On 25 Jun, 2023, Seniors Today hosted their weekly Health Live webinar with Dr Siddharth M Shah, a Consultant Orthopaedics and Joint Replacement Surgeon at SL Raheja Hospital, Mumbai who spoke on and answered questions about Managing Bone Health in Seniors.
About Dr Siddharth M Shah
Dr Siddharth M Shah is a Consultant Knee and Hip Replacement Surgeon with over 15+ years of experience. He has trained extensively in knee and hip surgery (including computer-assisted and robotic surgery) at world-renowned centres in the UK, Australia, Singapore and the US with eminent surgeons . He has a vast experience with over 2000 knee and hip replacements which include partial and total joint replacements, as well as complex and revision joint surgeries. He has published several pioneering research papers in leading international journals and has authored various textbook chapters. He is a reviewer for many high-impact international journals. He has presented his research at prominent global and national conferences and has several awards & recognitions to his credit.
In the present times of technology and information available online, patients are more specific with their complaints. But the problem is that the information that is available online and on other social media platforms is uncontrolled information. It mayn’t be specific to their problems, but people do often misinterpret them as their own and oftentimes self diagnose themselves. It is suggested that you leave the decision making on the consulting physician/ specialist. When you visit the hospital, only present your chief complaints and a detailed history and leave the rest to the doctor.
Knee arthritis is one of the most common problems that affects seniors.
Arthritis is the inflammation of a joint. Inflammation can occur in any joint. The knee is one of the most commonly affected joints.
Causes of arthritis:
- The commonest cause is osteoarthritis. Osteoarthritis is due to wear and tear.
- Rheumatoid arthritis- autoimmune
- Post traumatic arthritis- malunion of an old fracture
- Infection
- Gout
- Genetic component
Knee osteoarthritis, as stated earlier, is due to wear and tear of the joint. As one grows in life and years, as you use and move your joints, the cartilage in the joint wears out. Once the cartilage wears out, the bones can no longer glide smoothly over each other resulting in pain and inflammation.
Prevalence: 30 %
It affects people over the age of 50 years of age.
It is more common in women than men.
Definitive treatment for advanced knee osteoarthritis is knee replacement.
Every year, nearly 1.5-2 lakh knee replacement surgeries are performed in India.
97% of all knee replacement surgeries in India are all due to knee osteoarthritis.
Symptoms of osteoarthritis:
- Pain around the knee joint
- Swelling around the knee
- Sound/ noise of cracking from the knee
- Deformity in the knee joint
- These symptoms tend to affect the activity levels of the individual
Risk factors of osteoarthritis:
- Obesity
- Diabetes mellitus- high blood sugar levels make the cartilage brittle
- Shape of the legs
- Sports injuries
Things that you can do, once you’ve been diagnosed with osteoarthritis of the knee
- Weight reduction and control
- Avoid sitting on your knees and squatting
- Engage in physical activities and physiotherapy
- Keep your blood sugar levels under control
- Cease smoking
Possible treatment modalities:
- No definitive treatment is available to restore worn out cartilage. The aim is to avoid any further deterioration
- Analgesics/ pain killers- judicious use is advised
- Steroid injections
- Platelet injections- these too have a limited time period of effect and are short lived
Misconceptions about knee replacement surgery:
- Delay knee surgery as much as you can- false. The quality of implants and materials today are very good and can last for over 30 years. It is better to have a good quality of life rather than delaying surgery.
- Success rate of knee replacement is low- the success rates are as high as 95%
- It is painful- multiple modalities are available to make you comfortable after your surgery
- Long recovery periods- most patients can walk independently within a month of surgery
- Obese patients should not undergo surgery- also false, if you are fit to undergo surgery after the PAC, you can undergo the surgery. Age is no bar.
Lower back pain is another common complaint often experienced by the seniors.
Some patients also complain of radiation of pain to the leg from the lower back.
Claudication- after walking a certain distance, there is either pain, heaviness or numbness which compels the person to sit down. Symptoms improve on rest. This is seen in patients with advanced spondylosis.
Common causes of back pain:
- Degeneration
- Wear and tear
- Spondylosis
- Slip disc
- Osteoporosis- spine bone is the most common fractured bone due to osteoporosis. Certain cancer medications/ drugs can also increase the risk of osteoporosis. It also progresses quickly in post menopausal females.
- Infection
- Cancer- primary or metastatic
Things that you should and shouldn’t do:
- Rest
- Avoid too much rest/ complete bed rest as it may cause further weakening of the muscles.
- Posturer modification
- Avoid lifting weights. If absolutely necessary, bend at the knee and then lift
- Avoid sitting for too long in the same position
- While getting up from bed, turn and then get up
- Avoid soft mattresses
- Weight control and reduction
Treatment:
- pain control and analgesia
- Injections in the spine
- Surgery- usually indicated in radiculopathy / involvement of nerve
