osteopenia-a scary-sounding term to describe early bone loss that often occurs with normal aging.
The more risk factors you have, the higher your fracture risk.
Let's work together
Let us work together to improve the mobility and well being of our arthritis patients. The "We" should include the patient, doctors
involved in the care, the physiotherapist, relations of the patient, society, and the government. In India 150 million people (15% of
the population) suffer from the disease. The most affected are those in the 20-45 age group. Degenerative arthritis affecting the knee
is more prevalent in India with every third person above the age of 70 being affected.
The number of arthritis patients is increasing day by day. Arthritis is caused by aging and by disease. Age-related problems increase
because now we live long. As we get the joints start degenerating, may be simply by the age, may be due to genetic factors, obesity
and by injuries. The joints have cartilage surfaces. Bones are covered at the joints ends by cartilage. The cartilages are smooth and
always covered by a lubricant. Cartilages do not have blood supply and the nutrition is dependent on the lubricant fluid that bathes it,
called Synonid Fluid secreted by the synovial membrane lines in the joint. Movement of the joint helps the Synovia fluid to be pumped
into the cartilage. Therefore, movement of joints within physiological limits increases the nutrition of the joint preventing degeneration.
The "Wisdom" of the general public that movement of the joint will produce wear and tear is not therefore correct. Movement produces
more nutrition and more life to the joint.
Now let us see which diseases can produce joint pain. Rhematoid disease is a disease of the tissues that produces arthritis in multiple
joints. The joints become swollen and painful, movement diminishes and cartilages get eroded, making the joints stiff. Diseases like
psoriasis, ankyolosing spondylites and other conditions also can produce arthritis.
Now which way can we manage it? The patient can be managed depending on the condition by operative or non-operative means. Let us take
the case of age-related osteoarthritis first. Mild Osteoarthritis (abbreviated as OA-this can then be expanded as old age) can be
managed by pain relieving medicines, exercise, physotherapy and changing habits. Operative treatment may be to correct deformities
and replace joints. Joint replacement is simply an operation to give a metallic or polyethylene artificial bone end where bones meet
For the condition that are due to disease like Rheumatoid Arthritis, plenty of medicines are available. Most of them are medicines to
relieve pain and also to arrest the disease, and some times cortisone has to be used to prevent joint destruction.
Cortisone is a life saving and joint saving medicine and when used with care & caution can save many joints from total destruction.
Let us work together to obtain a satisfactory life for the Arthritic patient.
SBF Healthcare offers non -surgical cure for osteoarthritis through QMR Theraphy TM
Osteoarthritis is the most common form of arthritis joint disease and is on of the primary casues of pain and disability in advancing
years of life. Some degree of osteoarthritis will develop in every one in old age and is estimated that three out of four persons who
are more than 60 years of age will have definite evidence of osteoarthritis in at least one joint.
Quantum Magnetic Resonance Therapy (QMR Therapy TM) is the world's first scientifically proven, non-surgical treatment to
help regenerate cartilage and restore mobility of arthritic knee joints. The method is painless, safe, non-invasive and cost effective
when compared to kenee replacement surgery.
Clinical Trialsled by Wg. Cdr(Dr) VG Vasishta (Retd), Founder and CEO of SBF Healtheare began in 2004 at the Institute of Aerospace
Medicine (IAM), an Indian Air Force establishment.
For excellence in medicine, Wg.Cdr(Dr.)VG Vasishta was awarded the 2006 Suvarna Karnataka Rajyotsava Award by the Government Karnataka
for his work on osteoarthritis and cancer. In 2006, he launched SBF Healthcare on his retirement from the Indian Air Force to bring
this technology into the public sphere.
The results of the study on the patients of Osteoarthritis have been already published in a peer reviewed scientific journal.
(Vasishta VG et al, Rotational Field Magnetic Resonance (RFQMR) in treatment of osteoarthritis of the knee joint, Indian Journal
of Aerospace Medicine, 48(2), 2004; 1-7)
The subjective and objective improvements in the cases taken up for this study opened the vistas for further application of this
technology to other diseases. Now phase-II of the trial has been completed taking 400 subjects with MRI as modality of evaluating
the subjects in addition to internationally accepted knee-rating system. The results of the study are a landmark, as was demonstrated
by the increase in the cartilage thickness, documented through MRI (which is accepted worldwide as gold standard).
QMR Therapy TM is noninvasive, painless and safe. Clinical trials have been conducted on over 400 cases of osteoarthritis.
It involves the application of electromagnetic beams to regenerate tissues that wear and tear due to ageing. The beams can be precisely
controlled and focused onto tissues therein generating streaming voltage potentials. This is lower than what is used in cell phones
thereby making it safe for human use.
The International Commission for Non-Ionizing Radiation Protection (ICNIRP)has defined emission levels that are considered safe for
human use. Both electric and magnetic field emissions from QMR exposure are well below the levels specified by ICNIRP.
The promising results that have been received from this therapy have brought recognition for this technology not only from the
scientific community, but also from the international medical and academic community. The preliminary results have been presented at
international scientific symposia. The numbers and volume of patients that are looking up to this therapy as a beacon of hope is huge.
The treatment for Osteoarthritis is a 21-day process which does not require hospitalization. The total time required for treatment
each day is 60 minutes. SBF Healthcare now operates two centres in Bangalore and Mumbai. More than 2000 cases have now been treated
by SBF Healthcare since inception.
Young joints at risk
On the eve of World Arthritis Day, discover why younger people need to be aware of what can go wrong with their joints
When it comes to knees, there are generally two kinds of problems:
Mechanical knee problems
Inflammatory knee problems
Some knee problems result from injury, such as a direct blow or sudden movements that strain the knee beyond its normal range of movement.
Osteoarthritis in the knee, results from wear and tear on its parts. However, inflammation that occurs in some rheumatic disease, such as
rheumatoid arthritis, can also damages the knee.
In rheumatoid arthritis, the joint becomes inflamed and cartilage may be destroyed. Arthritis not only affects joints, it can also affect
supporting structures such as muscles tendons and ligaments.
RHEUMATOID ARTHERITIS OR OSTEOARTHRITIES?
Osteoarthritis may be caused by excess stress on the joint from deformity. It most often affects middle-aged and older people. A
young person who develops osteoarthritis is may have an inherited form of the disease or may have experienced continuous irritation
from an unrepaired torn meniscus or other injury.
Rheumatoid arthritis often affects people at an earlier age than osteoarthritis. Another cause of knee arthritis in the young in
India is road accidents where there is high-energy trauma which often involves joints. Any fracture that causes joint line incongruity
very often leads to secondary arthritis. The American Academy of Orthopedic surgeons says only one in our people with knee
osteoarthritis need surgery.
Non-surgical treatments include losing weight, special exercises, medication and supportive device like shoe inserts, braces and canes.
When surgery is necessary, surgeons may turn to arthroscopic surgery to clean out the knee or repair torn cartilage; osteotomy to cut
the shinbone or thighbone to improve the knee joint’s alignment: or knee arthroplasty, which involves replacing severely damaged knee
joint cartilage with metal and plastic.
For some people with limited cartilage loss, cartilage grafting is an option. In cartilage grafting, cartilage is either transplanted
from another part of the body into the knee or a sample of knee cartilage is removed and cultured in a lab. This new technique holds a
lot of promise for young people with knee cartilage injury.
There is also a place for viscosupplimentation in certain patients in the early stages of arthritis. In this treatment modality,
synovial fluid is replenished thereby increasing the joint lubrication and enhancing the shock absorption capacity. It also has an
indirect effct5 on pain control through as yet unclear mechanisms.
Surgical treatments specifically for the younger population are emerging, including partial knee resurfacing. The procedure involves
removing only damaged cartilage and minimal bone and implanting a small replacement. When considering surgery it is important to
recognise how difficult- and how personal-this choice is. The final decision will be made based not only on symptoms, physical findings
on a surgeons’ exam, and also on the patient’s goals, expectations, job demands, and level of motivation. Knee replacement surgeries
include the following.
• Unicompartment knee replacement
These are implanted through a less-invasive surgical approach which can significantly shorten the recovery period. These are not meant
for people doing impact or twisting sports.
• Total Knee Replacement
The ‘gold standard’ for knee arthritis surgery in order adults, this operation also is being used in younger patients.
• High Tibail Osteotomy
This operation involves cutting and repositioning one of the bones round the knee joint. This is done to re-orient the loads that occur
with normal walking and running so that these loads pass through a non-arthritis portion of the knee.
Dealing with osteoarthritis
Arthritis shouldn’t be a getting you down. A combination of exercise, life style changes and surgery as a final stop can have you
walking in no time.
Osteoarthritis is the most common type of arthritis. It is the result of the wearing down of cartilage and joint surfaces. Cartilage
damage occurs in people who put strain on it (over-weight, muscle imbalances), who injure it (by performing high impact activities like
jogging on hard surfaces with incorrect footwear) and in people who have unhealthy joints in the first place.
COPING WITH ARTHRITIS
Osteoarthritis is a progressive disease. It cannot be cured but can be controlled. The progress can be slowed down by weight
reduction, activity modification, muscles strengthening and balance exercises with judicious use of anti-inflammatory medication,
and orthotic devices that reduce loading (egbraces and walking sticks).
It is extremely important to keep your muscles strong and joints mobile.
• One should have frequent periods of rest between exercises.
• Warming up and cooling down before and after exercise respectively is mandatory.
• Wear comfortable footwear and well-cushioned shoes and avoid high heels
• Swimming and hydrotherapy are excellent for stiff, painful joints.
• Stiff and swollen joints can get relief from a combination of hat and ice.
These conservative measures of treatment are useful in all stages of the disease. However in all stages of the disease. However it is
extremely important to it is extremely important to monitor the progress of joint deterioration regularly.
• SURGICAL THREATMENT
Similar options are available for the shoulder and elbow surgical options vary from the very simple keyhole procedures (arthroscopy),
which can be done as day cases without the need for any stitches and postoperative immobilization to joint replacement surgery.
For the disease which is at the last stage, where changing the unhealthy surface is the only option, one can perform partial or total
joint replacement surgery depending on the extent of the disease. Partial knee replacements can be done through a very small incision
and give much better joint movement as compared to total knee replacement.
For hip disease, hip resurfacing surgery conserves bone and high end hip replacements allow easy movement and function without
dislocation. Similar options are available for the shoulder and elbow joints.
No surgery ,no drugs
With tomorrow being World Arthritis Day, take a look at newer methods that help handle arthritic pain naturally.
Living with arthritis is a dilemma for majority of suffers. With painful symptoms like stiffness, painful and creaky joints, swelling
and restricted mobility, the disease lasts a lifetime. Many people mistakenly assume that arthritis is part of the ageing process and so
they out of the ageing process and so they put up with it.
The fact, however, is they put up with arthritis lead painful, restricted lives because they choose to ignore symptoms during initial
occurrence and do not to visit the doctor at the right time. In such cases arthritis can be disabling.
Upon diagnosis, well-guided treatment options in advancing orthopedics guarantee great improvement in the quality of living,
especially for the elderly. Sometimes the symptoms may be well-defined, sometimes vague. So, accurate diagnosis of the exact
type of arthritis can be made by a through physical examination and a few tests.
The effectiveness treatment is largely dependent on the patient carrying out the doctor’s directions. General options for arthritis
may involve medications, arthritis-friendly exercises, Joint protection techniques, natural remedies pain relief techniques, changes
in diet and nutrition, weight control, adapting to work habits and coping strategies.
Generally, patients get immediate relief by taking anti-inflammatory medicines. But this is not a wise option. Prolonged use of a
wise option. Prolonged use of pain killers and other similar drugs have severe side-effects. There are other non- invasive ways to
get relief. Natural ways are the best options as it is non-invasive way of treating the disease.
One of the most-recent treatment techniques to help patient sp suffering from muscleoskeletal disorders is Pulsating Electro-Magnetic
Field (PEMF) Therapy, without using drugs or surgery, this painless therapy approved by the European Union uses a patented technology
, which mimics natural signals in order to activate and stimulate normal haling processes that lead to the growth and repair of tissues.
This unique therapy harnesses the body’s ability to heal itself. Tremendous benefits are documented from the PEMF therapy, now also
available in India. It helps patients reduce medication while offering absolutely no side effects.
REMF is found to be effective on the spine, hip hand, foot and the knee. It is also found to have bone healing protocols that produce
end-result in non-union fractures and failed arthrodeses. Treatment with PREF protocols also reduces time taken to heal the fracture.
The long list of treatable conditions under PEMP includes arthritis, back pain, bursitis, cervical arthritis, coxitis, osteo-arthritis,
peri-arthritis, tendonitis, sciatica, fractures, delayed fractures varicose veins, varicose ulcers, wound healing, diabetic ulcers,
non-healing ulcers, and trauma wounds. Patients can resume complete mobility and carry on with their daily activities without
restriction and guarantee great improvement in the quality of living.
While conventional methods like proper diet and exercising continue to keep the body going, non-invasive treatment options like the
new technology PEMF provide effective solutions to pain.
People with arthritis need not lead painful, restricted lives. It is possible to relieve the pain and lead an arthritis free life.
What better way to shed the many misconceptions of arthritis on World Arthritis Day!
Elbows replaced in two hrs
BACK IN THE SWING OF THINGS
Like other major joints, the elbow can also be affected by osteo or rheumatoid arthritis, as well asby past injury. These conditions
can cause pain and stiffness that may be alleviated by surgery. Elbow replacement may not be appropriate for those who have a history
of elbow infection.
The elbow is a hinge joint consisting of three bones. All these three bones are in contact with each other. The joint is surrounded
and lined by cartilage, muscles, and tendons that provide support, stability and ease of movement. The elbow joint allows for the
extension, flexion and rotation of the arm. The range of motion is dependent upon the proper articulation of the elbow joint.
What is Elbow Replacement?
In elbow replacement surgery, the painful surfaces of the damaged elbow are replaced with artifical elbow parts. One part fits into upper
arm, and other part fits into forearm. The two parts are then connected and held together by a pin. The resulting hinge allows the elbow
How long will a replacement last?
It depends on many factors, such as a patient's physical condition and activity level, as well as the accuracy of implant placement during
surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint.
How much does it cost?
Rs.70,000 to 80,000.Today, total elbow replacement is becoming a common procedure. Many patients enjoy relief from pain and improved
New shoulder surgery promises quick relief
There is consitent pain relief. In the past decade or so Dr. Stephen Copeland, who pioneered the surgery, has been performing it
successfully in the UK. After coming to Mumbai I was keen on introducing patients to this procedure as it will definitely give them
After five years of tossing and turning in sever pain 62-year-old Santhosh Sharma slept peacefully on March 5 this year. Wrong diagnosis
for the excruciating pain in her shoulder forced her to go on a staple diet of pain killers, endless rounds of doctors and alternate
therapies for over five years.
However, while waiting in queue to be treated for a hairline fracture on her leg she overheard a conversation which changed her life
forever. On the initiative of her regular surgeon, Sharma found herself at a meeting with Dr.Parag Munshi, a United Kingdom certified
upper limb specialist, who would change her life forever.
Dr.Munshi, consultant Orthopaedic surgeon at Bombay Hospital, performed a one of its kind surgery on Sharma. The Copeland Resurfacing
Surface Arthoplasty or the shoulder resurfacing surgery, introduced to Mumbai for the first time, is the latest in the treatment of upper
This surgery, which was performed on March 5 this year, is a first for Bombay Hospital. Compared to the widely performed shoulder
replacement surgery, the shoulder resurfacing surgery is an uncemented procedure with a hospital stay of merely four days. While the
former costs anything between Rs.50,000 to Rs.90,000 the latter is priced at approximately at Rs. 45,000. No blood transfusion required
during the resurfacing surgery and the mobilisation too is much earlier, Dr.Munshi told DNA.
"There is consistent pain relief. In the past decade or so Dr.Stephen Copeland, who pioneered this surgery, has been performing it
successrully in the UK.Since I have worked with him this surgery is not new to me. On my relocation to Mumbai I was keen on introducing
patients to this procedure as it will definitely give them better relief,' he said.
Sharma's post surgery progress has reinforced the point that it can be successfully replicated. An increasing number of patients
affected by arthritis of the shoulder joint are wrongly diagnosed as suffering from frozen shoulder. "Wrong diagnosis is the reason
for the worsening of the problem. About 30 to 40 per cent of those diagnosed with frozen shoulder suffer from arthritis which is not
picked up by doctors," he added.
There are three types of arthritis- osteo-arthritis which is age related, rhematoid arthrits and post-traumatic arthritis. These
patients are affected by excruciating pain, stiffness and loss of motion in the upper limb.
The only condition for resurfacing is the need for a spherical shaped humeral head (the ball of the shoulder joint). This surgery can
be performed for all age groups. "Those who have a badly damaged, severely fractured or previously infected humeral head do not
qualify for the shoulder resurfacing surgery," disclosed Fr.Munshi.
The implants for the shoulder resurfacing surgery are imported from UK. They come in pre-sterile bottles. Studies are presently on
to check the life span of these implants. However, various research papers published by Dr.Copeland indicate that he has not yeat
done a revision surgery on any of the operated patients. Dr.Munshi conducts a shoulder clinic on the Bombay Hospital. An Upper Limb
Fellow from UK and a shoulder Fellow from New York, Dr Munshi is also a trauma consultant to well known cricketers in India and
Sharma, who ws the first to undergo this surgery here, was far from frightened."The doctor gave me the will power to go through with
it. After all the pain I have suffered I am overwhelmed that I can now sleep peacefully,'she said.
Indians susceptible to Knee problems: Expert
MAYSORE, MARCH 9. Kent samuelson, Head of Neuro-muscular skeletal disorders Department at the LDS Hospital in the U.S; said today
that Indians were susceptible to knee problems due to their cultural and physical activities.
Addressing presspersons here, Dr. samuelson said neople in India squat for hours, and this was one opf the reasons for knee problems.
Obesity also led to knee problems. Starting that he was conducting a research on knee problems. Stating that he was conducting a
research on knee problems among Indians, he said more research was necessary in the Asian continent. He said the cost of knee
surgeries would come down in the next few years. Joint replacement. He said the cost of knee surgeries would come down in the
next few years. Joint replacement surgeries were necessary., particularly among the aged. Surgery would relieve acute joint plains,
Dr. samuelson said prosthesis used in joint replacement surgery was in a revolutionary stage, and it had moved from plastic to
polythene with metal backing. He was also working on prosthesis where the patient would be able to bend his knew fully. This
prosthesis would also allow patients to squat without difficulty. The work to bring down the cost of the instrument was also
being planned, he added.
He said the quality of knee joint surgeries in India was on par with those performed in the West. Dr. samuelson has conducted
over 10,000 knee surgeries, and he has been instrumental in designing and developing artificial knee joints.
One of the artificial knee joints developed by him. Freeman-samulelson Knee (FS Knee), is popular in Asia. Dr. samuelson, who is
one of the leading experts in the field, is participating in the two-day “joint replacement Workshop” organized by the continuing
medical education programme. A work-shop -cum-demonstration. A work-shop-cum-demonstration was held for 150 orthopedic surgeons from
different places in South India.
Leading surgeons, including Dr. Samuelson and K. Srinivasan, were assisted by a team of doctors from Mysore, Banglaore, and Manipal
to conduct the workshop. Knee joint and hip joint surgeries were performed on six villagers during the workshop. While Dr.
Srinivasan performed three hip joint formed three knee joint surgeries. N. Nityananda of the Department of Orthopedics, B.M.
Hospital, said the first of the three hip joint surgeries was performed in a record time of 35 minutes.
India to be largest knee replacement mkt
Entry of Newer Joint Implants Availability Of Options Deiving Factors Behind The Growth
New Delhi:India is poised to become the largest market for orthopaedic implants (knee and hip) over the next
five years, growing at a compunded growth rate of over 30% annually.
At present, the total joint replacements in India are estimated to be around 40-50,000 with knee surgeries growing faster than
the other categories, and doubling every year. The factors driving their growth include the entry of newer joint implants and
availability of several options, right from joints that can bend and rotate, to gender-specific ones developed especially for the
In India, every two in 10 people above 65 years are believed they have osteoarthritic kneen affecting mobility. In osteoarthritis,
the joint is damaged and the surrounding bone grows thicker. The cartilage surface allows the bone ends to move freely. In
osteoarthritis, the cartilage gradually roughens and becomes thin. Muscles around the joint weaken and become thin or wasted.
The loss of cartilage leads to wearing of bone, bony overgrowth at the edges, change the shape of the joint and deformity.
But what is alarming is that very few people actually go in for surgeris, due to a plethora of factors including lack of
awareness, fear ( of surgical procedure) and high costs. A knee replacement surgery costs Rs. 1.5-2 lakh for one knee, while
the computer-aided one will be more expensive by 5-10%
The latest implants being used are developed to over-come the limitation of previous implants in the range of motion and longevity.
The implants available in the country include Depuy (Johnson & Johnson), Zimmer and Stryker. For the patient this means a knee that
more closely mimics the natural motion of a knee joint, allowing them to perform activities like squating, and bending their knee,
which otherwise was almost impossible.
"The market for DePuy's RP-F (rotating platform high flexion) knees has been steadily increasing since its launch nearly two years
ago," says Anil Nayak of Johnson &Johnson. Now computer assisted technology is helping surgeons to maintain accurate alignment,
and for placing the implant in the bone with precision.
Says Dr AS Prasad, a leading orthopaedic surgeon in the north"Now computer-assisted surgeries are being done where the computer
helps surgeons in evaluating different steps of the surgery during operation and bringing perfection to the results. However, a
computer is only a tool for the surgeon and not a substitute. It cannot make a bad surgeon a good one."
Dr SKS Marya, Max Hospital (Delhi) who claims to have introduced this technology two years back, adds "the better the alignment,
the greater is the longetivity in the joint."
Though the level of accuracy is higher with these surgeries, they come at a higher price. The machines used for the surgery cost
over Rs 50 lakh, making them unaffordable, and inaccessible to many across the country.
New hips, new knees... now new fingers
Doctors develop a new finger joint for arthritis
London: A new type of artificial finger joints is set to improve treatment for thousands of patients who
suffer with arthritis.
The joint, which is made of a high-tech lightweight metal, has been designed to be small but ultra-hard-wearing to cope with the
millions of movements a finger makes every day.
Although the joints of the ingers can be one of the first areas where arthritis strikes, most replacement work has centered on
other parts of the body. More than time out of ten replacement operations involve the hips and knees.
The designers of a successful artificial joint for the finger have faced a number of challenges-it has to be small, light enough
to be comfortable, painless for the patient and tough enough to withstand the considerable everyday pressures.
An added problem is that in order to be successful, the joint needs to be replaced at a relatively early stage of the disease.
Another complication is that because finger joints are small, they can sometimes repair themselves.
Although a number of different types of material have been tried in fingers, the main difficulty has been that the artificial
joints have become stronger than the bones, resulting in too much pressure and the risk of stress fractures, or other damage. That
is a problem that does not arise with the big, heavy bones involved in hip and knee replacements.
Now doctors have developed a finger joint that seems to meet the requirements.
It is made of a light carbon based material that has been successfully used in heart valve replacements where it has with stood high
levels of stress.
The material used to make the new finger joints-which have been tested on small number of patients at Tulane University in America-has
been shown in a series of trials to be tough and hard-waring.
The joints are designed for patients with a range of finger problems, including osteoarthritis and rheumatoid arthritis. It has also
been used on patients who have suffered hand injuries.
Doctors open up the joint and take out all the bits of cartilage, leaving just two pieces of bone. The artificial joint has a join
in the middle so it bends and two very sharp 'stems' which are inserted into each of the bones.
The procedure varies in time depending on the degree of erosion of the joint, and the patient can choose either a local or a general
anaethetic. They will need to wear a splint or a case for six weeks after the procedure.
There are 200-plus types of arthritis and rheumatic disease.
Rheumatoid arthritis is caused by persistent inflammation.
In the right place and for a limited period, inflammation is good, because it is the body's mechanism for dealing with a problem an
dresults in the attraction of white cells from the blood to help fight the infection.
But in rheumatoid arthritis, the inflammation becomes persistent an doccurs in the layers of tissue that line the joint, causing
pain, swelling an dstiffness.
Osteoarthritis is a non-inflammatory disease that breaks down joint cartilage, causing pain and stiffness, which usually occurs in
weight-bearing joints such as the hips, knees, spine, back and neck, but it can also affect finger joints, toe joints or the spine.
Osteoporosis a childhood ailment that strikes later?
Washington: Osteoporosis, long considered as a disease of the elderly, could actually be a pediatric ailment which surfaces later in life,
says a study.
“While the importance of calcium nutrition throughout childhood and adolescence is well recognized, our work suggests that calcium
nutrition of the neonate may be of greater importance to lifelong bone health due to its programming effects on mesenchymal stem cells,”
Dr Chad Stahl from the North Carolina State University, said.
“It also points to a potential paradigm shift in which health professionals might want to begin thinking about osteoporosis not so much
as a disease of the elderly, but instead as a pediatric disease with later onset,” said Stahl.
Stahl and his team studied the nutritional regulation of growth and development for which they used neonatal pig as a surrogate for the
human infant. The team bottle-fed 12 piglets a calcium-rich diet and another 12 piglets a calcium deficient diet during the first 18
days of life.
In both the groups, the team found no differences in terms of blood markers of calcium status and growth, but there was a marked
difference in bone density and strength such that the calcium-deficient piglets were compromised.
An analysis of the bone marrow tissue showed that many of the calcium-deficient piglets’ cells appeared to have already been programmed
to become fat cells instead of bone-forming osteoblast cells.
As per the research, fewer osteoblast cells in early life may lead to a reduced ability for bones to grow and repair throughout the
remainder of life, thus suggesting that early calcium nutrition may have more impact than earlier thought.
Knee surgery puts doc in record book
Mumbai: Santa Cruz resident, Baby Shetty (54), was suffering from terrible pain in both her knees for almost two years before
she finally consulted doctors for a treatment. The doctors said both her knees would have to be replaced, but what they did not know
was that she would set a record. Dr. Vijay Shetty from L.H.Hiranandani hospital and Baby Shetty are going to get a mention in the 2010
edition of Limca Book of Records for having the shortest hospital stay after bilateral knee replacement surgery.
“I had been suffering from terrible pain in both my knees while walking. We went to Hiranandani Hospital in February last year and Dr.
Shetty decided that I needed a knee replacement,” said Baby.
Both doctors and Baby’s family were surprised to see the speed of her recovery post-operation.”My surgery was done on February 10. By
next day, I started walking. I was discharged on February 12,” said Baby, who now doesn’t hesitate to play with her grandchildren.
Interestingly, this isn’t the first time that Dr. Shetty is getting a certificate from the Limca Book. In the 2007 edition, Dr. Shetty
was credited for discharging a 70 year-old woman from Mangalore in 48 hours after a replacement surgery for one of her Knees.
“It depends upon the quality of surgery. It usually takes around 5-8 days for a person who has undergone bilateral replacement to go
home. But if the surgery is done well, then the recovery time is less . Still, it takes about five days to discharge a patients,” said
Dr. Pradeep Bhosale, head of orthopaedic department at KEM Hospital.
Cell therapy could be boon for athletes MumbaiA procedure that allows new cells to be grown from cartilage cells could be a boon for sportsmen with torn
or damaged cartilage, as well as those who suffer due to drug abuse or traumatic injuries resulting from improper exercising practice.
The technique can be used to mend any traumatised joints, be it the knee, hip or shoulders, say doctors at Kokilaben Dhirubhai Ambani
Besides Malad resident Mohammed Mustaq Sheikh, two other patients have also undergone the autologue chondrocyte implantation/
transplantation."Both are doing extremely well, and we have identified several other patients who want to undergo this treatment,'
said Dr. Dinshaw Pardiwala of Ambani Hospital. The 'cell regrowing' or regenerative technique, which started some 20 years ago, is practised in clinics worldwide, but it's only
recently that India has got hold of its latest version. Moreover, a Mumbai-based company called Regenerative Medical Service Pvt
Ltd will inaugurate its special laboratory for cell regeneration in Lonavala in June.
"Once our laboratory is operational, it will cost patients only Rs. 1.5 lakh,' says Satyen Sanghavi of RMS. In the UK and the US,
where the technique is commonly used, it costs RS.15 lakh!
According to Dr. Pardiwala, the USP of the regenerative technique is the fact that it arrests the patient's descent into permanent
disability and obviates expensive replacement surgeries."Sheikh would have needed knee replacement if it weren't of this cell
therapy," he says.
In the future, as the technology improves, doctors say it will be possible to arrest the progress of painful ailments like arthritis,
says Dr. Pardiwala.
However, Dr. A. Chandanwale who heads the orthopedic department of state government run JJ Hospital in Byculla points out that
autologous chondrocyte implantation is still in the 'clinical trial stage'. He says, "We have to wait for the long term outcomes
of these patients. It's quite possible that they may still need replacement surgery at a later date
Back of your feet Dr. Harish Bhende fills you in on the basics of hip and knee replacement surgeries
Wear and tear of the main weight-bearing joints such as the knee and the hip joint is amongst the most common ailments with out parents
and granparents today. In fact 70-80 per cent of the people over the age of 60 develop this problem, which is medically referred to as
arthritis of the joint(s). WHAT IS ARTHRITIS OF THE JOINTThe cartilage in the joint gets worn out and as a result bone lubircation is reduced. This leads to significant friction of the bone
causing bone loss an dfluid collection in the joint. Eventually, the joint starts bending and develops deformities, which affect mobility.
To counter this, the joint surface needs to be replaced by artificial components which are achieved through hip or knee replacements
surgery. Occasionally, non-age related factors such as damage caused by injury, accidents, fractures, infections etc may also lead to arthritis
of the joints. Again, replacements surgery many be recommended wherein near-normal movement can be achieved SYMPTOMS TO WATCH OUT FOR
Occasional pain in the joints or minor discomfort is not an indication of arthritis of the joints. However, constant pain, appearance
of crackling sounds during movement, collection of fluid in the joint and development of deformities in the joint are symptoms that must
not be ignored. A confirmed diagnosis however can only be made by a qualified orthopaedic surgeon by means of an X-ray of the joint as
also an MRI scan. CHOOSING THE RIGHT SURGEON
Joint replacement surgery is a very technical an dspecialised operation. In fact, the American Academy of Orthopaedic Surgeons dignates
a surgeon as a joint replacement surgeon only when he/she performs more than 75-199 such surgeries a year. In India the standards are
not quite as stringent. However, one must remember that even the slightest error can lead to complete failure of the surgery. Therefore,
your best bet would be to opt for a surgeon who has a track record of several successful joint replacement surgeries. Another factor to take into consideration is the facilities available at the hospital. Opt for a hospital which has a laminar air-flow
system which filters the air in theatre and removes bacteria to the tune of 99.97 per cent efficiency every 45 seconds. Also, a hospital
that is equipped with exhaust body suits (which will be worn by the doctors, technicians and all others present in the theatre) would
be a safe option. Both these equipments grreatly reduce the risk of infection. If the patient contracts an infection during or soon
after surgery, it can create a major complication in the outcome of the surgery RECOVERY FROM SURGERY
Usually the operation lasts for around 75 minutes. Just a single incision of 10-14 cms is made wherein the new joint is inserted. The
Patient is able to move his/her legs the very same day. But, close to a week is required for the patient to become mobile with the
help of crutches or a walker. Within a little over a month, most patients usually becoe fully mobile.
With time, most patients are able to resume activities such as walking, driving a car, participating in recreational sports such as
badminton, cycling etc., in almost a normal fashion. In fact only a trained eye would tell the difference between the artifical joint
and the normal one.
However, there are a few restirctions such as one may not be allowed to sit cross-legged or squat and also one cannot engage in high
impact sports such as long-jump, jogging, jumping etc. SIDE EFFECTS?
As with any surgery, joint replacement also entails certain risks such as thrombosis (blood cloting in the calf veins), infection,
wearing an dloosening of the joint an dpain or instability. However the overall risk factor when it comes to such side effects is
merely 1-1.5 per cent. WALKING ON
The artificial joint is normally expected to last for a period of 10-15 years. Newer designs of artificial hip are expected to last
even 20-25 years. However, when the joint components wear out or become loose, they need ot be replaced. This is referred to as
revision hip/knee replacement surgery. SLOW DOWN
If you suffer from early arthritis of the joint and would like to delay surgery, here are some options that can slow down the process
of joint degeneration:
*Reduction of weight, if you are on the heavier side
*Exercise designed for the joint(non-loading)
*Cartilage supplements like Glucosamine; but only when prescribed by a qualified doctor
*Physoitherapy, splints and diathermy. Arthritis Gave Me a New Life…
Yoga expert Raju Ghosh was devastated when he was struck with arthritis. He recounts his journey to full recovery through food, yoga
and Buddhist philosophy
They say adversity makes you stronger. Looking back, what could have been the bleakest period of my life-being afflicted with arthritis
at the age of 21-was actually the turning point. And it was a simple three-pronged approach that saved me: food, yoga and prayer.
AN EVENTFUL JOURNEY I started learning yoga at the age of four. Despite hailing from an under privileged background, my efforts bore fruit when after a
long struggle, I established myself as a yoga teacher. For me, teaching yoga was a way to connect to the soul; an extremely intense approach inclined towards healing. While working with
clients, I’d give 200 per cent, often taking up to 12 classes a day, understanding their personality, emotional and physical problems,
and giving them confidence to face ailments. Unknowingly, the effort was taking a toll on my own body. BEING BED-RIDDEN As I later realized, while curing a patient, I was transferring a lot of energy to him/her, thus depleting my own energy levels
One day my body gave away. The simple act of pushing the door sprained my foot. There was shooting pain and swelling which gradually
spread to other areas- collar bone, ankles, knees and elbows. I also started vomiting and my system practically collapsed. Often my
hands started closing by 3 pm and I couldn’t open them. The pain was excruciating.
My diagnosis read ’Seronegative arthritis arthritis’, a condition, that doctors said, had no cure; only life-long medication could
Naturally, I was devastated as even my business was affected. My condition was never known to anyone except my close friend Seimaa,
who came upon a book about curing arthritis without using drugs. Though I was on medication, we decided to try the approach. We
contacted renowned nutritionist and naturalist Vijaya Venkat who gave my nutrition philosophy a make over. She taught me the importance
of body rhythm, rest and relaxation, silence and poise-things I’d known but had forgotten in my busy quest to “make it”. A NEW APPROACH Food formed a major part of this healing process. Firstly, I started having lots of fruits and vegetables in natural and raw form,
and gradually turned vegan. I began my day with nearly half-a-kilo of fruits. I would then consume six to eight glasses of vegetable
juices-lauki, carrot , tomato, palak, pumpkin-all seasonal. This was complemented by salads, sprouts and nuts. And I’d have dinner at
6.30 pm (or 8.30 pm at the lates), mostly a plate full of raw fresh salad and moderately cooked food like one cup of rice and one cup
dal or sabzi. Simultaneously, I also tried to reduce my intake of medicines. I also sun-batched and did pranayama while sunning.
Interestingly, though I had very little cooked food, there was no loss of energy or nutrition. Moreover, for me eating is almost
spiritual; I enjoy each bite with gratitude. I follow this diet even today.
Around the same time, another life-altering episode happened. A client-turned-friend introduced me to Buddhism and the power of chanting.
I-my chanting increased from 10 minutes and stretched to three to four hours.
This was voice meditation to connect with the soul. The Buddhist philosophy of making others happy to be happy, self-dignity, respect
and seeking true peace by being in rhythm with the universe deeply impacted me. I also believed in the cause an defect theory which made it clear why I had taken ill. My ailment was simply a message from my body to
slow down. I had been over-exerting myself. The results were magical. In just one month, my hands started opening up.
I slowly felt flexibility in my joints and my system welling up with energy.
BACK TO SQUARE ONE
I was pain-free and could even get back to teaching. The good phase continued for seven months before the pain and swelling returned.
One day I felt very breathless. The chest X-ray indicated a shocking 90-92 per cent inflammation in my lungs. I was suffering from
drugs toxicity, probably the result of all the medicines and steroids I was taking. That’s when I decided to use my mind power to the maximum. I had to spend 26 days in hospital, but even then I religiously practiced
pranayam followd a diet and chanted, which gave me energy to heal my lungs.
My belief paid off. In just a few days there was about 70 per cent improvement. In the process, the arthritis too had been subdued.
And when it would have taken four to six months of hospitalization and three to four months of best-rest to get cured, I was back in
action 15 days after being discharged. Since I was on strong steroids in the hospital, I had to withdraw slowly. Therefore, I took a small does for a month. What worked for
me more was a combination of the three- diet, pranayam and spirituality. Ever since I was healed, I have been completely drug-free.
WHAT HAS CHANGED I feel illnesses happen because of an imbalance in the system. Hence it is important to take care of your body. In retrospect, I feel
my arthritis was a blessing in disguise. It taught me so much about my body and its tremendous healing power. You only need to take care
of it with the right nutritious and complete food, prayers, and yoga
DISSOLVABLE IMPLANTS HELP BODY REPLACE MISSING CRANIAL BONES Researchers have created a new material for bone implants that can promote the body’s natural healing process while minimizing the need
for the extra surgeries required in conventional titanium implants….
In a medical emergency, a puncture of the cranium is commonly treated with an implant. While replacements made of titanium just plug
holes, a new kind of implant can stimulate the body to regenerate itself: It is custom fit and disappears to the same extent the bone
The body can heal minor bone injuries itself-but with major injuries, it needs help. That’s when implants come into use. In contrast to
titanium-based solutions, degradable implants are intended to replace the missing pieces of bone only until the fissure closes itself
up. That may last months or even years, depending on the size of defect. The new implant improves the conditions for the healing. Unlike the conventional substitutes, it is not made up as a solid mass, but is
porous instead. Precise little channels permeate the implant at intervals of a few hundred micrometres. “Its precision fit and porous structure, combined with the new biomaterial and promises a total bone reconstruction that was previously
impossible to achieve,” said Ralf Smeets of the University Medical Centre of Aachen, Germany.
The porous canals create a lattice structure which the adjacent bones can grow into. Its basic structure consists of synthetic
polylactide, or PLA for short. The stored granules from tricalcium phosphate (TCP) ensure rigidity and stimulate the bone’s natural
healing process. Through extensive research TCP and PLA already have proven to be degradable implants. The body can catabolise them
as rapidly as the natural bones can regrow. But the material can only be applied in places where it will not be subject to severe
stress: Thus, the implants will primarily replace missing facial, maxillary and cranial bones. Currently, they are able to close fissures of up to 25 square centimeters in size. The unique structure was made possible through a
process developed at the Fraunhofer Institute in Germany. Using Selective Laser Melting (SLM): A razor-thin laser beam melts the
material layer-by-layer to structures that may be as delicate as 80 to 100 micrometers. The patient’s computer tomography serves as
the template for the precision-fit production of the implants. A new implant can be produced in just a few hours, while a
five-centimetre large section can be done overnight.
In addition to the obvious benefits, there is a considerable gain in time during surgery. The operations are now also fewer in number:
Physicians no longer take the bone from the patient’s own pelvic bone. Similarly, they can dispense with the countless follow-up
operations on children to exchange long-time implants that don’t grow as the child matures.
Body’s own molecular protection against arthritis discovered
An international team of scientists has discovered that a natural molecule called micro RNA 140 (miR-140) in the body counters the
progression of osteoarthritis. The findings could one day lead to new therapies for some common diseases of aging. The study was
published in an advanced, online issue of the journal Genes &Development.
NEW PLASTIC CORNEA TO BRING SIGHT TO MILLIONSResearchers build an artificial plastic cornea to help patients suffering from corneal blindness the second most common type of
blindness in the world… According to a bulletin by World health organization approximately 4.9 million individuals have corneal blindness around the world.
Considering the abysmal eye donation rates several of them will die before they get a transplant.
For many of these patients who become blind after an accident or illness, a corneal transplantation could restore the ability to see.
Joachim Storsberg of the Fraunofer Insitute in Germany has developed material and production process for a corneal prosthesis made
of plastic. These can help patients who are unable to tolerate donor corneas due to the special circumstances of their disease, or whose donor
corneas were likewise destroyed. PROSTHETIC CONTRADICTION The miniscale artificial cornea has to meet almost contradictory specifications, on the one hand, the material should grow firmly
together with the cells of the surrounding tissue; on the other hand, no cells should settle in the optical region of the artificial
cornea- the middle-since this would again severely impair the ability to see.
In addition the outer side of the implant must be able to moisten with tear fluids, otherwise the implant will cloud up on the anterior
This would consequently require the patient to get a new prosthesis after a relatively brief period of time.
Plus the outer side of the implant must be able to moisten with tear fluid, so that the eyelid can slide across it without friction.
Storsberg found the solution with a hydrophobic polymer material. This material has been in use for a long time in ophthalmological
In order for it to satisfy the various characteristics required, complex development steps were necessary. The material was thoroughly
modified on a polymer-chemical basis, and subsequently re-tested.
In order to achieve the desired characteristics, the edge of the implant was first coated with various, special polymers.
Then, a special protein was added that contains the specific sequence of a growth factor. The surrounding natural cells detect this
growth factor, are stimulated to propagate and populate the surface of the corneal margin.
Thus, the cells of the surrounding tissue grow with the implant, and the artificial cornea attains stability.
The research team needed three years to fully develop the artificial cornea and a test prosthesis is currently in use LAB ON A PLASTIC CHIP TO MONITOR BODY FUNCTIONS
Scientists have built a tiny plastic chip based lab that can quickly detect several medical conditions. The low cost of production for
the chip will pave the way for disposable diagnostic systems…
A small blood lab that fits into the pocket of a jacket can quickly analyze the risk of blood clots in legs prior to a flight; a sensor
wristband for measuring electric smog can warn pacemaker patients of exposure:”Smart plastics” can turn such tools into reality thanks
to the scientist at the Fraunhofer Institute for Reliability and Microintegration IZM in Germany.
Each year thousands of people become seriously ill from occlusions of veins caused by blood clots.Such thromboses can cause pulmonary
embolism or even heart attacks. Even airline passengers at long distance flights can be affected by deep vein thrombosis. But with the
new system, a fast and easy test of a risk of travel-related thrombosis will soon be possible.
The passengers would only have to relinquish one drop of blood to the measuring device. The lab-on-a-chip is designed in plastic to be
inexpensive. This would facilitate cost-efficient manufacturing of disposable diagnostics. However, such tiny system is still science
HOW THE SYSTEM WORKS
The current lab-on-a chip is a small, high-precision single-use cartridge that acts as a tool for the biochemical analysis of a drop
of blood. It consists of a polycarbonate plate with a thin foil on which a filigree network with conductor lines and gold sensors for
blood analysis is attached, as well as a fluid channel for conducting blood to the analysis elements.
Inside the sensor chamber, the abtibodies are integrated on electrodes that allow to analyse the concentration of blood clotting
markers. If the number is elevated, then the risk of a thrombus-a clot-is high.
But this system can be an important life companion not only for air passengers or stroke patients, but also for smokers, pregnant
women or the obese. They will no longer have to wait days for lab results.
The sensor wristband(pictured) is suited for the long-term monitoring of important body functions of patients-but also of athletes.
It is like a plastic wristwatch. Instead of a clock dial, the sensor is equipped with an illuminated “ electroluminescent display”
that indicates for example the actual body temperature at any time of the day. It also detects skin moisture, which may be a sign
for the dehydration. For a person with a pacemaker the patient wristband may also signal potential danger, indicating the strength
of electromagnetic fields in close proximity. A number of other applications are conceivable.
From a technical perspective, the wristband is a combination of polymer and conventional electronics made of silicon.
A three micrometer-thin resonance circuit with an etched coil- a kind of minute antenna-records the electric smog. An interdigital
capacitor attached detects skin moisture. While a comb-shaped copper band can measure the body temperature.
“The sensor wristband shows the potential that lies within the flexible electronics mounted on foils,” clarifies Karlheinz Bock, head
of the Polytronic Systems” division at IZM. The tiny sensors and the optical functions are applied to the foils through a combination
of printing and lithographic processes. The wristband, just like the diagnostic device for deep vein thrombosis, can be manufactured
cost-effectively in large batches.
Face-saving surgery removes gland stones
Endoscopic /method Helps Two People keep Their Saliva Glands
Muzaffar Mohammed(22) from Kashmir was recently in the city after having scouted several other places, seeking an answer to why he had
huge facial lumps during or after meals. The pain and irritation forced him to stay away from food even when he was extremely hungry.
Sion resident Bharat Meitari(25) too found his cheeks swelling during and after meals. Both their conditions had deteriorated to such
an extent that their respective surgeons had advised that they get rid of the glands inside the mouth.
However, doctors at the civic-run BYL Nair Hospital found that both were suffering from a condition called Sialolithiasis-formation of
tiny stones inside salivary glands-and suggested that they had the technique to get rid of the stones without really removing the
The condition sialolithiasis itself remains less known, though its incidence is significantly high. The salivary glands, found in
and around the mouth and throat have ducts (small passageways) that drain saliva. But, chemical, mostly calcium, in saliva. But
chemicals, mostly calcium, in saliva can lead to formation of stones which obstructs the ducts, much like stones in kidneys. Obstruction
invariably causes pain that can take anything between a few minutes to a few hours to subside.
Associate Professor of ENT at Nair Hospital, Dr Milind Navalakhe, used a relatively new technique call Sialendscopy and managed to
preserve their salivary glands.
But what causes the swelling in mouth? Navalakhe explained that there is saliva formation every minute that is used to initiate digestion,
protect teeth decay and moisten mouth. “But, stones in the duct obstruct the drainage of saliva. So, swelling is maximum during and
after meals as well as salivation are at its peak,” he added.
Muzaffer travelled thousands of miles from Kashmir to Mumbai when they learnt the stones could be removed without losing his salivary
glands, in fact without even his mouth being cut open. His 4mm stone was removed using Sialendoscopey. “We inserted an endoscope inside
the tiny duct of his mouth and removed the stone,” said Navalakhe.
In Bharat’s case though, it was not one but several stones ranging from 2-5mm. “I had about six stones, which were removed one after
another.” he said.
Navalakhe claimed the use of the endoscope to take care of salivary glands diseases can avoid the fear of undergoing a facial surgery
in many patients. “In open surgery doctors have to cut open a side of the cheek for better access to the stone area. Use of endoscopes
definitely saves possible complications like damage to important facial nerves,” added the doctor.
But, as is the case with every technology, this too comes with its share of disadvantages. “It is an invasive procedure as against
medical management of the pain.” Said a senior ENT surgeon of a suburban hospital. “Also, it may not be an ideal option for may not
be ideal option for stones bigger than 6 mm size and once may have to combine the technique with few others for optimum results. Not
to mention that it is an expensive procedure,” he added.
Shoulder prosthesis rids woman of pain in the arm
Mumbai Seventy-two-year-old Radha Pednekar had been suffering from a stiff and painful shoulder for the last six years. She
couldn’t move her left hand at all. No amounts of painkiller and therapies helped her. Radha had lost all hopes of ever moving her l
eft arm again. However, last month, she probably became the first in the India to get a reverse shoulder replacement.
“Around six years ago, my left shoulder started giving me immense pain after I picked up a heavy bucket. Even after doctors examined
me, the pain, which would subside for some days, would return. From almost last two years, I was in so much pain that it becomes
impossible to move my arm,” said Radha.
However, when the local doctor failed to do anything, Mohan Pednekar, Radha’s husband took her to Kokilaben Ambani Hospital in
“When she was brought here, we realized that the muscles attached to her shoulder joint (rotator cuff) were completely torn. As
the rotator cuff supports the shoulder joint, it cannot be replaced normally if it is not functional,” said Dr Dinshaw Pardiwala,
orthopaedic surgeon at Kokilaben Ambani Hospital.
Fortunately for Radha, the doctors had got the reverse shoulder prosthesis, which was earlier not available in India. “In a normal
shoulder, a joint has a socket in which the ball-like head of the upper arm bone (humerus) fits. The rotator cuff muscles are responsible
for the joint’s functioning. Damaged rotator cuff muscles can be fixed once. Even then, normal replacement cannot be done,” said Dr
However, with the reverse shoulder replacement, even those with a damaged rotator cuff muscles can get a new join as this prosthesis
makes use of deltoid muscles for movement. “When the ball is placed in the mid-line, the center rotation changes from the blade to the
humors, “said Dr Pardiwala.
“It is a good option for patients whose shoulder joint socket is shallow, or whose rotator cuff muscles are torn, But this technique
cannot be used on everyone, “said Dr Pradeep Bhansole, head of the orthopedic department in KEM Hospital.
“Generally, people over 60 need this surgery. The replacement generally remains for a lifetime. The technique, which has been used in
the UK for a decade, is coming to India now,” said Dr Vijay Shetty, orthopedic surgeon in L H Hiranandani Hospital.
Arthritis gets younger
(Arthritis gets younger...)...with even teenagers complaining of joint pains
Arthritis has generally been associated with old age. But these days, people as young as 15 are complaining of it, says Chaitanya
Shah, practising podiatrist and mobility consultant. "When was the last time you took your child to a doctor? It is usually when
there is fever or a viral infection. Even in schools, there are eye and dental check-ups, but no school ever gets a podiatrist for
a check-up and problems like alignment of the body and balance of the feet are ignored till they move upwards and manifest problems
in the knee, hip and spine. Often, a two millimetre difference in leg lengths can be debilitating for the neck and can lead to
severe pain in the knees, neck, back.
Peter Mayhew gets double knee replacement surgery
Actor Peter Mayhew, best known for playing Chewbacca in the "Star Wars" films, got a double knee-replacement surgery done.
According to his wife Angie, the 69-year-old underwent the procedure Monday at a Texas hospital, reports aceshowbiz.com. Angie
added that Mayhew, who had been using a wheelchair for two years, hoped to walk again. The actor's medical issues will be
highlighted in an upcoming documentary, "Standing in the Stars - The Peter Mayhew Story".
98-yr-old Yemen citizen gets knee replacement
MUMBAI: Ali Saleh Hussein, who has the distinction of being the oldest citizen of Yafea city in Yemen, has become one of the
oldest patients to receive a knee replacement in India. Hussein, whose passport shows his age as 98, underwent a surgery on his
left knee at Breach Candy Hospital here on December 11. Incidentally, the Limca Book of Records says 94-year-old S N Bhatt from
Chhattisgarh's Bhilai steel township is the oldest man to have undergone knee replacement surgery in both...
Total knee replacement surgery using computer
Bangalore : A total knee replacement surgery was conducted at Sagar Hospitals, Banashankari, using computer navigation on a
60-year-old patient suffering from arthritis in both knees. According to doctors, computer-assisted knee replacement surgery
enables surgeons to operate with smaller incisions and greater precision. It helps in ligament balancing, which is important
for total knee replacement. Orthopaedic Surgeon Dr Yang Kuang Ying from Singapore conducted the...
94-year-old undergoes knee replacement surgery
BANGALORE: At ninety-four, Lakshmi is up and doing, thanks to a knee replacement surgery that has helped her go about life,
sans an excruciating pain in the knees. In a rare surgery conducted by a team of super-specialists at the Apollo hospital, both
knee joints of the nonagenarian were replaced at one go. The patient was back on her feet and back to normal within a few days,
said Dr Lakshminath, Orthopedic and Spine surgeon, who headed the surgery team.
Slump dips Non-Resident Gujarati inflow in Gujarat
SURAT: Vandan Patel, a motel owner near New York and Non-Resident Gujarati (NRG) from a village in Bardoli taluka, had to visit
his native place with his wife Krina and son Kunal in November, 2013. However, the family cancelled the trip of Krina and Kunal
as she was likely to lose the job if she applied for leave in a general store where she worked. Only Vandan came to India as his
old father had to undergo a knee replacement surgery. He stayed for 15 days and rushed back to the US...
Twin sisters with knee disease operated on same day
MUMBAI: Identical twin sisters, both suffering from the same knee disease which was also diagnosed around the same time nine years
ago, underwent surgery on the same day in a Navi Mumbai hospital. The 59-year-old sisters, who could barely walk for a few minutes
without support before the surgery, now hope to lead near normal lives. Sisters Swapna Samel and Archana Shingare were diagnosed
with knee osteoarthritis, where joints start degenerating, about nine years...
Say goodbye to knee replacement surgery for oesteoarthritis
KANPUR: Osteoarthritis can be treated without going for an expensive knee replacement surgery and even without the usage of long
term plaster application (for 2-3 months). This was revealed by the principal, also head of department Orthopaedics Ganesh Shankar
Vidyarthi Memorial (GSVM) Medical College Dr Anand Swaroop, while discussing on the 'Non-Replacement Options in Management of
Osteoarthritis Knees' at IMACGP. Dr Swaroop who has been working on this...
Patient walks within hours of knee replacement surgery
MUMBAI: 65-year-old Nanjibhai can look forward to an active and independent lifestyle as he is no longer troubled by the painful
knee ailments that had brought his lifestyle to a standstill. After living with an excruciating knee pain for six years, Nanjibhai
was recently operated using the minimally invasive subvastus knee replacement surgery that helped him walk again within few hours
of the surgery. Normally, patients take around 3-4 days to walk with support. The procedure...
98-yr-old Yemen citizen gets knee replacement
MUMBAI: Ali Saleh Hussein, who has the distinction of being the oldest citizen of Yafea city in Yemen, has become one of the oldest
patients to receive a knee replacement in India. Hussein, whose passport shows his age as 98, underwent a surgery on his left knee
at Breach Candy Hospital here on December 11. Incidentally, the Limca Book of Records says 94-year-old S N Bhatt from Chhattisgarh's
Bhilai steel township is the oldest man to have undergone knee…
Asia records 1st custom-fit knee surgery
BANGALORE: Asia's first custom-fit knee replacement surgery was performed at Fortis Hospital in Bangalore . Recently, two patients
with a degenerative disease of the knee were treated with custom-fit replacement surgery. The new technology ensures less pain and
tissue damage and faster mobilization. Fortis hospitals, CEO, Vishal Bali said on Wednesday: "The custom-fit knee replacement
surgery is currently done only in US and Australia. Now, India...
Interactive session on computer assisted surgery at Lokmanya Hospital
PUNE: Lokmanya Hospital, Nigdi organised an interactive session on the advanced technology in orthopedic surgery recently.
Orthopaedic surgeon Wolfram Kluge from England and orthopaedic surgeon Narendra Vaidya, executive medical director of Lokmanya
Hospitals guided the session. The experts guided the doctors on the latest Computer Assisted Surgery (CAS) System in lower limb
joint replacement, revision surgery and complex reconstruction. An expert in the field of...
Diesel don granted bail after three years
MUMBAI: Diesel mafia kingpin Mohammed Ali was granted temporary bail on medical grounds after spending three years behind bars
for hatching the plan to murder rival oil mafia don, Sayyed Madar Chand. The Bombay high court granted Ali bail after his lawyer
argued that he was suffering from multi organ failure and urgently needed treatment at a private hospital. While bail has been
granted for three months, police say Ali may get an extension if his health does not improve...
Peter Mayhew gets double knee replacement surgery
Actor Peter Mayhew, best known for playing Chewbacca in the "Star Wars" films, got a double knee-replacement surgery done. According
to his wife Angie, the 69-year-old underwent the procedure Monday at a Texas hospital, reports aceshowbiz.com. Angie added that
Mayhew, who had been using a wheelchair for two years, hoped to walk again. The actor's medical issues will be highlighted in an
upcoming documentary, "Standing in the Stars - The Peter Mayhew...
Arthritis gave me a new life...
I started learning yoga at the age of four. Despite hailing from an under-privileged background, my efforts bore fruit when after
a long struggle, I established myself as a yoga teacher.
For me, teaching yoga was a way to connect to the soul; an extremely intense approach inclined towards healing. While working with clients, I’d give 200 per cent, often taking up to 12 classes a day, understanding their personality, emotional and physical problems, and giving them confidence to face ailments. Unknowingly, the effort was taking a toll on my own body. Being bed-ridden As I later realised, while curing a patient, I was transferring a lot of energy to him/her, thus depleting my own energy levels tremendously. One day my body gave away. The simple act of pushing the door sprained my foot. There was shooting pain and swelling which gradually spread to other areas - collar bone, ankles, knees and elbows. I also started vomiting and my system practically collapsed. Often my hands started closing by 3 pm and I couldn't open them. The pain was excruciating.My diagnosis read 'Seronegative arthritis', a condition, that doctors said, had no cure; only life-long medication could contain it.Naturally, I was devastated as even my business was affected. My condition was never known to anyone except my close friend Seimaa, who came upon a book about curing arthritis without using drugs. Though I was on medication, we decided to try the approach. We contacted renowned nutritionist and naturalist Vijaya Venkat who gave my nutrition philosophy a makeover. She taught me the importance of body rhythm, rest and relaxation, silence and poise - things I'd known but had forgotten in my busy quest to "make it". A new approach Food formed a major part of this healing process. Firstly, I started having lots of fruits and vegetables in natural and raw form, and gradually turned vegan. I began my day with nearly half-a-kilo of fruits. I would then consume six to eight glasses of vegetable juices — lauki, carrot, tomato, palak, pumpkin — all seasonal. This was complemented by salads, sprouts and nuts. And I’d have dinner at 6.30 pm (or 8.30 pm at the latest), mostly a plate full of raw fresh salad and moderately cooked food like one cup of rice and one cup dal or sabzi. Simultaneously, I also tried to reduce my intake of medicines. I also sun-bathed and did pranayama while sunning.Interestingly, though I had very little cooked food, there was no loss of energy or nutrition. Moreover, for me eating is almost spiritual; I enjoy each bite with gratitude. I follow this diet even today. Spiritual strength Around the same time, another life-altering episode happened. A client-turned-friend introduced me to Buddhism and the power of chanting. I took to the beliefs whole-heartedly — my chanting increased from 10 minutes and stretched to three to four hours. This was voice meditation to connect with the soul. The Buddhist philosophy of making others happy to be happy, self-dignity, respect and seeking true peace by being in rhythm with the universe deeply impacted me. I also believed in the cause and effect theory which made it clear why I had taken ill. My ailment was simply a message from my body to slow down. I had been over-exerting myself. The results were magical. In just one month, my hands started opening up. I slowly felt flexibility in my joints and my system welling up with energy. Back to square one I was pain-free and could even get back to teaching. The good phase continued for seven months before the pain and swelling returned. One day I felt very breathless. The chest X-ray indicated a shocking 90-92 per cent inflammation in my lungs. I was suffering from drugs toxicity, probably the result of all the medicines and steroids I was taking.That’s when I decided to use my mind power to the maximum. I had to spend 26 days in hospital, but even then I religiously practised pranayam, followed a diet and chanted, which gave me energy to heal my lungs. My belief paid off. In just a few days there was about 70 per cent improvement. In the process, the arthritis too had been subdued. And when it would have taken four to six months of hospitalisation and three to four months of bed-rest to get cured, I was back in action 15 days after being discharged.Since I was on strong steroids in the hospital, I had to withdraw slowly. Therefore I took a small dose for a month. What worked for me more was a combination of the three — diet, pranayam and spirituality. Ever since I was healed, I have been completely drug-free. What has changedI feel illnesses happen because of an imbalance in the system. Hence it is important to take care of your body. In retrospect, I feel my arthritis was a blessing in disguise. It taught me so much about my body and its tremendous healing power. You only need to take care of it with the right nutritious and complete food, prayers and yoga. The road to ill-health It is not just your lungs that are affected by traffic. It's also hitting your knees, wrists and spine Sayoni.Sinha@timesgroup.comShipra Varma experienced a niggling knee pain every time she drove from her Panvel home to her workplace in Worli. Eventually, the pain refused to subside, so much so that Shipra gave up driving long distances. A visit to a doctor and a subsequent X-Ray revealed that she had developed Chondromalacia patellae. The soft cartilage tissue under the knee cap had roughed out and was rubbing against her knee cap. She was advised to go for cartilage regeneration procedure. Shipra is not the only one. Long hours of driving and riding on potholed roads, the frequent clutchand-brake action in bumper to bumper traffic and sitting upright for hours takes its toll on all of us. Here are a few things to be careful about if you are a daily driver. KNEE JERK Long hours inside the car and the lack of mobility can lead to stiffness of the knee joints. "The knees are at a constant angle when you are stuck in the traffic," says Dr B S Rajput, consultant at Breach Candy Hospital. "As a result, it builds a pressure on the knee cap or the patello-femoral joint, resulting in snapping of the cartilage.Not only that, the bumpy rides on pot- holed roads send shockwaves across the body. Regular exposure to these jerks over many months or years can lead to spinal damage and back pain. The longer you are exposed and the higher the level of whole-body vibration, the greater the chances of you suffering a back injury.Once you begin to suffer back pain, continued exposure to jerks is likely to make the pain worse. "Bikers have it worse," says Rajput, "as they have to constantly use their left hand to change gears. This constant stop and go action puts pressure on the tendons and results in tendonitis. If you have recurrent pain and painful movements, it is advisable to see a doctor.Not only that, the disc in the lumbar region of the spinal cord which acts as shock absorbers becomes overloaded, starts to hurt and even break. When a disc breaks, it can put pressure on the big nerve which runs down the tunnel in the centre of the spine and cause numbness or tingling sensation in the legs. SHOCK TREATMENT Since you cannot do anything about the traffic woes in the city, the best way to deal with the problem is with exercise and regular stretching. "It is important for city drivers and riders to strengthen the muscles supporting knees and spine," says Rajput. "Simple stretching exercises for the calves and quadriceps will relax the fatigued muscles and make them strong. Back stretching goes a long way in preventing backache.Any posture, no matter how good it is, can lead to discomfort if held for too long. Therefore it is important to adopt a range of comfortable driving positions and to make frequent changes to avoid, or help delay, the onset of discomfort. If you have to travel for more than an hour it is advisable to support your lower back with a cushion to absorbs the road shocks. DRIVE RIGHT IN 2008, a team of ergonomists and physiotherapists in UK came up with the following ways to reduce back pain in high mileage drivers » Get the right seat position: You should be sitting such that you can easily depress the clutch and accelerator fully. » Your thighs should be supported along the length of the cushion. » Avoid pressure behind the knee by stretching occasionally. » Adjust back-rest so it provides continuous support along the length of the back and is in contact with your body up to the shoulders. » Avoid reclining the seat too far as this will cause excessive forward bending of the head and neck. It may also cause you to slide. » Sit down and outstretch your hand. Your wrist should rest on the steering wheel. That is the right position. STRETCH OUT Do these sets of stretches twice a day CALF STRETCHESStand with your palm on a wall and go up on your toes. Hold for 5 seconds and repeat thrice. BACK STRETCHES Stand erect and place your hands on your hips back. Slowly bend backwards and hold for 5 seconds. Repeat thrice. HAMSTRING STRETCHESSit on the floor with both legs outstretched. Bend forwards and reach for your toes. Hold for 10 seconds. Repeat thrice. SHOULDER AND NECK ROLL Roll your neck clockwise and anti-clockwise. Then roll your shoulders forward and backwards. Repeat thrice. India to be largest market for knee, hip replacements NEW DELHI: India is poised to become the largest market for orthopaedic implants (knee and hip) over the next five years, growing at a compounded growth rate of over 30% annually.At present, the total joint replacements in India are estimated to be around 40-50,000, with knee surgeries growing faster than the other categories, and doubling every year. The factors driving their growth include the entry of newer joint implants and availability of several options, right from joints that can bend and rotate, to gender-specific ones developed especially for the Asian population. In India, every two in 10 people above 65 years is believed to have osteoarthritic knees, affecting their mobility. In osteoarthritis, the joint is damaged and the surrounding bone grows thicker. The cartilage surface allows the bone ends to move freely. In osteoarthritis, the cartilage gradually roughens and becomes thin. Muscles around the joint weaken and become thin or wasted. The loss of cartilage leads to wearing of bone, bony overgrowth at the edges, change the shape of the joint and deformity.But what is alarming is that very few people actually go in for surgeries, due to a plethora of factors including lack of awareness, fear (of surgical procedure) and high costs. A knee replacement surgery costs Rs 1.5-2 lakh for one knee, while the computer-aided one will be more expensive by 5-10%.The latest implants being used are developed to overcome the limitation of previous implants in the range of motion and longevity. The implants available in the country include DePuy (Johnson & Johnson), Zimmer and Stryker. For the patient this means a knee that more closely mimics the natural motion of a knee joint, allowing them to perform activities like squatting, and bending their knee, which otherwise was almost impossible."The market for DePuy's RP-F (rotating platform high flexion) knees has been steadily increasing since its launch nearly two years ago" says Anil Nayak of Johnson & Johnson. Now computer-assisted technology is helping surgeons to maintain accurate alignment, and for placing the implant in the bone with precision.Says Dr AS Prasad, a leading orthopaedic surgeon in the north ''Now computer-assisted surgeries are being done where computer helps the surgeon in evaluating different steps of the surgery during operation and bringing perfection to the results. However, a computer is only a tool for the surgeon and not a substitute. It cannot make a bad surgeon a good one".Dr SKS Marya, Max Hospital (Delhi) who claims to have introduced this technology two years back, adds "the better the alignment, the greater is the longetivity of the joint". Osteoporosis drug works magic,helps regrow jaw Boston: The osteoporosis drug Forteo can regrow bone in jaws damaged by severe bone-destroying conditions called osteonecrosis and periodontitis,doctors reported.The research,reported at the annual meeting of the American Society for Bone and Mineral Research in Toronto,suggests that the drug may spur growth in a damaged jaw,the researchers said on Saturday.Forteo,known generically as teriparatide,cuts in half the risk of bone fractures in patients with thinning bones by stimulating the growth of new bone.But it is seldom given for more than two years out of fear that long-term exposure might lead to osteosarcoma,a type of bone cancer.The first of two reports,also published in the New England Journal of Medicine,showed people whose severe periodontitis was damaging the tissue around the teeth developed nearly 10 times more bone with Forteo compared to those who received daily placebo injections.There was a significant gain in the bone around the teeth as measured by X-rays, Laurie McCauley of the University of Michigan said.This relatively short dosing period of six weeks resulted in improvements that were sustained,and things actually improved over 12 months.The 40 volunteers were also treated with periodontal surgery as part of the test,which was financed by Eli Lilly and company,which makes Forteo.Periodontitis is a major cause of tooth loss,affecting more than one in five adults in the United States.We were very pleased with these results and were looking at other approaches, Mc Cauley said.One is trying to administer the drug locally.Were also looking at the use of teriparatide in conjunction with dental implant therapy.There are situations where patients need to augment their bone to be able to have an implant.We think this could be a promising avenue for that. REUTERS Bone lengthening procedure puts him on his feet again Mumbai: Kalyan resident Chandrakant Kothere never believed doctors who told him three years ago that he would not be able to walk properly again. It was perhaps his positive belief that led to a near-complete cure—a bone-lengthening procedure known as the Ilizarov technique and a subsequent operation over the lasted over nine months.Kothere, who had met with a road accident while going to Alibaug on a bike, suffered multiple fractures on his right leg, resulting in a limp and extensive pain. "Some doctors suggested an amputation after the initial treatment," said Shobha Kothere, wife of Chandrakant. But the couple was determined that he would walk without a stick—sooner than later. In the interim, the fracture on Kothere's right leg caused a bow leg appearance. He was "shorter" by almost three inches on his right side."He resumed work, but came back twice with a fracture that needed plastering. How long could we go on?" said Shobha. That is when Shobha went to Wockhardt Hospital in Mulund in January this yea r to meet a doctor for a cure. At Wockhardt, the doctors decided to conduct the surgery in two stages. "In the first stage, we cleared the infected bone and alligned the leg using a ring shaped Ilizarov External Fixator," said Dr Sachin Bhonsale, consultant orthopaedic surgeon at Wockhardt. The screws were turned-1 mm a day-to facilitate lengthening. "It took four months for the bone tissues to grow. That is when we performed the second stage of attaching a titanium rod and screws," the doctors said.The significance of the case lies in the fact that even after three years of the fracture, a procedure to transport the bone and fix the joint was successful .Turmeric may help prevent osteoporosis Arecently published study by Janet Funk of the University of Arizona College of Medicine adds to the literature supporting the potential health benefits of turmeric,showing that it may be an effective resource for preventing osteoporosis,or bone loss,a significant concern for postmenopausal women,among others.The study findings also point to characteristics of the turmeric tested that may determine its efficacy.Turmeric comes from a plant that is related to ginger.It is a mainstay of Indian cooking,and it has been used for centuries in Ayurvedic medicine as a treatment for a variety of ills,from stomach ache to arthritis.Commercially produced turmeric is consumed widely as a spice and is readily available as a dietary supplement.Funk,an endocrinologist,has studied turmeric for several years,working with carefully characterised extracts that have been processed specifically for her research.In earlier studies that she conducted to assess the antiarthritic effects of turmeric,Funk discovered that it not only prevented arthritis,but also prevented the development of bone cells that foster bone resorption and bone destruction around the joint in a model of rheumatoid arthritis.To study whether turmeric might prevent bone loss occurring with postmenopausal osteoporosis,Funks team evaluated and compared two turmeric extracts analogous to those that are commercially available and marketed. The extracts contained a mixture of three major curcuminoids chemical substances also known as polyphenols that occur in turmeric in varying proportions.One was a complex turmeric fraction containing 41 per cent cucuminoids.The second,a curcuminoid-enriched turmeric fraction,contained 94 per cent curcuminoids and was by far the more effective in preventing loss of bone mineral density and trabecular bone,the spongy or porous bone found in the spine and hip,the types of bone areas that are most subject to fracture in post-menopausal women.The study appears in the Journal of Agricultural and Food Chemistry. Herbal medicines for the treatment of osteoarthritis: a systematic review Objective. Limitations in the conventional medical management of osteoarthritis indicate a real need for safe and effective treatment of osteoarthritis patients. Herbal medicines may provide a solution to this problem. The aim of this article was to review systematically all randomized controlled trials on the effectiveness of herbal medicines in the treatment of osteoarthritis.
Methods. Computerized literature searches were carried out on five electronic databases. Trial data were extracted in a standardized, predefined manner and assessed independently.
Results. Twelve trials and two systematic reviews fulfilled the inclusion criteria. The authors found promising evidence for the effective use of some herbal preparations in the treatment of osteoarthritis. In addition, evidence suggesting that some herbal preparations reduce consumption of non‐steroidal anti‐inflammatory drugs was found. The reviewed herbal medicines appear relatively safe.
Conclusions. Some herbal medicines may offer a much‐needed alternative for patients with osteoarthritis.
Key words 1) Osteoarthritis 2) Degenerative joint disease 3) Herbal medicine 4) Phytomedicine. Osteoarthritis (OA) is a progressive rheumatic disease characterized by the degeneration of articular cartilage. It is the most common of all rheumatic disorders and is destined to become one of the most prevalent and costly diseases in our society.Therapeutic interventions conventionally employed for OA include the use of physiotherapy and antidepressant therapies, patient education and weight control. In addition, drug therapy includes non‐opioid analgesics such as paracetamol, non-steroidal anti‐inflammatory drugs (NSAIDs), topical analgesics, opioid analgesics and intra‐articular steroid injection. Such treatments may prove ineffective in some patients and NSAIDS often have serious adverse effects. Gastrointestinal complications are frequently reported with NSAIDs, with 12000 hospitalizations and about 2000 deaths attributed to NSAID use in the UK every year. Hence there appears to be a need for drugs with good efficacy and low toxicity in the treatment of OA. Specifically, there is a need for safe and effective drugs for patients who do not respond well to conventional medical therapy. Such patients are turning increasingly to complementary/alternative medicines (CAM). The use of CAM by sufferers of rheumatic diseases is highly prevalent and increasing. Arthritis is the sixth most frequently cited health problem treated with CAM in the USA. Individuals who use CAM regularly are more likely to have OA and severe pain. Patients suffering from musculoskeletal problems are likely to be users of herbal treatments. It is therefore important to determine the effectiveness and safety of herbal medicines in the treatment of OA.The objective of this systematic review is to evaluate the existing evidence from randomized controlled trials (RCTs) of herbal medicines and plant extracts for OA that are either taken orally or applied topically. Methods Identification of clinical trials Systematic literature searches were performed to identify all RCTs of herbal medicines for OA. Computer databases used were Medline, Embase, Biosis, CINAHL and the Cochrane Library (all from their respective inception to May 2000). The search terms used were 'osteoarthritis', 'osteoarthrosis', 'degenerative joint disease', 'degenerative arthritis', 'degenerative arthrosis', 'gonarthrosis' and 'coxarthrosis'. Herbal search terms used were 'botanic', 'phyto', 'herb' and all their derivatives, together with individual plant and herb names. A manual search for additional trials was performed using the bibliographies of studies and reviews located through the electronic searches and by scanning our own files. In addition, 11 experts and 15 manufacturers in the field were contacted to provide published and unpublished material.All potential articles (or abstracts if only available as abstracts) were read in full and, if additional information was required, authors were contacted wherever possible. Inclusion/exclusion criteria There were no restrictions regarding language or age group in this systematic review. Studies were limited to RCTs of patients with OA. RCTs with any type of objective and/or subjective parameters were considered. Comparative studies of one herbal treatment measured against another active drug were included, as were relevant systematic reviews. Parenterally applied herbal preparations were excluded. Studies focusing exclusively on back pain and osteoarthritic conditions of the spine, including cervical spondylosis, were excluded. Animal studies were excluded, as were trials that were lacking in essential methodological detail, such as dosage descriptions. Trials that did not include baseline data and clinical end‐points were also excluded. All articles were read by two reviewers and any disagreements were resolved through discussion. Data extraction and quality assessment Data relating to demographic patient information, interventions, outcomes, results, treatment duration, documentation of power calculation and inclusion/exclusion criteria and the assessment of concomitant medications and compliance were extracted by the first author into predefined tables (Tables 1 - and 2) and validated by the other authors. Data relating to adverse effects were extracted into Table 3 - and validated by the last author.Methodological quality was assessed using the standard scoring system developed and validated by Jadad et al., with items on random allocation, double-blinding and description of dropouts and withdrawals Worried about undergoing spine surgery? Spine and leg treatments are no more painful. Courtesy new technology, you now have the option of 'stitch-less surgeries' done under local anaesthesia What has changed for back and leg pain surgery in recent times? Well, the change is revolutionary. These days, such surgeries are almost always done under local anaesthesia and that too, without stitches. It is more predictable, minimally invasive and has less chances of morbidity after operation. How does this change benefit the patient? The surgery can be done in a day, helping one reduce expenses. It is especially helpful for the busy working class and the elderly, who are associated with comorbidities and dependency. Due to less morbidity, no dressings or anaesthesia, post-op visits are minimal. Post-operative costs are also negligible. There are no blood transfusions, IV saline or stitches, which keep pain and anxiety at bay. Who can benefit from this new surgical procedure and technology? The new technology is a stitch-less surgery done under local anaesthesia. It is beneficial if:
The cause of back pain has been identified -- by a discogram -- as a central annular tear or loosening of the coating of the disc. This is treated by annular sealing.
There's pain in the back due to joints of the back or facet joints treated with facet denervation. New technology avoids fusion and use of metal implants/support in almost all patients.
Leg pain, caused by swelling due to the use of steroids and other medications, can be treated using needles and injections.
Severe leg pain is treated by removing the slipped disc fragment under endoscopic magnified vision. This is done under local anaesthesia without stitches or surgery.
It's applicable to all stages and causes of pain, and, also to patients who have undergone surgery previously, but have had no relief.
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