Dr Amir Ijaz, an Orthopedic surgeon at Ittefaq Hospital Lahore sheds light on common bone and joint problems including body aches and joint pains. Also talks about knee replacement surgery and shares tips to maintain bone health
SN: What do orthopedic surgeons deal with?sni
Orthopedic is a very vast field. It covers all the bones, soft tissues and limbs of the body expect for head and brain. In foreign countries every orthopedic surgeon is specialized. For example, if he is a knee surgeon he will only deal with knee, etc. But in Pakistan things are different. Here, almost every doctor is dealing with everything. Trauma, corrective and joint replacement surgeries are common.sni
SN: What common bone and joint problems have you seen here?sni
I have seen trauma or neglected trauma patients most commonly. People go to pehalwans for such problems and then come to us after the problem has worsened. Backache comes next in the list. Because of lack of health awareness people do not get their calcium and vitamin D levels checked regularly. It is the responsibility of the GPs to recommend blood tests of patients and make sure their levels are alright. Lack of these minerals causes body aches and pains.sni
I have also seen that young females are also deficient in calcium, especially those who breastfeed their kids. Moreover, women in menopausal age have hormonal problems due to which they have problems like generalized body aches and pains and osteoporosis. There is no trend of exercising in Pakistan. Every person should brisk walk 30 minutes, three times a week. But people are just busy with their work and lack of physical activity also causes bone weakness. Dietary habits and lifestyle play a key role.sni
SN: Why are bone and joint problems more common in women?sni
Osteoporosis, weakness of the bones, is highly common in women. Dietary, hormonal and age being the reasons. Pakistani women, generally, also do not do any exercise and keep putting on weight. And then complain about backaches and knee pain. Obesity is also common in women here. The health status of women abroad is much better. They are well aware and are physically active. Even 70-80 year old women walk three to four miles a day. Contrarily, women of this age group in our country do not go out of their house. They just lie in bed and family members are pressing their legs.sni
Children nowadays just sit glued to their computer screens and play games with least physical activity. What bone growth do you expect them to have
SN: Even youngsters nowadays complain of body aches and joint pains. What can be the reason?sni
Unhealthy eating habits and physical inactivity are the culprits. Children nowadays just sit glued to their computer screens and play games with least physical activity. What bone growth do you expect them to have? If you assess the bone of a Pakistani and a European child, you will know the difference. I had the opportunity to put a plate in a 15 year olds leg and I was shocked to see the bone quality. His bone was very soft. I had never in my 18 years of experience, seen this quality of bone in a child.sni
I consulted my colleagues who told me the bone quality I am looking for will rarely be found here. Parents definitely have a role to play in this. What will they teach their children when they do not have awareness and are not into any sort of physical activity? Some parents tell their kids that all they need to do is study. This is so wrong. Everything needs to be done in a balance. Lack of playgrounds is also a big problem here and even schools do not have them.sni
SN: Since which age should people be conscious about bone health and what can be done to improve it?sni
Firstly, it is the responsibility of parents to introduce healthy foods to their children. Then as they grow they should not be told to just focus on studies. Psychical activity of some sort is highly important. So as grown ups they should be well aware about what they should do to improve their health. People, especially kids nowadays are more into fancy foods, which should be avoided. Keep life simple.sni
SN: Injections for knee joint pain are usually recommended to patients. But many complain that it was given unnecessarily as they did not get any relief. Your take on this?sni
There are a lot of controversies regarding this. There are actually two types of injections, one is for pain relief in which local anesthetics and steroids are given for temporary relief. I tell my patients that it may help you but there is no guarantee. Pain relief can be for few months or weeks or there may be no improvement at all. The injection can be effective for a maximum of three months. If it is mechanical pain due to arthritis then definitely it will help relieve the pain. The injection should not be given more than thrice in a year. Patients are right in complaining that the injection did them no good because they were not informed. It is the doctor’s responsibility to explain to the patient what treatment is being done, why and what outcomes it will have.sni
A patient may find no relief if the injection is given for the wrong reason, is not administered in the appropriate place or the patient is resistant to drugs
SN: What does it mean to find no relief with the treatment?sni
A patient may find no relief if the injection is given for the wrong reason, is not administered in the appropriate place or the patient is resistant to drugs. 90 percent patients with mechanical symptoms should get some relief if applied in the right place. And if it is advance osteoarthritis, then the injection will have some level of effect but then the patient would require a transplant.sni
SN: Why is the concept of going to pehalwans for bone and joint problems common in our culture?sni
Socio-economic conditions and beliefs are the reasons why people go to them. People have been going to them for generations that is why have firm belief in them. Earlier people did not have options. Now people have options and treatment availability as well. In healthy people, undisplaced fractures naturally heal on its own with time. And pehalwans get the credit for it.sni
Recently, a two year old kid was brought to me who had been to a pehlawan and had supposedly fixed his shoulder joint. He had wooden planks around it and I had never seen this in my life. This is because of lack of education. Health and education budget in our country is almost insignificant that is why we have issues.sni
SN: Other than calcium, what else do we need to make bones strong?sni
Bones are made up of calcium and phosphate. Vitamin D is required to absorb calcium. If you eat normal balanced diet you will not be deficient of these minerals.sni
When a child reaches maturity, the length of bones stop increasing. After that stiffness and strength of the bones depends on the amount of physical activity
SN: How effective is oil massage for pain?sni
Massage with any lubricant is effective for muscles. It increases blood flow, removes toxic agents and relieves pain.sni
SN: Bones build a new skeleton every three months; is it true?sni
When a child grows and reaches maturity then the length stops increasing. After that stiffness and strength of the bones depends on the amount of physical activity of the individual. Remodeling or wear and tear of the bones keeps occurring that causes the changes. The structure however, remains the same. They keep becoming strong and weak depending on the psychical activity and age.sni
SN: Can every joint of the body be replaced through surgery?sni
Yes it can be. But according to evidence, successful joint replacements are of knee and hip joints. Shoulder and elbow joints come next. Replacement of ankle and wrist joints is not much successful. Fusion (permanently joining together two or more bones so there is no movement between them) is a better option in such cases.sni
SN: When is knee replacement surgery required?sni
Individual who has pain to an extent that it disturbs the lifestyle and makes it impossible for him to sleep during the night. Moreover, the individual is unable to walk or perform daily activities like going to the washroom and there is a need to take painkillers frequently. And before that he has tried every possible treatment like injections, etc but in vain. Then the patient is counseled for surgery and is informed about its pros and cons.sni
SN: How much time does it take to heal the wound?sni
Normally, with physiotherapy and no complication hospital stay can be around five days after the surgery. After that the patient should be able to walk and in six weeks time should be able to come back to normal life.sni
The education level of our general population is low. They need to be made aware, especially through media
SN: How long do these artificial joints last?sni
Longest survival is around 40 to 50 years. But normally we tell patients they will last around 10-15 years. After that revision surgery is required.sni
SN: Anything left at the end that you would like to add?sni
The education level of our general population is low. They need to be made aware, especially through media. Media does not inform about patient’s rights and in which conditions does a patient need to visit a doctor and in which it is not required. Moreover, unhealthy eating habits should be modified. The Westerners and Europeans are moving away from such unhealthy lifestyle while we are adopting them. Normal simple diet and physical activity can keep you away from many health problems.sni
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