This article has been prepared in conversation with one of the familiar known orthopedic surgeons and joint transplant specialist. Here is his thoughts on joint pain treatment, myths and reality in his own words:
Common myths about joint pain and its correct treatment
Bone-joint pain related problems are experienced by many people, some of whom get confused in misleading treatment. A lot of people have a misconception that heat should be applied for joint pain. Some people have the myth that eating nuts has caused joint pain. Some people are taking expensive supplements under the myth that medicine is better than food. Some people are under the myth of oil massage because of bone rubbing depending on advertisements, while some people are falling into the clutches of having to have surgery even in the treatment of normal medicine, exercise and lifestyle changes. What are the misconceptions people have about joint pain and what can be the correct treatment? Do you have to have an operation or an implant if you have joint pain?
What is a joint transplant?
For the movement of the joints of the body, there are cartilages between the bones, which act as cushions. If we talk about the knee, there are ligaments, meniscus, cartilage. When the cartilage cannot function due to injury or rheumatism or age-related bone loss, an artificial object is placed through an surgery to move the joint. This procedure is called joint replacement. In our society, some people think that joint transplant is like a kidney transplant, but it is not about taking someone else's joint. To make the joint move as before, the worn part is removed and an artificial object is placed. It is made of different types of metals. In the middle, a substance (soft metal washer) that looks white like a crunchy bone is placed. This makes it easier for the joints to move. This element is not visible in X-ray, but metal is. Due to this, the X-ray shows a gap in the middle like before.
Painful joints do not need to be transplanted
Most joint pain does not require implants. Implantation should not be done only after looking at the X-ray and MRI report of a patient who is being treated for joint pain. If the doctor only looks at the X-ray and does not understand the rest of the parts, the patient will not be properly treated.It should be seen whether the patient's knee is loose, stuck/not stuck, sound coming/not coming. Joint pain is also caused by various other diseases. It should be checked and treated first. Information about the patient's daily lifestyle, obesity, shoes worn, diet, etc. should be improved as needed.
If the joint pain is reduced due to this, there is no need to have a joint transplant. But it did not go well, the joints continued to deteriorate, the wear and tear has reached the third stage, it is difficult to carry out daily life and one needs a wheel chair, if there is a situation where one is bedridden, one should have a joint transplant.
Although the need for joint replacement is usually for older people, it can happen at a younger age due to various reasons. We have transplanted joints as young as 98 years old and as young as 22 years old. The young man had to take steroids due to some disease.Maybe that's why his bones were crushed inside and his hip joint had to be replaced. Bones can be creaky without any reason, but steroid group drugs cause creasing more. Non-level Ayurvedic or other medicines in the form of powder, pills, sachets etc. are sold in our market.
Even though the herbs are called Ayurvedic, it has been proven that the amount of steroids under allopathic medicine in them is high when tested by the Drug Administration Department. Such drugs have also made people's bones weak without knowing it.Steroid group drugs are also used for respiratory diseases (COPD), rheumatic diseases. Their bones are also crushed. The doctor who prescribes such medicines to such patients or by referring them to the relevant doctor should also treat osteoporosis together.
Similarly, if the uterus has prolapsed due to any reason, the gynecologist should consult the relevant doctor and get the hormonal balance done. Failure to do so may result in the need for joint replacement in the future. Infections, tumors and menopause in women can also cause joint damage. In that case, joint transplant is also done. Some of the patients with Rheumatoid Arthritis may have bone-joint problems while receiving treatment and some without treatment. Since this disease eats up the joints quickly, joint transplant may be required at a young age. After the injury, the inner part of the bone is shattered and even if the joint cannot be made, then a transplant is required.
In old age, bones become weak due to various reasons and may break due to falls and collisions. Likewise, people suffering from various mental illnesses such as dementia and Parkinson's should be treated immediately if they need joint replacement for any reason. Since it is not possible for such people to walk with crutches, walkers, sticks like others, they should be treated so that they can walk on their feet from the next day. We make them able to walk two hours after the operation.
How to know in the beginning?
It is fine while walking and working all day, but after sleeping at night, it is stiff, the joints feel very stiff, and it hurts. That is, at first you don't feel it when you work, but you feel pain when you rest. That is, the flesh (membrane) stretched, contracted, swollen when loaded and started to hurt when resting.
At such an early stage, why did I get hurt, I should think about what I did, what I ate, what kind of shoes I was wearing and I should correct myself. Even if someone has just started yoga, squats, zumba, gym, it starts to hurt. If there is no improvement even after changing the diet and all these, you should consult a doctor. Diet and lifestyle improvement activities are also taught by doctors in the beginning. Only if this does not resolve, joint transplant is considered.
Transplantation based on need
"We are not going to transplant joints based on X-ray and MRI reports, but we are going to treat the patient." I looked at the X-ray report. Based on this, I said, 'Oh yes, grade 3 has already reached the joint, let's change the joint', but if that person is digging the field, that is not correct.
Because if you look at the x-ray of a 90-year-old man in the village, you can see that his knees are worn out, but he is digging the fields and walking well. Because he has adapted it to his daily life. There is no need to change the joint. Those who have difficulty walking and sitting, who cannot bear the pain, should be changed. Not by looking at the report but by looking at his pain, daily life etc. There are many types of joint implants. One is done with cement and the other is done without cement (pressfit). Bone cement is placed on the knee.
On one side there is cement and on the other side there is no cement. There is also a method of cleaning or removing the ligament and saving the existing ligament and transplanting it. The type of implant is chosen based on the reason why the joint had to be replaced.
The hip and knee joints change a lot
If necessary, all joints can be changed, but the most common is the hip, followed by the knee joint. These joints are essential for walking. If they are unable to work, they may have to walk in a wheelchair or lie in bed. If the elbow joint is damaged and the main working hand cannot be used, if the elbow joint of a person who works very hard or at a young age is damaged, the ankle joint is damaged and cannot be moved, it is replaced. Such transplantation is done based on the needs of the patient.
Ways to protect joints
It is most important to improve diet and lifestyle in order to avoid the problem of bone-joint deterioration and wear and tear. The body should be strengthened, not fat, that is, the muscles and bones should be strengthened, but the fatty lungs should not be allowed to grow.
Eating like a farmer, walking in a car, working at a table, not exercising increases obesity. If you do a lot of physical work, you can eat carbohydrates and protein. Ghee, meat can also be eaten in abundance. But if you don't do physical work and exercise, you should reduce your food.
You should not eat market junk food that is closed in sissy, cardboard, plastic, eating such things will increase obesity in a surprising way. If you are old, your knees have started to wear out, you should not climb or fall down high stairs, walk up or down, or sit with your shoulders tight. Similarly, if it is difficult to sit on the toilet pan, you should sit on the commode.
Common people understand that cold causes joint pain. If that is the case, many people in the Himalayan region will suffer from joint pain. If walking on the hills causes pain in the joints, it should be more painful for those who live in the mountains, but this is not the case. There are 60-70 year old people working in the fields, walking up and down.
Those who have adopted the natural lifestyle and food according to the geographical conditions of the place, the same is true for that place. It is wrong if people from remote villages are told to wear sports shoes and not to walk up and down. The way of life since childhood should be the same.
A person who lives in the city and rides a car may need an elevator to climb five floors. Either he had to have a lifestyle of walking and exercising from a young age. That's why urban dwellers like to ride bicycles, go to the gym, and go hiking. People living in villages and hill settlements do not need this. There is no problem if the village people live the way they grew up.
When the parents who worked in the fields in the village are brought by their children to the city and the problem may start there. Because there suddenly starts adopting an unfavorable lifestyle.
Lasts about 30 years
Joint replacement usually lasts 28 to 32 years. It varies from company to company. If I replace a 22-year-old's joint, he may have to replace it later. But it can happen if you don't change everything but only change the middle one.
When the joint is damaged, it is considered better to make the patient comfortable by using other techniques as much as possible and to transplant the joint slowly. It is better if one transplant lasts a lifetime. It can also deteriorate quickly due to falling or infection. In this case, it may be necessary to repeat the same as the one who did it at a young age.
How reliable is the transplant?
Today's new generation has learned many good technologies. But it is not only by acquiring knowledge. The operation theater should be level enough to avoid infection. Also, the team of physicians should be good. Some may have sugar, some may have pressure problems, they should be able to balance it. The anesthetist must be good.
Physiotherapy should also be effective for post-transplant rehabilitation. Good results can be given only when all these are good. Almost all the big hospitals of the country have good operation theatres. It is better to do the operation in a place where there is a full-time doctor. Going abroad is not necessarily good.
In terms of expenses, joint transplant is costly. Inserts are expensive. In it, quality and reliable items should be kept rather than cheap ones. All disposable items are used. Due to this, the cost will increase a little. This operation usually involves a 3-night hospital stay.
Then you can exercise at home. The quality of life improves dramatically. There are many cases of people who were bedridden for five-seven years because they did not have surgery, they came in wheelchairs and went home walking within three days after the surgery. Some may need the support of a walker, crutches, sticks for two weeks, some for six weeks. But no one needs such support after 6 weeks.
Post transplant precautions
After the joint transplant, you should not do risky activities such as jumping, climbing trees, and jumping. Shoes should be easy to wear. Walking, sitting, exercising should be done according to the doctor's advice. If it is swollen, it should be raised and slept, usually it subsides the next day.
Myths and Facts about Joint Pain
There is a misconception among many people that they should apply heat in case of bone pain. Even though the heat gives one pleasure, the result is not good. By doing this, it will worsen and become swollen. Cold baking is beneficial. Cold-baking does not mean over-chilling, it's just freezing. It is also found that some have iced it and made it blue, that is also wrong.
We have a wrong practice of eating calcium and vitamin D willingly to strengthen bones and joints. Eating too much vitamin D increases toxicity in the body. It damages the kidneys. Therefore, vitamin D is given to kidney patients in a different way. Calcium is also harmful if you buy and eat it yourself. If you eat more calcium, it can affect the heart muscles and valves.
Therefore, vitamin D, calcium should not be eaten without checking. Instead, these elements should be obtained from food itself. For example, milk and eggs are rich in calcium. Vitamin D is found in egg yolk. Some people are under the myth that egg yolk contains cholesterol, eggs increase uric acid, and should not be eaten. Such myths should be broken.
Eggs can be eaten but exercise should be done regularly. Vitamin D is also found in pulses, legumes, mushrooms, and seeds. Sitting in the sun is also beneficial for vitamin D. Ghee is also a good food. Some other foods eaten by humans need fat to be dissolved and absorbed in the body.
Some people say that 'today my joints hurt because I ate lentils and pulses yesterday'. Eating yesterday will not hurt today. High uric acid does not necessarily cause knee pain. People with kidney disease have more uric acid. Joint pain is not often found in them. Even if you don't drink plenty of water for two to four days, uric acid can increase, so don't panic.
Now some people have started taking expensive supplements under the myth that foods are bad and medicine is right. This understanding is wrong. It is wrong to rely on advertisements, hear in interviews that 'joints are fixed without surgery' and follow it.
This is not right. Many patients, who have been treated by relying on such false advertisements, come to us later, and their bones and joints are often destroyed. This situation does not occur if the problem occurs gradually. It is not possible to publish such misleading advertisements in foreign countries, it seems that they advertise anything here.
Treatment should not be incentivized
Health treatment should not be incentivized, it leads to commercialization of health services. New things are coming in joint transplant. Like - today, if we see that the cartilage of the players is worn out at a young age, we inject it, this was not the case before. But this injection is wrong when administered to the elderly, yet I have found that some doctors are administering it.
If the patient asks for calcium in the drug store, the store will give it to him. It is not his job to teach whether it is necessary to eat or not, it is the doctor's job. Doctors should teach. But if the doctor himself has gone towards commercialization with incentives, he will not teach. We are doctors who teach people to avoid diseases and stay healthy. It is important to understand this.
Our goal is to perform a joint transplant on less than 10 percent of those who need it. If we can treat 90 percent without transplantation, we will be worthwhile. For this, other necessary information should be given to the patient including lifestyle changes.