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Bones Clinic

0124-4360590 : 8447918981

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About The Doctor

  Best knee replacement surgeon in delhiDr Anurag Awasthi is affiliated to Artemis Hospital, Sector 51 (JCI & NABH accredited) & Columbia Asia hospital Sector 23 (NABH accredited) in Gurgaon (now Gurugram), India as Honorary Consultant for all Orthopedic Bone Injury, Sports Medicine & Joint Surgery (including, Hip & Knee Replacement).  

Bones Clinic Gurgaon is started by Dr Anurag Awasthi as a holistic center dedicated to Bone, Joints, and Spine Health. It focuses on prevention, treatment and rehabilitation of patients suffering with Bone & Joint disorders. Dr Awasthi is among one of the best Orthopedic doctors in Gurgaon*, India (Delhi NCR), who believes in following best ethical practices, with patient participation in decision making process. Specialization Areas : Hip & Knee Arthritis, Sports Injury, Fractures & Complications, Key hole Knee Surgery, Cartilage preserving Surgery to delay Knee Arthritis, Joint Replacement including Customized Knee Replacement and Ceramic Hip Replacement, Bone & Joint Infections.

Experience & Training:
1. Current Position- Visiting Consultant Orthopedics & Joint Surgery- Affiliated to Artemis, Columbia Asia, & Bones Clinic.
2. Fortis Hospital, Vasant kunj, New Delhi (2009-2013), and
3. Artemis Hospital, Gurgaon (2008)
4. P.D. Hinduja Hospital, Mumbai,(2006-2008).
5. Residency Training- LLRM Medical College, Meerut 2003-2005
6. MBBS- King George Medical College, Lucknow 1996-2002

CLICK HERE TO VISIT DR ANURAG AWASTHI'S OFFICIAL WEBSITE ►

Consultation Timings:   Monday to Saturday - 9:30 AM - 2 PM; 6 - 8 PM

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Knee Meniscus Tear

Knee Meniscus Tear develops due to twisting injury, commonly during sports injury or sometimes even while dancing or sudden jerk while walking. Most Meniscus Tear heal without Surgery. However, in cases of Horizontal tear, Complex or Radial tear or Bucket handle tear, surgery may be warranted. The procedure involves a key-hole surgery performed by arthroscope, and patients are able to resume normal activity within 24-48 hours.

Knee Arthroscopy- Key Hole Surgery

Knee Arthroscopy is a minimally invasive procedure for correction of internal derangement of the knee. This procedure is performed by making a small ‘5 mm’ size cut on both sides of the knee joint. These portals are used to insert an arthro-scope with camera, and another is used for instruments to perform the required procedure.
It is usually performed under spinal anaesthesia. Common procedures/ indications for knee arthroscopy include,
Meniscal tear
Recurrent synovitis,
Loose body removal,
Osteochondral defects,
Para-meniscal cysts excision,
Synovial Chondromatosis,
Synovial biopsy,
Arthrolysis
Mosaicplasty
Arthroscopic Chondroplasty

Arthroscopic Laser Chondroplasty
The patient may start walking from the next day of surgery, and over 90 % of them resume office within a week. Active sport activities should be avoided for approximately 3 weeks

How to delay knee arthritis

Lifestyle modification, regular activity and timely medical opinion helps a long way in delaying Knee Arthritis.
Most common factor leading to rapid aggravation of knee arthritis is increased body weight. It is important to keep BMI check and monitor weight gain beyond the acceptable limits. Although, increased body weight is not a cause of arthritis; however, if arthritis is developing body weight can accelerate the rate of damage.

Second factor is presence of Positive family history. It covers those healthy individuals who have a sibling or parents with arthritis. It is important to ascertain the type of arthritis, as management depends upon the etiology. Normal individuals with positive family history should get a routine check done every year after 40 years of age to check of early signs and symptoms.

Third important step is Education. It is helpful to gather information about the natural course of arthritis progression, so that patients and healthy subjects can pick up earliest warning signs and symptoms. Any knee pain persisting for more than 6 weeks, or knee pain over 3 weeks with positive family history; or knee pain associated with swelling or fever – Such cases need urgent Orthopedic opinion.

Fourth step is towards adoption of healthy lifestyle. Knee Arthritis is more common in Asian population due to adoption of postures like squatting and cross leg sitting, and some genetic influence. It is advisable to healthy individuals that they should avoid squatting/ cross leg sitting/ kneeling if they experience earliest signs of knee pain.

Hip/ Knee Replacement surgery cost

Cost of Total Hip Replacement/ Total Knee Replacement surgery depends upon two factors-

1. Implant Specifications

2. Hospital/ Room Category

The approximate cost of a THR/ TKR starts around 1.6 lacs for a standard imported implant in a affordable hospital category. In a corporate hospital, the cost starts around 2.25 lacs.

The cost includes Surgeon / Anesthesia Fee, Hospital expenses, Medications, Room Stay, and routine blood tests.

Cartilage Lesions

Knee Cartilage defects or Osteochondral lesions may produce pain and stiffness of the joint. If un-treated such lesions may lead to development of full thickness cartilage loss, and eventual arthritis.
Arthroscopic Chondroplasty can be performed in such cases, to allow cartilage regrowth, and delay the development of full blown arthritis.
Arthroscopic Chondroplasty procedure involves Microfracture/ Abrasion chondroplasty/ Laser. This allows the growth of fibrocartilage and help to fill up the void created by cartilage loss.
In cases of large solitary Osteochondral defects, Mosaicplasty may also be performed.These procedures help in delaying Arthritis, and are very useful in younger patients with knee pain not responding to conservative trial and physiotherapy. The patients are usually admitted in hospital for 24-48 hours. Ambulation with walker/ stick support is started the next day of surgery.

AVN HIP- Avascular Necrosis

Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately lead to destruction of the hip joint and arthritis.

Osteonecrosis is also called avascular necrosis or aseptic necrosis. AVN hip can lead to Degenerative Arthritis of Hip Joint necessitating Total Hip Replacement Surgery.

Risk Factors :

Although it is not always known what causes the lack of blood supply, there are a number of risk factors that can make it more likely for someone to develop the disease:

  • Injury — Hip dislocations, hip fractures, and other injuries can damage the blood vessels and impair circulation to the femoral head
  • Alcoholism
  • Corticosteroid medicines
  • Osteonecrosis is associated with other diseases, including Caisson disease, sickle cell disease, myeloproliferative disorders, Gaucher’s disease, systemic lupus erythematosus, Crohn’s disease, arterial embolism, thombosis, and vasculitis.

hip replacement surgery

Will the pain go after surgery ?
After a hip replacement, the pain due to arthritis usually subsides in 4-6 weeks. Thereafter, there may be occasional reminders of pain after unaccustomed activity. If however, the pain re-appears after a prolonged pain free period; or the pain tends to worsen progressively, there is a definite cause for concern. This requires an urgent evaluation by the Orthopedic surgeon

How much time do I need to stay in Hospital; and how much time off work  ?
As regards hospital stay, the usual duration is 1 week. The timing of going back to previous level of activity depends upon the type of Hip replacement – Cemented/ Un-cemented; and the quality of bone stock. Usually patients may resume office and sedentary work after 4-6 weeks.

What are the chances that I will need a repeat surgery in future  ?
The typical longevity of a Hip replacement depends upon- quality of bone/ level of physical activity/ Age/ body weight/ technique of surgery. Most hip replacements survive an average of 15-20 years. However, a large number of variables affecting longevity prevents accurate survival analysis. Individual patient assessment should be done carefully, and the risk- benefit analysis should be explained to the patient before surgery.

What precautions I need to take, and for how long   ?
The most important of all, are the precautions to be taken by the patient himself. Dislocation of the new joint is a potential risk. extreme of movements should be avoided under all circumstances. The soft tissue healing takes approximately 6 weeks, however, if the hip joint is structurally unstable, or the soft tissue tension is not adequate, precautions need to be taken for a longer time.

What are the different types of Hip Replacement Surgery ?
Total Hip Replacement Surgery involves a change of both Femoral head & neck, and Acetabular socket. There are several bearing options which are available depending on the patient requirements.
Common Bearing Options include, – Metal on Polyethylene/ Ceramic on Polyethylene/ Ceramic on Ceramic.
Partial hip replacement involves a change of only the femoral head and neck region; acetabular socket is usually preserved. This is preferred in cases of Femoral neck fracture with healthy acetabular cartilage.

ACL reconstruction

ACL reconstruction is advised to patients with persistent knee instability despite physiotherapy trial of at least 6 weeks. In cases of road traffic accident patients with high energy trauma who develop ACL tear along with variable injury to other ligaments and bony contusions, we prefer to wait for approximately 10-12 weeks before offering ACL reconstruction surgery. This allows adequate time for healing of other structures, before ACL reconstruction is undertaken.
ACL reconstruction is commonly performed as Arthroscopy assisted procedure, with minimal scar. We routinely perform ACL reconstruction surgery using Endobutton technique with Double bundle Hamstring grafts harvested from Semitendinosus and Gracilis muscles.
In this surgery tendinous grafts are harvested from the back of knee, doubled over to increase the tensile strength, and then looped over an Endobutton. This graft –endobutton composite is tunnelled across the tibia and femur along the axis of original ACL ligament. The tibial end is usually secured with titanium or bio-absorbable screws.
After surgery, patients are allowed to walk with Knee brace and walker support from the next day. Knee bending is increased in a sequential manner with increments week by week. Supervised physiotherapy is required for an estimated 6 weeks. It is estimated that most patients are able to walk full weight bearing after approx. 6 weeks, and walk without support after an average of 10-12 weeks

Types of Knee Replacement

Do I Need A Knee Replacement ?
Knee replacement is required for advanced arthritis of the knee joint, producing painful limitation of movements and restriction in activities of daily living.
Knee replacement as a solution should be offered only after supervised physiotherapy trials, have failed.

What Are the different types of knee replacement, and which one do I Need ?
Knee replacement can be total or unicondylar, depending on the number of compartments involved. Among the total knee replacement, there are two popular designs- Cruciate Retaining, and Posterior Stabilized. The decision for the design is best taken by the operating orthopedic surgeon based on the integrity of ligaments. Patella resurfacing as a routine is a debatable subject.

<< Customized or patient specific Knee Replacement >> is the latest in technology. Helps the surgeon to get the most accurate result, less blood loss, minimizes risk of Embolism for the patient.

What to expect during / after Knee Replacement surgery

When can I resume work after a knee replacement ?
After a unilateral knee replacement, most patients can resume community ambulation within approximately 4 weeks, and start office after 6 – 8 weeks. In a Bilateral Knee replacement, patients attain community ambulation status after an average of 10-12 weeks (approximately 3 months).
In our practice, most of the patients are able to walk without support approximately 3 weeks after surgery.

What are the risks involved in a knee replacement surgery ?
The most significant risks include Infection, Deep vein thrombosis,and Aseptic loosening of implants. The risks correlate with the co-morbid medical condition, and must be discussed with the patient before surgery.

How long do I need to stay in hospital?
Patients normally require hospitalization for 3-4 days in single knee replacement, and up to 7 days in both knee replacement surgery

How much is the surgery duration ?
A single knee replacement takes approximately 90 min- 2 hours. Both knee replacement surgery takes approx 3- 4 hours.

How long do I need to take rest after surgery?
Under normal circumstances, patients are allowed to stand with walker support on next day of surgery. Ambulation with walker starts within 2-3 days, depending upon the medical condition and pain control.

What should I expect during the hospital stay ?
Patients are given epidural anesthesia for surgery, and post op pain relief. They are expected to follow instruction from physiotherapist regarding muscle training.

When do we remove stitches?
Staples / stitches are normally removed 2 weeks after surgery. In case of Diabetic patients with delayed wound healing, staple removal may be delayed by a few days. Absorbable sutures for skin should be avoided due to risk of reaction in some patients.

When can I walk without support ?
Under normal circumstances, patients are able to walk without support after 3 weeks in single knee replacement surgery. In both knee replacement surgery, they take approximately 5-6 weeks.