Treatments
- Home
- treatments
Knee Replacement
Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.
The first artificial knees were little more than crude hinges. Now, you can choose from a wide variety of designs that take into account your age, weight, activity level and overall health. Most knee replacement joints attempt to replicate your knee's natural ability to roll and glide as it bends.
Types of surgery
There are two main types of surgery, depending on the condition of the knee:
- 1) Total knee replacement (TKR) – both sides of your knee joint are replaced.
- 2) Partial (half) knee replacement (PKR) – only one side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period
-
What is a total knee replacement?
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material.During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic "button" may also be added under the kneecap surface. -
How you prepare
An orthopedic surgeon performs knee replacement procedures. Before the procedure, the surgeon takes your medical history and performs a physical examination to assess your knee's range of motion, stability and strength. X-rays can help determine the extent of knee damage. Knee replacement surgery requires anesthesia to make you comfortable during surgery. Your input and personal preference help the team decide whether to use general anesthesia, which renders you unconscious during the operation, or spinal or epidural anesthesia, during which you are awake but can't feel any pain from your waist down. Your doctor or anesthesiologist may advise you to stop taking certain medications and dietary supplements before your surgery. You'll likely be instructed not to eat anything after midnight before your surgery. -
Precautions after joint replacement.
For several weeks after the procedure, you may need the assistance of crutches or a walker. In addition, you will undergo some combination of physical and occupational therapy starting at the hospital. In most cases, you will likely be able to stand and walk, at least with the assistance of a cane or walker, before you leave the hospital. Starting in the hospital, and usually before you exit the operating room, your knee may be cradled in a passive motion machine and medical staff will monitor the flexion (bending in) and extension (extending out) limits of your knee. -
Are there any risks?
Knee replacement surgery is a common operation and most people do not experience any complications.
Hip Replacement
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
When Surgery Is Recommended
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
- Hip pain that limits everyday activities, such as walking or bending
- Hip pain that continues while resting, either day or night
- Stiffness in a hip that limits the ability to move or lift the leg
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
-
Procedure
After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you. The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.
-
Right after surgery
You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots (anticoagulants). It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you feel ill. When you wake up from surgery, you may have a catheter, which is a small tube connected to your bladder, so you don't have to get out of bed to urinate. You may also have a compression pump or compression stocking on your leg, which squeezes your leg to keep the blood circulating and to help prevent blood clots. And you may have a cushion between your legs to keep your new hip in the correct position. Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced. You may also learn to move your feet up and down to flex your muscles and keep your blood circulating. And you may begin to learn about how to keep your hip in the correct positions while you move in bed and get out of bed. -
Recovery and Rehabilitation
Usually, people do not spend more than 3 to 5 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, your overall health, and the success of your rehabilitation. It is important to get instructions from your doctor before leaving the hospital and to follow them carefully once you get home. Doing so will you give you the greatest chance of a successful surgery.
Arthroscopic Surgery
Arthroscopy is a surgical procedure which uses a thin telescope with a light source (an arthroscope) to look inside joints. As well as being able to look inside, the surgeon can use an arthroscope to perform 'keyhole' surgery. Arthroscopy is most often used to investigate or treat knee problems. Arthroscopy can also be used for other joints, including the shoulder, hip, elbow, wrist and ankle joints, and even for hand or foot problems. Arthroscopic procedures can be performed to evaluate or treat many orthopaedic conditions including torn cartilage ("meniscus"), torn surface (articular) cartilage, ACL reconstruction, and trimming damaged cartilage.
Arthroscopic surgery could potentially be performed on any joint, and as time passes, more and more different joints are being arthroscopically treated. Common types of arthroscopic surgery include:
- Knee Arthroscopy
- Shoulder Arthroscopy
- Hip Arthroscopy
- Ankle Arthroscopy
- Elbow Arthroscopy
- Wrist Arthroscopy
-
Knee arthroscopy
Knee arthroscopy is surgery that uses a tiny camera to look inside your knee. Small cuts are made to insert the camera and small surgical tools into your knee for the procedure. Different types of pain relief (anesthesia) are used for knee arthroscopy surgery depending upon your health report. A cuff-like device may be put around your thigh to help control bleeding during the procedure. The surgeon will make two or three small cuts around your knee. Salt water (saline) will be pumped into your knee to stretch the knee. A narrow tube with a tiny camera on the end will be inserted through one of the cuts. The camera is attached to a video monitor that lets the surgeon see inside the knee. The surgeon then put other small surgery tools inside your knee through the other cuts. The surgeon will then fix or remove the problem in your knee. At the end of your surgery, the saline will be drained from your knee. The surgeon will close your cuts with sutures (stitches) and cover them with a dressing. Pictures of the procedure is taken from the video monitor, so that you may view these pictures after the operation, to see what was done.
-
Shoulder arthroscopy
Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small incision (cut) in your skin. First, your surgeon will examine your shoulder with the arthroscope then Insert the arthroscope into your shoulder through a small incision. The arthroscope is connected to a video monitor in the operating room. Inspect all the tissues of your shoulder joint and the area above the joint -- the cartilage, bones, tendons, and ligaments. Repair any damaged tissues. To do this, your surgeon will make 1 - 3 more small incisions and insert other instruments through them. A tear in a muscle, tendon, or cartilage will be fixed. Damaged tissue may need to be removed. -
After Arthroscopy
Depending on the area of the arthroscopy, you may need to wear a brace after the procedure, or use a sling or crutches. You should only need this support for a few weeks—or you may not need it at all. Your doctor will give you specific instructions based on your situation. In the same way, your recovery period from the procedure depends on the type of arthroscopy performed. For example, the recovery time from diagnostic arthroscopy (where the surgeon just examines your joint) will be shorter than one in which surgery was performed to repair a problem. In all procedures, you’ll have to care for the incision wound. This involves keeping it clean and dry, and regularly changing bandages until the stitches are removed.You will be advised to avoid any strenuous activity in the days following the procedure. You should be sure to rest, put ice and compresses on your injury, and elevate it if necessary. You may also be given physical therapy exercises to do. -
Benefits of Arthroscopic Surgery
Arthroscopic surgery has a number of potential benefits. In general, arthroscopic procedures involve less dissection and less trauma to the soft tissues surrounding the affected joint. Open shoulder surgery involves cutting through some of the muscles surrounding the shoulder to allow full view of the area to be repaired. This exposure traumatizes the muscle and can lead to increased pain, greater stiffness after surgery, and a slower return of proper muscle function during the recovery phase. Arthroscopic shoulder surgery results in less trauma to this muscle envelope and can help accelerate patient recovery. Less trauma to the surrounding tissue usually results in less pain after surgery as well.Some areas are more easily assessed and evaluated with arthroscopic assistance. The back of the knee, the deep space between the calf muscle and the bones of the knee, is not easily seen from an incision over the front of the knee. An incision on the back of the knee can risk potential injury to blood vessels and nerves in this area and frequently leads to formation of scar tissue behind the knee, limiting knee motion. An arthroscope can more easily be placed through a small incision and used to evaluate the back portions of the knee, significantly minimizing these risks.
Sports Injury
Sports injuries are injuries that occur in athletic activities. They can result from acute trauma, or from overuse of a particular body part.
- Sprains and strains
- Knee injuries
- Swollen muscles
- Achilles tendon injuries
- Pain along the shin bone
- Rotator cuff injuries
- Fractures
- Dislocations
The most common sports injuries are
If you get hurt, stop playing. Continuing to play or exercise can cause more harm. Treatment often begins with the RICE (Rest, Ice, Compression, and Elevation) method to relieve pain, reduce swelling, and speed healing. Other possible treatments include pain relievers, keeping the injured area from moving, rehabilitation, and sometimes surgery.Treatment for a sports injury will depend on how severe the injury is and the part of your body affected.
-
Surgery
Most sports injuries do not require surgery but very severe injuries, such as badly broken bones, may require corrective surgery. In some cases it may be possible to use a non-surgical technique, known as closed reduction, to realign broken bones. During surgery for a broken bone it may be necessary to fix the bones with wires, plates, screws or rods, known as open reduction and internal fixation (ORIF). A torn knee ligament can also require reconstructive surgery. -
Rehabilitation
Rehabilitation is an important part of treating sports injuries. A rehabilitation programme aims to return the injured body part to normal function by gradually introducing it to movement and exercise. With most sports injuries, after the initial recovery, it helps to move the injured part as soon as possible to help speed up the healing process. Gentle exercises should help improve the area’s range of motion. As movement becomes easier and the pain decreases, stretching and strengthening exercises can be introduced. -
Treatment for a Knee Ligament Injury
For severe collateral ligament tears, you may need surgery to attach the ligament back to the bone if it was pulled away or to the other part of the ligament if it was torn in the middle. At VIVEK Hospital arthroscopic ACL & PCL reconstruction are done with excellent results. In reconstruction procedure tendons are taken from the other parts of your leg.
Stryker Arthroscopy
Stryker offers a wide array of arthroscopy hardware featuring patented, state-of-the-art Speed-Lock technology. Cannulas have been specially designed to provide the surgeon with remarkable versatility and strength during joint procedures, with the diameters promising acute performance and greater freedom of movement. Stryker’s arthroscopy advances in cutter and bur technology incorporate increased sharpness, enhanced suction and extremely tight tolerances for outstanding cutting blades and high performing burs.
- Efficient debridement
- Optimal bone removal
- Programmability
- Angled cutters
- Small joint cutters and burs
- Hip cutters and burs
- Specialty blades
Features & Benefits
Including everything from peak efficiency to specialty blades to customized tools, Stryker cutters and burs offer:
-
Shaver System & Shaver System
This software-based system helps surgeons in various specialties perform aggressive tissue resection and rapid bone debridement during arthroscopic procedures. The system can be directed with unique wireless footswitches and offers powerful, precision cutting to ensure maximum performance for today’s surgeon.- Touch screen display
- Allows two footswitches to operate one hand piece or two hand pieces simultaneously
- Allows three hand pieces to be connected at once
Features & Benefits
The CORE Arthroscopic Shaver System includes a variety of innovative features to provide maximum performance in the operating room:
Physiothearpy
The aim of physiotherapy is to help restore movement and normal body function in cases of illness, injury and disability.As well as treating specific problems, your physiotherapist also suggest ways to improve your general wellbeing – for example, by taking regular exercise and maintaining a healthy weight for your height and build. Physiotherapists take a holistic approach, looking at the body as a whole rather than focusing on the individual factors of an injury or illness. The person being treated is directly involved in their own care.A physiotherapist will look at your individual situation. As well as treating the problem, they suggest things you can do on a daily basis to help relieve pain and discomfort. They also give you advice about how to prevent the injury re-occurring.
Pysiotherapy Treatments
Achilles Tendon Pain
Your ankles support the weight of your body which means injuries are common. In fact, the Achilles tendon is the most commonly injured tendon in the body. The Achilles tendon is the largest and strongest tendon in your body, connecting your calf muscle to your heel. It’s named after the mythical Greek hero, Achilles, who was dipped in the River Styx by his mother to make him invincible. By holding him by his heel, this part remained vulnerable. An injury to the Achilles tendon can be incredibly painful and we would advise you to seek medical advice immediately. It usually takes around three to four months to heal completely with the assistance of a physiotherapist.
Acupuncture
Acupuncture refers to the insertion of sterile, single use needles into specific points of the body to help relieve pain and symptoms. Traditional Chinese Medicine says that acupuncture promotes the body’s natural healing mechanisms in an attempt to help address any energy imbalance within the body and promote healing. Acupuncture is only used following a thorough assessment process and is usually used in conjunction with other physiotherapy skills such as exercise prescription.
Aquatic Therapy (or Hydrotherapy)
Aquatic therapy (or hydrotherapy) involves exercise and rehabilitation in water. This is an effective way of assisting muscle and joint rehabilitation (amongst many other conditions) in an environment that can help relax and offload the weight of the body. As well as assisting with movement, hydrotherapy can provide pain relief in some patients as well. It is not essential to be able to swim (although it would be beneficial to inform your physiotherapist of this in advance). Nuffield Health Physiotherapists have undergone training to provide specific water based therapy and rehabilitation work.
Back Pain
Back pain is incredibly common and can be due to a variety of reasons. The key to successfully treating back pain is taking an accurate history of how it started and how the pain behaves. Our physiotherapists are all trained to provide an in-depth assessment that then allows them to target the specific issues affecting you using an individualised treatment plan. This may include manual therapy such as manipulation and soft tissue massage, and probably specific exercises to get you moving properly again. You will also be given advice on how to look after your back and how to prevent the pain returning.
Chronic Pain Management
Chronic Pain Management Programmes involve a team of healthcare professionals working with you in order to help support and assist you in improving your level of function, fitness and ways of managing your symptoms. Support can be offered in a number of ways and can vary (for example) from psychological support to physiotherapy exercise based rehabilitation or even “hands on” treatment where appropriate. Sessions can also be individual or group based depending on what is deemed the most appropriate for you. Following a thorough assessment your physiotherapist / healthcare team will discuss the options with you.
Elbow Painopen
Also known as “tennis elbow”! Despite the name, you can get tennis elbow from any activity that involves repeated strain from gripping or twisting your hand or wrist. In fact, only 5% of all patients seen with tennis elbow have actually played any form of tennis recently! Physiotherapy should always be the first treatment option and even if steroid injections or surgery are required these treatments should still be followed by a course of physiotherapy.
Knee Injuries
Your knees are the largest and most complex joints in your body. They’re particularly vulnerable to injury as, like your ankles, they support the weight of your body. Anterior knee pain accounts for 15-25% of all running injuries, although it’s certainly not something that only happens to runners. Physiotherapy is considered the treatment of choice for knee injuries and our expert physiotherapists will not just look at treating the physical injury but also at correcting training errors and muscle imbalance to help prevent the problem from reoccurring.
Musculoskeletal Physiotherapy
This skill-set means that your physiotherapist is fully equipped to assess any issue that affects the body with regard to joint, muscle and nerve conditions. These include (amongst many others) back pain, whiplash injuries, muscle strains and joint sprains. You will have a thorough and detailed assessment session with your physiotherapist – following this they will talk you through their findings and recommend treatment accordingly.
Neck Pain
Neck pain can occur as a result of a specific injury, such as a whiplash from a car accident, or it can come on gradually, often from working in an awkward posture. Our physiotherapists include questions about your working position as part of their assessment and are able to give specific advice to help reduce the risk of persistent pain.
Women’s Health Physiotherapy
Female / Women’s health physiotherapists can help treat a range of conditions such as pregnancy related (pre and post birth) pelvic issues, problems with bladder or bowel incontinence, pelvic organ prolapse, pelvic pain and pelvic floor weakness. They will assist / advise you on the best course of action for your symptoms following a thorough assessment process.
Spine Surgery
If you’ve struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Sometimes, surgery is the only treatment. However, there’s good news. The vast majority of back problems can be remedied with non-surgical treatments—often referred to as non-surgical or conservative therapies.Spine surgery may be recommended if non-surgical treatment such as medications and physical therapy fails to relieve symptoms. Surgery is only considered in cases where the exact source of pain can be determined—such as a herniated disc, scoliosis, or spinal stenosis.
-
Spinal instrumentation
Examples of spinal instrumentation include plates, bone screws, rods, and interbody devices; although, there are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies. -
Minimally Invasive Spine Surgery
Minimally invasive techniques are beginning to be used for a wider range of spine procedures, and have been used for common procedures like decompression and spinal fusion since the 1990s. Decompression relieves pressure put on spinal nerves by removing portions of bone or a herniated disk. Spinal fusion corrects problems with the small bones of the spine (vertebrae). The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. Minimally invasive spine surgery (MISS) is sometimes called less invasive spine surgery. In these procedures, doctors use specialized instruments to access the spine through small incisions. -
Lumbar Spine Surgery
Lumbar surgery refers to any type of surgery in the lumbar spine, or lower back, between one or more of the L1-S1 levels. There are two general types of lumbar spine surgery that comprise the most common surgical procedures for the lower back: Lumbar Decompression & Lumbar Fusion.
Maternity
Our aim is to provide a service to meet the individual needs of all women and their families, throughout their pregnancy, birth and in the early days at home.We are renowned for our high level of clinical and midwifery care. We believe that it is important to offer parents-to-be an informed choice both in the type of birthing care they receive (whether this is consultant-led or midwife-led) through to the type of birth, from natural birth with or without epidural through to caesarean section or water birth.Some women will require their care to be planned in conjunction with an obstetric consultant. In these circumstances our approach to care is to actively promote a positive birth experience for women who may have or develop complications in their pregnancies.
-
Antenatal care
Antenatal care is the care you receive from healthcare professionals during your pregnancy. The purpose of antenatal care is to monitor your health, your baby’s health and support you to make plans which are right for you. Consultant-led care You may require the additional care of an obstetrician during your pregnancy because of an existing or new medical condition or pregnancy related problem. Obstetricians are medical doctors who specialise in more complicated pregnancies and births. This is called consultant-led care. -
The Postnatal Ward
Postnatal care is the care you and your baby receive from healthcare professionals after your baby is born. The purpose of postnatal care is to monitor your health, your baby’s health and support you to make plans which are right for you. We encourage you to care for your baby and recommend long periods of skin-to-skin contact during the early days which helps your baby normalise their temperature and breathing patterns, makes them feel safe and secure and prompts early feeding.The safest place for your baby will be in a cot next to your bed when you are asleep, feeling unwell or less able to respond to your baby’s needs following strong medication.
Gynaec Services
Gynaecology is the medical practice dealing with the health of the female reproductive systems (vagina, uterus and ovaries) and the breasts. Almost all modern gynaecologists are also obstetricians . In many areas, the specialties of gynaecology and obstetrics overlap.
- Secondary gynaecology, including menstrual disorders, pelvic floor dysfunction, endometriosis, pelvic pain and sterilisation
- Colposcopy and treatment of cervical and vulvo-vaginal epithelial abnormalities
- Management of miscarriage and pregnancy failure
- Complex hormone replacement therapy and family planning
- Vasectomy consultation and procedures
Services
-
Gynaecology services
Our gynaecology services encompass general gynaecology (i.e. menstrual disorders, pelvic floor dysfunction, sterilisation), hormone replacement therapy and family planning, endometriosis and pelvic pain, urogynaecology and colposcopy, gynaecologic oncology and pre-admissions clinic. -
General gynaecology
Our General gynaecology service offers an initial consultation and diagnostic test in one visit. An ultrasound scan can also be carried out simultaneously if required, enabling treatment plan to be drawn up immediately.
- Sexual Health and Reproductive Advice
- Urogynaecology
- Cervical screening
- Colposcopy
- Early pregnancy advice
- Local and regional Gynae Oncology services.
The Gynae service offers a wide range of inpatient ,outpatient and community-based services to women. These include:
Pediatric Fracture Management
Pediatrics deals with the medical care of infants, children, and adolescents, and the age limit ranges from birth up to 18 . Vivek hospital provides outpatient care and treatment to children requiring a variety of procedures. Fractures happen when there’s more force applied to the bone than the bone can withstand. If your child has a fracture, it means that his bone has partially or completely broken. A fracture in a child can be very different from a fracture in the same location in an adult, so it requires treatment by doctors and nurses trained to take care of children. Pediatric patients are at risk for a specific set of fractures for a variety of reasons. If the fracture involves the ends of the bone, it can affect the growth of the bone.
Fractures in a child's bones begin to heal much more quickly than an adult's bones. If you suspect a fracture, you should obtain prompt medical attention for the child so that the bones can be set for proper healing.
- Pain or swelling in the injured area
- Obvious deformity in the injured area
- Difficulty using or moving the injured area in a normal manner
- Warmth, bruising or redness in the injured area
Signs and symptoms
What causes a child to get a fracture?
Fractures happen when there’s more force applied to the bone than the bone can absorb. These breaks in bones can occur from falls, trauma or a direct blow. Most childhood fractures result from mild to moderate (rather than severe) trauma that happens while they’re playing and participating in sports, with the rate of fractures peaking in adolescence. The arms are the most common location for fractures.