Posts Tagged "Overview"

Knee replacement in India : overview

Knee replacement in India : overview

Knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The surgery can be performed as a partial or a total knee replacement. And if you are looking for a cost saving surgery, India is your destination. Here not only you are getting best facilities provided by the hospitals compared to the Western and European hospitals, but also very low cost of surgery package. Knee replacement in India is more then half of price that Western or European hospitals quote.

Pre-operative preparation and Technique

Knee arthroplasty is major surgery. Before surgery is performed, pre-operative tests are done. They are complete blood count, electrolytes, APTT and PT to measure blood clotting, chest X-rays, and ECG for possible transfusion. Accurate X-rays of the affected knee are needed to measure the size of components which will be needed Medications such as warfarin and aspirin will be stopped some days before surgery to reduce the amount of bleeding.

The surgery involves exposure of the front of the knee, with detachment of part of the quadriceps muscle from the patella. The patella is displaced to one side of the joint allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The lower part of the knee replacement joint is comprised of a flat metal plate and stem that your surgeon will implant in the tibial bone. A round ended implant is used for the femur, mimicking the natural shape of the bone. On the tibia the component is flat, although it often has a stem which goes down inside the bone for further stability. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable.

Total Knee Replacement Implants A diagnosis of advanced osteoarthritis of the knee will indicate the need for total replacement of the knee joint. Based upon your age and lifestyle, some options are: 1.  Fixed bearing –  The polyethylene cushion may be part of the fixed platform, many people get fixed bearing that dramatically reduce there knee pain. And any last for many years. 2. Medial Pivot - The Medial-Pivot knee replicates the rotating, twisting, bending, flexion, and stability of your natural knee, so it feels more like your natural knee. 3. Rotating platform and mobile bearing – Knee implants imitate the motion of your natural knee. In the Rotating Mobile Knee prosthesis, the polyethylene insert can rotate slightly around a conical post.  It also slides back and forth on the tibial tray.  This allows the knee to twist and turn, as well as move back and forth, flexing and extending. Partial knee surfacing : Partial Knee Resurfacing is an innovative procedure designed to provide quicker recovery and improved surgical outcome for patients with osteoarthritis in only one part of the knee. By selectively targeting the portion of the knee that has become damaged by osteoarthritis, surgeons can isolate and resurface only the arthritic portion of the knee without compromising the healthy bone and tissue surrounding it.                                                                                          This procedure is made possible through a surgeon-interactive robotic arm system. This system allows the surgeon to pre-operatively determine the damaged area of the bone to be removed and to plan the precise alignment and placement of the resurfacing implant specific to the patient’s anatomy. This level of consistently reproducible precision enables surgeons to restore knee function by resurfacing the arthritic defects rather than replacing the entire knee. so it maybe the alternate solution for knee replacement in some cases. Partial knee replacement : Unicompartmental arthroplasty (UKA), also called partial knee replacement, is an option for some patients. The knee is generally divided into three “compartments”: medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most patients with arthritis severe enough to consider replacement have significant wear in two or more of the above compartments and are best treated with total knee replacement. A minority of patients have wear confined primarily to one compartment, usually the medial, and maybe the candidates for unicompartmental knee replacement. Advantage of UKA compared to TKA include smaller incision, easier post-op rehabilition, shorter hospital stay, less blood loss, lower risk of infection, stiffness, and blood clots, and easier revision if necessary. Risks and complications : The most serious complication is infection of the joint, which occurs in <1% of patients. Deep vein thrombosis occurs in up to 15% of patients, and is symptomatic in 2-3%. Nerve injuries occur in 1-2% of patients. Persistent pain or stiffness occurs in 8-23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years. Deep Vein thrombosis

According to the American Academy of Orthopedic Surgeons (AAOS), “blood clots in the leg veins are the most common complication of knee replacement surgery. Your orthopedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood.”

Fractures

Periprosthetic fractures are becoming more frequent with the aging patient population and can occur intraoperatively or postoperatively.

Loss of Motion

The knee at times may not recover its normal range of motion (0 – 135 degrees usually) after total knee replacement. Much of this is dependent on pre-operative function. Most patients can achieve 0 – 110 degrees, but stiffness of the joint can occur. In some situations, manipulation of the knee under anesthetic is used to improve post operative stiffness. There are also many implants from manufacturers that are designed to be “high-flex” knees, offering a greater range of motion.

Instability

In some patients, the kneecap is unstable post-surgery and dislocates to the outer side of the knee. This is painful and usually needs to be treated by surgery to realign the kneecap. However this is quite rare.

Infection

The current classification of AAOS divides prosthetic infections into four types.

Type 1 (Positive intraoperative culture): 2 positive intraoperative cultures Type 2 (early postoperative infection): Infection occurring within first month after surgery Type 3 (acute hematogenous infection): Hematogenous seeding of site of previously well-functioning prosthesis According to a recent review the following tests can be used in the diagnosis of a periprosthetic infection. Conventional radiograph: Rule out other conditions such as loosening and/or osteolysis. Radionucleotide Imaging: Technetium-99m Sulfur imaging combined with indium-111-labeled leukocytes probably offers improved specificity than either test alone. Gallium 67 scans alone have low sensitivity for infection. FDG-PET imaging has been shown to have variable specificity and sensitivity. Serology: Elevated serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) more than three months following arthroplasty are good screening tests. Joint fluid leukocyte counts: A joint fluid white blood cell count of more than 500/?l is suggestive of an infection. Frozen sections of implant membranes: More than five white blood cells/High power field is indicative of infection. Newer tests: Polymerase chain reactions involving the bacterial 16S rRNA have high rates of false positives because they can detect necrotic bacterial debris even in the absence of active infection

Why India:

Indian medical tourism offers you a complete package of surgical treatment in India for specialized healthcare sectors. There are ample of knee repalcement surgery hospitals in India. which provide international medical healthcare facilities to abroad patients. The package shall include: Pre-Operative stay in Specialized Guest Houses, surgical package, which includes domiciliary hospitalization and stay in India, in patient care, post operative medical consultancy with complete healthcare advice. In cases of emergencies / critically ill patients we have state of the art Ambulances well equipped with life saving equipments and paramedical forces. In order to facilitate you Indian medical tourism helps in visa processing, Airport pick and drop and your local travel, they will guide you as per your treatment plan.

Cardiac Rehabilitation ? An Overview

Cardiac Rehabilitation – An Overview

Definition

Cardiac rehabilitation — also called cardiac rehab — is a customized program of exercise and education, designed to help you recover after a heart attack, from other forms of heart disease or after surgery to treat heart disease. Cardiac rehabilitation is often divided into phases that involve monitored exercise, nutritional counseling, emotional support, and support and education about lifestyle changes to reduce your risks of heart problems. The goals of cardiac rehabilitation are to help you regain strength, to prevent your condition from worsening and to reduce your risk of future heart problems. Cardiac rehabilitation programs increase your chances of survival.

Why it’s done

Cardiac rehabilitation is an option for people of all ages and with many forms of heart disease. In particular, you may benefit from cardiac rehabilitation if your medical history includes -

Heart attack Coronary artery disease Heart failure Peripheral arterial disease Chest pain (angina) Cardiomyopathy Certain congenital heart diseases Coronary artery bypass surgery Angioplasty and stents Heart transplant Heart valve replacements

Don’t let older age hold you back from joining a cardiac rehabilitation program. Even if you’re older than 65, you’re likely to benefit from cardiac rehabilitation.

Risks

Cardiac rehabilitation isn’t appropriate for everyone who’s had heart disease. Your health care team will evaluate your health to make sure you’re ready to start a cardiac rehabilitation program.

Rarely, some people suffer injuries, such as strained muscles, sprains or broken bones, while exercising as a part of cardiac rehabilitation. Your health care team will carefully monitor you while you exercise to lower this risk and will teach you how to avoid injuries when you exercise on your own.

How you prepare

If you’ve had a heart attack or heart surgery or if you have another heart condition, ask your doctor about joining a cardiac rehabilitation program. Insurance and Medicare often cover the costs of cardiac rehabilitation.

What you can expect

During cardiac rehabilitation

Cardiac rehabilitation often begins while you’re still in the hospital and continues with monitored programs in an outpatient setting until home-based maintenance programs can be safely followed.

The first stages of most cardiac rehabilitation programs last about three to six months. During that time, you may work with cardiologists, nurse educators, dietitians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists.

Cardiac rehabilitation has four main parts –

Medical evaluation – Initial and ongoing evaluation helps your health care team check your physical abilities, medical limitations and other conditions you may have, and keep track of your progress over time. Your health care team looks at your risk factors for heart disease, stroke or high blood pressure. This helps your team tailor a cardiac rehabilitation program to your individual situation, making sure it’s safe and effective. Physical activity - Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing, or even jogging and other endurance activities. You may also do strength training (lifting weights, for example) to increase your muscular fitness. Don’t worry if you’ve never exercised before. Your cardiac rehabilitation team will make sure the program moves at a comfortable pace and one that’s safe for you, but in general you should exercise three to five times a week. You’ll be taught proper exercise techniques, such as warming up and stretching. Lifestyle education – Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol intake. You receive support and education on making lifestyle changes and breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue you may have. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as sexual activity. Finally, it’s critical you closely follow your doctor’s advice on medications. Support - Adjusting to a serious health problem often takes time. You may feel depressed or anxious, lose touch with your social support system, or have to stop working for several weeks. If you get depressed, don’t ignore it because depression can make your cardiac rehab program more difficult, as well as impact your relationships and other areas of your life and health. Counseling will help you learn healthy ways to cope with depression and other feelings, and your doctor may also suggest medications such as antidepressants. Vocational or occupational therapy will teach you new skills to help you return to work.

Although it may be difficult to start a cardiac rehabilitation program when you’re not feeling well, you’ll benefit in the long run. Cardiac rehabilitation can guide you through fear and anxiety as you return to an active lifestyle, with more motivation and energy to do the things you enjoy. Cardiac rehabilitation helps you rebuild your life, both physically and emotionally. As you get stronger and learn how to manage your condition, you’ll likely return to a normal routine, along with your new diet and exercise habits. It’s important to know that your chances of having a successful cardiac rehab program rest largely with you; the more dedicated you are to following your program’s recommendations, the better you’ll do.

After cardiac rehabilitation

After your initial cardiac rehabilitation program ends, you’ll need to continue the diet and exercise habits you learn during cardiac rehabilitation for the rest of your life to maintain its heart health benefits.

Results

Cardiac rehabilitation is a long-term maintenance program — something to follow for the rest of your life. After about 12 weeks, you probably will have developed your own exercise routine at home or at a local gym. You may also continue to exercise at a cardiac rehab center. You may remain under medical supervision during this time, particularly if you have special health concerns. Education about nutrition, lifestyle and weight loss may continue, as well as counseling. For best success, make sure your exercise and lifestyle practices become lifelong habits.

Over the long term, you gain strength, learn heart-healthy behaviors, improve your diet, cut bad habits, such as smoking, and learn how to cope with heart disease. You’ll also decrease your risk of coronary artery disease and other heart conditions. One of the most valuable benefits of cardiac rehabilitation is often an improvement in your overall quality of life. If you stick with your cardiac rehab program, you’re likely to come out of your cardiac rehabilitation program feeling better than before.

Why consider India?

Cardiac rehabilitation program in India is available at various hospitals in Mumbai, Bangalore, Hyderabad, Chennai and New Delhi at a reasonable price. With India becoming a hottest destination for medical tourism, healthcare facilities that India offers with great expertise includes heart care and heart surgery. Indian hospitals have good infrastructure and is well equipped with all sophisticated investigative techniques and equipments. Cardiologists in India have made several breakthrough researches on cardiology and have performed complex cardiac surgeries that have never happened anywhere in the world. Cardiologists in India are very innovative who can use their skills with great proficiency with success rate of around 98.50%. Indian Hospitals can handle all stages of cardiac disorder and help diagnose, prevent possible cardiac risk. It can also handle high risk patients that need surgeries that are performed using invasive or non-invasive techniques and robotic surgery.
The cost involved for cardiac care in India comes around $8,000 whereas the same service is delivered in the US at a cost of $30,000.  International patients can save more than half the cost if they avail the treatment from India. With medical tourism sector booming effectively in India, patients can couple their heart care trip with visiting some beautiful places across India.