Press Coverage

With recent advances like computer navigation and patient specific instrumentation, knee replacement surgeries have emerged as an effective and viable option for knee arthritis, said Dr Nishikant Kumar, consultant(orthopaedics) at Paras HMRI Hospital, while speaking on ‘An insight into knee arthritis’ at NABARD in Patna.

With increase in risk factor like lack of exercise, wrong food habits and a sedentary lifestyle, arthritis – a disease traditionally associated with older age groups – is inflicting people of increasingly younger age groups, Dr Nishikant Kumar, consultant(Orthopaedics) and joint replacement surgeon at Paras HMRI Hospital. Dr Nishikant was giving a presentation on ‘ An insight into knee arthritis’ at NABARD Patna, on October 13 just a day after World Arthritis Day.

“ Diseases that inflicted 60year age group are now inflicting 40 Years age group, and it’s alarming. Primarily, in those Diseases where advancing age does not play the major role, Wrong lifestyle ups the susceptibility,” he said. Discussing the types of arthritis and their treatment and management options, Dr Nishikant said, “ Arthritis can be categorized in non-inflammatory(osteoarthritis) and inflammatory(rheumatoid arthritis and ankylosing spondylitis, septic  arthritis and gout), and while the former is more common in older age groups, the latter is in the blood and age has no role to play in it.”

He elaborated on rheumatoid arthritis and ankylosing spondylitis, explaining about the criteria and diagnostics tests like Anti- CCP antibody and MRI respectively. He finally touched upon osteoarthritis, which is a degenerative disease.

“The symptoms of osteoarthritis include medial and anterior compartment pain in the knee, which basically translates into pain in climbing stairs, Pain in getting up from a sitting position, etc. The other symptoms include stiffness , instability and deformity of the knee, mostly towards the inside,” Dr Nishikant pointed out. The best way to deal with this is quadriceps and hamstring strengthning exercises, he said.

In Response to an audience’s query, DrNishikant impressed that calcium and vitamin D have Zerorole to play in osteoarthiritis treatment. He further pointed out that intra-articular injection like steroids, visscosupplementation and platelet rich Plasma(PRP), which are generally advised in many cases, have not been proven to have much efficacy in curing osteoarthritis. Similar in the case with medicines; their effect is as yet unproven.

Dr Nishikant also shared interesting but pertinent insights, pointing out that the practice of wearing knee braces for long periods to minimize the load on the affected knees is actually counterproductive. He held an interactive session at the end of the presesntation, whwerein the audience was askes to discern the myths from the facts from a set of commonly flung- around statements. Myths included:Osteoarthiritis can be treated with medications, patients with osteoarthiritis should avoid exercise and rest more; while facts included: Exercises are useful, Knee replacement is a viable option, etc.

He then progressed to discuss in detail the misconceptions about total knee replacement(TKR), debunking myths like patients can’t sit cross legged after TKR, it cannot be performed in severelydeformed knees, etc. He also stressed that age is not a criteria for knee replacement- rather pain and deformity is.

Emphasizing that computer navigation TKR(or CAS as it’s commonly called) is any day better than conventional TKR, Dr Nishikant pointed out,”Similar to wheel alignment in a car, a poorly aligned knee joint is prone to early wear and discomfort to the patient. Computer navigated system is an additional check to confirm proper alignment of the knee joint. It helps maintain proper mechanical axis of the limb, reduces the chances of human error, reduces intra-operative time,reduces complications to minimum and endures proper recovery.” He elaborated on the two techniques of CAS: Pinned and Pinless navigation. While the former entails a slight risk of post-operative fracture, the latter is risk free. This recent technique is a boon for patients who have some implants placed around knee due to trauma.

The orthopaedician discussed other latest advancements in orthoarthritis treatment, like patient specific indtrumentation where a CT scan of the patient is done and a customized mould is made to ensure accurate bone cuts and better results. Gender Knee, made specifically for females keeping in view  theiranatomical configuration, and custom made knee are some of the other advancements to ensure effectiveness of treatment, he said. He also stressed that with recent inclusion of multi-radii knee implant and highly cross linked poly, the wear rate is minimum and knee lasts longer.

As well done TKR lasts more than 25 years, said Dr Nishikant. He shared that he had performed the firstpinlesscomputer navigated TKR of East India recently at Paras HMRI Hospital. He signed off on a cheeky but wise note—“Support your bones; they support you!”

 I would like to Thank The Times of India for extending their hand in partnership, as well as Paras HMRI Hospital for making this effort to educate NABARD employees about osteoarthiritis. Plain is the body’s natural and automatic response to change, and as we grow up and grow old, this pain becomes even more peonounced, courtesy our changing lifestyle and evolving environment. In this light, this health talk show is much appreciated as it made us aware about simple yet effective preventive measures to ensure a healthy life. – Ranjeet Kumar Das, CGM NABARD.