Bone and Joint Care treatment

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					Bone and Joint Care treatment In India

Knee Replacement,Hip Replacement,Hip Resurfacing,Arthroscopy (key hole surgery)

Shoulder Replacement,Malunited fractures,Musculo skeletal tumor surgery

Sports Injury Surgery – Knee Acl Surgery,Rheumatology Services,Knee Replacement

 Spinal treatments Minimally invasive spine surgeries like kyphoplasty, nucleoplasty and
microendoscopic surgery Discectomy Microdiscectomy Decompressive Laminectomy Artificial disc
replacement Common pediatric tumors like medulloblastoma, craniopharyngioma or Astrocytoma are
removed by surgical treatment and is followed by treatment by a multidisciplinary team.

What Are The Causes Of Knee Pain ?

There are many different causes of knee pain, including injury, arthritis and infection.

What is an arthritic knee?

The most common cause of chronic knee pain and disability is arthritis.There are three kinds of arthritis:

Osteoarthritis - commonly known as 'wear and tear arthritis' or degenerative arthritis since the cartilage
simply wears out. When cartilage wears away, bone rubs on bone causing severe pain and disability.

Rheumatoid Arthritis - occurs due to inflammation of the joint lining, resulting in erosion of the articular
cartilage and eventually damaging the knee joint surface.

Traumatic Arthritis - is caused by a serious knee injury or severe tears of the ligaments in the knee.

Is there a cure ?

 It depends on the problem. Some knee pain can be treated through rehabilitation, other cases may
require surgery. Non-surgical or conservative treatment is effective in the early stages of arthritis. Pain
can sometimes be relieved through lifestyle modification, anti-inflammatory drugs, corticosteroid shots,
joint fluid therapy, glucosamine/ chondroitin (dietary supplement), physical therapy, bracing and
arthroscopic surgery. These methods can ease pain temporarily and, in some cases, permanently.

How do we know if knee replacement is required or not ?

 If you have difficulty walking or performing everyday activities, it may be time to consider Knee
replacement Surgery. Doctors generally try to delay Total Knee Replacement for as long as possible in
favor of less invasive treatments. However for patients with advanced joint disease, knee replacement
offers the chance for relief from pain and a return to normal activities.
Knee replacement or knee arthroplasty

 Is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and
disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and
psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long
standing osteoarthritis, the surgery may be more complicated and carry higher risk.

Knee replacement surgery can be performed as a partial or a total knee replacement.

What is total knee replacement ?

Total Knee Replacement is a surgical procedure of implanting an artificial knee (called prosthesis). The
damaged cartilage and bone from the surface of knee joint are removed and replaced with new metal
and plastic surfaces to restore the alignment and function of the knee.

In Total Knee Replacement Surgery, the parts of the bones that rub together are resurfaced with metal
and plastic implants. Using special, precision instruments, the damaged surfaces of the bones are
removed and replacement surfaces fixed into place. The surface of the femur is replaced with a rounded
metal component that comes very close to matching the curve of your natural bone. The surface of the
tibia/leg bone is replaced with a smooth plastic component. This flat metal component holds a smooth
plastic piece made of ultra-high-molecularweight polyethylene plastic that serves as the cartilage. The
undersurface of the kneecap may also be replaced with an implant made of the same polyethylene

What happens during the surgery ?

 The patient is first taken into the operating room and given anesthesia. After the anesthesia has taken
effect, the skin around the knee is thoroughly scrubbed with an antiseptic liquid. The knee is flexed
about 90 degrees and the lower portion of the leg, including the foot, is placed in a special device to
securely hold it in place during the surgery. Usually atourniquet is then applied to the upper portion of
the leg to help slow the flow of blood during the surgery. An incision of appropriate size is then made.

Removing the Damaged Bone Surfaces

 The damaged bone surfaces and cartilage are then removed by the surgeon. Precision instruments and
guides are used to help make sure the cuts are made at the correct angles so the bones will align
properly after the new surfaces (implants) are attached.
Small amounts of the bone surface are removed from the front, end, and back of the femur. This shapes
the bone so the implants will fit properly.The amount of bone that is removed depends on the amount
of bone that has been damaged by the arthritis.

A small portion of the top surface of the tibia is also removed, making the end of the bone flat.
The back surface of the patella (kneecap) is also removed.

Attaching the Implants

An implant is attached to each of the three bones. These implants are designed so that the knee joint
will move in a way that is very similar to the way the joint moved when it was healthy. The implants are
attached using a special kind of cement for bones.

The implant that fits over the end of the femur is made of metal. Its surface is rounded and very smooth,
covering the front and back of the bone as well as the end.

 The implant that fits over the top of the tibia usually consists of two parts. A metal baseplate fits over
the part of the bone that was cut flat. A durable plastic articular surface is then attached to the
baseplate to serve as a spacer between the baseplate and the metal implant that covers the end of the

The implant that covers the back of the patella is also made of a durable plastic.

Closing the Wound

 If necessary, the surgeon may adjust the ligaments that surround the knee to achieve the best possible
knee function.

When all of the implants are in place and the ligaments are properly adjusted, the surgeon sews the
layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow
liquids to drain from the site during the first few hours after surgery. The edges of the skin are then
sewn together, and the knee is wrapped in a sterile bandage. The patient is then taken to the recovery

Partial knee replacement surgery / unicompartmental knee replacement ?

 Unicompartmentalarthroplasty (UKA), also called partial knee replacement,... is an option for some
patients. The knee is generally divided into three "compartments": medial (the inside part of the knee),
lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most
patients with arthritis severe enough to consider knee replacement have significant wear in two or more
of the above compartments and are best treated with total knee replacement. A minority of patients
have wear confined primarily to one compartment, usually the medial, and may be candidates for
unicompartmental knee replacement. Advantages of UKA compared to TKA include smaller incision,
easier post-op rehabilitation, better post-operative ROM, shorter hospital stay, less blood loss, lower
risk of infection, stiffness, and blood clots, and easier revision if necessary. Persons with infectious or
inflammatory arthritis (Rheumatoid, Lupus, Psoriatic ), or marked deformity are not candidates for this

What happens after the surgery ?

 When you are back in your hospital room, you will begin a rehabilitation program that will help you
regain strength, balance and range of movement in your knee. Your physiotherapist will help you
perform appropriate exercises. After 24 hours after surgery, you will probably be asked to stand. Within
next 24hrs, you will probably begin to walk a few steps with the help of walker. You will be discharged as
soon as you surgeon feels that you have recovered sufficiently. You can expect to stay in the hospital for
about 3 days after the surgery. You may or may not be transferred to a rehabilitation facility for a few
more days, as determined by your surgeon. Your physiotherapist will instruct you about proper home
care, and may continue to work with you.

Hip replacement

The hip and its working

 The hip is a ball-and-socket joint comprised of the following structures:

•       Head of the femur

•       Acetabulum of the pelvis

•       Ligaments of the hip joint

The head of the femur or "ball" of the hip joint articulates or moves within the cup-like "socket" called
the acetabulum of the pelvic bone. Together, these structures are referred to as a "ball and socket"
joint. The ball shaped head of the femur fits into a rounded socket (acetabulum) in the pelvis which
enables the leg to have a broad range of movements. The femoral head and acetabulum are covered by
a specialized surface called articular cartilagethat allows the two surfaces to slide against one another
and enable them to move easily.
The joint is held together by several strong ligaments and a strong dense tissue called the capsule which
envelops the joint.

What are the common causes of hip pain

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, Rheumatoid
Arthritis, Avascular Necrosis and Traumatic Arthritis are the most common forms of this disease.


Commonly known as ' wear and tear arthritis’, often occurs in an individual with advancing age, perhaps
due to a genetic tendency.

Rheumatoid arthritis

Is an auto-immune disease where the inflammation causes an erosion of the articular cartilage and
eventually damages the hip joint surface.

Avscular necrosis

 Low blood supply to a part of femoral head leads to its collapse and hence degenerate the hip joint.
Alcoholism, fractures and dislocation of the hip and long term treatment with steroids are its prime

Traumatic arthritis

Serious injury to the hip or strange conditions of hip in childhood (congenital dysplasia of the hip) can
also lead to degeneration of hip joint.
Is there any non-surgical treatment for hip pain ?

There are many ways to get relief from hip pain viz. changing one's lifestyle and pain relieving

What is hip replacement surgery ?

 It is a procedure in which the head of the femur (ball) and the acetabulum (socket) are replaced with
artificial components, called prosthesis. A healthy hip joint will allow the leg to move easily within its
range of motion while supporting the upper body and absorbing the strain that occurs from common
activities like walking and running.

Who should have a hip replacement surgery ?

 If all other conservative measures have failed to cure and the pain is so severe that it is limiting your
everyday activities such as walking or bending, you should seriously consider Hip Replacement Surgery.
The goals of Hip Replacement Surgery include correcting any deformity (inequality in leg length),
improving the function of hip joint, enhancing the quality of life and relieving pain.

What is surface replacement of the hip ?

 It's an advanced alternative of the traditional Hip Replacement Surgery, wherein the damaged and worn
out surface at the end of the thigh bone (femur) is resurfaced with a metal cap. This implant is
potentially more stable and long lasting than the traditional hip surgery and allows the patient to do
multitude of strenuous physical activities like squatting and sitting on the floor. This surgery best suits
young and/or active adults with better bone quality.

What is the hip prosthesis made of ?

 A hip prosthesis is made up of many different materials. The acetabular component that replaces the
acetabulum, has an outer shell made up of metal and the inner shell can be of plastic, metal or ceramic
or the entire socket may be made up of plastic. The femoral component that replaces the femoral head
can either be of single piece or two piece design. A single piece design includes a femoral stem made up
of metal alloy and the femoral head that joins the stem can either be of ceramic or metal alloy. This
component is also known as modular prosthesis.

What happens during the surgery ?

During surgery, once the hip joint is exposed, the head and neck of the femur are removed. The shaft of
the femur is then reamed to accept the metal component consisting of the head, neck, and stem. The
acetabulum is then reamed to accept a plastic cup. The ball and socket are then replaced into normal
position. Both of these implants can be fastened into the bone with or without special cement.


Cemented procedure

 The cemented procedure utilizes a doughy substance mixed at the time of surgery that is introduced
between the artificial component and the bone. This type of fixation in total hips remains the gold
standard and is the method of choice for many surgeons. Depending upon their health and bone
density, people over the age of 60 will receive this type of joint fixation.

Noncemented procedure

 Despite its common use, not all individuals are candidates for a cemented hip. Studies show that young
active adults tend to loosen their artificial components prematurely. The current trend therefore, is to
use an artificial joint covered with a material that allows bone tissue to grow into the metal. A tight
bond of scar tissue if formed, which anchors the metal to the bone. This is called a cementless total hip

This type surgery is technically more sensitive, requiring a more exact fit of the metal component to the
femur. In this procedure, the surface of the metal is prepared with a small porous roughened coat,
which attracts bone in growth. This process is called porous in growth or oseointegration. In general, the
artificial joint implants used in the non-cemented procedure are larger than those used with cement but
are still proportional to the size of the individual bone.

There are other types of hip replacement procedures:

Hybrid fixation

Refers to a procedure in which one component (usually the socket) is inserted without cement, and one
component (usually the stem for the ball of the femur) is inserted with cement.

Hemi-surface replacement of osteonecrosis

This is one option the surgeon will utilize to minimize tissue reaction. It involves replacing only the
diseased part of the joint. A hemi-surface replacement is often recommended for people who have
avascular necrosis and have some remaining articular cartilage on the acetabulum. The hemi-surface
replacement preserves and maintains bone by providing stress transfer to the femoral neck and upper
femur. It can also help avoid inflammatory reaction and joint loosening.

Hip resurfacing

 The surgeon uses specialized tools to prepare the bone for resurfacing after dislocating the hip. The
neck of the femur is preserved rather than amputated as in conventional stem-type total hip
replacement. The head of the femur is prepared to receive the resurfacing component, while the socket
is shaped to accept the new surfacing cup. After careful manipulation, the socket is placed to allow bone
to grow around it, providing further stability, and the component is fixed into position on the femoral
head using bone cement.

What happens after the surgery ?

 After your surgery, you will be shifted to the recovery room for close observation. You'll be given a drip
or two to restore fluids into your body. When you wake up from surgery, you'll feel pain in your hip and
you'll find your leg swollen and bruised and the muscles stiff and sore. Pain medication will be given to
make you as comfortable as possible. Once you are fully conscious and your blood pressure and pulse
rate become stable, you'll be shifted in the ward. You'll lose appetite for a couple of days but it is vital to
take fluids. The scar on the side of your hip will fade to a thin white line, over a period of time.

Your physiotherapist will visit you a day after the surgery, to teach you specific exercises to strengthen
your hip and restore movement for walking. Initially you may feel unstable and experience some
discomfort but you'll be given a frame to assist you in walking. Gradually you'll be walking with crutches
or a stick after few days. Over a period of 4-6 weeks, you will be able to walk without support, as per
your surgeon's instructions.

Once you, your surgeon and the physiotherapist are satisfied with your condition and mobility you'll be
discharged from the hospital. Your stay in hospital will last for approximately 5-7 days.

What is medical tourism?

Medical tourism, also known as health tourism or health travel, is a term that describes travelling to a
foreign country for medical, dental, or cosmetic treatment. It involves the benefit of cost effective
treatment, private medical care, in collaboration with the tourism industry. The concept of medical
tourism is fast growing in India and people from different part of the world are choosing India as their
desired destination.

Why Choose India?

Medical tourism is a rapidly growing sector in India and millions of medical tourists from all over the
world have come here to experience a world-class healthcare service.

In 2010, about 600,000 patients travelled to India from over 30 countries for treatment, including the
USA, Canada, UK, Russia, the Middle East and Africa.

According to a study by the Confederation of Indian Industry (CII) on healthcare, after software, the
medical tourism industry is poised to be the next big success story in India. It has predicted that the
industry will grow to earn additional revenue of $2.3 billion by 2012 and will soon account for a major
share of the country’s revenue.

There are several reasons behind this tremendous growth:

Patients come to India to get specialized treatments not available in their home country. Indian hospitals
excel in performing complex cardiac surgeries, kidney transplants, bone marrow transplants, orthopedic
surgeries, infertility treatments amongst their wide repertoire.

India provides world-class quality treatments at a fraction of the priceof developed countries. The cost
of medical treatment in India is generally one tenth of western countries and among the cheapest in
India has state of the art medical institutes and hospitals of international standards with highly qualified
medical professionals.

These centers are backed by high quality equipment and technology. This fusion of highly qualifiedstaff
assisted by the latest equipment gives India the edge over other countries.

With hospitals and clinics in every region including urban, semi-urban, or rural parts of the country, India
has ample choice in terms of preferred destinations.

In countries such as Canada and the UK, patients almost always have to wait weeks and sometimes
months to avail of medical treatments. In India the consultations with the doctors are prompt and
patients receive a turnaround to their treatment plan at a quicker pace.

As English is a commonly spoken language in India, the patient will be comfortable communicating with
the doctors.

Medical tourists find that the cost of their treatment (including the return airfare, holiday and
accommodation) leaves them with a total bill substantially less than they would have spent just on
having the procedure in the UK.

Why Arman

There are several concerns that flicker in the minds of the foreigners who come for treatment to India,
particularly for first time fliers. The first among them is which hospital to choose for their treatment.

India is flooded with hospitals, medical centers and hotels which have their websites that attract the
foreign patients. This makes them even more confused and the complexity of decision making becomes
a challenging task.

We, at Arman can address all these concerns and issues by acting as intermediary with hospitals, clinics,
surgeons, hotels.

Arman is a healthcare facilitator that has painstakingly brought together highly qualified professionals
and hospitals of repute and health care providers.

We take the responsibility of screening the hospitals by checking their track record, accreditations,
associations and have partnered with the best internationally accredited hospitals in India.
Arman update and monitor our network of hospitals on a regular basis and maintain a database on the
hospital’s certifications, type of facilities and other factors critical in choosing a medical center.

Arman also negotiate a lower price from the hospital which foreign patients would not get by directly
approaching the hospitals This helps the patient to save a lot on the medical procedure costs

We provide assistance with logistics, documentations, permits and other travel arrangements required
for medical tourism.

Our coordinators are highly trained to foresee every need of the patient and make the entire process
hassle free from start to finish. They help the patient plan his medical procedures before leaving home,
and schedules all his appointments, surgery, treatments and plans for recuperation.

This in turn helps the patient to choose the hospital according to his convenience and also get a clear
picture of the cost of treatment, accommodation beforehand that helps them to arrange their finance.

We are aware that a lot of trust is put in our hands and ensure that this trust is well placed by serving
each patient individually with care and comfort.

How We Work

Patient query received by the patient himself or his doctor/ hospital.

This query along with medical reports is forwarded to the concerned hospitals to get expert opinions

After the hospitals respond, we create a package for the patient which includes recommendation on the
treatments, duration of stay, and the costs involved.

The patient reviews the various options presented to him and makes a decision based on budget and
the line of treatment recommended by the doctors. Occasionally, a patient may clarify his concerns or
questions he may have regarding the treatment with the doctor by telephone.

In liaison with the patients, Arman representatives will make prior bookings with the hospital, airlines,

Patient travels and checks into hospital to start the treatment. We provide assistance through out your
stay in the hospital which include pre and post opeartive care.

Once fit and able to travel, the patient if wishes can enjoy the vast tourist destinations within India
before returning to their home country fully rejuvenated. (at an additional cost)(ebranding/mum/ts/19)
Arman Health Care Facilitators


422, Bonanza, 'B' Wing,Sahar Plaza Complex, Next to Kohinoor Hotel,

Andheri Kurla Road, Andheri East Mumbai India 4000059.

Contact: land line No: ( 022-28387433 ) Email


Arman Health care Facilitators,Gallery Saint-Pierre, 36 local

UtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa / Ngaliema,DRC Mobile : +243998290384


Arman Health Care Facilitators C/O Doctor Pharma Kenya Limited Vision Tower, Muthithi Road,

Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329

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