Frequently Asked Questions
The following is a guide to the fees charged by Dr Aziz Bhimani.
Please do not hesitate to contact our staff on 02 4229 9116 if you require further information or assistance.
Consultation Fees
Each consultation attracts a fee which is reimbursed in part from Medicare. The consultation fee will be advised to you at the time of booking your appointment.
Operation Fees
If you require a surgical procedure a detailed itemised quote of Dr Bhimani & his surgical team’s fees will be provided up front as well as an estimate of out-of-pocket expenses.
You will meet with your anaesthetist before your operation so that you can obtain an estimate of his/her fees also.
Procedures vary in complexity, difficulty and duration and these are all factors that determine out-of- pocket expenses. Please check with your Private Health Insurer regarding whether an excess is payable to the hospital under your level of cover.
Pensioners
Dr Bhimani is a no-gap surgeon for pensioners.
Worker Compensation
If you have your claim number, your consultation and operation fees will be charged directly to your workers compensation insurer with no personal charge to you.
Veteran's Affairs (DVA)
If you have a valid DVA number, your consultation and operation fees will be charged directly to the Department of Veterans’ Affairs with no personal charge to you.
Do you have pain in your knees, hip or groin?
Is the pain restricting your daily activities?
Is the pain not relieved on taking medications?
Do you have swollen knee?
Do you limp while walking?
Does pain makes you stop when you walk more than a few blocks?
Are you having pain when lying or sitting down?
Are you getting pain for about 3 to 4 days per week?
Do your knees hurt when climbing or descending stairs?
Do you feel pain when walking for long time?
Does pain disturbs your sleep?
Do you find difficult to put your socks and shoes?
Do you have a sensation of instability or the knee is going to give out when you are physically active?
Do you need crutches, cranes or walkers to help you while walking?
Do you have tightness or limited range of hip motion?
If your answer is yes to the any of these questions, you might be suffering from arthritis - a degenerative joint disease, and you should contact us to arrange a consultation.
Surgery is the right decision when patients have tried non-surgical options first but are still not coping. Dr Bhimani encourages patients to make the decision to have surgery based on how their condition is upsetting their quality of life, their level of pain and their loss of normal function.
As a dedicated orthopedic surgeon Dr Bhimani always make sure his patients fully understand their condition, the treatment options available to them, as well as any risks or potential complications of a particular treatment. However it is crucial that patients understand that the decision to have any kind of orthopedic surgery is always theirs to make.
Once Dr Bhimani understands your diagnosis, you can both plan and agree on a sensible and holistic approach to treatment and rehabilitation for your best long-term results.
If you decide that surgery is necessary, then not only is our objective to reduce your pain and increase your mobility, but to also facilitate the earliest possible return to normal activity post-surgery.
To accomplish these objectives for patients Dr Bhimani is extremely dedicated to ensuring he is at the forefront of developments in hip and knee surgery to provide patients with the best possible orthopaedic care.
Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs help to ensure you're physically and emotionally prepared for surgery and to maximise your recovery after surgery. Dr Bhimani will choose the least invasive surgical procedure suited to your condition to minimise your recovery period. Dr Bhimani will ensure you understand what procedure you are having, how to prepare for surgery and what recovery program you need to follow. Physiotherapy is an essential part of this education, preparation and recovery process and will help you obtain a better surgical outcome.
General
Acute Knee Clinic
Non-surgical treatment
Many orthopaedic conditions have many non-surgical treatment options. And to the patient’s benefit, rehabilitation times with these conservative methods are typically shorter and carry less risk than undergoing a surgical procedure.
Dr Bhimani will explore all the possible options to avoid surgery, but sometimes it becomes the only option for effectively treating the injury and managing pain. We also consider if avoiding surgery could result in long-term impairment, pain or dysfunction.
Non- pharmacological Treatments
Physical and Occupational Therapy
Through a range of motion exercises, strengthening techniques and patient education, physical and occupational therapy can help patients with orthopaedic injuries, diseases or changes in physical conditions.
Weight reduction and physical exercise
The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of knee and hip conditions.
Thermotherapy
Thermotherapy involves application of hot or cold packs to the affected area. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.
Orthotics
Orthotics involves the use of devices such as splints or braces to correct an injury. These devices need to be properly designed by a qualified orthotist to fit the patient’s body and their specific injury.
Pharmacological Treatments
Platelet-rich plasma therapy (PRP)
This procedure uses the patient’s own blood chemistry to heal tendon and ligament injuries, as well as osteoarthritis.
Steroid injections
These injections of steroids are given directly into the affected joint for severe pain when use of Non-steroidal anti-inflammatory drugs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.
Medications
To manage pain throughout recovery, we often prescribe patients with anti-inflammatories, acetaminophen, muscle relaxants, topical medications and other types pain relievers. Prescription of medication is most often used in combination with other non-surgical orthopaedic treatments.
Non-steroidal anti-inflammatory drugs are found to be effective in reducing pain and inflammation . Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must take extreme care while using them.
They can cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
Stem cells
These are special cells in your body that can turn into other types of cells. During the healing process, stem cells are called to the area of your body that needs repair. Factors in the area influence the stem cells to become repair cells. Note that the same stem cell that repairs bone can also repair a tendon or ligament.
Of all the types of cells, stem cells have the greatest potential for promoting healing. As discussed above, stem cells are immature cells that are influenced by their surroundings. When brought to an injury site, a stem cell can develop into the kind of cell needed to help in healing - bone, muscle, ligament, and cartilage.
Because of the healing capabilities of stem cells, doctors have developed ways to bring stem cells to an injury site faster and in greater numbers. The first step in this process is to retrieve the stem cells. This can be done by harvesting them from the patient, or through a stem cell donor program.
Stem Cell Harvesting:
There are many sources of stem cells in the human body. The most important source is bone marrow. Bone marrow is located in the centers of long bones, such as the bones in your arms, forearms, thighs, and legs. The pelvic bone contains the highest concentration of stem cells. Therefore, the bone marrow in your pelvic bone is the most common source for harvesting stem cells.
The doctor draws the stem cells out of the bone marrow with a needle, in a similar way that blood is drawn from your arm for tests. An orthopaedic surgeon then inserts this large supply of stem cells into the injury site. This eliminates the time it would take for the stem cells to reach the injury on their own and delivers them in a higher concentration, which speeds the healing process.
Stem Cell Donation:
Orthopaedic surgeons can also use donor stem cells to promote healing. In much the same way that blood transfusions help millions of patients each year, stem cells taken from donors after they pass away help millions of orthopaedic patients. When these cells are harvested, they are treated so that they will not create an immune or allergic reaction in the patient.
Preparing For Surgery
If you and Dr Bhimani have decided that surgery is the best course of action given your level of pain, loss ofnormal function and given that non-surgical treatments have not adequately solved the problems, it isimperative that you clearly understand what to expect from the surgery and what will be required of you interms of the post-operative treatment and rehabilitation in order to attain the best possible results long-term.
Preparing mentally and physically for surgery is an important step toward a successful result. Understandingthe process and your role in it will help you recover more quickly with fewer problems and concerns.
If at any stage of the process you have any questions or concerns please do not hesitate to contact Dr Bhimanito discuss.
Before surgery, Dr Bhimani will perform a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.
It is important that you discuss with Dr Bhimani any medications you are taking to understand which ones you should stop taking before surgery and when.
Please go through the list of pre-operative advice below carefully:
Dr Bhimani may discuss options for preparing for potential blood replacement, including donating your own blood, medical interventions and other treatments, prior to surgery.
If you are overweight, losing weight before surgery will help decrease the stress you place on your new joint. However, you should not diet during the month before your surgery.
If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding you will need to stop taking them one week before surgery to minimise bleeding.
If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery.
Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of
infection later.
Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
Update Dr Bhimani about any infections you have or acquire before your surgery. Surgery cannot be performed until all infections have cleared up.
Arrange for someone to help out with everyday tasks like cooking, shopping and laundry post-surgery.
Put items that you use often within easy reach before surgery so you won’t have to reach and bend asoften.
Remove all loose carpets and tape down electrical cords to avoid falls.
Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.
If you are having Day Surgery, remember the following:
Have someone available to take you home as you will not be able to drive for at least 24 hours.
Do not drink or eat anything in the car on the trip home. The combination of anaesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours
If you had surgery on an extremity keep that extremity elevated and use ice as directed. This will help decrease swelling and pain.
Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty controlling the pain.
For joint replacement surgery, you may expect life to return to the way it was — but without the pain. In many ways, you are right. But it will take time. Dr Bhimani will encourage you to use your "new" joint as soon as possible. Although it may be challenging at times, following Dr Bhimani’s instructions will speed your recovery.
You are a partner in the healing process. The success of your surgery is dependent upon your commitment to your recovery. This video from the American Academy of Orthopaedic Surgeons will help you get started.
Anaesthesia
A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia.
Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body).
Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses.
In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations.
Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand.
Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful.
Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions.
Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm.
They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations.
Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.
Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain.
This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery.
They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety.
There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia.
Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team.
They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.
The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure.
General anaesthesia
You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts.
Regional anaesthesia
A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts.
Local anaesthesia
A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched.
Sedation
The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.
‘Day of surgery admission’ and ‘day surgery’
Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery. Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you. Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital.
What should I tell the anaesthetist?
Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions.
5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging.
6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you.
Your role
There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure.
4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are.
6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery.
7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed.
8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need.
9. For children, many hospitals can arrange a preoperative visit.
10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery.
11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia.
12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions.
Is fasting really necessary?
You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious. If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.
The anaesthetist will consider several factors when planning your anaesthesia, including:
• Past experience with surgery.
• Health and physical condition.
• Reactions or allergies to medicines.
• Risks of each type of anaesthesia.
• Preferences of your surgical team.
• Your preferences.
Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body.
BEFORE THE OPERATION
It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as:
• Any recent coughs, colds or fevers.
• Any previous anaesthetics or family problems with anaesthesia.
• Abnormal reactions or allergies to drugs.
• Any history of asthma, bronchitis, heart problems or other medical problems.
• Any medications you may be taking.
WHAT TO EXPECT
Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections.
After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward.
Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer.
As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications.
Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation.
Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.
There is no safer place in the world to be anaesthetised than in Australia. Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing. Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking. Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know. There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist. We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome.
Risk of infections
Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
Blood transfusion
With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains. Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.
Post-operative CARE
Avoiding Problems After Surgery
Recognising the Signs of a Blood Clot
Follow Dr Bhimani's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. Notify Dr Bhimani immediately if you develop any of the following warning signs. The warning signs of possible blood clot in your leg include:
Pain in your calf and leg that is unrelated to your incision
Tenderness or redness of your calf
New or increasing swelling of your thigh, calf, ankle, or foot
The warning signs that a blood clot has traveled to your lung include:
Sudden shortness of breath
Sudden onset of chest pain
Localized chest pain with coughing
Preventing Infection
A common cause of infection following surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.
Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter your bloodstream. Dr Bhimani will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.
Notify your doctor immediately if you develop any of the following signs of a possible infection:
Persistent fever (higher than 100°F orally)
Shaking chills
Increasing redness, tenderness, or swelling of the wound
Drainage from the wound
Increasing pain with both activity and rest
Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip or knee and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.
Dr Bhimani and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.
Other Precautions
To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery.
These precautions will vary from patient to patient.
Prior to discharge from the hospital, Dr Bhimani and your physical therapist will provide you with any specific precautions you should follow.
Recovery
The success of your surgery will depend in large measure on how well you follow Dr Bhimani's instructions regarding home care during the first few weeks after surgery.
Wound Care
You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Diet
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Activity
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.
Your activity program should include:
A graduated walking program to slowly increase your mobility, initially in your home and later outside.
Resuming other normal household activities, such as sitting, standing, and climbing stairs.
Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy centre the first few weeks after surgery.
If you have any questions please contact Dr Bhimani via 02 4229 9116.
Joint Replacement Surgery
For more information visit: Knee or Hip
Hip joint and knee joint replacements are helping people of all ages live happier more active lives. Joints are formed by the ends of two or more bones connected by tissue called cartilage. Healthy cartilage serves as a protective cushion, allowing smooth, low-friction movement of the joint. If the cartilage becomes damaged by disease or injury, the tissues around the joint become inflamed, causing pain. With time, the cartilage wears away, allowing the rough edges of bone to rub against each other, causing more pain.
When only some of the joint is damaged, Dr Bhimani may be able to repair or replace just the damaged parts. When the entire joint is damaged, a total joint replacement is done. To replace a total hip or knee joint, Dr Bhimani removes the diseased or damaged parts and inserts artificial parts, called prostheses or implants.
Over the last several years hip and knee replacement has evolved to be a minimally invasive surgical technique for patients to undergo.
The advantages of always aiming for the most minimally invasive surgical technique are clear:
Less tissue trauma – muscles and tendons are avoided or separated when possible so as to
not be cut
Promotes faster and less painful recovery
Incisions are smaller and there is less scarring
Shorter time in hospital
Reduced blood loss and less need for pre-surgery blood donation
Faster return to work and normal activities
Several conditions can cause joint pain and disability and lead patients to consider joint replacement surgery. In many cases, joint pain is caused by damage to the cartilage that lines the ends of the bones (articular cartilage)—either from arthritis, a fracture, or another condition.
If nonsurgical treatments like medications, physical therapy, and changes to your everyday activities do not relieve your pain and disability, your doctor may recommend total joint replacement.
In the weeks before your surgery, your surgical team and primary care doctor will spend timepreparing you for your upcoming procedure. For example, your primary care doctor may check your general health, and Dr Bhimani may require several tests — such as blood tests and a cardiogram — to help plan your surgery.
There are also many things you can do to prepare. Talk to Dr Bhimani and ask questions. Prepare yourself physically by eating right and exercising. Take steps to manage your first weeks at home by arranging for help and obtaining assistive items, such as a shower bench, handrails, or a long- handled reacher. By planning ahead, you can help ensure a smooth surgery and speedy recovery.
For a step-by- step guide to planning your joint replacement surgery:
Arthroscopic Surgery
Arthroscopic Surgery is a procedure Dr Bhimani can use on a patient by patient basis depending upon the patient’s medical circumstances, to visualize, diagnose, and treat problems inside a joint.
Arthroscopic surgical procedures are usually performed on an outpatient basis and the patient is able to return home on the same day as the procedure. If a procedure can be done arthroscopically instead of by traditional surgical methods, it can cause less trauma, may result in less pain, and may promote a quicker recovery for the patient.
In an arthroscopic examination, Dr Bhimani makes a small incision in the patient's skin and then inserts a small tube that contains optical fibers and lenses. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.
By attaching the arthroscope to a miniature television camera, Dr Bhimani is able to see the interior of the joint through this very small incision rather than a large incision needed for traditional surgical methods.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing Dr Bhimani to look, for example, throughout the knee or hip. Dr Bhimani can then see the cartilage, ligaments, and under the kneecap to determine the amount or type of injury and can sometimes repair or correct the problem.
However there are many instances when arthroscopic surgery would be insufficient to treat the problems a patient is experiencing and more traditional surgical options such as a joint replacement may be required.
Dr Bhimani will always discuss the non-surgical and surgical options available to you, and which option he believes is most suitable in order to obtain the best long term result given your diagnosis, pain and loss of normal function.
An arthroscope may be recommended even if the condition causing you pain has already been diagnosed or to help find a diagnosis. Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI or CT scan also may be required. A final diagnosis may be more accurate following an arthroscope to assist your surgeon to treat the issue, whether during an arthroscope or more traditional surgical options.
On a case by case basis, as determined by Dr Bhimani, arthroscopy can be helpful in the diagnosis and treatment of many non-inflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.
Non-inflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy).
Arthroscopy is commonly used in the evaluation of knees but can also be used to examine and treat conditions of the hips.
Common knee joint injuries for which arthroscopy is considered include cartilage tears (meniscus tears), ligament strains and tears, and cartilage deterioration underneath the kneecap (patella).
Lastly, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns or needles, which become lodged within the joint, can be removed via arthroscopy.
While uncommon, complications do occasionally occur during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures.
Arthroscopic surgery, although much easier in terms of recovery than ‘open’ surgery, still requires the use of anaesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anaesthetic, depending on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to insert the arthroscope while other incisions may be made to see other parts of the joint or insert other instruments.
Corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.
For instance, many meniscal tears in the knee can be treated successfully with arthroscopic surgery. The surgeon inserts miniature scissors to trim a torn meniscus
.After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications.
Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, Dr Bhimani will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, Dr Bhimani may discover that the injury or disease cannot be treated adequately with arthroscopy alone.
Anterior Cruciate Ligament (ACL) Injuries
One of the most common knee injuries is an anterior cruciate ligament sprain or tear.
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia.
When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.
About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered "sprains" and are graded on a severity scale.
Grade 1 Sprains: The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains: A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains: This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.
These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:
Pain with swelling: Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
Loss of full range of motion
Tenderness along the joint line
Discomfort while walking
During your first visit, Dr Bhimani will talk to you about your symptoms and medical history.
During the physical examination, Dr Bhimani will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Imaging Tests
Other tests which may help Dr Bhimani confirm your diagnosis includes:
X-rays: Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a broken bone.
Magnetic resonance imaging (MRI) scan: This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.
Treatment for an ACL tear will vary depending upon the patient's individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, Dr Bhimani may recommend simple, nonsurgical options.
Bracing: Dr Bhimani may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy: As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Rebuilding the ligament: Most ACL tears cannot be sutured (stitched) back together, so to surgically repair the ACL and restore knee stability the ligament must be reconstructed. Dr Bhimani will replace your torn ligament with a tissue graft. This graft acts as scaffolding for a new ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.
There are advantages and disadvantages to all graft sources. You should discuss graft choices with Dr Bhimani to help determine which is best for you.
Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.
Whether your treatment involves surgery or not rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.
If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return.
The remaining rehabilitation will be supervised by a physiotherapist and will involve activities such as exercise bike riding, swimming, proprioceptive exercises and muscle strengthening. Cycling can begin at 2 months, jogging can generally begin at around 3 months. The graft is strong enough to allow sport at around 6 months however other factors come into play such as confidence, fitness and adequate fitness and training.
Professional sportsmen often return at 6 months but recreational athletes may take 10 -12 months depending on motivation and time put into rehabilitation.
The rehabilitation and overall success of the procedure can be affected by associated injuries to the knee such as damage to meniscus, articular cartilage or other ligaments.
The following is a more detailed rehabilitation protocol useful for patients and physiotherapists. It is a guide only and must be adjusted on an individual basis taking into account pain, other pathology, work and other social factors.
Acute (0 – 2 Weeks)
Goals
Wound healing
Reduce swelling
Regain full extension
Full weight bearing
Wean off crutches
Promote muscle control
Treatment Guidelines
Pain and swelling reduction with ice, intermittent pressure pump, soft tissue massage and exercise
Patella mobilisation
Active range of motion knee exercises, calf and hamstring stretching, contraction (non-weight bearing progressing to standing), muscle control and full weight bearing. Aim for full extension by 2 weeks. Full flexion will take longer and generally will come with gradual stretching. Care needs to be taken with hamstring co contraction as this may result in hamstring strains if too vigorous. Light hamstring loading continues into the next stage with progression of general rehabilitation. Resisted hamstring loading should be avoided for approximately 6 weeks
Gait retraining encouraging extension at heel strike
Stage 2- Quadriceps Control (2-6 Weeks)
Goals
Full active range of motion
Normal gait with reasonable weight tolerance
Minimal pain and effusion
Develop muscular control for controlled pain free single leg lunge
Avoid hamstring strain
Develop early proprioceptive awareness
Treatment Guidelines
Use active, passive and hands on techniques to promote full range of motion
Progress closed chain exercises (quarter squats and single leg lunge) as pain allows. The emphasis is on pain free loading, VMO and gluteal activation
Introduce gym based exercise equipment including leg press and stationary cycle
Water based exercises can begin once the wound has healed, including treading water, gentle swimming avoiding breaststroke
Begin proprioceptive exercises including single standing leg balance on the ground and mini tramp. This can progress by introducing body movement whilst standing on one leg
Bilateral and single calf raises and stretching
Avoid isolated loading of the hamstrings due to ease of tear. Hamstrings will be progressively loaded through closed chain and gym based activity
Stage 3- Hamstring/Quadriceps Strengthening (6-12 Weeks)
Goals
Begin specific hamstring loading
Increase total leg strength
Promote good quadriceps control in lunge and hopping activity in preparation for running
Treatment Guidelines
Focal hamstring loading begins and is progressed steadily throughout the next stages of rehabilitation
Active prone knee flexion which can be quickly progressed to include a light weight and gradually increasing weights
Bilateral bridging off a chair. This can be progressed by moving onto a single leg bridge and then single leg bridge with weight held across the abdomen
Single straight leg dead lift initially active with increasing difficulty by adding dumbbells
With respect to hamstring loading, they should never be pushed into pain and should be carefully progressed. Any subtle strain or tightness following exercises should be managed with a reduction in hamstring based exercises
Gym based activity including leg presses, light squats and stationary bike which can be progressively increased in intensity as pain and control allow. It is important to monitor any effusions following exercise and if it is increasing then exercise should be toned down
Once single leg lunge control is comparable to the other side hopping can be introduced. Hops can be made more difficult by including variations such as forward/back, side to side off a step and in a quadrant
Running may begin towards the latter part of this stage
Prior to running certain criteria must be met
No anterior knee pain
A pain free lunge and hop that is comparable to the other side
The knee must have no effusion
Before jogging start having brisk walks, ideally on a treadmill to monitor landing
Action and any effusion. This should be done for several weeks before jogging properly
Increased proprioceptive manoeuvres with standing leg balance and progressive hopping based activity
Expand calf routine to include eccentric loading
Stage Four-Sport Specific (3-6 Months)
Goals
Improve leg strength
Develop running endurance speed, change of direction
Advanced proprioception
Prepare for return to sport and recreational lifestyle
Treatment Guidelines
Controlled sport specific activities should be included in the progression of running and gym loads. Increasing effusion post running that isn’t easily managed with ice should result in a reduction in running loads
Advanced proprioception to include controlled hopping and turning and balance correction
Monitor potential problems associated with increasing loads
No open chain resisted leg extension exercises unless authorised by your surgeon
Stage Five-Return to Sport (6 Months Plus)
Goals
A safe return to sporting activities
Treatment Guidelines
Full training for 1 month prior to active return to competitive sport
Preparation for body contact sports. Begin with low intensity one on one contests and progress by increasing intensity and complexity in preparation for drills that one might be expected to do at training
To improve running endurance leading up to a normal training session
Full range, no effusion, good quadriceps control for lunge, hopping and hop and turn type activity. Circumference measures of thigh and calf to within 1 cm of other side
Arthritis is inflammation of one or more of your joints that causes pain and stiffness. While arthritis is mainly an adult disease, some forms affect children.
There are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis.
While each of these conditions has different causes, the symptoms and treatment are often thesame. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in weight-bearing joints such as the knee and hip.
Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep patients staying active.
Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or may develop following an injury (post-traumatic arthritis).
Other types of arthritis, such as crystalline arthritis, may come from an inflammatory process.
Still others, such as rheumatoid arthritis or lupus arthritis, are the result of a systemic diseasethroughout the body.
Regardless of whether the cause is from injury, normal wear and tear, or disease, the joint becomes inflamed, causing swelling, pain and stiffness. Inflammation is one of the body's normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability.
The most common type of arthritis is osteoarthritis. Also known as "wear and tear" arthritis,osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away.
It results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging.
Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may show signs of osteoarthritis.
In many cases, bone growths called "spurs" develop at the edges of osteoarthritic joints. The bone can become hard and firm (sclerosis). The joint becomes inflamed, causing pain and swelling meaning continued use of the joint is painful.
Rheumatoid arthritis is a long-lasting disease.
Rheumatoid arthritis affects many parts of the body, but mainly the joints. The body's immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invade surrounding tissues. Chemical substances are produced that attack and destroy the joint surface.
Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.
Post-traumatic arthritis results from an injury to the joint. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint surfaces. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.
Septic arthritis is an infection of the joint. Most often bacteria reach the joint through thebloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotics.
Gouty arthritis develops as the result of uric acid build up in the bloodstream. The uric acid forms crystals which cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful. The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medicine rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.
Arthritis is diagnosed through a careful evaluation of symptoms and a physical examination. X-rays are important to show the extent of any damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. Some of the findings of arthritis include:
Weakness (atrophy) in the muscles
Tenderness to touch
Limited ability to move the joint passively (with assistance) and actively (without assistance)
Signs that multiple joints are painful or swollen (an indication of rheumatoid arthritis)
A grating feeling or sound (crepitus) with movement
Pain when pressure is placed on the joint or the joint is moved
Medications
Over-the- counter medications can be used to control pain and inflammation in the joints. These medications, called anti-inflammatory drugs, include aspirin, ibuprofen, and naproxen. Acetaminophen can be effective in controlling pain.
Prescription medications also are available. Dr Bhimani will choose a medication by taking into account the type of arthritis, its severity, and your general physical health. Patients with ulcers, asthma, kidney, or liver disease, for example, may not be able to safely take anti-inflammatory medications.
Injections of cortisone into the joint may temporarily help to relieve pain and swelling. It is important to know that repeated, frequent injections into the same joint can cause damage and undesirable side effects.
Viscosupplementation or injection of hyaluronic acid preparations can also be helpful in lubricating the joint. This is typically performed in the knee.
Exercise and therapy
Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learningmethods of performing daily activities that are the less stressful to painful joints also may be helpful.
Certain exercises and physical therapy may be used to decrease stiffness and to strengthen the weakened muscles around the joint.
In general, Dr Bhimani will perform surgery for arthritis when other methods of nonsurgical treatment have failed to relieve pain and other symptoms. When deciding on the type of surgery, Dr Bhimani will take into account the type of arthritis, its severity, and your loss of normal function.
There are a number of surgical procedures. These include:
Removing the diseased or damaged joint lining
Realignment of the joints
Fusing the ends of the bones in the joint together, to prevent joint motion and relieve joint pain
Replacing the entire joint (total joint replacement)
In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.
In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function.
Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Arthritis
Osteoarthritis
Osteoarthritis, also known as "wear and tear" arthritis, occurs when the cartilage that cushions and protects the ends of your bones gradually wears away. This leads to pain and stiffness that worsens over time, making it difficult to do daily activities.
Osteoarthritis is the most common form of arthritis. It develops slowly and most often occurs during middle age.
Although there is no cure for osteoarthritis, there are many treatment options available to help manage pain and keep people staying active.
With osteoarthritis, the articular cartilage that covers the ends of bones in the joints gradually wears away. Where there was once smooth articular cartilage that allowed the bones to glide easily against each other when the joint bent and straightened, there is now a frayed, rough surface. Joint motion along this exposed surface is painful.
Osteoarthritis usually develops after many years of use. It affects people who are middle-aged or older. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint, and family history of osteoarthritis.
Osteoarthritis can affect any joint in the body including the joints of the spine. Symptoms may range from mild to disabling.
A joint affected by osteoarthritis may be painful and inflamed. Without cartilage, bones rub directly against each other as the joint moves. This causes the pain and inflammation. Pain or a dull ache develops gradually over time. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.
The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint. Joint movements such as bending, straightening and rotation may become more difficult and loss of motion may follow.
Loose fragments of cartilage can interfere with the smooth motion of a joint. The joint may lock or "stick." It may creak, click, snap, or make a grinding noise (crepitus). An arthritic joint may weaken and weight bearing joints such as a knee or ankle may buckle and give way. Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.
Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.
When you visit Dr Bhimani, a complete medical history, physical examination, x-rays, and possibly laboratory tests will be done.
Medical History
Dr Bhimani will want to know if the joint has ever been injured. Dr Bhimani will want to know when the joint pain began and the nature of the pain. Is the pain continuous, or does it come and go? Does it occur in other parts of the body? Is it worse at night? Does it occur only with activity or at rest as well?
Physical Examination
Dr Bhimani will then examine the affected joint in various positions to see if there is pain orrestricted motion. Dr Bhimani will look for creaking or grinding noises (crepitus) that indicate bone-on-bone friction. muscle loss (atrophy), and signs that other joints are involved. Dr Bhimani will look for signs of injury to muscles, tendons, and ligaments.
X-rays
X-rays can show the extent of joint deterioration, including narrowing of joint space, thinning or erosion of bone, excess fluid in the joint, and bone spurs or other abnormalities. They can help Dr Bhimani distinguish various forms of arthritis.
Laboratory Tests
Sometimes laboratory tests, such as blood tests, can help rule out other diseases that causesymptoms similar to osteoarthritis.
Early, nonsurgical treatment can help maintain joint mobility, improve strength, and relieve pain. Most treatment programs combine lifestyle modifications, medication, and physical therapy.
Lifestyle Changes
Dr Bhimani may recommend rest or a change in activities to avoid provoking osteoarthritis pain. This may include modifications in work or sports activities. It may mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling). A weight loss program may be recommended, if needed, particularly if osteoarthritis affects weight-bearing joints (such as the knee, hip, spine, or ankle)
Medications
Non-steroidal anti-inflammatory drugs can help reduce inflammation. Sometimes, Dr Bhimani may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint. Corticosteroids provide short term relief of pain and swelling.Dietary supplements called glucosamine and chondroitin sulfate may help relieve pain fromosteoarthritis.
Physical TherapyA balanced fitness program, physical therapy, and/or occupational therapy may improve flexibility, increase range of motion, reduce pain, and strengthen the joint. Supportive or assistive devices (such as a brace, splint, elastic bandage, cane, crutches, or walker) may be needed. Ice or heat may need to be applied to the affected joint for short periods, several times a day.
If early treatments do not stop the pain or if they lose their effectiveness, surgery may beconsidered. The decision to treat surgically depends upon the age and activity level of the patient, he condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, osteotomy, joint fusion, and joint replacement.
Arthroscopy
Dr Bhimani uses a pencil-sized, flexible, fiberoptic instrument (arthroscope) to make two or three small incisions to remove bone spurs, cysts, damaged lining, or loose fragments in the joint.
Osteotomy
The long bones of the arm or leg are realigned to take pressure off of the joint.
Joint replacement
Dr Bhimani removes parts of the bones and creates an artificial joint with metal or plasticcomponents (total joint replacement or arthroplasty).
Rheumatoid Arthritis
Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invadessurrounding tissues, and produces chemical substances that attack and destroy the joint surface.
People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.
Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.
Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:
Swelling, pain, and stiffness in the joint, even when it is not being used
A feeling of warmth around the joint
Deformities and contractures of the joint
Symptoms throughout the body, such as fever, loss of appetite and decreased energy
Weakness due to a low red blood cell count (anemia)
Nodules, or lumps, particularly around the elbow
Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.
Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease.
The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:
Morning stiffness around the joint that lasts at least 1 hour
Arthritis of three or more joints for at least 6 weeks
Arthritis of hand joints for at least 6 weeks
Arthritis on both sides of the body for at least 6 weeks
Rheumatoid nodules under the skin
Rheumatoid factor present in blood testing
Evidence of rheumatoid arthritis on X-rays
Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relievesymptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.
Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and TherapyExercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.
SurgeryJoint replacement surgery is also an option and is often effective in restoring function.