KNOW ABOUT KNEE
VITAMIN - D
- Essential for healthy bones, teeth, muscles.
- Vitamin - D is need to help body absorb calcium & Phosphate from our diet.
- Lack of Vitamin - D
- 75% suffer deficiency
- Rickets (Children)
- Osteomalaria (Adults)
Rich Sources:
- Sunlight conversion of inactive from Vitamin - D to active form (UV-B Radiation)
- At least 10 - 15 min of exposure to sunlight in essential per day, dark people need to spend longer than people with light skin
Other Sources:
Oily Fish, Mushrooms, Cheese, Cereal and Oatmeal egg yolks, Milk
Everyone of us goes through the paediatric (childhood), adolescent /adulthood and gaediatric (elderly) phase of our life. We do encounter certain normal deviations, abnormal conditions, traumatic conditions (accidents), sports injuries and degenerative changes/arthritis, last but not the least infections.
Paediatric Age Group
Briefing upon the kids commonly encountered conditions are the knock KNEE - most of the time physiological, bow knees & growth pains (tibial splints) which gradually disappear as the child grows. Need to have a check on vitamin D levels and metabolic disorder, congenital abnormalities to be evaluated. If gross surgical intervention to be done such as growth plate pinning/staples and also the corrective osteotomies (Bony Procedures).
Adults
In adults we commonly encounter patients coming with accidents followed by fracture around the knee & ligament injuries either by accidents or while sporting and few incidents of self fall at home with sudden twisting force.
Most common bony injuries around knee and distal femur fractures, Proximal tibia fractures, patella fractures. Intra articular fractures requires meticulous pre-op planning. Articular reduction is mandatory & should confirm intra op with arthroscopy.
On contrary to the fracture, the ligament injuries & the cartilage defects will be neglected in the initial stage as they start troubling at later dates. Either the knee can be hurt/injured with ligament tears such as ACL tear, PCL, MCL/LCL injury, which mainly cause the instability(giving away). MRI does help in diagnosing the level of injury, grading of the ligament tear and need for the repair.
These ligament reconstructions are the minimally invasive arthroscopic surgeries. Where in the entire knee joint is addressed with 2 to 3 portals. Once the diagnostic scopy is done, and noted with the status of the meniscus, cartilage & the ligaments.
Meniscus repair can be done with the special implants such as fast fix, meniscal cinch, etc. Except for the complex tears where the partial / subtotal meniscectomy will be done.
Most of the times, ligaments such as MCL & LCL injuries occur at the bony attachments and they do heal well with the conservative management with braces.
Stem Cell Therapy
In minimal traumatic conditions and in case of cartilage loss (PRP/BMAC)
In many of the cases in the early stages of osteoarthritis or small cartilage loss/defects, physiotherapy & some medications to prevent further damage and enhance recovery to a greater extent. In small percentage of cases it does require debridement & the latest advent procedures such as STEM CELL THERAPY (PRP/BMAC). Following MRI if required an arthroscopic debridement (wash) will be done & for lesions approx less than 5mm PRP would be done & also if there is partial tear of ligaments PRP injection would enhance healing.
In cases upto 10mm lesions PRP along with fibrin glue would be sticked to the cartilage defect and allow it to heal. Knee bending can be done immediately after the procedure & if there is weight bearing area involved in the procedure, weight bearing will be delayed by 3-4 weeks.
In cases of large cartilage defects 1-3cm & depending upon the area of involvement OATS (Osteo Articular Transfer System/ Osteochondral Autograft Transplantation), if the lesion is smaller damaged cartilage is replaced & transfered from the non weight bearing portions of the knee to retain the best functionality & biologics.
Who needs knee replacement
· Patients not able to stand/walk for 10-15 minutes
· Pain more than 6 months to 1year
· History of difficulty in day to day activity
· X-Ray shows severely damaged joints (GradeIV)
· Medical/Physical Therapy & preservation procedures have not been helpful
· Patients without neurological deficits pain being the main cause for the disability.
Benefits of Knee Replacement
Total knee replacement can increase mobility and decrease pain in people who have an injured or arthritic knee joint. More than 90 percent of patients who have knee replacement surgery experience less pain and greater mobility in their knee after the procedure.
In very few percent of patients where in only the medial (most commonly) are the lateral compartment is involved a Unicondylar Knee Replacement can be done which restore the alignment & balances the Knee from further deteriorating & delaying in the arthritic changes in the other compartments of the knee joint.
Advantages of Unicondylar Knee Arthroplasty
· Smaller incision faster recovery
· Retaining the ligaments retain the natural proprioception
· High flex & patient can be made sit cross legged
· Less bone loss/cuts --> less pain--> less time off the work
Contra indications
· Involvement of the multiple compartments
· Inflammatory/Rheumatoid Arthritis
· Obese patients/short patients
· Ligamentous / Neurological deficits
When a patient has a grade IV OA knee with medial, lateral & anterior compartment involvement with gross deformities patients have to go for the Total Knee Replacement
Navigation helps in determining the size of the implant & the balancing of the knee intra operatively also double checking with each and every cut taken. It has made the balancing more and more precise.
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Consultant Orthopaedic Surgeon,
Srikara Hospitals,#222 & 223,
Mythri Nagar,Phase-II,
Miyapur,Hyderabad-500 049.
Srikara Hospital, Hyderabad.
To Contact: + 91 9177 679 797
E-Mail ID: dr.kirthi.paladugu@gmail.com
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