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Osteoporosis::
What can I do to prevent osteoporosis or keep it from getting worse?
How is osteoporosis diagnosed?
How is osteoporosis treated?
Why does my hip hurt?
How will I know if i should have shoulder replacement ?
How will I know if I should have elbow replacement?
What can I do to prevent osteoporosis or keep it from getting worse?

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression and protect yourself from fractures.

Include adequate amounts of calcium and vitamin D in your diet.

Calcium: During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life. Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium canít prevent gradual bone loss after menopause, it continues to play an essential role in maintaining bone quality. Even if youíve gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture.

How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:

  • Males and females 9 to 18 years: 1,300 mg per day
  • Women and men 19 to 50 years: 1,000 mg per day
  • Pregnant or nursing women up to age 18: 1,3000 mg per day
  • Women and men over 50: 1,200 mg per day

Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones and green leafy vegetables, including broccoli and collard greens. If your diet doesnít contain enough calcium, dietary supplements can help. Talk to your doctor before talking a calcium supplement.

Vitamin D: Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 200-600 in daily. Supplemented dairy products are an excellent source of vitamin D. Vitamin supplements can be taken if your diet doesnít contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic.

Exercise regularly: Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise is effective for the prevention and management of osteoporosis. Weight bearing exercise such as walking, jogging, hiking , climbing stairs, dancing, treadmill exercise, and weight lifting are probably best. Falls account for 50 percent of fractures, therefore, even if you low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.

 

How is osteoporosis diagnosed?

The diagnosis of osteoporosis is usually made by doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia or hyperparathy-roidism (overactivity of the parathyroid glands). Bone densitometry is a safe, painless X-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at itís highest. It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry , quantitative computed tomography , radiographic absorptiometry and ultrasound. Your doctor can determine which method would be best suited for you.

How is osteoporosis treated?

Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopaedist, gynecologist and endocrinologist.
While exercise and nutrition therapy are often fey components of a treatment plan for osteoporosis, there are other treatments as well. Estrogen replacement therapy is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning and improve urinary function. ERT is not without some risk, including enhanced risk of breast cancer. It should be discussed with your doctor. New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures and lower the risk of breast cancer.

Calcitonin is another medication used to decreased bone loss. A nasal spray from of this medication increases bone mass, limits spine fractures and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs and Calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.

 

TOTAL JOINT REPLACEMENT::

Why is total joint replacement necessary?

The goal is to relieve the pain in the joint caused by the damaged done to the cartilage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, possibly some laboratory tests and x-rays will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve your pain and disability


What is the recovery process in a Total Joint Replacement?

In general, your orthopaedic surgeon will encourage you to use your "new" joint shortly after your operation. After total hip or knee replacement you will often stand and begin walking the day after surgery. Initially, you will walk with a walker, crutches or a cane. Most patients have some temporary pain in the replaced joint because the surrounding muscles are weak from inactivity and the tissues are healing, but it will end in a few weeks or months. Exercise is an important part of the recovery process. Your orthopaedic surgeon or the staff will discuss an exercise program for you after surgery. This varies for different joint replacements and for differing needs of each patient. After your surgery, you may be permitted to play golf, walk and dance. However, more strenuous sports, such as tennis or running, may be discouraged. The motion of your joint will generally improve after surgery. The extent of improvement will depend on how stiff your joint was before the surgery

Is total joint replacement permanent?

Older persons can expect their total joint replacement to last a decade or more. It will give years of pain free living that would not have been possible otherwise. Younger joint replacement patients may need a second total joint replacement. Materials and surgical techniques are improving through the efforts of orthopaedists working with engineers and other scientists. The future is bright for those who choose to have a total joint replacement to achieve an improved quality of life through greater independence and healthier pain free activity

At what age can joint replacement be done? Can it be done for children?

Joint replacement is commonly done for patients above the age of 60 years. It may be done between ages of 40 and 60 depending on the pain and disability. It is occasionally done between ages of 20 and 40 in very severe arthritis only. It is never done in children.

What is the average hospital stay recommended after joint replacement?

The average hospital stay is for seven days after joint replacement.

What is the average time taken for joint replacement surgery?

The average time taken for joint replacement surgery is one to one and half hours.

Can a person with diabetes, high blood pressure, or heart trouble undergo joint replacement?

A person with diabetes, high blood pressure, or cardiac disorders can undergo joint replacement surgery under medical supervision. The diabetes or BP must be under control.

Does one need some support of walker or stick after joint replacement?

Yes, if only the knee is involved then a walker for one week and a walking stick for 3 weeks. If both knees are replaced then twice the time. The same protocol for hip replacement with cement. Non-cemented hips walking after two to three months with weight bearing.

What are the common complications after joint replacement?

The possible complications after joint replacement are deep vein thrombosis and infection. Long-term complications are loosening and wear and tear.

Can a patient be operated for both joint replacements at the same time?

Usually one joint is resurfaced at a time, but if the patient is fit, both knees or both hips may be resurfaced in one sitting. The blood loss and infection risk may be slightly higher.

What are the precautions to be followed after joint replacement?

It is advisable to use a commode and at home a western toilet. Avoid sitting on the floor, jogging, running and fast sports after joint replacement surgery. Moderate distance and speed walking, climbing stairs and swimming are permitted.

What is the cost of joint replacement?
On an average ,a TKR & THR costs about Rs. 75,000 & the cost of implant(artificial joint).

How will I know if I should have hip replacement?

The orthopedic surgeon will perform a very thorough examination of your hip by performing physical tests and analyzing x-rays, as well as taking your medical history. X-rays will provide your surgeon with images of your hip joint to show changes in size, shape, or unusual circumstances to determine if surgery would be the best option. If so, the x-rays will also help in the sizing and fitting of your new hip. Based on this examination, your surgeon will determine whether you are a candidate for total hip replacement. Although widely practiced, total hip replacement is a major surgical procedure and should only be considered when all other treatment methods have failed.

What is it like to have total hip replacement surgery?

Before Surgery 
If you and your surgeon decide that total hip replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example your surgeon might ask you to have a physical examination, by your primary care physician. You should also finish any dental work that may be underway to prevent germs in your mouth from entering the bloodstream and infecting the new joint. If you prefer, or if your surgeon feels it is needed, you may want to donate your own blood ahead of time to reduce the risk of your body reacting to the blood transfusion.
During Surgery
On the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia. The surgery usually takes two to four hours, although this is dependent upon the severity of the arthritis in your hip. In the operating room, a urinary catheter will be inserted and left in place for one or two days. Compression stockings and pneumatic sleeves will be put on both legs. The procedure is performed through an incision over the side of the hip. The ball end of the thighbone is cut and replaced with the new metal ball and stem component. It may be stabilized with or without cement. The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. You will also find small drainage tubes coming out of the hip to drain fluid from the wound. 
After Surgery
You will be sent to the recovery room and as the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. You will also be given pain medication and will find a foam wedge or pillows placed between your legs to help hold your joint in place. When you are fully conscious, you will be taken back to your hospital room.


Why does my hip hurt?

In a healthy, normal hip, the movement of bending, straightening, or rotating is absorbed by the cartilage, allowing the ball to move freely in the socket without pain. Overtime, however the cartilage can wear away or get damaged causing the bones to rub and grind together. This causes much of the pain and stiffness patients feel. Although people frequently associate joint pain with an injury or fracture to the hip, other common causes of a damaged hip include the breakdown of the joints cartilage inflamed and stiff cartilages and decay of the bone from long term use of alcohol or steroids.

How will I know if I should have shoulder replacement?

Your orthopaedic surgeon will perform a very thorough examination of your shoulder. This will include a check of the muscles and tendons to determine how much strength and range of movement you have. Your surgeon will also ask you many questions to determine your medical history. For example, you will be asked to describe your pain and how you have treated this pain in the past. You will also be asked about other joints problems, and about injuries, infections, and other disorders you have experienced in your life that may have affected your shoulder. Your surgeon will also want to know what medications you are taking.
Finally, your surgeon will take x-rays, a CT scan or an MRI which will be used to further assess the condition of your shoulder joint. If you decide on shoulder replacement surgery, these images will also be used to help your surgeon select the best type and size of artificial shoulder. Based on this examination, your surgeon will determine whether you are a candidate for shoulder replacement. Although widely practiced, shoulder replacement is a major surgical procedure and should only be considered when all other treatment methods have failed. There are more conservative alternatives which you and your surgeon may want to consider. These include medications or injections for pain and inflammation, physical therapy, or other types of surgery. 

How will I know if I should have elbow replacement?

Your orthopaedic surgeon will perform a very thorough examination of your elbow. This will include a check of the muscles and tendons to determine how much strength and range of movement you have.
Your surgeon will also ask you many questions to determine your medical history. For example, you will be asked to describe your pain and how you have treated this pain in the past. You will also be asked about other joint problems, and about injuries, and other disorders you have experienced in your life that may have affected your elbow. Your surgeon will also want to know what medications you are taking.
Based on this examination, your surgeon will determine whether you are a candidate for total elbow replacement. Although widely practiced, total elbow replacement is a major surgical procedure and should only be considered when all other treatment methods have failed. There are more conservative alternatives, which you and your surgeon may want to consider. These include medications or injections for pain and inflammation, physical therapy, or other types of surgery.
 

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