Treating knee pain in the young -
Biological Cell Therapy, the new frontier
Treating knee pain for younger people, between the ages of 15 to 55, poses the biggest challenge. Primary osteoarthritis is uncommon below age of 30 years, secondary arthritis due to previous trauma or sports injury is not so uncommon. Damage to the articular cartilage in the knee due to an injury or sudden impact may affect millions of people world-wide, but treatment is hampered by the fact that in adult life, articular cartilage is limited in its ability to regenerate. Therefore treating such injury leading to arthritis of the younger person becomes more challenging.
What is cartilage?
Cartilage is the most vital structure of the knee joint, that help to prevent the grinding of two bony surfaces.
What is the answer to treat cartilage injury?
ACI(Autologous Chondrocyte Implantation) technique appears most promising, due to its ability to generate hyaline type cartilage, which is more durable.
How is ACI performed?
Healthy knee cartilage is harvested from the non weight bearing area of the affected joint. In a high tech cell culture lab, these cartilage cells are re-grown in multiplication over five weeks. In the second stage, cells are injected into damaged area covered by bone membrane called periosteum
What is new in cartilage implantation?
MACI (Matrix Induced Autologous Chondrcyte Implantation) is a current advanced innovative technology over previous method described. This uses collagen membranes and Tisseel fibrin sealant to attack the chondrocyte seeded scaffold and fill the cartilaginous defect void.
Hips: ALL NEW AGAIN
Osteoporosis, the degenerative joint disease that usually sets in with age, causes pain, not only to the person suffering from it, but also to the family of the patients. Seeing someone close to you hobble with every step can be agonising. Especially of there’s nothing you can do to take the pain away. But there is, Studies have shown that new disphosphonate drugs can cure osteonecrosis of the hip, a debilitating disease that could only be cured by surgery earlier.
Total hip replacement and total knee replacement surgeries are no longer necessary.” In the past few years, doctors have made possible the option of surface replacement--- surgery where the surface of the joint is ‘capped’, ”says Dr. Sanjay Agrawal, consultant orthopaedic at Breach Candy and PD Hinduja Hospitals, and specialist in joint replacement surgeries. “This preserves a large portion of the natural bone. And just in case the patient needs a revision surgery in a few years, natural bone is easier to work with.
New instruments, surface finishing materials and computerisation are now being used in surgery of he joints. “Technology now allows the patient full range of movement with minimal damage to the bone. The patient has the ability to do things that were impossible earlier.” Says Dr. Agarwala. Sitting cross-legged and squatting are just a few of the things a patient is not forbidden any more. “ This also offers greater longevity of the joints, ”he adds.
Osteoporosis cure in once-a-day pill?Tested on rodents, New Drug completely Rebuilds Bones Chicago: a once-a-day pill helped completely rebuild bone in rodents with server osteoporosis, a finding that could lead to a new class of drugs to treat the brittle-bone disease in humans, US researchers said.
The team tested a compound that blocks the production of the serotonin hormone produced in the gut in mice and rates with a severe form of the disease and found they completely recovered their bone density.
“If you break the bone, it looks like a normal bone,” said Gerard Karsenty of Columbia University Medical Centre in New York, whose study appears in the Journal nature Medicine.
Using the findings, he said the team is working to develop this type of treatment for human patients with osteoporosis, in which bones become fragile and porous. Increasing the risk of fracture.” There is an urgent need to identify new, safe therapies that can increase bone formation on a long-term basis,” Karsently said.
The study builds on prior research conducted by the same team that found that the chemical messenger serotonin-when released by the gut-inhibits bone formation.
Serotonin is most commonly known for its role in the brain as a chemical messenger but 95% of the serotonin in the body is produced in the gut as a way to regulate bone formation, Karesenty said. ”we thought that if we could inhibit the synthesizing of serotonin in the gut, it could be a way to treat osteoporosis, ”he said.” Luckily for us, there are a couple of inhibitor of gut-derived serotonin that do not affect the synthesis of brain-derived serotonin.”
The team tested a compound that blocks the production of serotonin in the gut in mice and rats with osteoporosis.” Indeed, when you deprive the system of serotonin in the gut, consistent with the human genetic data, what you see in mice or rats is that you correct completely the osteoporosis,” Karsenty said .
He said the drug had already been tested in people in early safety studies.
“This molecule is given once a day orally. Obviously it is very attractive. There are very few molecules that can induce bone formation.
Beer is good for Bones’
London: Beer is a significant source of dietary silicon, a key ingredient for increasing bone mineral density, and hence a moderate consumption may help fight osteoporosis.
An international team has carried out the study and found that beer is rich in silicon—a mineral found in barley, a key ingredient in the beverage---- which survives the brewing process as orthosilicic acid. And, according to the study, it’s silicon which helps strengthen bones and prevent osteoporosis, a disease that is characterized by low bone as well as the deterioration of bone tissue.
Lead researcher Charles Bam-forth of California University was quoted by the British media as saying,” Beer containing high levels of malted barely and hops are richest in silicon. It’s the husk of barely that’s rich in this element,While most remains during brewing, significant quantities are none the less extracted into wort and survive into beer” .
Bone Lengthening procedure puts him on his feet again
Mumbai: Kalyan resident Chanrakant Kothere never believed doctors who told him three years ago that he would not be able to walk properly again. It was perhaps his positive belief that led to a near-complete cure—a bone-lengthening procedure known as the IIizarov technique and a subsequent operation over the lasted over nine months.
Kothere, who had met with a road accident while going to Alibaug on a bike, suffered multiple fractures on his right leg, resulting in a limp and extensive pain.
“Some doctors suggested an amputation after the initial treatment,” said Shobha kothere, wife of Chandrakant. But the couple was determined that he would walk without a stick---sooner than later. In the interim, the fracture on Kothere’s right leg caused a bow leg appearance. He was “Shorter” by almost three inches on his right side.
“He resumed work, but came back twice with a fracture that needed plastering. How long could we go on? Said Shobha. That is when Shobha went to Wockhardt Hospital in Mulund in January this year to meet a doctor for a cure. At Wockhardt, the doctors decided to conduct the surgery in two stages. “In the first stage., We cleared the infected bone and aligned the leg using a ring shaped IIzarov External Fixator,” said Dr. Sachin Bhonsale, consultant orthopedic surgeon at Wockhardt. The screws were turned—1 mm a day – to facilitate lengthening. “It took four months for the bone tissues to grow. That is when we performed the second stage of attaching a titanium rod and screws,” the doctors said.
The significance of the case lies in the fact that even after three years of the fracture, a procedure to transport the bone and fix the joint was successful.
Doc up & running after cell therapy
Dying Hip Joint Repaired With Cultured Cells
A 25-year-old Ratna girl doctor could be the first in India to be treated for avascular necrosis using cell therapy.
Avascular necrosis is a disease in which the tissues of the hip joint die because of lack of blood supply. The top of femoral head (the ball portion of the ball and socket joint) collapses as a result and begins to flatten. The most common treatment of this disease is complete hip replacement.
But 25-year-old Suhas Khanavilkar deicided to take a chance—with a new therapy. Instead of surgery, he only needed an implant of bone cells cultured from his own bone marrow.
“Ten months ago, I suddenly stared experiencing pain in both my hips while walking. I neglected it for a long time, but there came a time, when a cracking sound came from my hip joint whenever I sat down or stood up. CT and MRI scans showed that the head of my thigh bone had become uneven. The left side was still better. But the right hip was so painful the joint even fractured,” said Suhas’ Dr. Gauresh Palekar, Suhas ‘doctor, says the therapy, which was performed eight months ago, was possibly the first in India.
Satyen Sanghavi, chief scientific officer of ‘Regrow’, a Lonavala-based cell therapy services company, said it was a five-week –long procedure. “First 10 ml of Suhas’s bone marrow was taken form his posterior bone. This was sent to our lab in Korea where it was cultured into bone cells. Around 10,000 stromal cells were separated from the bone marrow, which were then cultured into 50 million osteoblasts (bone cells).”
In November, the bone was pushed back into its original place, and the inside was filled with calcium cement, and a mixture of cultured bone cells and fibrin gel. “The calcium cement turns into bone within a year. The gel is used to keep the cultured bone cells in place,” said Dr Palekar, who runs a clinic in Girgaon.
Although Suhas walked with the help of crutches for three months after the surgery, today, he walks runs and climbs stairs just as earlier.
“Drug treatment of avascular necrosis helps preserve the disease bone till nature can take over and restore the bone, Stem cells, however, will hasten this procedure. Still, it is too early to say if it will be successful,” said Dr. S Agarwala orthopedic surgeon with Hinduja Hospital. Dr. Vijay Shetty, orthopedic surgeon with Hinduja Hospital. Dr. Vijay Shetty, orthopedic surgeon with Hiranadani Hospital says,” We need to look at long-term results before we can start doing it on every patient.”
Chronology of An Implant
Avascular Necrosis (AVN) occurs in the hip joint, when the top of the femoral head (the ball portion) collapses and begins to flatten due to the stoppage of blood supply
Osteoblast Culture
• 10 ml of bone marrow is taken from the pelvic bone
• In the lab, around 10,000 stromal cells are separated from the marrow.
• These are cultured into osteoblasts (bone cells)
• In a span of five weeks, these are expanded into 50 million cells
1 Due to lack of blood supply, the bone tissues die
2The bone starts collapsing and flattens inwards
3The bone is pushed back in its normal position and is filled with a calcium and bone cells mixture.
Causes
• Prolonged use of alcohol/steroids
• Working in extreme atmospheric conditions
• Injury, fracture or dislocation of the hip joint
• Most known cases of AVN are idiopathic (where cause is unknown)
Stem cell therapy saved his cricketing career
Mumbai: a dying cricketing career and four surgeries later, stem cell therapy came to the rescue of budding cricketer Ankit Parasher. Repeated wear and tear in the playground wear and tear in the playground damaged his left knee to such an extent that his performances on filed had hit rock bottom.
21-year-old Parasher, state level player from Madhya Pradesh, had been suffering from Osteochondritis Dissecans (OCD)-a condition in which cracks appear in the lining of the knee joints. Gradually, blood supply to the affected area got disrupted and fragments of the affected bone and its covering of cartilage loosened up and some even got detached.
A common orthopedic procedure, arthroscopy, performed twice on him, also failed to yield any results. “It affected my performance on the field as I would be in pain after every match.” Said Parasher, who is going to be back in action next month after a break of more than a year.
If not for the stem cell therapy, there was little doctors could have done to revive his career. Orthopaedic surgeon Dr. Anant Joshi, who specialises in sports injuries, went ahead with a procedure called chondron. In this procedure, patient’s own healthy cartilage tissue is harvested, stem cells are cultured from the tissue and implanted in the affected area, he said.
The stem cells, which were harvested from Parasher’s 67mm of cartilage tissue, tool around 4 weeks to culture. Once the cells were formed, they were injected in his affected left knee joint. The results were visible in six months. Said Joshi.
The treatment could also mean boon to sportsperson who suffer from repeated injuries, said Joshi, who is also an advisor to the Board of control for Cricket in India (BCCI). “Before cartilage cell treatment, we had very limited options to treat sportsmen,” said Joshi.
Joshi, however, cautioned that this therapy may not hold much promise for arthritis, or conditions requiring joint replacement.
Osteoporosis drug overuse narms limbs:
Drugs used to treat osteoporosis—the brittle bone disease—could make limbs easier to bone disease—could make limbs easier to break if used for too long, new studies have found. According to two studies—presented at the annual meeting of the American Academy of Orthopedic Surgeons in New Orleans---overuse of the a drugs upsets the mineral and crystalline structure of bone, causing weakness that can lead to fractures, Scientists found that bisphosphonates improve quantity. at the expense of quality. Although the medicines helped preserved bone, over time they appeared to impair its structure.
TAKE CARE OF YOUR BONES
Osteoporosis is affecting millions of women, Zeenia F Baria asks experts more about this disease
Are you aware that Osteoporosis is an illness that is affecting millions of women across the globe? This disease usually targets people after the age of 45 and is more common in post menopausal women. Often called the silent disease because bone loss occurs without symptoms, there is an urgent need for more awareness of osteoporosis.
According to Consultant Orthopaedic, Joint Replacement and Hip Resurfacing Surgeon, Dr Sanjeev Jain, people may not know that they have osteoporosis untile their bones become so weak that a sudden strain, bump or fall causes a hip fracture or a vertebral collapese. "Pain and weakness all over is a common symptom.Unfortunately, in many cases, the first real 'symptom' is broken bone. Loss of height, with the gradual curvature of the back, (caused by vertebral compression fractures) may be the only physical sign of osteoporosis," says Dr.Jain. The best ways to prevent it and to protect your bones is to do exercises that help in strenthening bones. "Building bones through adequate calcium intake and exercises when you are young is an investment that will pay off years later with a reduced risk of hip and other fractures. An inactive person should start these exercises slowly and gradually increase the intensity.
Brisk walking, jogging, climbing stairs are especially good. Muscle building exercises are not recommonded for people with osteoporosis. In pregnant, lactating, nursing, post-menopausal women and in men and women over 65 years, the requirement of calcium and vitamin D increases. Vitamin D can be obtained from eggs, liver or even spending about 15 minutes in the sunshine is good. Apart from calcium, Vitamin D,K,B6,B12 and minerals like magnesium, zinc, manganes and silicon are also important in strengthening bones. To prevent menopausal bone loss, estrogen replacement therapy, calcitonin, bisphosphonate, parathyroid hormone therapy and other medications should be considered," he says.
Orthopaedic and Joint Replacement Surgeon, Dr Dilip D Tanna, says that the human body forms bones until the age of 35 years after which new bone formation is negligible. "This remains our highest bone mass. Post 35 years our bone mass remains steady untile 45-50 years after which it gradually begins to lose bone mass due to menopause. Most women lose around one per cent of their bone mass each year post menopause. Osteoporosis can be detected only over a period of time with a few tests. Include a lot of calcium rich alternatives in your diet. These include dry beans, such as black-eyed peas, kidney beans and black beans, turnip greens, collard greens, broccoli, sardines, tofu and fortified orange juice. Almonds, sunflower and sesame seeds ae also a rich source of calcium," says Dr.Tanna.
Consultant Orthopedic Surgeon, Dr Sanjay Agarwala, concludes saying that osteoporosis isn't always hereditary."There can be a predisposition mediated through hormonal lack. The peak bone mass i.e. the amount and quality of bone is genetically linked. However, environmental factors and personal habits determine the final quality of bone. On needs to replenish stores of calcium and vitamin D and at times consider hormones that can makes bones grow. One can prevent this illness by going in for weight bearing exercises during young age and maintaining the intake of calcium and vitamin D," says Dr Agarwala.
Never in vein
Many who suffer from varicose veins think there is not cure for this problem But this is a misconception.
There are several instances of people silently suffering from varicose veins unable to find a cure or learn how to handle them. Also, when the pain and disease recurs despite treatment, patients are under the impression that varicose veins are not curable. But this is a misconception.
Payal Shah, who lives in the U.S. had suffered from various veins for five years. She tried several treatments but found only temporary relief. While travelling to India, on the 14-hour flight, she experienced tremendous discomfort and pain in her legs and her ankle was red, swollen and painful. Soon her ankle, was a pool of blood; a varicose vein had ruptured and was bleeding heavily. The first-aid on flight controlled the bleeding and on landing, she was brought to hospital. The bleeding varicose veins were treated with a combination of laser and scleriotheraphy treatments, where the affected vein was destroyed from within. The results were very effective; not only did bleeding stop within 24 hours, but Payal also found a permanent cure.
The problem
What are varicose veins? Why do they occur? Varicose veins are swollen and enlarged veins, which are usually blue or dark purple and may appear lumpy, bulging, or twisted in appearances. They can occur in any part of the body but generally appear on the legs.
With awareness being low, patients are often unaware of advanced treatments that can give permanent relief. Often patients tend to take what they do with fever. Take a Crocin for the pain. This does not help treat the underlying main cause. If left untreated for long, varicose veins can cause long-term damage. The patient may not be able to walk in the long run, or the vein may burst and cause bleeding and wounds that may not heal.
Various veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows smoothly back to the heart and is prevented from flowing backwards by a series of tiny valves, which open and close to let blood through. If these valves weaken , or are damaged, the blood flows backwards, and collects in the vein, eventually causing it to be varicose.
There are several reason why they might just suddenly appear. Varicose veins tend to be hereditary. If your mother or grandmother had them during pregnancy, you news is that they tend to get better after delivery.
In another case, a 31-year-old store manager working on his feet most of the day suffered from ulcer that would not heal for a few years. Northing worked despite several kinds of treatment. Finally he top was treated with a combination of laser and surgical treatment, which is the best form of treatment for young patients. He recovered completely in four weeks.
Treatment options
So what are the most effective treatments available? The type of treatments depends on your general health and the size, position, and severity of your varicose veins. The most effective method is endovenous laser along with hook phlebectomy. Other available treatments include use of compression stockings, sclerotherpy, which is usually suitable for people who have small to medium-sized varicose veins. This involves a special chemical being injected into the veins and then seals then closed. Surgery may be required when large varicose veins need to be removed.
The other option is endovenous laser treatment where a narrow tube, known as catheter, is inserted into the vein using an ultrasound scan . A tiny laser is then passed through the catheter and positioned at the top of the varicose vein. It emits short bursts of energy, heating the vein up and sealing it closed. The laser is slowly pulled along the vein using the ultrasound scan as a guide, allowing the entire length of the vein to be closed.
Total Knee Replacement surgery-A Patients Perspective
A patient taking a decision to undergo knee replacement goes through a big turmoil and apprehension. These is always an anxiety and fear factor related to its s success. Several questions to be answered prior to decision making. Postoperative painful physiotherapy, prolonged recovery, worsening of condition prior to surgery and safety having one or both side surgery is major reasons govern myths about this wonderful operation.
Result of surgery is excellent provided there is prior understanding of problem, acceptance of surgery and its results and co-operation for post suirgery physiotheraphy program. With advance post operative pain management program there is negligible or no pain after knee replacement in today’s time.
Complimentary to pain management is minimally invasive knee replacement. Here operation incision is very small with least damage to muscles and tissues during surgery and hence pain factor is negligible or even not there. This all contributes to over all stay after surgery to 2 to 3 days.
There is always a high degree of expectation from surgery, particularly related to gaining more bending after knee replacement with Indian cultural and social background. Newer design of knee implants and special surgical technique provides this needed complete bending for sitting cross legged position. I have performed more than 800 surgeries using this design if implant with excellent expected results.
Since both, knees are severely involved in most of the patient, there is always a swing in the mind to have one side or both side surgeries done, both sides—Bilateral Knee Replacement can be done vey safely in medically cardiac fit and motivated group of the patients. Main advantages are one time anesthesia. Surgery, recovery and physiotherapy. Current technology using computer navigation helps surgeon to align joint and implant to highly accurate, precise and desired position to have excellent long term results. After total knee replacement there is improved quality of life through greater independence & far superior mobility.
