Arthritis patients have surgical options other than knee replacement

March 23, 2017

New Delhi, Mar 23: For those suffering with age-related (degenerative) arthritis of the knee, a stage comes when all the reasonable non-operative options stops working. Here's when the option of surgery comes into the picture.

KneeDr J Maheshwari, Director and Chief of Knee & Shoulder Service and Head, Max Smart Super Specialty Hospital, Saket said that one common option suggested is knee replacement, and it being as intimidating as it sounds, it is natural that patients look for an alternative. Other non operative options such as stem cell treatment, oil messages etc. with large claims and no scientific backing also come into consideration.

Scared of the so called 'Total Knee Replacement', the patients often fall for alternative treatment modalities with tall claims and no scientific validity, and ultimately land up in a situation where knee replacement, like it or not, remains the only option.

Sometimes the surgery is delayed so much that even the best of surgeons cannot give a good result, and the fear of the patient actually 'comes true', said Dr Maheshwari.

There is a recent advance in medicine, where the scientific community is focusing on 'joint preservation' and not 'replacement' options. Some of these are non surgical - such as physiotherapy, weight reduction, modification in life-style etc, but others are surgical, where effort is to keep the original joint going. Some of these options may be surgical, aimed at corrective surgery in early stages of the arthritis, where one can see that if left to itself that particular joint is going to the path of damage, and hence future knee replacement.

These options could be key-hole surgery (arthroscopic surgery), which, if done at the right time, can halt the progress of the disease and may save one from knee replacement. Unfortunately, most patients do not have significant complaints at this stage, and may ignore their problem.

Dr Maheshwari further stated, in some patients with deformed legs (bow legs), the progress of arthritis can be halted by correcting the alignment, what is called high tibial osteotomy (HTO). Best approach, therefore would be to see a specialist to get yourself evaluated whether you have some such issue which may be the reason for your knee to take downhill course, and whether some intervention can prevent it from reaching knee replacement stage.

Even in cases, where joint is damaged beyond a certain level, it is not necessary that total replacement is the only option. There are options where only the damaged part of the knee is capped (partial replacement).

Knee, as we know it today, is made up of three distinct compartments. Often the damage is limited to only one of the three compartments, and in such cases, a limited surgery on that compartment can produce good results, without changing the whole joint. These operations are more recent in the armamentarium of knee surgeons, and have been shown to be effective. These options are not applicable in every patient of advanced knee arthritis, but in some, selected by careful investigations and special X rays. These are good joint preserving options.

As a last resort, knee replacement is always an option in case it is ascertained that all compartments of the knee are damaged. Also knee replacement remains a potent back up option in any case where partial replacement has been done in the past, and for some reason it has not given desired results.

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Agencies
July 21,2020

New Delhi, Jul 21: The Centre has written to all states and union territories warning against the use of N-95 masks with valved respirators by people, saying these do not prevent the virus from spreading out and are "detrimental" to the measures adopted for its containment.

The Director General of Health Services (DGHS) in the Ministry of Health, in a letter to the Principal Secretaries of health and medical education of states, said it has been observed that there is "inappropriate use" of N-95 masks, particularly those with valved respirators, by the public other than designated health workers.

The DGHS referred to the advisory on the use of homemade protective cover for face and mouth available on the website of the Ministry of Health.

"It is to bring to your knowledge that the use of valved respirator N-95 masks is detrimental to the measures adopted for preventing the spread of coronavirus as it does not prevent the virus from escaping out of the mask. In view of the above, I request you to instruct all concerned to follow the use of face/mouth cover and prevent inappropriate use of N-95 masks," DGHS Rajiv Garg said in the letter.

The government had in April issued an advisory on the use of homemade protective cover for face and mouth, asking people to wear it, particularly when they step out of their residences.

The advisory stressed such face covers must be washed and cleaned each day, as instructed, and stated that any used cotton cloth can be used to make this face cover.

The colour of the fabric does not matter but one must ensure that the fabric is washed well in boiling water for five minutes and dried well before making the face cover. Adding salt to this water is recommended, it said.

It also listed the procedures of making such homemade masks, asking to ensure it fits the face well and there are no gaps on the sides.

It urges people to wash hands thoroughly before wearing the face cover, switching to another fresh one as the face cover becomes damp or humid, and never reusing it after single use without cleaning it.

"Never share the face cover with anyone. Every member in a family should have separate face cover," the advisory stated.

India's COVID-19 case tally crossed the 11-lakh mark on Monday, while the total number of recovered patients increased to over seven lakh, according to Union health ministry data.

The death toll due to the disease rose to 27,497 with 681 fatalities reported in one day.

The ministry data updated at 8 am on Monday showed that a record single-day jump of 40,425 COVID-19 cases had taken the total number of cases to 11,18,043.

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Agencies
February 23,2020

Los Angeles, Feb 23: According to researchers, if administered quickly, a common medication that reduces bleeding could be a treatment for bleeding stroke.

The Spot Sign and Tranexamic Acid on Preventing ICH Growth - Australasia Trial (STOP-AUST) was a multicenter, prospective, randomized, double-blind, placebo-controlled, phase 2 clinical trial using the antifibrinolytic agent tranexamic acid in people with intracerebral hemorrhage (ICH).

ICH is a severe form of acute stroke with few treatment options.

Tranexamic acid is currently used to treat or prevent excessive blood loss from trauma, surgery, tooth removal, nosebleeds and heavy menstruation. For this study, one hundred patients with active brain bleeding were given either intravenous tranexamic acid or placebo within 4.5 hours of symptom onset.

Researchers analyzed brain CT scans taken during the 24-hour period after treatment with tranexamic acid or placebo.

Researchers found a trend towards reduced hemorrhage expansion in the group treated with tranexamic acid, especially in those treated within 3 hours of the brain bleed. However, this trend was not statistically significant. The finding was consistent with previous research using the medication.

"Further trials using tranexamic acid are ongoing and focusing on ultra-early treatment - within 2 hours. 

This is where the greatest opportunity for intervention appears to be. Tranexamic acid is inexpensive, safe and widely available. Our results and others provide great impetus for further, focused research using this treatment," Nawaf Yassi said.

Larger trials focused on patient outcomes are required for this therapy to enter routine clinical practice.

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Agencies
June 19,2020

While coughing, fever and difficulty in breathing are common symptoms of COVID-19, a new case study has found that pink eye is also a reason to be tested for the disease.

The study, published in the Canadian Journal of Ophthalmology, determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms of COVID-19.

The researchers noted that in March, a 29-year-old woman arrived at the Royal Alexandra Hospital's Eye Institute of Alberta with a severe case of conjunctivitis and minimal respiratory symptoms.

After the patient had undergone several days of treatment with little improvement -- and after it had been determined that the woman had recently returned home from Asia -- a resident ordered a COVID-19 test.

The test came back positive, according to the researchers.

"What is interesting in this case, and perhaps very different to how it had been recognised at that specific time, was that the main presentation of the illness was not a respiratory symptom. It was the eye," said Carlos Solarte, an assistant professor at the University of Alberta in Canada.

"There was no fever and no cough, so we weren't led to suspect COVID-19 at the beginning. We didn't know it could present primarily with the eye and not with the lungs," Solarte said.

Academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptoms in about 10 to 15 per cent of COVID-19 cases, he said.

Since then, scientists have gained greater knowledge of how the virus can transmit through and affect the body's mucous membrane system, of which the conjunctiva -- the clear, thin membrane that covers the front surface of the eye -- is an extension.

While the finding provides important new health information for the public, it also makes eye exams more complicated for ophthalmologists and staff, the researchers noted.

"The patient in this case eventually recovered well without any issues. But several of the residents and staff who were in close contact with the patient had to be under quarantine," said Solarte.

"Fortunately, none who were involved in her care also tested positive," he said.

Patients coming into an eye clinic with conjunctivitis and keratoconjunctivitis are now treated as potential cases of COVID-19 and extra precautions are taken by staff, according to the researchers.

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