Question 1

Based on the Kellgren-Lawrence (KL) grading system, what is the gold standard for diagnosing osteoarthritis — the presence of osteophytes, the absence of joint space, or both?

Dr. Ramkinkar Jha · Accepted Answer

KL is just the WHO classification of osteoarthritis — it's not very good. Diagnosis is a clinical one: patients complaining of typical pain — pain while walking, pain while taking stairs, pain while sitting cross-legged — with definitive tenderness on the joint line, is almost confirmatory. That's the real gold standard, not the X-ray. X-ray is the baseline test, but it's not the criterion for deciding which patient should undergo surgery — a grade four KL arthritis patient with minimal pain treated well with physical therapy may not be a candidate for joint replacement, while a grade three patient who has tried all conservative measures without relief could be. It's a paradox, so X-ray grading alone isn't the gold standard. On location: for osteophytes, the location of weight-bearing matters more, but for me it's typically joint space reduction that matters most, because it indirectly shows the articular cartilage is gone — and that's irreversible.

Question 2

How effective is medical therapy, and what is the role of steroids in early-stage osteoarthritis?

Dr. Ramkinkar Jha · Accepted Answer

Medical therapy is the first line of treatment — it should be tried first, and once pain is not relieved with medical therapy and physical therapy, and the patient is having difficulty in activities of daily living, then the patient becomes a candidate for surgery.

Question 3

What is the success rate of replacement therapy in terms of biocompatibility and durability?

Dr. Ramkinkar Jha · Accepted Answer

The survivorship of newer implants, taking an average value, is more than 20 to 25 years, though there's a range. To measure success there's a prerequisite: we presume the patient has taken care of the joint, followed the precautions, physical therapies and exercises they've been told — the value I've mentioned is the average assuming that's been taken care of.

Question 4

How often is the implant reviewed, and will it need to be removed, or is it permanent?

Dr. Ramkinkar Jha · Accepted Answer

It's a permanent, non-removable procedure — it doesn't need to be removed. The follow-ups: the first milestone is at two weeks, to remove the stitches, then six weeks post-surgery, then three months, six months, and then annually.

Question 5

What special care must an athlete take after a hip replacement?

Dr. Ramkinkar Jha · Accepted Answer

In athletes the demand of activity is much more than the normal population — jumping, contact sports — and there's wear and tear involved in the artificial joint over time. We generally tell patients not to jump or run, for the sake of the longevity of the implant — the more activity, the more wear, and the more chance of needing revision surgery. First we tell them to change their activity level if possible; if that's not possible, there are certain implant variations available, like hip resurfacing or metal-on-metal implants, which can be offered if it's mandatory for the athlete to continue their sport — though ceramic implants are not good for them because of a higher chance of breakage.

Question 6

If a patient develops an infection around the implant, should the implant be removed or treated with antibiotics? And are there implants that are MRI-compatible?

Dr. Ramkinkar Jha · Accepted Answer

For infection: understand the kind and duration of it. If it's acute, be very aggressive — antibiotics alone won't suffice, don't hesitate to go inside and clean the joint, with multiple debridements till it feels clean; antibiotics work as an adjuvant, not the primary therapy. In the knee you can also change the polyethylene component, put a drain for three to five days, give antibiotics. But if it's longstanding — more than a month — you may need staged revision surgery: stage one, remove the implant and put an antibiotic spacer, monitor for six weeks until infection markers are normal and skin has healed, then stage two, the revision total replacement. On MRI: all joint replacements can have an MRI done, provided the implant is well fixed — if it's unstable, MRI may not be a good idea, but if the joint is stable, MRI can be done using implant-specific coils that neutralise the implant artefact.

Question 7

Can you explain the '90 degree rule' for hip replacement surgery?

Dr. Ramkinkar Jha · Accepted Answer

This is a common perception, actually — in the first six to eight weeks we don't want the patient to bend beyond 90 degrees, talking about hip replacements, to reduce the chances of dislocation so the capsule heals well. That's the 90 degree rule for hip replacement.

Hip Replacement, Knee Replacement, Revision Surgery & Arthroscopies

Questions Doctors Asked Dr. Ramkinkar Jha