Liver Cancer Treatment in India

What is Liver Cancer

Liver Cancer or Hepatic Tumour is a cancer of Liver. There are several different types of tumours that can develop in the liver as liver is made up of various cell types. These growths can be benign or malignant. Cancerous tumours can start in liver and spread to other areas of your body, through your bloodstream or your lymphatic system. This spread of cancer is cahepatactomylled metastasis. Tumours may also spread from other parts of your body, such as from your bowel, breast or lungs, to your liver.

Symptoms of Liver Cancer

Most people do not have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:

  • Losing weight without trying
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • An enlarged liver
  • Abdominal swelling
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)

There are two broad categories of liver cancer: Primary and Secondary

 Primary Liver Cancer
Primary liver cancer starts in the cells, bile ducts, blood vessels or connective tissue of the liver . There are different types of primary liver cancer that include:

  • Hepatoma :This is the most common type. It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. The bulk of the liver is made up from hepatocytes. A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis or types of hepatitis (liver inflammation).
  • Fibrolamellar : This hepatoma is a rare sub-type of hepatoma. It typically develops in a liver that was previously healthy.
  • Cholangiocarcinoma : This is uncommon. It develops from cells which line the bile duct.
  • Hepatoblastoma : This is a very rare cancer that occurs in some young children.
  • Angiosarcoma : This is very rare. It develops from cells of blood vessels within the liver.

Secondary Liver Cancer
Secondary liver cancer is a cancer that first develops elsewhere in the body and then spreads (metastasizes) to the liver. It is sometimes called metastatic cancer.

When a cancer forms in a part of the body, a few cancer cells may break off and find their way into the bloodstream. Because your liver filters your blood, any cancer cells in the bloodstream have a high chance of settling in the liver to form a cancer nodule (metastasis).

People who are most at risk of secondary liver cancer are those with cancers of the large bowel (colon), pancreas, stomach, lung or breast. It is important to know where the cancer started as this will determine the type of cells which are causing the cancer and affect which treatment is best suited for you. Secondary cancer diagnosed in the liver may be a sign of cancer in other organs. Sometimes, secondary cancer is found in the liver and yet, even with thorough medical tests, it’s not possible to find out where the cancer started.

Diagnosis of Liver Cancer

  • Physical exam — The doctor feels the abdomen to check the liver, spleen, and nearby organs for any lumps or changes in their shape or size. The doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. The doctor may examine the skin and eyes for signs of jaundice.
  • Blood tests — Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.
  • CT scan — An x-ray machine linked to a computer takes a series of detailed pictures of the liver and other organs and blood vessels in the abdomen. The patient may receive an injection of a special dye so the liver shows up clearly in the pictures. From the CT scan, the doctor may see tumors in the liver or elsewhere in the abdomen.
  • Ultrasound test — The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of the liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.
  • MRI — A powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
  • Angiogram — For an angiogram, the patient may be in the hospital and may have anesthesia. The doctor injects dye into an artery so that the blood vessels in the liver show up on an x-ray. The angiogram can reveal a tumor in the liver.
  • Biopsy — In some cases, the doctor may remove a sample of tissue. A pathologist uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a thin needle into the liver to remove a small amount of tissue. This is called fine-needle aspiration. The doctor may use CT or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue with a thick needle (core biopsy) or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another way is to remove tissue during an operation.

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Liver Cancer Treatment in India

Spinal Fusion Surgery in India

What Spinal Fusion Surgery ?

Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone.spine_3 Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.

When is Fusion Recommended

  • Fracture
  • Tumor
  • Infection
  • Spondylolisthesis
  • Degenerative disc disease
  • Scoliosis
  • Spinal Stenosis

Types of Spinal Fusion Surgery

Lumbar spinal fusion can be divided into two categories.

  • Posterolateral Fusion :In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.
  • Interbody Fusion :In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic. Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-
    • Posterior Lumbar Interbody Fusion (PLIF)
    • Transforaminal Lumbar Interbody Fusion (TLIF)
    • Anterior Lumbar Interbody Fusion (ALIF)
    • Transpsoas Interbody Fusion (XLIF or DLIF)

 

What are the Advantages of Spinal Fusion Surgery?

In most cases, spinal fusion can eliminate the pain and other symptoms. It is important for a surgeon to explain the options, and benefits of spinal fusion surgery. There are many advantages of Spinal fusion surgery such as:

  • By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.
  • A second advantage of spinal fusion surgery is that it reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.

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Spinal Fusion Surgery in India

Cervical Cancer Treatment in India

What is Cervical Cancer ?

Cervical cancer is the malignancy that starts in the cervix. Cervical cancer instigate from the cells located on the surface of the cervix. Cervical cancer occurs in several forms. The most common is squamous cell carcinoma, which accounts for 85 to 90 percent of cervical cancers. Other forms include adenocarcinomas and combination cancers such as adenosquamous carcinoma. Some strains of the human papillomavirus (HPV), a virus transmitted during sex, play a role in causing most cases of cervical cancer.cervical-cancer The type of cervical cancer is determined by the type of cell where the early genetic mutation occurred.

What are Symptoms of Cervical Cancer? :

  • Abnormal bleeding Women with cervical cancer may experience abnormal vaginal bleeding. This can be heavy or light bleeding during the month.
  • Unusual heavy discharge –  An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick, or contain mucus. It varies from woman to woman. It is important to report any unusual vaginal discharge to your doctor.
  • Pelvic pain Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe.
  • Pain during urination Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder.
  • Bleeding between regular menstrual periods, after sexual intercourse, douching, or pelvic exam Bleeding after sexual intercourse, douching, or pelvic exam can be cervical cancer symptoms. This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.

What are various types of Cervical Cancer?
There are two major types of cancer that develop from the cervix.

  • Squamous Cell Cancers – Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Squamous cell cancers are unique because there is a well established progression through premalignant changes before a cancer develops. These premalignant changes are easy to detect by a simple screening test called the Pap test.
  • Adenocarcinomas – Adenocarcinomas arise from the glandular lining of the endocervical canal.

How to do Diagnosis of Cervical Cancer? 

  • Pap Smear Test A Pap smear is an examination under the microscope of cells scraped from the tip of the cervix. Doctors do this by putting an instrument called a speculum inside vagina and then scraping the cervix with a small brush.
  • Liquid Based Cytology – Liquid based cytology (LBC) is a way of preparing cervical samples for examination in the laboratory. The sample is collected in a similar way to the Pap smear, using a special device (spatula) which brushes cells from the neck of the womb.
  • Hybrid Capture II Test – The Hybrid Capture II HPV test tells if treatment is essential for women or not. It is a DNA based test that provides information about 13 types of HPV virus that might be the agent of infection of cervical cells.
  • Colposcopy – A colposcopy is a special way of looking at the cervix. It uses a light and a low-powered microscope to make the cervix appear much larger. This helps your health care provider find and then biopsy abnormal areas in your cervix.
  • Loop Electrosurgical Excision Procedure (LEEP) – The test involves the use of an electrode put inside the cervix to remove abnormal cells from the cervix and endo-cervical canal. A high frequency electric current is running through the wire.
  • Magnetic Resonance Imaging (MRI) This test uses magnetism to build up pictures of the organs in your abdomen. It is very good at imaging the tissues of the pelvis where the cancer is. MRI is painless, and the magnetism is harmless.
  • Computerized Tomography (CT) Scan – A CT scan is a type of x-ray that gives a cross-sectional picture of organs and other structures (including any tumours) in your body.
  • A Positron Emission Tomography (PET) A positron emission tomography (PET) scan can check to see if cancer has spread to other parts of the body.

What are various Stages of Cervical Cancer ?

  • Stage I. Stage I cancer is confined to the cervix. Gyneconcologist may further classify it as Stages IA1, IA2, IB1 or IB2 depending on the size of the tumor and how deeply the cancer has invaded.
  • Stage II. Stage II cancer has spread beyond the uterus, but not to the pelvic sidewall or the upper third of the vagina. Gyneconcologistmay classify it as Stage IIA or IIB.
  • Stage III. In Stage III, the cancer extends to the pelvic wall or the lower third of the vagina or causes expansion of the ureters, resulting in kidney problems. Gyneconcologistmay classify it as Stage IIIA or IIIB based on whether cancer cells have extended to the sidewall of the pelvis.
  •  Stage IV. In Stage IV, the cancer has invaded the bladder or rectum and may extend   beyond the pelvis. Gyneconcologistmay identify it as Stage IVA or IVB.

What are various Cervical Cancer Surgery procedures?

The following surgical procedures may be used as part of cervical cancer treatment.

  • Conization – Conization, also called a cone biopsy, is a procedure that is used to remove a cone-shaped piece of tissue from the cervix and cervical canal. A pathologist will view the tissue under a microscope to look for cancer cells. This type of surgery may be used to diagnose or treat a cervical condition.
  • HysterectomyA hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.
  • Radical Hysterectomy – Radical Hysterectomy removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
  • CryosurgeryCryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of cervical cancer surgery is also called cryotherapy.
  • Laser SurgeryLaser surgery is a procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
  • Pelvic Exenteration –  Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.

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Cervical Cancer Treatment in India

Urinary Incontinence Treatment India

What is Urinary incontinence ?

Urinary incontinence is not a normal part of aging. The aging process merely predisposes a woman to urine loss. Weak muscles, childbirth, poor nutrition and fluid intake, gynaecological surgery, urinary tract infections, spinal cord injuries and emotions all play a role in the aetiology of incontinence.urinarytract

Impaired mobility, chronic constipation and prescription drugs, which can cause bladder dysfunction, should be addressed in the incontinent elderly.

Causes of Urinary Incontinence

The two most common causes of incontinence involve bladder instability (Urge Incontinence) and anatomic lack of urethral support (stress incontinence). Overflow urine loss and lack of tone in the urethra (bladder tube) can happen as age advances.

Stress incontinence is the leakage of urine with activities that increase pressure inside the abdomen like coughing, sneezing and laughing. Women can also lose urine while engaging in sports, bending, getting up from a seated position and lifting weights.u125-stress

Urge incontinence is leakage of urine accompanied by a sense of urgency. Women typically complain of losing urine before they can make it to the bathroom. The sound of running water and activities like washing dishes can also precipitate sudden bladder spasms resulting in urine loss.

Diagnosis of urinary incontinence

Ways to diagnose urinary incontinence include:

  • A bladder diary – the doctor may ask the patient to record how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
  • Physical exam – the doctor may examine the vagina and check the strength of her pelvic floor muscles. If the patient is male, the doctor may examine his rectum to determine whether the prostate gland is enlarged.
  • Urinalysis – tests for signs of infection and abnormalities.
  • Blood test – to assess kidney function.
  • PVR (postvoid residual) measurement – measures how much urine is left in the bladder after urinating.
  • Pelvic ultrasound.
  • Stress test – the patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
  • Urodynamic testing – determines how much pressure the bladder and urinary sphincter muscle can withstand.
  • Cystogram – X-ray procedure to visualize the bladder.
  • Cystoscopy – a cystoscope (a thin tube with a lens at the end) is inserted into the urethra. The doctor can view abnormalities in the urinary tract.

Treatment for Female Urinary Incontinence in India

  • Behavioral Modification

Behavioral modification involves timed voiding and bladder training. Timed voiding is done by emptying the bladder at specific intervals regularly. Intake of fluid is adjusted according to the times of bedtime and also before going out, so that the accidental urinary incontinence can be avoided during outing and on the bed.

  • Vaginal Devices

Pessaries devices are used in the form of stiff ring for the urinary incontinence problem. It is inserted by either doctor or nurse. The device is inserted into the vagina to press against the vagina walls and also the surrounding of urethra. The pressure keeps the urethra to reposition so that the less stress leakage can be resulted.

  • Medications

Some medications are given to the candidate to relax the bladder and also its surrounding muscles so that the full emptying of bladder can be achieved

  • Neurostimulation

Neurostimulation is done for the nerves that come from the spinal cord and move towards the bladder. The nerve signals can be well modulated to the bladder so that the voiding can be controlled.

  • Kegal Exercises

Kegal exercises are useful to strengthen the pelvic floor muscles, so that the sphincter muscles are kept tight so that the outlet of the bladder will be closed while strenuous activities are performed. Pelvic muscles are to be closed and count of 3 has to be done.

  • Surgery or Stress Incontinence

After the childbirth, the bladder is moved from its position, for some of the women. Different surgical procedures can be performed to keep the bladder back to its position

  • Retropubic Suspension

The surgery involves supporting the neck of the bladder using sutures or surgical threads. Burch procedure is one of the most commonly preferred retropubic suspension procedure.

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Urinary Incontinence Treatment India

Spine Surgery for Herniated Disc Surgery in India

What is a herniated cervical disc?

A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if neck and/or arm pain is going to resolve it will do so in about 6 weeks.

Herniated Disc Symptoms 

Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, you may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.gi_89807_spinal-stenosis

Lumbar spine (lower back): Sciatica frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Along with leg pain, you may experience low back pain. Recommend using radiculopathy rather than sciatica since all leg pain isn’t “sciatica”)

Cervical spine (neck): Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.

Diagnosis

Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination and results of tests, including the following:

  • X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
  • Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.neck-pain-los-angeles
  • Magnetic resonance imaging (MRI): A diagnostic test that produces 3-D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas, as well as enlargement, degeneration, and tumors.
  • Myleogram: An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
  • Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury or whether there is another site of nerve compression.

 

Surgery for Cervical Herniated Disc or Ruptured Disc”-

Anterior cervical discectomy & fusion (ACDF): The surgeon makes a small incision in the front of your neck. The neck muscles, vessels and nerves are moved aside to expose the bony vertebra and disc. Using special instruments, the portion of the ruptured disc that is pressing on the nerve is removed. After removing the herniated disc, the disc space may be filled with a bone graft or cage to create a fusion. Fusion is the process of joining together bone.

Artificial disc replacement: can be performed during anterior discectomy instead of a fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion.

Minimally invasive microendoscopic discectomy: The surgeon makes a tiny incision in the back of the neck. Small tubes called dilators are used with increasing diameter to enlarge a tunnel to the vertebra. A portion of the bone is removed to expose the nerve root and disc.

Posterior cervical discectomy: The surgeon makes a 1-2 inch incision in the back of your neck. To reach the damaged disc, the spinal muscles are dissected and moved aside to expose the bony vertebra. A portion of the bone is removed to expose the nerve root and disc space.

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Spine Surgery for Herniated Disc Surgery in India

Coronary Bypass Heart Surgery In India

Coronary Bypass surgery

Coronary bypass surgery performed in world class hospitals in India is a procedure to allow blood to flow to your heart muscle despite blocked arteries. Coronary bypass surgery uses a healthy blood vessel taken from your leg, arm, chest or abdomen and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area. exercise_cabg_surgeryAfter a coronary bypass surgery, normal blood flow is restored. Coronary bypass surgery is just one option to treat heart disease.

Who Should Consider Coronary Artery Bypass Graft Surgery

• People diagnosed with arterial blockage or heart damage are recommended with the Coronary Artery Bypass Graft Surgery.

• People suffering from severe chest pain or angina due to the arterial blockage are recommended with the Coronary Artery Bypass Graft Surgery.

• People suffering from complicated conditions such as diabetes & high blood pressure are recommended the Coronary Artery Bypass Graft Surgery to reduce the risk of heart attack.

Procedure for Coronary Bypass Surgery

During a Coronary Artery Bypass Graft Surgery (CABG), the blood flow is re-routed around the clogged artery by detaching a long segment of an artery from the chest wall, arms or leg veins. Thereafter, the new artery is grafted to the clogged area of the coronary artery. Through the newly attached channel, blood gets unhindered route to flow to the heart muscles. This procedure is known as Coronary Artery Bypass Surgery. Depending upon the number of blocked coronary arteries, a patient may undergo more than one bypass graft.

Benefits of Coronary Artery Bypass Graft Surgery

• Lower risk of stroke

• Lower death rate

• Less need for transfusion

• Less heart rhythm problems

• Less injury to the heart

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Coronary Bypass Heart Surgery In India

KNEE REPLACEMENT SURGERY IN INDIA

What is Knee Surgery?

The knee has the responsibility of supporting the entire weight of the body which makes it particularly prone to stress and strain. The main aim of Knee Surgery is to increase the mobility and to reduce the pain associated with knee injuries and diseases.

revision-knee-replacement People world – wide are affected by knee problems. This problem is commonly found among people over 50 years of age and those who are overweight. Other reasons of knee pain can be health issues such as bursitis, arthritis, tears in the ligaments, osteoarthritis of the joints, or infections. Each year, millions of people undergo knee surgery and how quickly they recover depends on many factors such as their age, the severity, location of the injury and pre-existing conditions, such as arthritis.

Knee surgery typically refers to total knee replacement, or knee arthroplasty. Knee surgery can be performed arthroscopically or in an open fashion. Special techniques and latest implants ensure return of natural movements. It covers major surgeries like total and partial knee replacement surgery and less invasive procedures like knee arthrothscopy.

What is the cause of knee joint disintegration?

Osteoarthritis

Osteoarthritis occurs from ‘wear and tear’ and is the most common reason for the total knee replacement. It usually occurs after the age of 50 and is a genetic problem. When the tissue covering the bones softens and wears away, the bone began to rub against each other and leads to severe pain.

Rheumatoid Arthritis

When the tissues surrounding the bone releases excessive fluid due to inflammation, it causes damage to cartilage and other parts of the joint and causes pain and stiffness.

Traumatic Arthritis

This type of arthritis usually occurs after a serious knee injury. Due to the knee fracture, the connective tissue and the tissue covering the ends of the bone wears away, resulting in pain and stiffness.

Types of Knee Replacement Surgery

There are two main types of surgery, depending on the condition of the knee:

•Total Knee Replacement (TKR) – both sides of your knee joint are replaced

• Partial (half) Knee Replacement (PKR) – only one side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period

Knee surgery is recommended for older people, although adults or teenagers of any age can be candidates for the procedure, since they are physically active and will more rapidly wear the joint out. The weight, gender, or age of the person is never a factor when considering knee replacement surgery. When considering the option of knee replacement surgery, doctors take into account a number of symptoms:

• Severe knee pain or stiffness: Do symptoms seriously undermine the patient’s ability to carry out everyday tasks and activities, such as walking, going upstairs, getting in and out of cars, getting up from a chair, etc?

• Moderate but continuous knee pain: Is pain present while sleeping or resting?

• Chronic knee inflammation and swelling: Does the swelling not improve after taking medications or resting? Do drugs cause unpleasant side effects?

• Knee deformity: Is there is a noticeable arch in the inside or outside of the knee?

• Nothing else worked: The doctor has prescribed medications and physical therapy without any substantial improvement.

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KNEE REPLACEMENT SURGERY IN INDIA