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The Bone and Joint Clinic at Anna Nagar specialises not only in treating patients with knee and joint problems but also in sports medicine. Read on to know what the doctors there have to say.
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Dr. S. Sivamurugan (extreme left), Prof. S. Soundara Pandian (fourth from left) and Dr. S. Ravi Subramaniam (fifth from left).
BONES AND joints give one the ability to move freely; once they get affected, even day-to-day activities will be hard to carry out. How do they function, how should one take care of them and what are the treatment options available when complications arise are some of the questions answered by the doctors at The Bone and Joint Clinic, Anna Nagar, in an interview. The hospital is run by a three-member team of father and sons — Prof. S. Soundara Pandian and Dr. S. Sivamurugan and Dr. S. Ravi Subramaniam.
"We take the bones and joints for granted. Most of the people engaged in active physical work give scant respect to the knee, which is actually a `prime mover' enabling leg movements of all sorts. The knee is formed by a strong thighbone called femur and the bone of the lower leg is termed tibia. It is those powerful muscles near the knee which initiate the forward movement aided by the strong ligaments of the knee and that's how stability and mobility are achieved during all activities," says Dr. S. Sivamurugan, who specialises in joint replacement and shoulder surgery. How exactly do the joints move?
The ends of the tibia and femur that meet at the knees are covered with a smooth glistening material called hyaline cartilage which cushions the underlying bone from excessive pressure and allows the joints to move freely. Also, the knee is enclosed in a capsule with a smooth lining called the synovium, which provides the synovial fluid that helps reduce wear and tear in joints.
Arthritis is another ailment, which causes much strain.
"Any inflammation that occurs in the joint is called arthritis, which is basically characterised by the wearing away of the hyaline (articular) cartilage. The loss of this articular cartilage increases friction thereby causing inflammation and pain. Lack of activity, owing to pain, leads to weakening of the muscles and ligaments. This triggers off a `vicious cycle' and the knee gets increasingly unstable, more stiff and painful," says Dr. Ravi Subramaniam, whose areas of interest are knee arthroscopy and cruciate ligament reconstruction.
What are the types of arthritis?
Osteo arthritis and rheumatoid are the common forms though there is infective arthritis like tuberculosis arthritis, which is rare. In osteo arthritis, the area that gets affected is the articular cartilage owing to abrasive wear whereas the synovial membrane is supposedly at fault if one is said to suffer from rheumatoid. Pain is the frequent complaint though the degree of which may vary from a mild vague aching in the muscles to severe incapacitating pain. Eventually, the walking ability of the individual gets restricted and he has to go for a walking aid. Grinding sensation may occur. Swelling and redness may also be visible. A deformity develops which may lead to rapid deterioration of the joints, says Dr. Ravi Subramaniam.
If the knee gets affected irreparably, will a replacement be possible?
Prof. S. Soundara Pandian, the seniormost surgeon of the clinic, says, "It is possible. A total knee replacement is a surgical procedure where the damaged ends of the bones that meet at the knee are replaced along with the underside of the kneecap with artificial materials. A total knee replacement is required when arthritis causes a severe damage to the joint.
How exactly is it done?
The damaged parts of the joint are replaced with artificial materials after anaesthetising the patient and the whole process takes about two to three hours. It is significant to know that in total knee replacement, only the diseased articular cartilage is removed and resurfaced with a prosthesis. Both the knees can be replaced simultaneously, if the symptoms are severe in both. A major advantage in this is the walking ability of the patient improves faster as the pain is relieved in both the knees. There are about 100 centres all over the country doing this service.
What about the post-operative period?
It is a matter of regaining strength and confidence. Usually, one will be able to stand within a few days of the surgery and after appropriate exercises, walking will be possible with the help of a cane or a crutch.
What is the success rate of total knee replacement?
The results are good in about 95 per cent of the cases; but it largely depends on the extent of damage the knee has suffered before the surgery. The biggest advantage is the almost complete relief of pain. The deformities are usually corrected and the patient will be able to walk better and longer without pain. The movement of the joints will also improve.
The Bone and Joint Clinic also specialises in `Sports Medicine'. Prof. Soundara Pandian says sports medicine is a branch of medicine, which deals with the overall health of a sportsperson. One of the main aspects of sports medicine is the treatment of injuries and counselling of sportsmen against sustaining them. As a matter of fact, nearly 60 per cent of musculo-skeletal injuries are due to overuse and can be prevented.
Looking at the past few years, one would be able to understand the advances that have taken place in the treatment of injured sportspersons. This has been made possible by the development of arthroscope, a miniaturised telescope, which allows the surgeon to see the interior of a joint and diagnose precisely. Many surgeries are now being performed through arthroscopy. Post-operative care in the form of physiotherapy and bracing would help to a great deal in the overall management of these patients. "It has been our long-cherished dream to establish a special service for the injured sportsperson. Our Bonne Sante Arthroscopy unit offers a range of services to the patient, which include sports medicine, arthroscopic surgery of the knee, shoulder, elbow and ankle, ligament repair and reconstruction, physical medicine and rehabilitation, arthritis diagnosis and treatment, brace workshop, hip, knee, shoulder, wrist and foot surgery and also physical therapy," says Prof. Soundara Pandian, who was formerly professor of orthopaedics at the Government General Hospital, Chennai.
The cost of treatment for the sports medicine is being met by a trust formed by this trio. The physiotherapy and rehabilitation services rendered here deserve special mention as the hospital is in possession of the latest laser and nemectron equipment.
R. S. PRAKASH
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