FAQ
What are the common problems patients are facing due to COVID-19?
There are a subset of patients suffering from arthritis pain and also suffering from ligamental meniscal injuries, who have to put the surgeries forward due to the COVID.
There are a lot of people who are suffering from immense pain, they have postponed the surgery thinking that they will do it later, but now since the COVID has taken 6-7 months these patients are finding it tremendously difficult to do household activities like getting out of the bed, going to the restroom.
For example, a patient with very severe knee arthritis with a stress fracture or a patient with very severe hip arthritis, ligament injury with instability bleeding to bucket-handle meniscal tears. These are the people who are really feeling difficult to do normal household activities because they have to limp or there is a constant fear of fall due to severe arthritis.
How is Sakra World Hospital selecting patients for elective surgery?
We have found that the best way to operate patients who are considered as elective but unfortunately because of the pain they cannot wait for a long time. We think that with our exposure we did this 200 surgeries but we are very happy to say that neither the doctors got infected with COVID-19 nor our patient got infected with COVID.
What procedures were involved among elective surgeries?
Among these 200 elective procedures involved knee joint replacement and many arthroscopic procedures like ligament, meniscus injury and shoulder arthroscopy procedures.
What precautions is Sakra World Hospital taken amidst of COVID-19?
Strict surveillance eye is very much required, from the time patient decide to go for the surgery, better to go for COVID testing and also segregating the hospital three zones, one is COVID zone or red zone where patients came COVID positive and one is holding zones, where patients are waiting to get results. Holding zone is treated with the highest protocols which are also considered as COVID negative zones and there is a completely COVID free zone where the patients have been tested for COVID and the result came negative.
Is it safe to go for post-surgery rehabilitation in the current COVID situation?
Post-surgery rehabilitation is very important and we always try to encourage physiotherapists to do only home visits and not to do any OPD practice. So the rehabilitation specialists are doing only home visits when the patients are already tested by the hospitals. So there is never a mixing of COVID positive and COVID negative patients.
How many procedures have been performed in the orthopaedics department of Sakra World Hospital?
So far we have performed 300 to 350 orthopaedic procedures without having any cross infection rate both to the doctor and to the patient. Sakra also offers home health care where rehabilitation or the post-fracture treatment, and post-replacement patients are treated. It is all about maintaining proper chain so that the patient benefits at these times of crisis and also they don’t have the fear of getting infected by this coronavirus
What is the importance of Knee joint?
The knee is one of the important joints in the body because it carries the weight of the human being but is also important for sporting activities. So in the knee, there are structures like meniscus which are the rubber pad for cushioning, ligaments which support the stability of the knee.
What are the most common injuries caused to the knee?
The most common injuries to the knee are rubber pad injury or meniscus injury, ligament injuries, cartilage injuries. Meniscus injuries are quite common because of the sporting population. Usually, when we do sports the twisting movements can cause meniscus and ligament injuries. Also slipped in the house or fall, twisting in the house can also cause meniscus injuries.
What is meniscus?
The meniscus is a C-shaped structure in the knee, there are two menisci, inner menisci called middle menisci, outer menisci called lateral meniscus. It is divided into three zones:
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Outer Zone also called Red-red zone
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Middle zone is called the white-red zone
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The inner zone is called the white-white zone
These meniscus injuries can result in a tear of the meniscus. These tears are classified into radial, horizontal, complex, oblique, horizontal cleavage and root tears.
What are meniscus root tears?
Meniscus root tears are the tears in which menisci are attached to both the front and back of the leg bone or the tibia bone through a structure called root. So we have inner meniscus front attachment and back attachment, other meniscus front and back attachment. The detachment of the root from the bone is called root tears.
Do all meniscus tears require surgery?
Not all meniscal tears require surgery, some can be managed conservatively. Small peripheral tears are red-red zone tears that can be managed conservatively without surgery because the blood supply to the outer portion of the meniscus is present whereas small tears can heal by itself.
If the tears are extending from the Zone 2 to zone 1 that is the red-white zone and white-white zone then the surgery is contemplated or bigger tears in the periphery or the outer zone (red-red zone) need surgical treatment.
What are the types of surgeries?
Removal of the meniscus - It is called a meniscectomy. It should be done when the tears are in the white-white zone and which is not repairable and also in the complex tears where the meniscus is crushed and the tissues are not good. One should be very very careful to remove as least meniscus as possible because removal of too much of meniscus ends in losing the cushioning effect of the meniscus. The thigh bone and leg bone start crushing each other and develop cartilage damage or arthritis.
Repair of the meniscus - It is called meniscus repair. There are three techniques used in meniscus repair:
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Outside- in technique - Putting needles from outside and stitching the meniscus though suture materials. This is usually done for the front half of the meniscus.
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Inside-out technique - It is done for the posterior half of the meniscus
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All inside technique- There are very variegated uses in all inside techniques such as biodegradable material, peek material, all suture material.
These all suture devices come with disposable devices which help in delivering the implant into the meniscus and which creates a knot or suture around the meniscus which helps in repairing the meniscus.
In the last five years, I have performed almost 10000 meniscus repairs and in my experience, once the meniscus is repaired well.
What is JuggerStitch by Zimmer Biomet?
We are happy to introduce JuggerStitch by Zimmer Biomet, which is all inside a knotless meniscus repair device which doesn’t carry any implantable peak or biodegradable implant. It is made up of only suture material. This device has been introduced for the first time in the country by Sakra World Hospital. We are one of the premium hospitals in the country to do the meniscal repair.
The benefit of JuggerStitch by Zimmer Biomet is that it is knotless, all suture implant which allows easy implant insertion.
How much time does it take to go back to normal activities?
If meniscal repairs are followed up well you can do MRIs and see how the meniscus is healed and at the same time if you have retained the meniscus you can allow the patient to go back to complete sports activities after 6-9 months. Post-surgery good physiotherapy and rehabilitation are required, first, we do walking, then we do weight-bearing, then we train the patient for balance agility and sports training in future.
What should be preferred meniscus repair or meniscus removal?
At Sakra, we always suggest doing meniscal repair because if you remove the meniscus then there is no other option and the meniscus cannot regrow. If too much of meniscus is removed then the only option left with is meniscus transplant where you have to get the meniscus from the cadaver labs and do the meniscal transplant. So it is better to save as much as possible.
