Interview: Are injections to knee better than surgeries? Dr Thomas Chandy on the best treatment for joint pain

A. The weakening of bones, commonly referred to as bone loss, generally begins around the age of early 40s for women and in late 50s for men. The process of bone resorption (where bone tissue is broken down) starts to outpace bone formation, leading to a gradual decrease in bone density. This bone loss accelerates in women after menopause due to the decline in estrogen levels, a hormone that helps protect bone mass.

While bone loss is a natural part of aging, factors such as diet, physical activity, smoking, alcohol consumption, and certain medical conditions can influence the rate and extent of bone weakening. Regular exercise, a calcium-rich diet, and other lifestyle choices can help mitigate the effects of bone loss and maintain bone health as one ages.

Q. Are there any symptoms for bone loss?

A. In the early stages, bone loss typically does not present any noticeable symptoms, making it difficult to detect without medical testing. This is why osteoporosis is often referred to as a “silent disease.” As bone density decreases over time, weakened bones can lead to fractures, particularly in the spine, hips, and wrists, even with minor falls or injuries.

In some cases, fractures can occur spontaneously, without any significant trauma. More advanced bone loss may result in fractures from seemingly harmless activities, such as coughing, bending over, or lifting light objects.

Check for Vitamin D levels which must be above 30 and regular bone density tests such as DEXA scans, are crucial for detecting bone loss early, especially in individuals with risk factors like postmenopausal women, older adults, and those with a family history of osteoporosis. Vitamin D, Calcium supplements can be given and teriparatide injections are given in most complex cases based on prescription.

Also Read: Does your microwave kill pathogens? What you should know about bacteria in microwaves that can harm you

Q. Do knee injections help in relieving knee pain?

A. There is a common misconception that injections for knee arthritis, such as osteoarthritis or rheumatoid arthritis, can completely solve the problem. Traditionally, steroid injections have been used to manage knee pain, but they only mask the pain temporarily and can lead to complications by accelerating degenerative changes in the knee joint. Another option is lubricating injections, but these are often rejected by the body as foreign substances, providing only short-term relief of about 2-4 months.

Stem cell therapy has also been tried, where plasma from platelets is injected into the knee. While this may offer temporary improvement, the body does not allow it to sustain, and it fails to regenerate the smooth cartilage that cushions the joint. Many of these treatments are experimental, and their effects are usually short-lived, often giving just a placebo effect.

Patients should be aware that any relief from such injections typically lasts only about three to four months. If these injections are administered improperly, there is also a risk of introducing infection, which can lead to serious complications.

Q. Why is movement important for bone health?

A. Movement plays a critical role in maintaining bone health because bones are living tissues that constantly renew and repair themselves. When you engage in physical activity, especially weight-bearing exercises, your bones experience mechanical stress. This stress stimulates the activity of osteoblasts, which are bone-forming cells that help to build new bone tissue.

Essentially, the more you move, the more you signal your body to strengthen and maintain bone density. Without sufficient movement, bone mass can decrease, making bones more fragile and increasing the risk of fractures. If you are inactive, even if I put a cast on somebody’s leg and they don’t move, you would be surprised that there is osteoporosis already formed. Walking is the key.

Q. How does lifestyle affect knee health?

A. Lifestyle, particularly obesity, plays a significant role in knee health. Excess weight increases the load on the joints, causing them to wear out faster, which leads to pain in different areas, especially in the lower limbs used for walking. This additional stress on the joints accelerates wear and tear, creating a vicious cycle of pain and reduced mobility.

Obese individuals may fear walking due to the risk of joint pain or fractures, further exacerbating the problem. To manage these issues, physiotherapy and low-impact exercises like stationary biking are often recommended. Weight loss is crucial to reduce the strain on the joints, and in severe cases, minimally invasive procedures like keyhole surgery may be suggested to provide relief.

Also Read: Kolkata rape-murder accused Sanjay was drunk, fought with sex worker hours before crime: Friend recalls fateful night

Q. Dr Chandy, could you explain the CUVIS system and how it has revolutionised surgeries at HOSMAT?

A. Certainly. HOSMAT was among the first in India to use computer navigation for surgeries in 1998, similar to GPS, providing real-time information during knee, hip, and spine surgeries. This system is effective and still in use. However, we’ve advanced to robotic assistance with the CUVIS system, which combines AI with semi-automatic and automatic features. Pre-surgery, a CT scan or X-ray is taken and fed into the system. On surgery day, the system processes this data, registers the patient’s anatomy, predicts complications, and provides details on leg angles and anatomical landmarks. It even suggests the implant size, enhancing precision and safety.

Q. How does the integration of AI with the CUVIS system impact the role of the surgeon during these procedures?

A. The integration of AI into the CUVIS system significantly enhances the surgeon’s ability to perform complex procedures with greater accuracy. The AI processes the patient’s anatomical data and offers real-time guidance throughout the surgery. It doesn’t replace the surgeon but rather augments their skills, making the procedure safer and more precise.

The system’s ability to predict complications and suggest corrective measures is particularly valuable, ensuring that we can address issues before they arise. This technology is a game-changer in orthopedic surgery, providing a level of precision that was previously unattainable. Also, the amount of bone removed then is very small, with this post-operative pain is less, and recovery is faster.

Q. How does HOSMAT hospital utilise advanced technology in orthopedic surgeries to enhance patient outcomes?

A. HOSMAT Hospital uses advanced techniques like the C-arm image intensifier, which provides real-time X-ray imaging during surgery. This technology minimizes the need for open surgeries, leading to less trauma and quicker recovery, particularly in orthopedic and sports medicine procedures.

How does the use of a C-arm image intensifier improve outcomes in orthopedic surgeries at HOSMAT? The C-arm image intensifier allows precise, minimally invasive surgeries by providing real-time guidance. This reduces surgical trauma, lowers infection risks, and enhances recovery, especially in treating fractures and ligament injuries.

Also Read: Filmmaker Ranjith resigns as chairman of Kerala Chalachitra Academy over sexual assault allegations

Q. What is the age group most affected by sports injuries?

A. Nearly all age groups come with sports injuries. In adolescence it is usually school sports, recreational activities, growth spurts etc that makes them prone to injuries such as sprains, strains, and fractures. Meanwhile in young adults they tend to get into competitive sports and high-intensity physical activities. They are at risk for injuries related to overuse, such as tendinitis, and acute injuries like ACL tears, shoulder dislocations, and muscle strains.

Similarly in middle aged, they may experience injuries due to the natural aging process, reduced flexibility, and slower recovery times. Common injuries include tendon ruptures, joint issues like meniscus tears, and lower back pain.

While less involved in high-impact sports, older adults can still sustain injuries from activities like golf, tennis, or jogging. These can include fractures due to osteoporosis, joint degeneration, and overuse injuries. Our children’s orthopedics is highly regarded, handling fractures, broken bones, spinal injuries, joint replacements, hand injuries, and even bone cancer.

Q. What about injuries of famous cricketers? How does HOSMAT care for them?

A. HOSMAT has been the exclusive hospital for the Karnataka State Cricket Association, covering all international matches, including three World Cups. Many top players have come here for treatment. We have a digital X-ray system that provides results in one minute.

Sports injuries in cricket has increased as fielding has become more aggressive. Players often leap and land in ways that can result in wrist fractures, torn ligaments, knee injuries, and twisted legs. With HOSMAT being nearby, we have been able to provide immediate care onsite, with our own anesthesia team available. Players also visit us for consultations.

(Edited by Neena)

(South First is now on WhatsApp and Telegram)