Orthopaedics

Chakradhar Hospitals is well renowned for orthopaedic treatments to Foot, Shoulder, Hip, muscular dystrophy, arthroscopic surgeries, Spine, Knee, and Hand Traumas for both adults and children. Orthopaedics is the field of diagnosing, treating or preventing the disorders of skeletal deformities, pertaining to muscles, bones, ligaments, joints, nerves and tendons. Using a variety of advanced and effective methods we treat fractures, osteoporosis, arthritis, sprains, disc prolapse, Bone tumours, knee pains, low back pain, sciatica, limb deformities, club foot and other abnormalities, and cerebral palsy.

Orthopedic Problems and Surgeries

The department of orthopedics at Chakradhar Hospitals, Rajahmundry deals with the following conditions

Shoulders, Arms, Hand, & Wrists

Carpal Tunnel Syndrome

Arthritis of various joints

Tennis Elbow or lateral epicondylitis

Acromioclavicular Joint Trauma

Bicep Tendon Injuries

Rotator cuff injuries and tears

Spinal

Osteoporosis

Disc problems

Scoliosis

Knee, Hip, Foot & Ankle

Total & partial knee and joint replacement surgeries

Replacement of Hip joints

Cartilage repairs

Anterior Cruciate ligament (ACL) injuries

Total Hip replacement surgeries

Plantar Fasciitis

Others

Trauma Management

Care for Fractures

Sports Medicine

Arthroscopic Surgery

Knee and Joint Replacement Surgeries

Articular Surfacing (Hip Resurfacing)

Hip Replacement

Limb lengthening and re-plantation surgeries

Correction surgeries for Poliomyelitis

Sports Medicine

Injury care

Physiotherapy

Rehab program

• • Intensive Care Unit
• • Physiotherapy

The Institute of Orthopaedics at Chakradhar Hospitals is considered to be the best Orthopaedic hospital in Rajahmundry. It is the most preferred healthcare provider for orthopaedic surgery with the largest number of Joint Replacement surgeries (Hip, Knee & Shoulder) performed in Rajahmundry which include primary and revision. With a team comprising of the most adept orthopedicians and orthopaedic surgeons, Chakradhar Hospitals is a pioneer for Orthopaedics Treatments in Rajahmundry The Institute of Orthopaedics at Chakradhar Hospital in Rajahmundry has state-of-the-art operation theatres with laminar flow, the latest technology for joint replacements procedures using metal on metal articulation, advanced techniques like Diagnostic & Therapeutic Arthroscopy of the knee & shoulder and arthroscopic surgeries with advanced techniques in ligament repair. It performs surgeries for a wide spectrum of orthopedic problems including joint related injuries and diseases, bones and joints diseases, joint replacement procedures, total knee replacement, total hip replacement, hip resurfacing, rehabilitation and physiotherapy.

Patients with paralysis, stroke, trauma, cancer, heart disease, surgery etc. can be left with some form of disability, which can be in the form of physical, psychological, or social disability. A structured multi-disciplinary approach can help such patients get back to normal. This center offers support to such patients by maximizing the ability of the person to function optimally within the limitations placed upon them by a disease process.Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury.

The department of orthopaedics at Chakradhar Hospitals, Rajahmundry deals with the following conditions

Shoulders, Arms, Hand, & Wrists

• Carpal Tunnel Syndrome
• Arthritis of various joints
• Tennis Elbow or lateral epicondylitis
• Acromioclavicular Joint Trauma
• Bicep Tendon Injuries
• ⦁ Rotator cuff injuries and tears

Spinal

• Osteoporosis
• Disc problems

Knee, Hip, Foot & Ankle

• Total knee and joint replacement surgeries
• Anterior Cruciate ligament (ACL) injuries
• Total Hip replacement surgeries
• Plantar Fasciitis

Others

• Trauma Management
• Care for Fractures

Sports Medicine

• Arthroscopic Surgery - Knee, Shoulder
• ACL Reconstruction
• PCL Reconstruction
• Bankarks Repairs
• Rotator cuff Injuries
• Correction surgeries for Poliomyelitis

Sports Medicine

• Injury care
• Physiotherapy
• Rehab program

Contents

• Introduction
• Total knee replacement
• Preparation for surgery
• Pre- op Visit
• After surgery
• Physical therapy and Exercise program
• Guidelines for care.

The knee joint is among the strongest, largest and most complex joints of the body. When you walk, sit, squat, climb stairs up and down, play, jump and drive or do many other simple movements, you are depending on the knee for support and mobility.
When your knee is healthy, you may take it for granted, not giving a thought about the job it does for you. However, once it starts to become painful, stiff and you are forced to restrict certain activities, you may come to realise how much freedom of movement means for you.
Fortunately, today’s remarkable advances in medical technology and research makes it possible to replace the knee joint with long-lasting durable and fine-tuned artificial one that eliminates pain, corrects the deformity, strengthens your legs and improves your quality of life. This page provides information for you and your family regarding Total Knee Replacement surgery. The surgical procedure, pre-operative and post-operative Care, the risks and benefits of surgery, as well as rehabilitation, are explained.
Please read and discuss with your family before your total knee replacement surgery. The orthopedic surgeon’s goals are to restore your knee to a painless, functional status and to make your hospital stay as beneficial, informative and comfortable as possible. Please feel free to ask questions or share concerns with your consultant surgeon and physiotherapist.

Total knee replacement is a surgical procedure in which damaged components of the knee joint are replaced with artificial parts. The procedure is performed through a skin incision on the front of the knee; the muscular, ligamentous and bony components of the joint are exposed.
The worn out bony surfaces are shaved off with special instruments (resurfacing) and replaced with implants. Most common implant consists of three components: the femoral, the tibial and the patellar component.
Popular femoral component designs use highly specialized heavy metal alloys (Stainless steel, vanadium, titanium etc.) and are contoured more or less like the original bone.
The tibial component is a metal platform which holds a plastic tray (High density polyethylene) and this surface moves against the femur during joint motion. The patellar component is an all plastic button like implant which moves in the femoral notch simulating normal joint motion.

• People suffering from severe arthritis of knee joints.
• Daily knee pains from a very long time with swelling.
• Debilitating pain restricting activities of daily living.
• Severe deformity of the legs following knee pains (bent or bowlegs).
• People suffering with rheumatoid arthritis.( young and old )
• Arthritis or deformity following bony or ligamentous injuries around the knee joint

An artificial knee is not a natural knee, so it is unfair to expect it to function as a normal free joint. But a near normal function of the new joint is an achievable target. With the availability of technically advanced implants and well established surgical expertise in premier institutions such as Chakradhar hospitals the success rate of this surgery has been reported worldwide approximately 97% at a 12 year follow up. The average life of the implant for all age groups and indications has been found to be 15 years.

Relief from joint pain and stiffness.

Improve joint movement.

Ability for independent movement.

Improvement in the alignment of the deformed joints.

Independence to carry out functional activities of daily living like; walking, climbing stairs up and down, swimming, driving and social activities.

What are the risks of Total Knee Replacement?

Total Knee Replacement is a major operation. In spite of all precautions some complications are encountered in clinical practice.

The most common complications are

• Blood clots in legs.
• Blood clots in lungs.
• Post-operative blood loss may require transfusion.
• Complications affecting the knee are less common, they are:-
• Loosening of the prosthesis.
• Knee Stiffness.
• Infection in the knee

Maintaining good physical health before your operation is important. Activities that will increase your upper body strength will improve your ability to use walker or crutches after surgery. A blood transfusion may be needed after the operation. The Physician may order blood tests and urine analysis to rule out the presence of any infections. A review of your medical condition is necessary. Chest x-rays and an ECG may also be taken.

This visit would include an interview by your consultant or registrar about the past medical history and current medications and a chest x-ray will be taken. You may be instructed to stop taking Aspirin, Ecosprin and Warfarin group of medication four to seven days before surgery. Inform your doctor about drug and substance allergies.

⦁ You have to sign a written consent for surgery and rehabilitation.

⦁ Diet: you can take regular diet before surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT before the day of surgery.

⦁ AFTER MIDNIGHT before the day of surgery.

⦁ Bathing: A shower, bath or sponge bath should be taken the evening before and morning of surgery. If you are allergic to iodine or soap, please inform the nurse.

Care after surgery

After surgery, the patients are monitored in the intensive care unit until post-op stabilization and are transferred to the ward. It is important that any numbness, tingling or sudden severe pain in your feet and legs should be reported to the nurse immediately during this period. These are some of the things you would find after your surgery:

Dressing is applied to the surgical area. (Changed 2-3 days after the surgery)

⦁ A suction drain that has tubes leading directly into the surgical area.

⦁ An IV line that will continue till you can take adequate amounts of fluid by mouth.

⦁ Post-operative nausea or vomiting that can be reduced by anti-nausea medication.

Elastic stockings:

You may be fitted with suitable elastic surgical stockings that help prevent blood clots and improve circulation. You may wear these stockings every day for six to eight weeks following surgery.

Physical Therapy and Exercise program

When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you have not used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will be strengthened through regular exercise. You will be assisted and advised how to do this under therapist supervision.

Instituted in the immediate post-operative period

⦁ Elevation and positioning of the leg.

⦁ Thigh muscles tightening- loosening for both legs

⦁ Movements of the Ankle and Toes to prevent blood clots.

⦁ Straight lifting of the legs.

⦁ Coughing and deep breathing exercises to help prevent complications.

⦁ Mobility in bed – Turning to normal side and lifting the buttocks helps to prevent bedsores.

⦁ Once the dressing is reduced your doctor may advice you to undergo venous doppler study. (checking of blood clots in legs)

⦁ After that your doctor will decide when to make you walk and start knee bending exercises. Ambulatory activity like walking with the help of a walking aid, bearing as much weight as indicated by your doctor or physiotherapist, and often a support is applied to operated leg to pro-vide stability if your muscles are weak. In case of both knees replacement, ambulation is done with supports for few days.

Your consultant doctor will decide when to discharge once he ensures wound healing is good and your walking with the walker is satisfactory. He will review prescription for medication, home exercise and follow up date for staple removal. Your physical therapy will continue till you become more independent in your exercises, transfer from bed to chair, staircase climbing and other activities your therapist has designed for you.

Your knee replacement should give you years of service. You can protect it by taking a few simple tips for safety and greater efficiency

⦁ Exercise to maintain knee movement.

⦁ Cold application.

⦁ Weight reduction program if obese.

⦁ Bathroom modifications.

⦁ Prevent infection, urinary, dental etc, because your new knee is sensitive to infection.

⦁ Swimming, driving, normal family life and social activities.

⦁ In case of injury to your new knee apply ice and consult your doctor immediately.

Hot fomentation.

Forceful bending of artificial knee.

Bending beyond 120 degrees.

Massage over the artificial knee.

Squatting and low sitting.

Sudden jerky and rotating movements.

Crossed leg sitting.

Cycling.

Activities that over load the artificial knee must be avoided.

When you leave the hospital, you will be given a schedule of follow-up visits. These visits will ensure the long-term success of your operation.

⦁ Total Hip Replacement

⦁ Preparing for Surgery

⦁ Pre-op Visit

⦁ Day of Surgery

⦁ After Surgery

⦁ Home Exercises

Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts–the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the ” ball „ or head of the thigh bone (femur). During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. These artificial pieces are implanted into healthy portions of the pelvis and thigh bones and affixed with a bone cement (methyl methacrylate).

An alternative hip prosthesis has been developed that does not require cement. This hip has the potential to allow bone to grow into it, this is an important consideration for the younger patient. In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cement less. This would be called a ”Hybrid„ hip prosthesis.

Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or aseptic necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is occasionally performed on younger persons. Circumstances vary, but generally patients are considered for total hip replacements if:

Pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living

⦁ Pain is not relieved by arthritis (anti-inflammatory) medicine, the use of a cane, and restricting activities

⦁ Significant stiffness of the hip

⦁ X-rays show advanced arthritis, or other problems

A total hip replacement will provide complete or nearly complete pain relief in 90 to 95 percent of patients. It will allow patients to carry out many normal activities of daily living. The artificial hip may allow you to return to active sports or heavy labor under your physician’ s instructions. Most patients with stiff hips before surgery will regain near-normal motion, and nearly all have improved motion.

Total hip replacement is a major operation. The effect of most complications is simply that the patient stays in the hospital longer. The most common complications are not directly related to the hip and do not usually affect the result of the operation. These include:

⦁ Blood clots in the leg

⦁ Blood clots in the lung

⦁ Urinary infections or difficulty in urinating

⦁ Complications that affect the hip are very un-common, but in these cases, the operation may not be as successful:

⦁ Difference in leg length

⦁ Stiffness

⦁ Dislocation of hip (ball pops out of socket)

⦁ Infection in hip

A few of the complications, such as infection or dislocation, may require re–operation.

As we noted earlier, 90 to 95 percent of hip replacements are successful up to 10 years. The major long-term problems are loosening or wear. Loosening occurs either because the cement crumbles (as old mortar in brick building) or because the bone melts away (reabsorbs) from the cement. By 10 years, 25 percent of all artificial hips will look loose on an X-ray. Somewhat less than half of these (about 5% to 10% of all artificial hips) will be painful and require revision.
Wear can occur in the plastic socket after some years. Small wear particles can cause inflammation resulting in thinning of the bone and risk of fracture. Loosening and wear are in part related to how heavy and how active you are. It is for this reason we do not operate on very obese patients or young, active patients. Loose, painful artificial hips can usually, but not always, be replaced. The results of a second

Maintaining good physical health before your operation is important. Activities which will increase upper body strength will improve your ability to use a walker or crutches after the operation.

The day begins in the clinic, where an interview by the Doctor concerning past medical history and current medications will be taken. You may be instructed to stop taking your anti-inflammatory medications (ibuprofen, Naprosyn, Relafen, DayPro, aspirin) one week before surgery. You will be attending a teaching session which will include the following topics and other information about your surgery. There will also be time for discussion and questions. Bring a written list of past surgeries and of the medications and dosages that you normally take at home.

You should follow your regular diet on the day before your surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT. The day of surgery you may brush your teeth and rinse your mouth without swallowing any water.

A shower, bath or sponge bath should be taken the evening before and morning of surgery

You will be instructed in deep breathing exercises to minimize the risk of lung complications after surgery. These exercises are necessary to remove any excess secretions that may settle in your lungs while you are asleep during surgery. These exercises are to be done every one or two hours after surgery. An incentive spirometer may be demonstrated. This bedside device assists you in deep breathing exercises.

You may be fitted with elastic support stockings. The morning of surgery, you will receive these stockings to aid in the circulation of your legs and feet to reduce the risk of blood clots.

The physician will also review your medical history and the medications that you take. He will listen to your heart and lungs, and do a general physical exam. He will check for any type of infection. Any blisters, cuts, or boils should be reported. If infection is found, surgery is generally delayed until the infection is cleared. During your pre-op visit, blood will be drawn and lab tests one to ensure that you are in good general health. X-rays are taken if necessary (an ECG is obtained if you have not had one taken for six months or if otherwise indicated).
After all of these tests and exams are completed, an anaesthesiologist will talk with you to determine the type of anaesthesia that is best suited for you. After you see the anaesthesiologist, your pre-op evaluation is usually over. Before you leave the hospital make sure your questions are answered. If at any time you become ill, such as with a cold or flu, you need to call your physician. Remember we want you to be in your best possible health.

After surgery you will be taken to the Recovery Room for a period of close observation, usually one to three hours. Your blood pressure, pulse, respiration and temperature will be checked frequently. Although circumstances vary from patient to patient, you will likely have some or all of the following after surgery You will find that a large dressing has been applied to the surgical area to maintain cleanliness and absorb any fluid. This dressing is usually changed 2 to 4 days after surgery by the surgeon.
A hemovac suction container with tubes leading directly into the surgical area following surgery. The hemovac is usually removed by your doctor two to three days after surgery.
Post-operatively you may have temporary nausea and vomiting due to anesthesia or medications. Anti-nausea medication may be given to minimize the nausea and vomiting. Diet: You will be allowed to progress your diet as your condition permits; starting with ice chips and clear liquids to diet as tolerated.
Coughing and Deep Breathing: To help prevent complications, such as congestion or pneumonia, deep breathing and coughing exercises are important. Inhale deeply through your nose; then slowly exhale through your mouth. Repeat this three times and then cough two times. You will be encouraged to use your incentive spirometer.

⦁ Using 2-3 pillows between your legs and not crossing your legs

⦁ Not bending forward 90 degrees

⦁ Using a high-rise toilet seat

The first day after surgery you will be assisted to a reclining chair, and physical therapy may begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches. This initial rehabilitation generally takes 4-6 days. During this time, discomfort may be experienced while walking and exercising. Pain medication will be ordered by the doctor as needed. Most patients are relieved of their painful pre-surgical hip condition.

Following surgery, you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of your hip. You will be instructed by your physical therapist in a specific home exercise program to meet your needs.
Do the home exercises two to three times a day (see home exercises section). Do your exercises indefinitely. Walking is not a substitute for exercise. If an exercise is causing pain that is lasting, reduce your intensity. If it continues to cause pain, contact your physical therapist or physician.

Here is a list of potential exercises you may be asked to complete. Please refer to the exercises given in Articular resurfacing these exercises are sometimes done before surgery to help maintain the strength and range of motion of your hip

Total Number of Knee Replacement Surgeries

Total Number of Hip Replacement Surgeries

Total Number of Orthopaedic Surgeries

No of Trauma Surgeries

Patient Testimonials

DEPARTMENTS

Orthopaedics

Urology

General Medicine

Critical Care ICU

Plastic Surgery

Facio Maxillary surgery

Spine Surgery

ENT

General Surgery

Neurology

Anaesthesia

Pulmonology (Chest Medicine)

Dental Surgery

Physiotherapy