Textbook of Orthopedic Rheumatology
Textbook of Orthopedic Rheumatology
Under Aegis of Indian Orthopaedic Rheumatology Association
Jaypee Brothers Medical Publishers (P) Ltd
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Textbook of Orthopedic Rheumatology
First Edition: 2022
9789354651878
Printed at:
My parents, teachers, mentors, students and my patients who continue to provide lot of stimulating challenges in our clinical practice.
Contributors
- Aarti B Bhattacharya
- Professor
- Department of Pathology
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Abhay Elhence
- Professor
- Department of Orthopedics
- All India Institute of Medical Sciences
- Jodhpur, Rajasthan, India
- Abhinandan Reddy M
- Junior Consultant
- Department of Spine Surgery
- Indian Spinal Injury Center
- New Delhi, India
- Ajay SS
- Senior Resident
- Department of Orthopedics
- Sri Devaraj Urs Medical College
- Kolar, Karnataka, India
- Alok Chandra Agrawal
- Professor
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Amrit Kumar Singh
- Junior Resident
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Anil Gowtham Manivannan
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Arathana Hospital
- Pollachi, Tamil Nadu, India
- Ankit Kumar Garg
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Anupam Inamdar
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Arun Gulati
- Senior Resident
- Department of Orthopedics
- Kalpana Chawla Government
- Medical College
- Karnal, Haryana, India
- Arun Kumar Sharma
- Associate Professor
- Department of Orthopedics
- SMS Medical College and Hospital
- Jaipur, Rajasthan, India
- Arunabh Arora
- Junior Resident
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Arvind Kanchan
- Professor
- Department of Physiology
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Bhaskar Borgohain
- Professor
- Department of Orthopedics
- North Eastern Indira Gandhi
- Regional Institute of Health and
- Medical Sciences
- Shillong, Meghalaya, India
- Bikram Kar
- Associate Professor
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Dushyant Chaudhary
- Junior Resident
- Department of Orthopedics
- School of Medical Sciences and
- Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Gyaneshwar Tonk
- Professor
- Department of Orthopedics
- LLRM Medical College
- Meerut, Uttar Pradesh, India
- Harshal Sakale
- Associate Professor
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- J Mangwani
- Consultant Orthopedic Foot and
- Ankle Surgeon
- Department of Orthopedics
- University Hospitals of Leicester
- Leicester, UK
- Jitendra Chowdhary
- Consultant
- Department of Orthopedics
- Orthopedic Centre
- Jain Knee and Hip Clinic
- Ahmedabad, Gujarat, India
- Jitesh K Jain
- Consultant Orthopedic and
- Sports Surgeon
- Department of Orthopedics
- Rajasthan Hospital
- Jaipur, Rajasthan, India
- Kashif A Ahmed
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Rahman Hospital
- Guwahati, Assam, India
- Krishna Subramanyam
- Consultant Orthopedic Surgeon
- Department of Orthopedics and
- Sports Medicine
- Yashoda Hospital
- Hyderabad, Telangana, India
- Kushal Singh
- Assistant Professor
- Department of Radiodiagnosis
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Lalit Kishore
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Rajeshwar Hospital
- Patna, Bihar, India
- Madhan Jeyaraman
- Senior Resident
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Mahaveer Mali
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- Jodhpur, Rajasthan, India
- Manish Khanna
- President Emeritus
- Indian Orthopaedic Rheumatology Association
- Chairperson, Indian Stem Cell Study Group Association
- Professor
- Department of Orthopedics
- Lucknow, Uttar Pradesh, India
- Manju Agrawal
- Assistant Professor
- Department of Pharmacology
- Pt JNM Medical College
- Raipur, Chhattisgarh, India
- Md Neshar Ansari
- Assistant Professor
- Department of Orthopedics
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Mukund Madhav Ojha
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- N Nanavati
- Naveen Jeyaraman
- Senior Resident
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Neeraj Jain
- Consultant Rheumatologist
- Department of Rheumatology
- Sir Ganga Ram Hospital
- New Delhi, India
- Omkarnath Gudapati
- Professor
- Department of Orthopedics
- Great Eastern Medical School and Hospital
- Ragolu, Andhra Pradesh, India
- Prajwal GS
- Junior Resident
- Department of Orthopedics
- JJM Medical College
- Davanagere, Karnataka, India
- Rahul Ranjan
- Assistant Professor
- Department of Orthopedics
- Darbhanga Medical College
- Darbhanga, Bihar, India
- Raja TV
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Visa Medicure
- Chennai, Tamil Nadu, India
- Rajiv Lakhotia
- Professor
- Department of Anesthesiology
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Rajni Ranjan
- Professor
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Rakesh Kumar
- Associate Professor
- Department of Orthopedics
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Rashmi Chopra
- Orthopedic Consultant Hand and Wrist Surgeon
- Department of Orthopedics
- Apollo Spectra Hospitals
- New Delhi, India
- Rashmi Jain
- Resident
- School of Medical Sciences and Research
- Sharda University
- Greater Noida, Uttar Pradesh India
- Ravi VR
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Maruti Hospital
- Tiruchirappalli, Tamil Nadu India
- RB Kalia
- Additional Professor
- Department of Orthopedics
- All Institute of Medical Sciences
- Rishikesh, Uttarakhand, India
- RC Meena
- Professor
- Department of Orthopedics
- SMS Medical College and Hospital
- Jaipur, Rajasthan, India
- Sathish Muthu
- Assistant Professor
- Department of Orthopedics
- Government Medical College and Hospital
- Dindigul, Tamil Nadu, India
- Shashank Tiwari
- Consultant Medical Ethics and
- Clinical Research
- Lucknow, Uttar Pradesh, India
- Shantanu Lahkar
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Archana Trauma and Orthopedic Hospital
- Dibrugarh, Assam, India
- Shilp Verma
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Shilpa Sharma
- Professor
- Department of Pediatric Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- Shivakumar Bingi
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Fortis Hospital
- Bengaluru, Karnataka, India
- Shivaraj B
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Fortis Hospital
- Bengaluru, Karnataka, India
- Shweta Agarwal
- Associate Professor
- Department of Medicine
- Career Institute of Medical Sciences and Hospital
- Lucknow, Uttar Pradesh, India
- Sribatsa Kumar Mohapatra
- Professor
- Department of Surgery
- Veer Surendra Sai Institute of Medical Sciences and Research
- Burla, Odisha, India
- SS Jha
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Harishchandra Orthopaedic
- Research Institute
- Patna, Bihar, India
- Subir Kumar Mukherjee
- Consultant Orthopedic Surgeon
- Department of Orthopedics
- Raipur, Chhattisgarh, India
- Sujit Kumar
- Senior Resident
- Department of Orthopedics
- LLRM Medical College
- Meerut, Uttar Pradesh, India
- Sunil Kumar Gupta
- Associate Professor
- Department of Dermatology
- All India Institute of Medical Sciences
- Gorakhpur, Uttar Pradesh, India
- THS Bedi
- Chief Radiologist
- Department of Radiodiagnosis
- Bedi Ultrasound Clinic
- New Delhi, India
- Utkarsh Bansal
- Professor
- Department of Pediatrics
- Hind Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- V Adukia
- Venus Khanna
- Professor
- Department of Pathology
- Prasad Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Vipul Sud
- Consultant Plastic Surgeon
- Department of Plastic and
- Reconstructive Surgery
- Batra Hospital and
- Medical Research Centre
- New Delhi, India
I am pleased to write the foreword for this most-needed book on ortho-rheumatology, edited by Manish Khanna. He is a great visionary. It is his idea to start a new branch of orthopedics, “ortho-rheumatology” as a superspecialty in India. He is passionately dedicated to this superspecialty. For the last 25 years he has conducted lectures, conferences and webinars on this topic. This is comparatively a new specialty which has spread over globally. This is a comprehensive book combining the two large branches—medical and orthopedic rheumatology. This book not only covers medical and surgical rheumatology but also related arthropathies, basic sciences and crystal arthritis—a truly comprehensive book. All contributors are authorities in their fields. He has formed, “Indian Stem Sell Study Group Association”. In this book, a section is devoted to Regenerative Science in Orthopedic Rheumatology. He is also the Editor-in-Chief of International Journal of Orthopedic Rheumatology.
This book will be of great use not only to general orthopedic surgeons, but also to hand surgeons, foot specialists and spine surgeons as well. I sincerely congratulate Professor Manish Khanna for bringing out this most useful book.
With best wishes.
Professor GS Kulkarni
Director, Postgraduate Institute of Orthopedics, Miraj
Director, Sandhata Medical Research Society
Miraj, Maharashtra, India
Foreword
It is indeed my privilege to script the foreword for this important Textbook of Orthopedic Rheumatology edited by Manish Khanna. Rheumatology by itself is a vast specialty involving many specialists requiring a comprehensive care. Orthopedics compiled with rheumatology can play a vital role to put back a crippled patient to fairly normal activity.
This book with various chapters deals with basic sciences to various orthopedic disorders related to rheumatology. There is also a chapter on regenerative medicine and its application in patients with ortho-rheumatological disorders.
Unfortunately, even today with all the biological pursuits, the scientists have achieved, patients with various rheumatological disorders still suffer. I am sure this book with various subsections authored by reputed clinicians and researchers will provide definite guidelines on the management of different orthopedic rheumatological disorders. There is no doubt that this script will not only be a guide to the postgraduates and treating surgeons, but also to the orthopedic fraternity as a whole.
I wish the Editor-in-Chief and all those who have subscribed to this useful book all the very best and may God bless you in all their future endeavors.
With best wishes,
Professor M Shantharam Shetty
Past President, Indian Orthopaedic Association
Pro Chancellor, Nitte University, Mangalore
Chairman, Tejasvini Hospital Group of Institutions
Mangalore, Karnataka, India
Preface
Most often for treating complicated medical ailments there is a common need for involvement of various medical specialists for planning the treatment protocol. Ailments like bone and joint diseases are usually treated by Orthopedists who delve into a more surgical treatment approach. However, the treatment procedure for such patients who have autoimmune diseases and various forms of arthritis is often inclined towards a nonsurgical approach, especially during the initial phase of the disease which is something that is covered under the scope of ortho-rheumatology. While over the years, the patients have either approached rheumatologists first, prior to consulting an orthopedist, and vice versa, the process is often long and tiresome. The similarity between symptoms leads to confusion among patients and sometime delay in the care which results in a progression of the severity. Often times, patients are forced to alternate between two different clinics to merge together one concise plan of treatment. Not to mention, also patients often remain in pain due to the lack of awareness and inability to have access to specialists from two different medical backgrounds to provide them with relief.
The Textbook of Orthopedic Rheumatology for orthopedic surgeons aims to lessen this gap and delay in care by bringing forward the awareness and combining two specializations to provide in the needy patients with cutting edge therapies along with a combination of traditionally approached plans. The main aim of this book is to create awareness amongst orthopedic surgeons whilst encouraging broadened research and development.
The book delves into the continuous need for consistency in clinical care. A new wave of emerging high-quality treatment programs for patients who struggle with disease management is set to be the new evolving specialization of orthopedic rheumatology. The integration of orthopedics and rheumatology enables patients to receive the best possible care under one roof for their ailments, thereby minimizing patient effort and ensuring quick and early treatment of progressive ailments.
In addition to covering the technological aspects of this modern medicinal system, this book will target beginning specialists to develop a deeper interest in this combined specialty. The contents of book are prompted by the growing need for understanding, detailed healthcare plans and a full-fledged medical approach to the treatment of ailments that co-exist in a number of orthopedic intervention-beneficial rheumatoid patients.
Manish Khanna
Acknowledgments
I would firstly like to be grateful to the Almighty, who brought the idea to my mind for publishing a textbook on Orthopedic Rheumatology for the orthopedic surgeons. We are further grateful to the tremendous work of the contributors without whom this book would not be possible. I would like to acknowledge the dynamic, stimulating work of our Co-Editors Dr Madhan Jeyaraman and Dr Sathish Muthu who are the real pillars of the various academic work of the Textbook of Orthopedic Rheumatology. My heartful thanks to both of these young, dynamic orthopedic surgeons for continuously supporting the project. I would also like to acknowledge the excellent team work for the production of the book by M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), Ms Saima Rashid (Manager Publishing), Mr Ashish Rajput (Commissioning Editor), and Dr Pratul Roy (Development Editor).
My special thanks to the Medley Company for their support for bringing out this book which was very dear to me for years all together. Last, but certainly not the least we want to acknowledge our Indian patients who are the true backbone for our knowledge. Our patients truly provide all the stimulating challenges to learn in our clinical practice.
Introduction
Most often treating complicated medical ailments leads to an amalgam of medical specialists and treatment plans. The concept of one size fits all does not work in most medical plans. The same has been found in the treatment of rheumatoid and orthopedic conditions.
Certain ailments like bone, joint injuries and diseases, namely, body trauma and osteoarthritis are treated by orthopedists who delve into a more surgical treatment approach. However, the plan of care for patients who have autoimmune conditions and arthritis is often inclined towards a nonsurgical approach and covered under rheumatology.
The question arises then for those patients who need treatment for diseases that require both nonsurgical and surgical efforts. While, over the years, the patients have either approached Rheumatologists first prior to seeing an orthopedist, and vice versa, the process is long and tiresome.
Each specialization deals with separate concerns, for example, orthopedic surgeons deal with joint and musculoskeletal pain and joint replacement surgery. Whilst, patients who suffer from joint pain, stiffness and psoriasis often visit a rheumatologist. The similarity between the symptoms leads to confusion amongst patients and delays in care resulting in the progression of severity.
Often times, patients are forced to go between two different clinics to merge together one concise plan of treatment. Not to mention, patients often remain in pain due to the lack of awareness and inability to have access to specialists from two medical backgrounds to provide relief. Thus, it can be argued that it is essential to understand the dynamics between the two specialists to ensure the timely, most effective treatment.
The Indian Orthopaedic Rheumatology Association (IORA) aims to lessen this gap and delay in care by bringing forward awareness and combining two specializations to provide in need patients with cutting edge therapies with a combination of traditionally approached plans.
Having both specialists under the same hospital structure can also lessen patient effort. Wherein, patients whose joint pain is not amenable with traditional rheumatology efforts, can be referred to an orthopedic surgeon who can further use surgical treatment for the management of the disease.
The gap in communication leads to patients going in circles, sometimes often revisiting different doctors specialized in rheumatology under the impression that the current method of treatment is ineffective, rather than being aware of the orthopedic option.
Here is where the IORA comes into the picture, enabling comprehensive and accelerated care to patients. The main aim of IORA is to create awareness amongst orthopedic surgeons whilst encouraging broadened research and development. The first step is to research into the nuances of this nascent field and create scientific relations on an international and national level.
The limitations the IORA's include lack of infrastructure to provide elaborated care through a multispecialty approach, patient awareness and compliance, expensive biologicals. Patients' environment and lifestyle can also hamper treatment plans. There is also a great need in urban and rural areas for rheumatology specialists.
Despite these limitations, the IORA has surged forward, focusing and encouraging new research coupled with academic advancements in the field of Orthopedic Rheumatology. IORA understands the complexity of uncontrolled rheumatoid arthritis, disease modifying anti-rheumatic drugs (DMARDs), avascular necrosis (AVN) head of femur and osteoarthritis (OA) causing the stress on orthopedic surgical treatment and traditional Rheumatology.
Hence, the IORA has taken up through their peer-reviewed journals the action of providing orthopedic surgeons with insights, knowledge and cutting edge technology awareness. This further enhances and manages rheumatic and orthopedic musculoskeletal disorders. The IORA also provides a platform for newer aspiring researches to provide insight into a diagnostic and clinical guide for treatment through research.
The aim of this book is thus, to foremostly to create awareness, challenge orthopedic and rheumatology specialized to broaden their treatment scope to taking a newer more comprehensible multidimensional approach to the treatment of such diseases.