We have come a long way in orthopaedics with robots assisting in complex joint surgeries, precisely fitting implants, giving a second lease of life to our knees. But there’s one thing we must not forget—that nothing is as good as the joints that we were born with.
Health Heroes – This article is part of a series to celebrate some of India’s most amazing doctors and to understand the incredible work they are doing.
You and I are privileged to walk on two legs, thanks to the tireless working of our knees that extend and lock day in and day out. Knees are the largest joints in the human body, but also the most complex ones. What happens when this critical machine gets worn and torn or suffers swelling?
In a one-on-one with 2014 Padma Shri awardee Dr Ashok Rajgopal, Dr Priyamvada Chugh discusses everything about the life of the knee.
Dr Ashok Rajgopal is the Group Chairman of the Medanta Institute of Musculoskeletal Disorders and Orthopaedics, The Medicity, Gurugram. An internationally renowned orthopaedic surgeon, he holds a track record of over 30,000 total knee replacement surgeries and more than 15,000 arthroscopic surgeries for ligament repairs and reconstructions.
Born in 1953, Dr Rajgopal pursued his M.B.B.S from the Armed Forces Medical College in Pune, and his masters from the All India Institute of Medical Sciences in Delhi and the University of Liverpool, UK.
With an increase in the average lifespan of humans in all parts of the world, arthritis has become a household name for many. But what is “arthritis”?
Originating from ancient Greek, the word ‘arthritis’, which means “pertaining to the joint, limb”, is a scientific term used for hundreds of types of joint pains or joint diseases.
Osteoarthritis, the most common type of joint disease, occurs when the knee cartilage—the cushioning surface on the ends of the knee bones—wears away. This results in bone rubbing against bone, causing pain, swelling, and stiffness.
Osteoarthritis primarily affects the elderly population and is a major cause of disability in older adults worldwide. According to the World Health Organisation, 9.6 per cent of men and 18 per cent of women above the age of 60, worldwide, have symptoms of osteoarthritis.
“In fact, by 2050, people over 60 will account for 20 per cent of the world’s population. Of them, nearly 20 per cent will have osteoarthritis, with a third being severely disabled. This means that 130 million people worldwide will suffer from osteoarthritis by 2050, 40 million of whom will be severely disabled,” says Dr Rajgopal.
What are the available treatments for osteoarthritis?
Physiotherapy is always tried for at least 3-4 months to treat knee disorders. However, if these exercises don’t work, then invasive surgical options are considered. The two most common approaches are arthroscopic surgery and arthroplasty.
Arthroscopic surgery is a minimally invasive procedure in which examination, and if possible, the treatment of damage in the joint is performed using an arthroscope, a small fibre optic camera. The camera is inserted into the joint through an incision of about 4 mm. Classically, arthroscopy is performed to look at, diagnose, and treat problems inside a joint.
Arthroplasty, on the other hand, is an open surgical procedure performed by an orthopaedic surgeon. It is a replacement surgery performed to restore normal motion and relieve pain in a diseased/disabled joint. Based on the need, either the entire knee (all three parts) are replaced as in total knee replacement, or only the affected compartment of the knee is removed and replaced with artificial components as in partial knee replacement. Replacement is usually advised only in severe end-stage disease.
“35 years ago, when I started my practice, both arthroscopic, as well as arthroplasty surgeries, were more of a novelty than the norm. In the late 1980s and early 90s, we would see fewer patients and operate even less! Maybe 100-150 patients underwent surgery annually. These numbers have gone up dramatically in the past two decades. Now, annually, about 2,000 knees are replaced, and a similar number of people undergo arthroscopic surgeries for sports or other knee-related injuries,” shares Dr Rajgopal.
He shares the example of the badminton legend Pullela Gopichand, recalling, “When the sporting world had all but written him off because of his knee injury, he came to me. I performed his surgery and supervised his rehabilitation. The results are there for all to see. He went on to win the All England Badminton Championship after his surgery and is India’s most successful badminton coach today.”
We have come a long way in orthopaedics with robots assisting in complex joint surgeries, precisely fitting implants, giving a second lease of life to our knees. But there’s one thing we must not forget—that nothing is as good as the joints that we were born with. Thus, keeping problems of the knee at bay must always be our primary goal.
To protect the knees, Dr Rajgopal shares the mantras:
- Eat right
Although no specific diet has been shown to prevent osteoarthritis, certain nutrients like Omega-3 fatty acids and Vitamin D have been associated with a reduced risk of the disease.Omega-3 fatty acids are known to reduce joint inflammation and can be found in certain plant and nut oils, including walnut, soybean, flaxseed and olive oil. Vitamin D supplements are known to decrease knee pain in osteoarthritis. Your body makes most of the Vitamin D it needs in response to sunlight. You may supplement it by including eggs, cheese, fatty fish such as salmon, mackerel and tuna, as well as through foods fortified with vitamin D such as soy milk and cereals.
- Control your weight
Obesity is a risk factor for developing arthritis. Data from the first National Health and Nutrition Examination Survey in the USA showed that obese women were nearly four times more likely to have osteoarthritis.
- Exercise regularly
For the knees, the safest exercises are those that place the least body weight on the joints, such as cycling, swimming and hydro aerobics.
- Avoid injuries or get them treated as soon as possible
A study at the Johns Hopkins Medical School found that people who injured a knee in adolescence or young adulthood were at considerably increased risk of developing osteoarthritis in that knee, compared to those who had not suffered an injury. And, if you do sustain an injury to your knees, then get it treated in time to avoid further damage.
(Edited by Shruti Singhal)