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| Sunday, 7 September 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius A new approach to ... Knee replacement surgery Dr S.K.S. Marya, Director of Joint Replacement Surgery at Apollo Hospitals Delhi and orthopaedic surgeon specialising in Knee Replacement surgery, recently fielded questions from local media personnel on the latest improvements to knee replacement. This live interview where the media watched an operation at the Apollo Hospitals, Delhi was made possible by using Apollo Hospital Group's state-of- the- art Tele-medicine facility. The demonstration was hosted by the Department of Orthopaedics, Apollo Hospitals, Colombo with Dr M.S. Dhillon, Senior Consultant, Dept. of Orthopaedics acting as moderator. Following are some of the questions we asked the two doctors and their responses. by Carol Aloysius Q. Dr Dhillon, the Apollo Hospitals performed its first Total Knee Replacement surgery in July this year. Could you explain what this surgery involves? A. Knee Replacement surgery is one of the most important orthopaedic surgical advances of this century. While this surgery is not new, this is the first time our hospital was able to perform this operation using the latest techniques and materials developed in recent years. Q. What are these new techniques? A. For the operations we did in Colombo, we used the Natural Knee concept- so called because the shape of the implant we used in the knee was an exact replica of the natural knee. Q. Why is it necessary to have a total knee replacement? At what age do people have to undergo this surgery usually? A. Total knee replacement surgery is needed when you have severe arthritis and your joints are worn out. Most patients are thus usually over 60 years. An artificial knee will give them pain free mobility. Q. Dr Marya, you have been specialising in this field for sometime. Tell us what the surgery involves. A. This operation requires a lot of experience and skills. Alignment is also very important for long-term good results. The surgeon makes an incision in the front knee cap. Then the knee cap is pushed to one side in order to examine the knee. Next the lower bone is cut using a special device called the jid which goes precisely to the place you want it to. The lower part of the upper bone and thigh bone are then cut and made flat. After making holes in the flat surfaces, the implants are inserted using bone cement to keep them in place. The bone cement is a mixture of powder and liquid. It is not glue but used as a gap filler to ensure that the implant will stay in place. It takes about seven minutes to set. Finally the skin is sutured back and the patient taken to the recovery room. Q. How can you be sure the implant is not too tight or loose before it is 'cemented' in place? A. We do a trial run, to check if it is okay. Q. What kind of materials go to make this artificial knee? A. The artificial knee is actually two joints made with Titanium and stainless steel with a dense plastic centrepiece which allows the restoration of full function and alignment to the degree that was used prior to the damage to the knee. Although for our recent surgery we used titanium -stainless steel alloyed joints, there are many different types of designs and materials that are currently used for total knee replacement surgery. Q. How long does the operation last? Was it done under general anaesthesia? A. About 2 hours. We used epidural anaesthesia which is a refinement of the spinal anaesthesia with less complications. This is a fairly new concept in anaesthesia where a tube is inserted for about 48 hours in the back of the patient to keep the patient free from pain. Q. How soon can a patient go home after the operation? A. In about 5 -6 days. Q. Do you follow-up on the patient? A. Certainly. When he or she returns home we make arrangements for a physiotherapist to visit the patient and demonstrate various exercises to restore mobility in the leg. Q. What is the greatest risk a patient faces in this kind of surgery? A. Risks are as in any routine surgery. Infection is one of them. This can be serious for a patient when he is still recovering from the wounds. That is why it is important to have absolute sterile conditions as we do in our hospitals including the Colombo Hospitals. Another risk is Deep Vein Thrombosis which can be prevented by giving medicines to prevent clotting. Q. Dr Dhillon, can the patients you operated on recently be operated on again if there are future complications?. A. Yes. This is called Revision total Surgery when an implant becomes too loose after some time or develops other complications. Q. How much will the first operation cost in Sri Lanka? A. About four lakhs of rupees - all inclusive. This is money well spent since it gives the patient pain free mobility which is what he wants. Q. Once a patient undergoes total knee replacement surgery, can he resume a normal life and carry out his usual day-to-day activities? A. He can do everything he did before the operation. That means he can drive, walk, run, swim. But he must NOT squat because it strains the implant and thus reduces its life. Q. Dr Marya you have operated on several patients. How old is your oldest patient? A. Ninety seven years. Q. Which means.....? A. That this operation can be done at any age provided the patient enjoys good health. ############ Eggs are good and safe to eat The debate over the benefits of eating eggs, especially if you are prone to heart problems, continues this week as Dr. A. Nandakumar replies to Dr. D. P. Atukorale's article which we published recently. Eggs are an important source of Protein 53 per cent essential amino acids, essential vitamins and minerals and could make a significant contribution to a healthy diet. It contains all essential amino acids needed by the human body. Eggs are also low in sodium and contain 11 minerals and 12 essential vitamins. The egg is a good source of all the B vitamins, plus the fat-soluble vitamin A. It also provides a useful amount of vitamin D as well as some vitamin E. The egg also provides significant amount of Zinc, important for wound healing, growth and fighting infection. Selenium, an important antioxidant, calcium needed for bone and growth structure and nervous function. It is also an excellent source of iodine required to make thyroid hormone. Eggs are a rich source of lutein and zeaxanthins, two carotenoids that are yellow orange carotenoids known as xanthophythis, which reduce the risk of cataract. Lutein is also being found to reduce the risk of heart disease. Cholin in the yolk supplies about half the daily needs, which helps the brain at all ages. The high quality of protein in an egg can reduce muscular loss in old age, while eating eggs also helped antibody production against disease. Recent scientific studies have shown eggs actually lower the risk of cardiovascular disease instead of contributing, as popularly believed. ############## Guide to new mothers... How to breastfeed your baby Mother's milk is the healthiest food for baby and gives it natural protection against illnesses, reduces allergies and promotes close body contact with the mother. Following are some guidelines as to how you should breastfeed your baby. Before breastfeeding your child, wash the breasts well with soap and water. Gently rub the nipple with a clean cloth to toughen the skin. Gently roll nipple between your fingers to help it stand erect so that the baby can grasp it easily. Encourage baby to grasp nipple by expressing small amounts of milk from breast and brush it against his lips. Baby should have the nipple and surrounding dark skin in his mouth: this will keep the mother's nipples from becoming sore. Allow baby to feed until he appears content. Place a finger in the corner of baby's mouth before trying to remove him from the nipple. This will break the suction and the baby will not harm the mother's nipple. Burp baby gently and pat him on the back to release swallowed air by resting him on your shoulder or on your lap. Offer both breasts at each feeding. If you finish a feed on the left side, begin with the same breast at the next feed. Baby may also be nursed in a lying position. You should find the position most comfortable for you. After breastfeeding wipe breasts with a clean cloth or allow to dry naturally before wearing your bra. courtesy Nestles |
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