Know about Knee Cap Pain the Patellofemoral syndrome.

 

Knee cap pain is very common in the current scenario and affects mostly young active age group, it is a pain in front and side of knee cap, usually aggravates while walking up and down the stairs, squatting or kneeling, also knows as runners knee.

The other name of this is movie goers knee or people who do sedentary office desk top work as they keep their knees bent and it leads to pain.

 

The main reason of misaligned knee cap(patella) where the cap is not tracking accurately in its groove and the extra friction  leads to cartilage injury and in long run arthritis.

The multiple causes of PFC are:

Low back –irritated nerves which lead to weakening of butt (gluet) muscle and quadriceps which makes the quadriceps weak too and lead to friction and loss of cartilage.

Hip issues: studies have shown that biomechanics play a major role with foot turned in (internal rotation) or foot turned out (external rotation) can cause the groove for patella in femur bone to be misaligned https://www.ncbi.nlm.nih.gov/pubmed/20436239, this study explores how too much rotation of femur groove inside will track the knee cap to the outside and cause misalignment.

VMO muscle weakness (inner thigh muscle weakness) allows the knee cap to move too far to the outside

Patellar trauma:

Injury to the undersurface of the knee cap or the cartilage can cause arthritis

Hamstring stiffness and ITB over tightness can lead to knee cap and meniscal injury

Management and treatment:

IT involves joint preservation mechanisms  along with interventions which are done under regenerative medicine techniques, which involve injecting super concentrated platelets and mesenchymal cells which are taken from iliac crest and have similar activity as stem cells under imaging followed by a well structured rehabilitation programme for better outcomes.

 

 

Preventing shoulder rotator cuff injuries

Rotator cuff tears are very common and more than 10 to 15% of population above 50 and more than 25% active population or athlete’s  will suffer one of the rotator cuff tears or damages.

It affects all as shoulder is a highly mobile structure so from sedentary adults to weekend warriors and prime elite athletes everyone gets affected due to rotator cuff injury.

But here are steps that can be taken to reduce the injuries, specific exercises, ergonomic correction, stretches, conditioning and isometric strengthening helps you prevent your shoulder girdle from getting injured.

MOST COMMON REASON FOR SHOULDER INJURY IS OVERHEAD ACTIVITY.

For sports men, cricket player’s tennis players, trying to lift weights overhead without shoulder muscle activations, are the commonest causes of rotator cuff and AC joint injuries and pain.

Teachers writing on black boards, house wife who repeatedly keep reaching out to overhead cabinets while working in kitchen all injure their shoulders one way or other leading to nagging pain in the shoulder which is on the side and makes It difficult for you to sleep on one side and perform basic routine activates like combing hair, to unhooking the clips of the clothing.

EXERCISES HELPS IN PREVENTION OF SHOULDER INJURIES.

A good  shoulder exercise program which does not focus on just weight training or aerobics but should include, isometrics holds, chest and pectoral muscle stretch, with mobility exercises and strength training will help in both preventing and also healing the shoulder injuries.

 

TREATMENT OPITONS FOR ROTATOR CUFF TEARS.

CAN IT HEAL WITHOUT SURGERY?

Yes in a lot many cases non-surgical options are the way to go for mild to moderate tears or even complete tear without retraction of muscle fibres.

Opting out for AXIS ORTHOBIOLOGIC procedure where we use your own blood and cells and implant them on same day under usg and x ray guidance has shown to have a faster recovery from pain and less down time for athletes to get back to active games following our state of art orthobiologic treatment. Rotator cuff tendinitis treatment, rotator cuff bursitis all can be easily be cured with orthobiologic interventions and physical therapy after that, there is not much evidence for surgical decompression or artho scopy repair unless the tear is massive with tendon fibres damaged to an extremely severe level.

 

 

 

                                        AXIS SD OB*PROCEDURES                                                  SURGERY

Return to daily                 a week                                                                         4 to 6 weeks

Routine

 

Return to Sports           2 to 3 months                                                                   6 months plus

 

During recovery                  physiotherapy 6 weeks &                                  PT for months, less

Time post procedure  over counter pain med and brace                             driving and limited rom

 

Done same day                        Yes                                                                          needs IPD admission

 

Rotator cuff intact                  Yes                                                                                   NO

 

SD OB= Same day ortho biologic procedures.

 

We at AXIS always thrive for the best treatment solutions for our general public and elite athletes and DR Madhur Chadha our main lead in regenerative and sports science leads it from the fore front to develop tailored made programs for you to get back to active routine as soon as possible after a shoulder injury.

LIGAMENT INJURIES

A ligament is made up of specific fibres, like an elastic rubber band which connects a bone and a cartilage, a bone to a meniscus, a bone to a bone, ligaments are very strong and when a ligament is stretched or torn it is called a sprain.

 LOCATION AND COMMON CAUSES OF LIGAMENT TEAR AND SPRAIN:

Any movement which causes extreme or unnatural turning and twisting can cause the ligament to undergo extreme stress and leads to sprain or a tear. The most common ligaments affected are

Knee:  The main ligaments of knee are anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament and lateral collateral ligament, the ACL is the most commonly injured ligament and the lateral collateral ligament injury treatment involves treating the illio-tibial band along with the ligament.

Ankle:  In ankle the inversion injuries that is ankle bending inwards causes more common injury to the lateral ligament injury complex which includes anterior talofibular (ATFL), calcenofibular and posterior talofibular (PTFL) ligaments. The medial deltoid ligament is lesser common. A high ankle sprain is more common in athletes and involves the distal tibiofibular ligaments

Wrist: The most common ligament injuries in wrist is the triangular fibrocartilage complex (TFCC) and the scapholunate ligament

Shoulder: shoulder joint is kept stable with different ligaments and any dislocation of the joint can cause injuries to these ligaments the common are Superior glenohumeral ligament and inferior glenohumeral ligament, usually using regenerative medicine protocols to tighten these ligament are sufficient to heal them

Along with these ligaments of back illio-lumbar ligament of spine, the interspinous ligament is common to undergo sprain and whiplash injuries causes’ injury to the neck ligaments as well.

Diagnosis and treatment of ligament injuries

Usually clinical examination history and using imaging modalities like real time musculoskeletal examination using ultrasound gives a good picture of the grade of tear and sprain and along with it MRI can be ordered to have even more accurate diagnosis

The grading of sprains/tears are done as follows

Grade 1; mild sprain with some changes in fibre structure but no tear

Grade 2: swelling some fluid collection with partial tear with no joint instability

Grade 3: complete sprain and tear with joint instability

Ligament injury Treatment

For any acute and mild to moderate grade 1 and 2 tears first line of treatment is conservative using RICE approach (REST, ICE, Compression  and elevation) once the swelling has subsided over some days advanced management can be planned  which includes minimally invasive injections.

For mild to moderate ligament injuries (grade 1 and 2 and some times grade 3)  treatment like ACL, lateral collateral ligament injury treatment, TFCC (triangular fibro cartilage of the wrist) and ankle ligament sprain  is done using the best and most advanced treatment modality that is using orthobiologics and regenerative medicine protocol, where under image guidance and with precision specific blood products are injected to the tear site which helps in healing and getting the strength of the ligaments back, this ligament tear treatment using your own cells has advantages of less down time, faster recovery no scar and less complications which are associated with surgery.

Surgery is only required in very complex cases of ligament tear where the ligament has totally torn and no fibre connection is seen on MRI and has retracted more than 5 to 6 mm, even then if you want can avoid surgery unless there is instability in the joint as surgeries come with their own risk and also aggravate arthritis development in longer stages.

Stem Cell Interventions for Knee? Where do we stand!!

These days orthobiologics and regenerative medicine  for musculoskeletal  pain conditions is making a big stride across the western hemisphere and also finding its roots in south Asia, but few questions always crop up how effectively stem cell work for knee? Can they repair knee cartilage? How long they last?

How this idea of injecting same day stem cell (orthobiologics) Come into existence?

Usually patients with moderate to severe knee arthritis are generally offered traditional remedy, mainly surgery if they fail to get better with physiotherapy and basic medicines, In Indian subcontinent option of surgery is given even a bit earlier due to various factors, in western studies approximately 7 lakh knee replacement were completed in 2006 alone in USA and that number was set to rise to 3.5 million annually by 2030 (1)

In India the incidence of Knee OA is around 28-30% for a population of over a billion, which makes it an epidemic if you look at it closely (2)

This is a big surgery, and though very safe due to advances in the techniques, a recent study demonstrated that in many patients the procedure did not work that well as expected (3), the problem was patient selection, younger age who are more in more age active group, plus the understanding that knee pain in OA is more complex than previously considered.

So the idea of knee stem cell came into play almost two decade back, which is less invasive, and pushes back the need for a knee replacement for years together in middle age group and younger till they are more older, and is also helpful in patients who do not want to undergo knee replacement by mitigating their pain for few years.

What do they do?

Lot of claims that it regenerates the knee cartilage, which is of course not right, most of publication is coming from same day BMC (bone marrow concentrate)(4) where, stem cell are obtained from your iliac crest on hip and after same day centrifugation re-injected on same day, it has shown to help small tears, cartilage defects by improving the microenvironment  and a positive view in MRI images (5,6), it helps by changing the chemicals in knee joint, improving your pain, improving the quality of remaining cartilage, avoiding fast progression of the knee arthritis , thus it makes the knee more healthier, so it does not regrow, but helps in improving the general health of knee joint which is more than just bone on bone.

How long does it last?

Studies have shown the beneficial of one time same day Bone marrow stem cell intervention to last anywhere between 2-7 years, depending on your wear and tear your activity level.

Reference:

  1. Kurts S, Ong K, Lau E, Mowat F. Projections of primary and revision hip and knee arthoplasty in United states from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr; 89(4):780-5.
  2. Chandra Prakash Pal, Pulkesh Singh. Epidemiology of Knee Osteoarthritis in India and related factors, Indian Journal of Orthop.2016 Sep;50(5):518-22.
  3. Ferket Bart S, Feldman Zachary, Zhou Jing, Mazumdar Madhu et al. Impact of total knee replacement practice: Cost effectiveness analysis of data from Osteoarthritis Initiative BMJ 2017;356.
  4. Centeno CJ, Jusse D, Kisiday J Karli D. Increased knee cartilage volume in degenerative joint disease using percutaneoulsy implanted, autologous mesenchymal stem cell. Pain Physician.2008 May-Jun;11(3):343-53.

Vangsness Ct Jr, Farr J, Boyd J, Dellareo DT, Mills CR, LeRoux-Williams. Adult Human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double –blinded, controlled study. J Bone Joint8. Surg

AC JOINT SEPERATION

BASIC OF AC JOINT: IT is a prominent joint which is visibly seen  and made up of urn collar bone (clavicle) and acromion a part of the scapula the shoulder blade bone, it’s a prominence in front of the shoulder when you trace urn collar bone.

What is AC joint separation or shoulder separation.

It is a very frequent injury among athletes , physically active individuals , in this the collar bone (clavicle) separates form the scapula (shoulder blade), cause is due to a fall, a direct impact injury mainly seen in cyclist, runners, football players or contact sports.

There are different types of AC joint separations:

Grade 1 AC joint Separation:  Grade 1 is a mild form of displacement, this is where AC ligament may become partially torn or merely stretched, usually the symptoms are mild pain, tenderness on touch and some difficulty and pain when moving the shoulder, Grade 1 AC joint separation treatment is usually conservative , includes physical therapy along with use guided injections of super concentrated prep into the ligaments, it maintains the integrity of the ligament.

Grade 2 AC joint separation: In this there is partial joint dislocation with the acromioclavicular ligament being torn completely, though the coracoclavicular ligament is still intact, in this the patient may experience moderate to severe pains around the shoulder, some visible swelling  and also the movement of clavicle is more pronounced as the ligament which supports the clavicle acromial joint is torn, Grade 2 AC joint separation treatment is again focused on minimally invasive interventions including using your own concentrated cell therapy with high concentrated PRP, these regenerative medicine protocols and orthobiologics help in preventing further damage, maintains the integrity and with a good physical therapy protocol over time  most of the function is restored and pain is completely under control.

Grade 3 AC joint separation: in this there is complete tear of both the ligaments supporting the AC joint, the acromioclavicular and coracoclavicular are both torn, there is instability and also a visible bump on the shoulder, patients present with severe pain, popping sound, a visible deformity is appreciated in the shoulder region, the person needs support his arm by the elbow and will need a sling to avoid more movement.

The treatment of grade 3 AC joint separation is usually surgery, but with growing evidence pouring in a meta-analysis, researchers found out that a fusion surgery for high grade separation does not make any major significant difference in comparison to the group of other patients which same issues who were not offered any surgery, the group who dihttps://journals.lww.com/jorthotrauma/Abstract/2018/01000/Operative_Versus_Nonoperative_Management_of_Acute.2.aspxd not undergo surgery returned to work faster and had fewer complications too in the long run

So a good approach for treatment of AC joint separation is using a combination of interventions like PRP ( super concentrated platelets) cell therapy and physical therapy which yields better results and is more effective with less down time.

Osteoarthritis in young adults, why is it happening so soon and how to prevent?

Osteoarthritis is a progressive disease of the joints in which the cartilage which cushions the bones and absorbs the shock wears down, causing pain, stiffness and swelling around the knee joint, in over period we see a bone on bone phenomenon.

According to Indian data millions of patients are suffering from OA knee with a prevalence rate of 25 to 35% of which women are more common than men(C p PAL IJO 2016, 10.4103/0019-5413.189608)

Making it one of the most common arthritis in India, though it is age relegated but nearly 18to20% of arthritis is from injury to abjoint or posttraumatic arthritis and this is not only restricted to athletes layman and general public are also not spared the trauma of it which happens due to repetitive stress injury, over weight and genetics.

We need to understand that our knee is just not bone and cartilage but a complex structure formed of ligaments, soft tissue, tendons, nerves and fat and any event which can destabilize or injure any one of the structure can lead to early arthritis in the younger age group the main components which trigger these events are.

A. Injury to the ligaments

B. Injury or damage to the cartilage

C. Meniscal tear or tear of the labrum

D. early arthroscopy procedures in the young adults which increases risk of OA manifold.

Recent paper in Journal of Athletics Training highlights how small injures to the joints can get blown up into full arthritis over the period, eg a small rent in cartilage or meniscus can lead to bone swelling and can in turn put more pressure on the spot leading to multiple rents in cartilage and end up damaging the surrounding ligaments and joint structure, the single biggest issue which we can fix and can prevent early arthritis in knee is instability, which is easily diagnosed on dynamic use scanning and education of few points.

The person suffering from popping sensation and cracking in knee sounds but no pain is a potential arthritic patient in long run and should be evaluated by a regenerative and musculoskeletal physician who understands instability of joints better.

We see a lot of patients with these instability issue and opt for stress mask USG to identify the instability and the loose ligaments, if you had some knee injury in recent times and suffering from such issues we opt for PRP for ligaments to strengthen and tighten the ligaments and cartilage to provide better stability to the joint in order to prevent OA later stages.

 

Foods to ease Arthritis Pain

10 Foods To Ease Arthritis Pain

Foods To Ease Arthritis Pain

Arthritis, where “Arthr” means joints and “itis” means inflammation. So any kind of persistent joint inflammation qualifies as arthritis. If you feel pain & stiffness around your joints or have trouble moving around you might have Arthritis. There are different types of arthritis like rheumatoid Arthritis, osteoarthritis, gout, and so on depending on the cause.

If you suffer from Arthritis, there are certain nutritionally powerful foods that can ease your joint pain and slow down the progression of the Arthritis. Here is list of some food item commonly used in our kitchen which eases arthritis pain and inflammation.

food to ease arthritis

1. Fruits: All the fruits have health benefits however some have components that help lower inflammation associated with arthritis. All kinds of berries like blueberries, raspberries, strawberries, cranberries are loaded with antioxidants & ascorbic acid which provide arthritis – fighting power by reducing the risk of inflammation.

Pomegranates are rich in tannins and can fight the inflammation of arthritis. Watermelon reduces the risk of low levels of inflammatory marker CRP (C reactive Protein) and can reduce the risk of rheumatoid arthritis. Avocados & tart cherries also have good anti-inflammatory effect and decrease the risk of joint pain in osteoarthritis. Include these fruits in the diet for good joint cushioning & ease in pain.

2. Vegetables: Consumption of anti – inflammatory vegetables like cauliflower, broccoli, cabbage can help the patients to manage Arthritis. These veggies are part of the cruciferous family, and they are full of a compound called sulforaphane, which helps slow cartilage damage in joints. Beans like red beans, kidney beans, pinto beans can help lower your levels of C-reactive protein (CRP — a sign of inflammation).

3. Whole grains: Incorporating variety of whole grains such as sorghum, rice preferably brown rice, whole wheat flour, millets, barley, quinoa into your diet can add extra nutrient and may help lower CRP levels.

4. Oils: Extra virgin olive oil contains oleocanthal which has anti – inflammatory properties. Canola oil, Walnut oil & fish oil are all rich sources of omega 3 & 6. As many researches showed that Intake of omega 3 slow down the production of chemicals that raise inflammation and it block the enzymes which trigger it.

5. Spices: Turmeric contains curcumin and ginger has chemicals which help to reduce inflammation and improve RA symptoms. Both the spices are widely used in Indian & Chinese cuisine.

6. Nuts & Seeds: Walnuts, flax seeds, chia seeds & sunflower seeds are excellent source of Omega 3. Researchers studying their effects have found they lower C-reactive protein (CRP), a marker of inflammation linked to increased risk of arthritis and cardiovascular disease.

7. Fish: Fatty fishes like salmon, herring, sardines, and mackerel are all rich source of omega 3 which can decrease inflammation. Fatty fish also contains Vitamin D, which help prevent swelling & soreness. Include twice a week in your diet and don’t overcooked it.

8. Garlic & Onions: This allium family contains sulfur, which help to fight joint pain & reduce inflammation. Healthy joints depend on healthy cartilage. Inflammation can cause cartilage and joint damage.

9. Green tea: Researches show that certain anti-oxidants present in green tea reduce risk of severity of arthritis. Include non – decaffeinated green tea as decaffeinated version requires processing that will wipe off certain good nutrients.

10. Probiotics: Probiotics can reduce the progression & symptoms of the disease. So incorporate curd, kefir drink & kombucha tea in your diet.

Sciatica

What Is Sciatica?

Sciatica uncoded

It is quite common that a back pain is accompanied by a leg pain or a progressive numbness in the legs. But, for those people, taking back pains for granted, this new weird kind of pain forces them to seek medical help. This running pain down the legs is commonly referred to as Sciatica. It may affect people of any age group but it is mostly common among the working age group.

Sciatica

The term Sciatica originated from Sciatic nerve, which is the main nerve controlling sensations and the movements of our lower limbs. The nerve is made from many smaller nerve roots coming out of the lower spinal cord which in turn join hands to form the sciatic nerve. We refer to pain sensations perceived in the region from where sciatic nerve carries signals, as Sciatica. Since sciatic nerve is made from different nerve roots, any irritation of a single root can also cause sciatica. Even a small inflammation affecting the nerve roots or anywhere along the course of sciatic nerve would cause sciatic pain.

Reasons of sciatica

Slipped disc or disc herniation:

spinal disc herniation

This the most common cause and one generally comes across in working individuals. This is caused due to tear in the covering of the disc through which some of the disc material comes out. This initiates severe inflammation which irritates and puts pressure on the neighbouring nerve which results in chronic back pain with a pain running down the legs.

Degenerated spine:

Spinal Canal Stenosis

This is more common among elderly population where due to ageing there occurs some changes in form of growth of tissues in the spinal canal. This narrows the spinal canal where the spinal cord rests. Eventually, this starts compressing on the nerves so much so that the person gets pain or heaviness in legs after walking for some distance. This is a progressive condition where the person cannot move without pain.

Inflammation: Many a time inflammation in the lower back muscles from usage or some trauma leads to tensing of the muscles and generate pain in pelvis and legs. Other joints of pelvis and lower discs if inflamed due to some infection or trauma may also cause pain in the legs.

Spinal canal

There are many methods apart from the clinical examination, which is the most important, for the diagnosis of sciatica. Mri of the spine and electrophysiological studies of the nerve helps in defining the area of conflict which is causing the pain. These areas are then specifically treated for the relief of the symptom due to the nerve compression.

Treatment for sciatica:

Traditionally sciatica was treated conservatively especially in the younger population. A surgery was avoided in view of the risks involved. And this reason applied to both the surgeons and the patients to avoid a surgery even if it meant living with some pain. But when the pain didn’t improve or the progressive numbness or weakness in the legs ensues it becomes necessary to do an open spine surgery. And this is followed till date and practised.

sciatica treatment

During the recent time the newer ways of treatment for the same conditions came into being in form of minimally invasive endoscopic procedures where the same objective is achieved without cutting open the spine or damaging its integrity. These so called interventions are much safer and carry minimal risks to the patient. This could be said to be a treatment which addresses the fears of the patient yet treating him effectively. These stitchless endoscopic procedures are intended to be targeted and precision driven. The lesser invasive nature causes lesser collateral damage in return and enables the patient to go home in a short time after the surgery just like a sci- fi movie.

Staying pain free is a human right and I believe no one should be left out with a chance to treatment especially the working and the elderly people who are left out citing the complications of an open spine surgery. This fast growing minimally invasive interventions would definitely bring a positive change and a ray of hope in the lives of people who are living with pain of sciatica.

bursitis

What Is Bursitis?

What is Bursitis Doc?

what is bursitis doc

It is one of the most frequently used term used during any Consultation done for joint pain, often patients they failed to understand. So here we are to address this issue today so that none of our followers remains unaware and could discuss this matter with more confidence with your clinician.

Definition – Inflammation of the bursae is called as bursitis. Typically, bursae are the fluid-filled spaces at joints and muscles and helps in cushioning or greasing.

These are part of normal structure that vary in size and located around joints across body and contain varying amount of fluid depending on the locations, like in joints its volume is around several ml whereas in muscle’s its so minimum that we need to take help of sophisticated imaging to see them. As discussed, these are normal part of system but it becomes significant when its inflamed and start signalling us in the form of Pain.

Most Common Locations of Bursae –

The most common locations where we can find them are

elbow
Elbow
hip
Hip
shoulder
Shoulder
knee
Knee

 

 

 

 

 

 

 

 

 

 

 

 

Although there are neumerous other places but in clinics, almost 90% of patients present with these joints.

How to find if it is troubling you (Diagnosis)

There are few tips and tricks to diagnose it with good probability

  • Affected joint will look swollen
  • Very painful movement or when you press that joint
  • You won’t be able to lie down on that side
  • Redness maybe there
  • Feels stiff with movements.
  • There might be some rashes
  • Pain that gets better with rest and ice, get worse with work

When it comes to definitive diagnosis we have to take help of advanced imaging like – MRI or MSK – Ultrasound (Xray are not really helpful).

Bursitis – Causes and Treatment

Basically it developes due to over stress or repetitive stress injuries, trauma, Inflammation due to diseases (diabetes, arthritis, overweight and others), age, Occupation. Bursitis is simple to treat but it takes time depending on causative factors. But before treatment we would like to emphasise on Prevention as it’s the best cure. To prevent Bursitis to happen keep few things in your Mind, use paddings to distribute pressure, if you are putting a lot of pressure on joints (elbow – software professionals), ergonomic consideration while lifting weights, maintain your body weight in normal range, take frequent breaks during repetitive gestures, stretch and exercise properly. We assure you if you follow these advices you will never have to reach us. For person who is already suffering we have solutions for them like –

Medications –

Medicines like pain killers and antibiotics can do wonders in selected patients. (cautious use is recommended and please do not self medicate)

Physical Rehabilitation –

One of the important pillar of treatment which helps our patient naturally and without any side effects.
Assistive devices like canes or crutches may help you in coming out from it.(cautious use is recommended)

Steroids Injection And Surgery –

Although many clinicians prefers these options but we will recommend strictly not to go ahead with them as they are associated with wide variety of side effects and complications.

Regenerative Medicine –

One of the nobel and natural way of treatment. There are wide spread data available from many reputed universities and now is the preferred and most advanced treatment option to handle these situations. Regenerative therapy options like Plasma Lysate, PRP (Platelet Rich Plasma) and SCP (Super concentrated Platelets) are US-FDA approved and recommended options for bursities nowadays.

If you think you have bursitis kindly visit your doctor and ask them – what is bursitis doc, and discuss these things with them. Stay healthy.

Corona Era and Surgery

Corona Era & Surgery

How Coronavirus ban on elective surgery is teaching us that many patients need not undergo the knife for common surgeries.

Most Of the Elective Surgeries Are Not Needed And Can Be Avoided

As per the directives from the Indian government in the wake of the Covid 19 pandemic, most of the elective surgeries have been either postponed or cancelled in the hospitals across the country. This situation has compelled many of us to introspect on the surgical need for many of the ailments done before.

It has been observed that around 60% of surgeries in an urban area like Delhi are elective in nature and 80% of them are carried out at private hospitals/nursing homes as per the study stated below

View Research Report

Elective surgeries are those which are planned and does not impose any life threat if not operated immediately. The surgeries we want to highlight are the elective surgeries like joint replacements. These surgeries are non-urgent in nature. As most of the insurance companies provide coverage for these surgeries, they are becoming more common. It may not be entirely because the patients need them but it has become a market driven proposition which is governed by the manufacturers selling the expensive artificial joints. The average waiting time for these elective cases in public and private sector has huge variation from few days to months and that’s the burden it creates on the healthcare system.

According to a study by IKHS (Indian society of hip and knee surgeons) the average age for people undergoing knee replacement was around 55 to 60 years and in 90% of the cases the cause was osteoarthritis (OA). Now considering that OA can be managed very well with other conservative approaches including exercise, weight control, regenerative medicine where one’s own cells and platelets are injected in the knees to help the knees from becoming worse and controlling pain, why this high surgical conversion at an early age is emphasized. It is a known fact that a knee implant too undergoes wear and tear and have a life of around 10 years. On top of it the complication rates from any surgery are in tune of around 20 to 30%. Then why to rush for a surgical option especially when the joints are in a salvageable state? The answer is very simple. The focus of current healthcare system is more surgery centric and neglects on patient education tool, pain management, regenerative medicine, physiotherapy and weight loss programmes. As the companies provide reimbursement /insurance coverages for knee replacements and not for other much more important aspects of the treatment, the medical market is more enthusiastic in getting a surgery done and not pro for more effective conservative approaches.

exercise for joints
Exercises For Joint Mobility And Health

Studies comparing elective knee replacement surgery with physiotherapy (View Research Report) where a specific group underwent knee replacement and other was managed by exercise and weight control showed that those who did not undergo surgery also improved and almost 2/3 of those patients avoided surgery all together over a two year period.

Similar studies of using one’s own blood products and cell therapy showed good response in patients with knee OA compared to just physical therapy (View Research Report) which makes us conclude that surgery is not the only option when it comes to elective cases for knee pains, shoulder pains, tendonitis, frozen shoulders and rotator cuff tears.

cell therapy for arthritis
Precision Image-Guided Cell Therapy For Arthritis

Post covid (corona) era

At Axis Clinic which provides both non-invasive to minimally invasive procedures, we strongly believe that education will be an important tool that has to be used to make people aware of treatments available for joint pains. It is worth important to remember that elective surgical demands peak when surgical consultations are high and they never provide you with an alternative management strategy. In other words the expertise governs the treatment.

Secondly with the shooting costs of healthcare system, people would not be able to afford most of elective surgeries out of their own pockets. Lastly, insurances coverage might take a mighty dip and will not be able to cover a lot many surgeries. Over the time people will also start realising they do not need most of the elective surgeries being offered. This would be the dawn of educating the public in the right direction and giving them an alternate system to take care of their joints, ligaments, tendons and musculoskeletal spine and joint injures.

As we are focused on flattening the curve of corona virus to yield better results in time, we will realise that flattening the curve for elective surgeries is as effective as we don’t need so many surgeries to makes us better. If this curve of elective surgeries could be flattened, it can help billions of rupees which can be saved on unnecessary surgeries and improving the medical health of the population and making them more active without undergoing any open surgeries.