Pain after knee replacement surgery: When to see a doctor? - The Daily Guardian
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Pain after knee replacement surgery: When to see a doctor?

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Total Knee replacement surgery is now widely accepted as a precise, repeatable and successful surgery. A large number of cases of knee replacement surgery are carried out in India itself. With better trained doctors and good hospital infrastructure, the results of knee replacement surgery are getting better every day. However, there are a few patients who are not satisfied with their knee replacement surgery and they continue to experience pain. We need to identify the reasons for this and ensure that this does not happen.

Q. What to expect after surgery?

A. With better tissue handling techniques and accelerated rehabilitation methods, most patients can start mobilising 3-5 hours after surgery. There is some pain of the incision and sutures. Post surgery as the patient starts exercising, the pain gradually becomes much lesser and depending upon the person’s body type, age and deformity before surgery, it should go away within 25 to 30 days. With robotic surgery, the mobilisation is much faster and the amount of pain is much lesser and patients bend their knees much faster and more. Some might take a little longer than the others, especially if their muscles and bones are weak or they are elderly. Even comorbidities like diabetes or kidney disease can slow your recovery. If a person doesn’t have the above-mentioned conditions, then they should not have any pain and the joint should start feeling normal.

Q. What to do after discharge?

A. Here are the few tips a patient undergoing knee replacement surgery should follow to speed up his/her recovery process:

Follow doctor’s instructions diligently:  The patient should make sure that he/she is adhering to the doctor’s instructions. Many times people often ignore their surgeon’s suggestion and become doctors on their own by self-medicating. Such instances often yield poor results.

Exercising properly: Most patients can begin their knee exercise within hours of the surgery. But, they have to ensure that they are not overdoing the exercise because even that can cause some stretch pain or can hamper the alignment.

Avoiding falls: This is mostly experienced by elderly people. They should use crutches, a cane, a walker, and handrails to get around postoperatively until their strength, balance, and flexibility have improved.

Q. When to see a doctor?

A. The big question is of persistent pain even after knee replacement surgery. Let’s understand the causes for pain after surgery also. In the initial period, the pain is of the incision and the surgical invasion itself. As that goes down gradually with exercising, the pain can be coming from the spine or the muscles which are weak. Pain after that could be due to weak muscles – mainly the quadriceps of the thigh muscle which brings the leg straight up.

One very serious complication can be infection, which of course in any good centre now with the operation theatre discipline and bacteria free filtered air in OTs should not happen but if a patient has any redness with pain or swelling, high fever then he/she must immediately consult the doctor. Infections require immediate treatment to prevent further serious complications. Although the rates of infection in any good center are less than 1 percent in world, there is no harm in consulting the doctor once and ruling out these conditions.

Another reason for dull aching pain that goes on for months together is malaligned component or a knee which is not balanced properly. With the use of robotics, the artificial components put inside are actually balanced throughout the range of movement and the stretch on the ligaments is accurately assessed on the operation theatre itself. This ensures correct tracking of the knee just like the natural knee joint and hence no pain.

The writer is Orthopaedic & Robotic Joint Replacement Surgeon, NHS Hospital, Jalandhar

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OVERWEIGHT CHILDREN CAN REDUCE CARDIOVASCULAR RISK BY FOLLOWING HEALTHY DIET

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Statistically overweight children who follow a healthy eating pattern significantly improve their weight and reduce a variety of cardiovascular disease risks suggests the findings of a Cleveland Clinic-led research team.

The study, which was published in the Journal of Clinical Pediatrics, paired parents and children together throughout the trial. According to the Center for Disease Control and Prevention, obesity now affects 1 in 5 children and adolescents in the United States. Children who are obese are more likely to have high blood pressure and high cholesterol which are risk factors for cardiovascular disease. Adult obesity is associated with an increased risk of several serious health conditions including heart disease, type 2 diabetes, and cancer.

For one year, researchers studied changing cardiovascular disease risk markers associated with three healthy eating patterns in 96 children between the ages of 9 and 18 years old with a body mass index (BMI) greater than 95 percent. BMI is calculated by dividing a person’s weight in kilograms by the square of height in meters, but for children and teens, BMI is age and sex-specific and is often referred to as BMI-for-age.

The three healthy eating patterns studied were the American Heart Association Diet, Mediterranean Diet, and Plant-based diet. All three emphasised whole foods, fruits and vegetables and limited added salt, red meat and processed foods. Parent and child pairs attended weekly educational sessions for four weeks which covered suggested foods to eat and avoid how to read package labels, proper portion sizes and shopping tips.

Fasting blood tests were used to access biomarkers of cardiovascular risk. All three diets were associated with improvements in weight, systolic and diastolic blood pressure, total cholesterol, and low-density lipoprotein.

“This study helps show the importance of starting healthy eating patterns as young as possible. We know that cardiovascular disease begins in childhood, and children’s eating patterns are easier to mold than adolescents and adults,” said lead author Michael Macknin, M.D., Professor Emeritus of Pediatrics of Cleveland Clinic Lerner College of Medicine.

The American Academy of Pediatrics Committee on Nutrition recommends that healthy children age 2 and older follow a diet low in fat (30 percent of calories from fat). These are the same recommendations for healthy adults. In the study, dietary compliance rates averaged 65 percent in week 4 and 55 percent in week 52 suggesting small improvements in diets can still be very beneficial.

“Because the process of heart disease begins in childhood, prevention should begin there as well,” said W.H. Wilson Tang, M.D., study author and research director in the section of heart failure and cardiac transplantation medicine in the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.

“A large majority of heart disease is due to modifiable or controllable risk factors, so it’s important for children to understand that they are in large part responsible for their health,” added Tang.

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INDIA’S COVID-19 VACCINATION COVERAGE EXCEEDS 81.85 CRORE

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With the administration of 96,46,778 vaccine doses in the last 24 hours, India’s Covid-19 vaccination coverage exceeded 81.85 crores (81,85,13,827) as per provisional reports till 7 am on Tuesday, informed the Ministry of Health and Family Welfare.

The ministry said that this has been achieved through 80,35,135 sessions. As per the data, as many as 1,03,69,386 healthcare workers have been inoculated with the first dose of the Covid vaccine while 87,50,107 have been inoculated with both doses. The number of frontline workers vaccinated stands at 1,83,46,016 (first dose) and 1,45,66,593 (two doses).

According to the health ministry, 33,12,97,757 vaccine doses were administered as the first dose and 6,26,66,347 vaccine doses were given as the second dose in the age group 18-44 years.

Also, in the age group of 45-59 years, 15,20,67,152 people have received the first dose and 7,00,70,609 have received the second dose whereas 9,74,87,849 vaccine doses were administered as first dose and 5,28,92,011 vaccine doses given as the second dose to the people over 60 years. Meanwhile, India reported 26,115 new Covid-19 cases in the last 24 hours.

Sustained and collaborative efforts by the Centre and the states, UTs continue the trend of less than 50,000 daily new cases that are being reported for 86 consecutive days now.

“The recovery of 34,469 patients in the last 24 hours has increased the cumulative tally of recovered patients (since the beginning of the pandemic) to 3,27,49,574,” the ministry said.

The active caseload is presently 3,09,575 which constitutes 0.92 percent of the country’s total positive cases while the recovery rate stands at 97.75 percent. The testing capacity across the country continues to be expanded. The last 24 hours saw a total of 14,13,951 tests being conducted. India has so far conducted over 55.50 crores (55,50,35,717) cumulative tests. The weekly positivity rate at 2.08 percent remains less than 3 percent for the last 88 days now. The daily positivity rate was reported to be 1.85 percent. The daily Positivity rate has remained below 3 percent for the last 22 days and below 5 percent for 105 consecutive days now.

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‘Robotic lab’ at AIIMS has capacity to conduct 2 lakh tests in a day

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Amidst the prevalence of the Covid-19 pandemic, the country’s renowned hospital, All India Institute of Medical Sciences (AIIMS) here has prepared a ‘robotic lab’ that has the capacity to conduct more than two lakh general tests in a single day.

AIIMS “robotic smart lab” has the capacity to conduct two lakhs tests in a single day. This hi-tech lab was started last year in July and inaugurated by Former Union Health Minister Dr Harsh Vardhan. Union Health Minister Mansukh Mandaviya on Monday also visited this lab and spent more than 20 minutes to see the working of this robotic lab which is fully IT and digitally enabled. Currently, this lab is conducting 3,000-4,000 tests per day but it has a capacity to conduct 8,000 tests per hour and two lakh tests in a single day.

“As of now, we are conducting 3,000-4,000 sample testings in a single day via this lab. The capacity is almost 8,000 tests per hour and 2 lakh tests in a day,” said Dr Tushar Sehgal, Assistant professor, Department of Medicine at AIIMS, Delhi.

This AIIMS smart lab is providing high-quality diagnostics and reduced time in producing lab reports here. The lab is doing more than 70- 270 advanced tests and some of them are free of cost for the patients, the official said.

Elaborating further, Dr Sehgal told ANI, “The testing involves a few stages. It primarily involves three main stages i.e. pre-analytical, analytical and post-analytical stage.” “We have three different types of sample testing methods as well. Haematology, Coagulation, Chemistry are the methods,” he added. AIIMS Hi-tech robotic lab is also providing some free-of-cost tests like the D-Dimer test that costs around Rs 1,000 in private labs. “There are some tests which we do free of cost. Our vision is to provide most of the tests free of cost like LFT, CBC, D-Dimer test etc.”

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VARIOUS INFECTIONS SURGE AMONG CHILDREN AS POST-COVID SYMPTOMS

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Respiratory syncytial virus (RSV) is emerging as the latest post-Covid symptom among infants and young children, said a paediatric expert on Tuesday.

According to Dr Dhiren Gupta, a senior paediatric pulmonologist at Sir Ganga Ram Hospital, the early phase of RSV infection in babies and young children is often mild, like a cold. However, in children younger than age three, the illness may move into the lungs and cause coughing and wheezing. In some children, the infection can also turn into severe respiratory disease. Dr Gupta told ANI, “Among 100 cases of post-covid complications, 80 percent patients are suffering from RSV, whereas among RSV cases 80 percent patients are infants.”

The expert also added that if a patient had prolonged fever as a post-Covid symptom, then about 1 percent to 20 percent chances are patient is suffering from Tuberculosis.

“Unfortunately there is no specific treatment for RSV infection and normally takes between seven and 10 days to settle,” said Dr Gupta. The doctor said though the Covid-19 infections have not increased in number, the severity of Covid infection was a little bit more than generally found.

“Also, children who were completely fit and healthy before Covid are suffering from tuberculosis and liver abscess along with RSV and they were not given immunosuppressant such as steroids,” he added.

A pyogenic liver abscess is the development of a pus-filled pocket of fluid within the liver. Pyogenic means producing pus. A liver abscess can develop from several different sources including a blood infection, an abdominal infection or an abdominal injury that was infected.

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Completing recommended sleeping hours could lead to smarter snacking choices, says a new study

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The findings of a new study suggest that people who miss the recommended seven or more hours of sleep per night might make poorer snacking choices than those who adhere to shut-eye guidelines.

The study abstract has been published in the Journal of the Academy of Nutrition and Dietetics and the research will be presented in a poster session on 18 October at the 2021 Food and Nutrition Conference and Expo. The analysis of data on almost 20,000 American adults showed a link between not meeting sleep recommendations and eating more snack-related carbohydrates, added sugar, fats and caffeine.

It turns out that the favoured non-meal food categories—salty snacks and sweets and non-alcoholic drinks—are the same among adults regardless of sleep habits, but those getting less sleep tend to eat more snack calories in a day overall.

The research also revealed what appears to be a popular American habit not influenced by how much we sleep: snacking at night. “At night, we’re drinking our calories and eating a lot of convenience foods,” said Christopher Taylor, professor of medical dietetics in the School of Health and Rehabilitation Sciences at The Ohio State University and senior author of the study.

“Not only are we not sleeping when we stay up late, but we’re doing all these obesity-related behaviours: lack of physical activity, increased screen time, food choices that we’re consuming as snacks and not as meals. So it creates this bigger impact of meeting or not meeting sleep recommendations,” added Taylor.

The American Academy of Sleep Medicine and Sleep Research Society recommends that adults should sleep seven hours or longer per night on a regular basis to promote optimal health. Getting less sleep than recommended is associated with a higher risk for a number of health problems, including weight gain, and obesity, diabetes, high blood pressure and heart disease.

“We know lack of sleep is linked to obesity from a broader scale, but it’s all these little behaviours that are anchored around how that happens,” said Taylor.

Researchers analysed data from 19,650 US adults between the ages of 20 and 60 who had participated from 2007 to 2018 in the National Health and Nutrition Examination Survey. The survey collected 24-hour dietary recalls from each participan—detailing not just what, but when, all food was consumed—and questions people about their average amount of nightly sleep during the workweek. The Ohio State team divided participants into those who either did or didn’t meet sleep recommendations based on whether they reported sleeping seven or more hours or fewer than seven hours each night. Using US Department of Agriculture databases, the researchers estimated participants’ snack-related nutrient intake and categorized all snacks into food groups. Three snacking time frames were established for the analysis: 2:00-11:59 a.m. for the morning, 12:00-5:59 p.m. for the afternoon, and 6 p.m.-1:59 a.m. for the evening.

Statistical analysis showed that almost everyone—95.5 percent—ate at least one snack a day, and over 50 percent of snacking calories among all participants came from two broad categories that included soda and energy drinks and chips, pretzels, cookies and pastries.

Compared to participants who slept seven or more hours a night, those who did not meet sleep recommendations were more likely to eat a morning snack and less likely to eat an afternoon snack and ate higher quantities of snacks with more calories and less nutritional value.

Though there are lots of physiological factors at play in sleep’s relationship to health, Taylor said changing behaviour by avoiding the nightly nosh, in particular, could help adults not only meet the sleep guidelines but also improve their diet.

“Meeting sleep recommendations helps us meet that specific need for sleep-related to our health, but is also tied to not doing the things that can harm health,” said Taylor, a registered dietitian.

“The longer we’re awake, the more opportunities we have to eat. And at night, those calories are coming from snacks and sweets. Every time we make those decisions, we’re introducing calories and items related to increased risk for chronic disease, and we’re not getting whole grains, fruits and vegetables,” added Taylor.

“Even if you’re in bed and trying to fall asleep, at least you’re not in the kitchen eating – so if you can get yourself to bed, that’s a starting point,” noted Taylor.

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INFANTS EXPOSED TO DOMESTIC VIOLENCE HAVE POOR COGNITIVE DEVELOPMENT: STUDY

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A new study has revealed that infants coming from homes with domestic violence often go on to have poor academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating, and sleeping, as well as stress and illness.

The findings of the study were published in the ‘Maternal and Child Health Journal’. While assessing a pregnant woman with premature labour in 1983, Linda Bullock noticed bruises on the woman. When she asked what happened, the woman told Bullock a refrigerator had fallen on her while cleaning the kitchen.

“Something didn’t seem right, but I didn’t know what to say at the time. I just went on to the next question of the assessment,” said Bullock, now a professor emerita at the University of Missouri Sinclair School of Nursing.

“We stopped her labour and sent her home, but I will bet my last dollar I sent her back to an abusive relationship, and it sparked my interest in helping other nurses assist battered women. What we didn’t know at the time was the impact violence had on the baby,” Bullock added.

Bullock helped implement the Domestic Violence Enhanced Perinatal Home Visits (DOVE) program in rural Missouri, which empowered safety planning and reduced domestic violence for hundreds of abused pregnant women.

After learning from home health visits that many of the abused women had up to nine different romantic partners during and following pregnancy, Bullock conducted a study to examine the impact of multiple father figures on the cognitive development of newborn infants.

After administering neurodevelopmental tests during home visits three, six and 12 months after birth, she was surprised to find the infants of women who had only one male partner who abused them had worse cognitive outcomes compared to infants of women with multiple male partners, only some of whom were abusive.

“The findings highlight the variety of ways the multiple father figures may have been helping the mom support her baby, whether it was providing food, housing, childcare or financial benefits,” Bullock said.

“For the women with only one partner who abused them, the infant’s father, the father may not have provided any physical or financial support or played an active role in the child’s life. It can be difficult for busy, single moms struggling to make ends meet to provide the toys and stimulation their infants need to reach crucial developmental milestones,” Bullock added.

Bullock added that infants coming from homes with domestic violence often go on to have worse academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating and sleeping, as well as stress and illness.

“When nurses are visiting homes to check in on pregnant women and their developing babies, we want them to be trained in recognising the warning signs of potential intimate partner violence,” Bullock said.

“I still think back to 1983 when I sent that lady back home into a terrible situation, and I am passionate about making sure I can help nurses today not make the same mistake I made,” Bullock continued.

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