General :: Medical

General

How do I make an appointment?

Simply call us at during our working hours or you can request an appointment online using this form.

Do I need a referral to make an appointment?

Most medical specialists will accept only referred patients. This is mainly to try to ensure that the specialist you are seeing is appropriate for you and your condition. Check with your insurance company to see if a referral is necessary.

What to bring for your initial consultation?

For your initial consultation you will need to bring a referral letter from your physician if required.

Here is check list for your initial consultation:

• Copies of results, X-rays, MRI's, CT scans etc. and any other relevant information
• List of medications (if any)

We encourage you to come to your initial consultation with a written list of questions to ensure you don’t forget to ask them when you visit the doctor.

Are my medical records kept private and confidential?

Your medical file is handled with the utmost respect for your privacy. Our staff is bound by strict confidentiality requirements as a condition of employment regarding your medical records. We will not release the contents of your medical file without your consent.

How long do I need time off work after the surgery?

The post-operative recovery period varies based on the surgery. Generally, it is recommended patients take two weeks off work to recover from any surgery and to resume light duty following resumption of work. Your surgeon will give you specific instructions to follow for a successful recovery.

How long before I can resume driving?

You should wait at least one week before driving after surgery. The effects of anesthetic and surgery can affect judgment and reflexes during the first week following your surgery. Your surgeon will provide more specifics after considering your condition.

When can I resume exercise?

Your doctor will instruct you about post-treatment exercises – the type and the duration to be followed. You may be referred to a physical therapist to help with strengthening and range of motion exercises following surgery.

How do I contact after hours?

There will be a point of contact 24 hours a day for any concerns you may have. You will be provided with contact details following your treatment.

Medical

What are the non-surgical treatment options?

The non-surgical treatment options include rest, medications including analgesics and antibiotics, injections, and physical/occupational therapy.

Will physical therapy be required after surgery?

Getting full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post -operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.

What are the risks associated with surgery?

As with any surgery, risks include reactions to anesthesia, bleeding, infection, stiffness and nerve damage. Your doctor will discuss the risks associated with your specific procedure.

When can I return to daily activities?

This varies depending on the type of procedure undergone, and can range from a few days to a few months. Return to all activities, sports and exercise can take up to four to six months. Your doctor will advise you depending on your health condition.

What can happen if surgery is avoided?

Some complications of not undergoing an orthopedic surgery for your condition include pain, loss of joint motion, joint weakness, numbness and an early onset of arthritis.

What are the most common injuries?

The most common orthopedic injuries are sprains and strains, fractures and dislocations. Injuries can occur when playing indoor or outdoor sports or while exercising. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises.

What is Osteoarthritis?

Osteoarthritis is wear and tear arthritis. This is different to Rheumatoid arthritis. The joint cartilage is a specialised tissue that does not have any nerves, and hence we do not experience pain when it is intact. The joint cartilage is lost due to wear and tear and the bone is exposed.
It is probably a good idea to drink plenty of water as our body has two thirds of water and the cartilage consists of 80% of water!

Why do I get arthritis? Why does it affect only some joints and not the others?

It is not very well known why and how arthritis develops. There has been ongoing research at many centres of excellence. The role of inflammation triggered by something unknown is being studied as well.
One of the reasons for developing arthritis could be anatomical variation of joints, previous trauma, previous surgery to the joints, etc.

What are the treatment options before I go through joint replacement surgery?

You must exhaust all the following options before considering joint replacement surgery. These include over the counter or prescribed pain-killers, some physiotherapy, regular exercise, weight loss, joint injections, etc.
Despite all the above, if you are having pain at rest, pain that limits your activities of daily living, and having pain at night, then is the time to see a specialist.

Are there any specific medications I can take to help with my symptoms?

Some patients report some benefit with glucosamine tablets / injections. These can be bought over the counter. However, they can be expensive and does not show consistent results.
Recently, there has been an increased interest in other vicso-supplementation injections.
Please see here for more details.

Are there any natural remedies for joint pain due to arthritis?

If you look for published evidence in support of this, you may not find much. However, in my practice I have come across quite a number of patients who have reported improvement in pain with Turmeric capsules. Some of them reported significant symptom relief within a few weeks of taking them. It is worth trying them as they are naturally available and have anti-inflammatory effect.

What type of anaesthesia will I have?

One would normally have a spinal anaesthetic (an injection in the back, like an epidural). This would make you numb below the waist. You will also have some deep sedation so you are not aware of what’s going on.

The advantage of this is that you will not have any pain when you wake up from the operation and you wake up fresh as if you have just woken up from sleep. You can have more pain-killers before you get the sensation back, which could take up to 3-6 hours.
You are also not connected to the machine for breathing, as you are breathing on your own under the spinal anaesthetic.

You will have minimum side-effects such as drowsiness and sickness, which are more common with the general anaesthetic.

How long does the operation take?

A Knee or a hip replacement surgery would normally take about an hour and half to two hours.

How long would I stay in the hospital?
You would normally stay in the hospital for 2-3 days. You would go home once you are mobile enough safely and confidently with the crutches. This includes going up and down the stairs, if you have stairs at home.

How long would I need the crutches?

You will need the crutches for as long as you will need, which is usually 6 weeks. Once you are confident and comfortable, you may discard the crutches. You will be guided by the physiotherapist.

When can I drive again following a joint replacement surgery?

You can drive once you are able to walk without crutches, which is usually after 6 weeks.

What if get an infection after the operation?

There is a risk of infection with any operation. With joint replacement surgery the infection risk is roughly about 1 in 200. All the precautions would be taken that includes giving you an antibiotic prior to the operation.
If the infection is in the superficial layers, this could be very well treated with the antibiotics, but if infection is deep, you may have to go back to theatre for further surgery. You will be in the hospital for a few weeks to receive antibiotics through the drip.

Is there a risk of a clot in my leg?

With both hip and knee replacement surgery there is a risk of developing a clot in the legs.
You would be given a tablet for a few weeks to thin the blood to prevent clots. You will also wear special stockings for a period of 6 weeks to help prevent clots. Very rarely a clot can dislodge and get to the lungs which can affect breathing and circulation.

Would I need blood transfusion?

For a primary knee or hip replacement surgery, you are unlikely to require blood transfusion. If you are having the redo operation, you may need blood transfusion depending on the extent and the length of the operation.

Am I too overweight to have my joint replaced?

As one weighs more, there is more pressure on the joints, more so on the artificial joints. This would make the joints last much lesser time than otherwise. Hence, you are advised to lose weight prior to replacement surgery. This is not always easy, but it is worth it, since it helps in general recovery and less complications after the operation.

What are the other risks or complications following hip replacement surgery?

Dislocation: Hip joint is a ball and socket joint. The ball can come out of the socket which is called dislocation. If all the precautions are not taken at the advice of the physiotherapists, there is risk of joint dislocation in the first 2-3 months.

Unequal leg lengths: There is a small risk that you may have slightly longer / shorter leg on one side. If it is noticeable, it is usually more than 1 cm. You will need to have shoe-raise on one side.

What kind of hip replacement would I get?
This would really depend on your age and the bone quality. There is cemented type and there is one without cement. If you are under 70 and with a good bone quality, you would normally be given a hip without cement.

How long does it take to recover from hip replacement surgery?
You would usually be able to walk without sticks or crutches by 6 weeks, and you are able to do most things by about 3 months. Hip replacement surgery is a major operation and could take up to a year for full recovery.

How long would my hip replacement last?
The hip replacement should last about 15 – 20 years. The modern hip replacements may last even longer. Once and if they wear out, you would need another surgery which would be a bigger operation.

Would I be able to kneel after my knee replacement?
It would be uncomfortable to kneel with the artificial knee as there isn’t much flesh in front of the knee. You may be able to kneel using a cushion.

How long does it take to recover from a knee replacement?
The knee replacement surgery is a major operation. By 6 weeks you would usually be able to walk without crutches, but the knee would continue to improve for up to a year. The swelling, warmth takes months to settle down.

Would I keep my own knee cap?
There is great debate about the knee cap among the knee surgeons.
This would really depend on the state of the knee cap. If it is worn out, I would resurface it with a plastic button. There are surgeons who always resurface the knee cap, and there are who never do. The practise is extremely variable.

Why do I feel a click in my knee?
Having the artificial knee click is a common occurrence. This is because there is some movement between the metal on plastic.

Why am I told that I am too young to have knee replacement?
The knee replacements generally would last 10-15 years. If you are too young (<55 years), active and working, there is very likelihood that the replacement would not last long. It may wear out in much shorter time. If replaced when young, you will likely need at least one more revision (redo) surgery in your lifetime.