Let’s be honest: facing a joint or spine issue is already stressful enough. Then comes the monumental task of choosing the right specialist, the one person you trust with your health, mobility, and future. You are not just looking for a doctor; you’re looking for the best orthopaedic surgeon in Ludhiana, Punjab, or anywhere else.
At the N K Aggarwal Joints and Spine Centre, we want to simplify this search. This isn’t about looking at glossy brochures. It’s about checking for substance. Our head surgeon, Dr. N. K. Aggarwal set this standard, and every patient should demand it. Here are six essential filters to apply when making this life-changing choice.
1. Don’t Just Verify—Demand Elite Credentials
Every surgeon has a degree, but few have earned training that meets global standards. Your first step is to confirm the surgeon’s education. For a leader like Dr. N. K. Aggarwal, his background—including a Master of Surgery (Orthopaedics) and the highly regarded M.Ch. from the University of Liverpool, UK—shows a dedication far beyond the local baseline. To add to this Dr Aggarwal has worked at some of the best centres in the world and had fellowships in the USA, Switzerland and the UK. These credentials aren’t just letters; they are proof of a globally focused commitment to surgical mastery. Don’t settle for less.
2. Check Their Depth of Specialization
Think about it: would you hire a general handyman to fix a foundation crack? Of course not. The human spine and major joints are complex, so deep specialisation is vital. The best surgeons focus their entire practice on either the spine or major joint replacements (like the hip and knee), not general orthopaedics. A specialist at the N K Aggarwal Joints and Spine Centre performs these complex procedures constantly, meaning their expertise is razor-sharp.
3. Ask Them: “How Often Do You Do This?”
Surgical skill is a muscle, and it gets stronger through constant use. You have a right to ask about their experience: “How many times did you perform my exact procedure in the last year?” When a surgeon can point to a high volume of successful surgeries, as Dr. Aggarwal and his team can, you know you’re benefiting from competence that comes from experience.
4. Judge the Communication and ‘Vibe’
Your surgeon should be your partner, not a dictator. You need someone who listens to your story, the pain, the worries, the impact on your life—before looking at the MRI. Pay attention to how the surgeon communicates during your consultation. Are they patient? Do they explain your diagnosis in clear Hindi or English without rushing? If you walk away feeling confused or unheard, they aren’t the right fit, no matter how good their CV looks. Trust your gut feeling on this one.
5. Look for a Conservative Treatment Mindset
An ethical, patient-focused surgeon always views surgery as the absolute last resort. They are experts in pain management and non-surgical therapies (like targeted injections and physical therapy) first. If a surgeon pushes immediately for an operation without thoroughly explaining and attempting conservative options, that’s a significant red flag. Dr N.K. Aggarwal Joints and Spine Centre’s philosophy is simple: we want you back on your feet with the least invasive treatment possible.
6. Check Online Reviews for the Real-World Experience
Online reviews are a window into the patient experience, revealing the culture of the center beyond the operating room. Don’t just look at the star rating. Dig into the specific comments. Did patients mention the kindness of the nursing staff? Was the postoperative care clear and consistent? Reviews are where you find out if the surgeon not only has great hands but also runs a great, supportive operation. A consistent track record of patient satisfaction is the final piece of the puzzle.
Ozone Therapy for Knee Pain: A Game-Changer in Non-Surgical Treatment
The Moment You Hear “Knee Replacement”
Let’s be honest: when your doctor brings up knee replacement surgery, a little anxiety monster crawls into your stomach. It’s not just the procedure itself; it’s the risks of complications and failure of surgery, long, gruelling recovery, the weeks of physical therapy, and the temporary loss of independence, apart from a real possibility of repeat surgery due to fracture of bones or wearing out of the artificial joint. You just want to walk without pain, but the cure sounds almost as bad as the problem!
For years, it felt like surgery was the only option for serious, chronic knee pain caused by things like osteoarthritis. But thankfully, modern medicine is offering a truly promising alternative that avoids the knife: Ozone Therapy. It’s rapidly gaining popularity as an effective Ozone Therapy Knee Replacement Alternative.
What on Earth is Ozone Therapy? And How Does It Help?
First things first: this is not about the environmental ozone layer. This is medical-grade ozone, a special mixture of oxygen and ozone gas. When injected into the painful knee joint, it does some remarkable things that feel almost too good to be true, but the science is there.
Think of your knee joint as a crowded, angry room full of inflammation and tired tissues. Ozone comes in like a quiet, yet powerful, cleanup crew:
It Calms the Storm: Ozone is a potent anti-inflammatory agent. It helps reduce the painful swelling and irritation that are causing all that persistent, aching discomfort.
It Refuels the Healers: It significantly improves blood flow and increases the amount of oxygen in the joint capsule. More oxygen means your body’s own natural healing cells can finally get to work repairing and regenerating damaged tissue.
It Boosts Lubrication: A healthier joint environment means the knee can move more freely, often leading to better mobility and less stiffness.
Simply put, instead of cutting out the problem, ozone therapy works with your body to heal it from the inside out. That’s why it’s being hailed as an exceptional Ozone Therapy Knee Replacement Alternative, especially when used with other biological treatments.
Why Consider Skipping the Operating Room?
Choosing a non-surgical path isn’t just about avoiding a scar. It’s about choosing a treatment that respects your life and schedule:
Life on Your Terms: You’re looking at a quick, outpatient procedure, not a hospital stay. You can often get back to your routine the very next day. Compare that to the months of recovery required after major surgery!
Less Risk, More Reward: There are far fewer risks involved compared to major surgery. No general anesthesia. No risk of infection from a prosthetic joint. It’s a lower-stakes way to achieve high-impact pain relief.
Keeping What’s Yours: A knee replacement is exactly that—a replacement. Ozone therapy aims to heal and preserve your natural joint structure. You keep your original equipment, just optimized!
Ready to Explore a New Path?
If you’re sitting there rubbing your aching knee, maybe it’s time to stop worrying about surgery and start asking about modern alternatives.
If you’re serious about exploring Ozone Therapy as a genuine knee replacement alternative, the best first step is a consultation with a specialist who truly understands these cutting-edge techniques.
We highly recommend connecting with a renowned expert like Dr. N K Aggarwal at N K Aggarwal Joints and Spine Centre. Dr. Aggarwal and his dedicated team focus entirely on finding minimally invasive, regenerative solutions to get you back on your feet and back to your life without the trauma of major surgery. They can assess your specific condition and tell you honestly if ozone therapy is the right, positive step forward for you.
Why wait for the pain to get worse? Take control of your knee health today!
Source used to write this article:
Ozone Improves Pain, Function and Quality of Life in Patients with Knee Osteoarthritis (KOA):
Source:Middle East Journal of Rehabilitation and Health Studies
Is Your Back Pain Causing Your Anxiety? The Powerful Link Between Spine Health and Your Mood
We all know that chronic back or neck pain is a physical nightmare. It restricts your movement, steals your sleep, and makes every task feel impossible.
But what if we told you that lingering spine issues might also be the silent fuel for your stress, anxiety, and general emotional drain?
It might sound surprising, but the connection between your structural health (your spine) and your emotional state is profound. At the N K Aggarwal Joints and Spine Centre, led by Dr. N.K. Aggarwal, we treat the whole patient and understanding this spine-mind link is the first step toward true recovery.
Here’s why taking care of your spine is essential for mental peace.
1. The Nervous System Highway
Your spine isn’t just a stack of bones; it’s the protected housing for your central nervous system (CNS), the superhighway that transmits all signals between your body and brain. When a disc is herniated, a vertebra is misaligned, or joints are inflamed, this isn’t just pain—it’s irritation to the nerves.
This constant, low-level irritation doesn’t just register as physical discomfort; it floods your brain with signals of distress, keeping your entire system on high alert. Essentially, your nervous system is continuously signalling “threat,” which manifests in your mind as elevated stress and anxiety.
2. The Cortisol and Stress Loop
Chronic pain is one of the most powerful stressors the human body can endure. When you live with back pain every day, your body responds by pumping out stress hormones, primarily cortisol.
This is meant to be a short-term survival mechanism. However, when cortisol levels are chronically high, they interfere with sleep, disrupt mood regulation, and increase feelings of anxiety and irritability. The loop is vicious: Pain causes stress hormones, which lead to anxiety, which makes you tense up, which worsens the pain. Treating the source of the pain is the only way to break this physiological cycle.
3. How Posture Affects Your Confidence and Mood
Think about the physical appearance of depression or deep fatigue: hunched shoulders, a lowered head, and a slumping posture. This isn’t just a visual symptom; it’s a feedback mechanism. Studies show that people who maintain an upright, “powerful” posture report higher levels of self-esteem and lower levels of social anxiety.
Conversely, when spine issues force you into a guarded, slouched position, it restricts your breathing and limits the production of endorphins, making you feel physically and psychologically closed off. Treating neck and back issues allows you to physically stand tall, which literally changes the chemical signals your brain receives about your current emotional state.
4. The Hidden Toll of Sleep Deprivation
One of the most immediate effects of back or joint pain is the total destruction of quality sleep. You toss, you turn, and you wake up stiff, often leading to only a few hours of light, fragmented rest.
Lack of deep, restorative sleep is a direct trigger for heightened anxiety and depression. When you’re tired, your emotional resilience drops to zero. Everything feels harder, more overwhelming, and more urgent. Until the underlying spinal issue is managed, getting the rest you need to stabilize your mood will remain a challenge.
Treating the Spine, Calming the Mind
If you’ve been struggling with unexplained anxiety, irritability, or persistent stress alongside your physical pain, understand that they are likely connected. Addressing the structural problem in your spine is one of the most impactful ways to reset your entire nervous system and regain emotional balance.Whether through conservative therapies, targeted injections, or specialized surgical intervention, the goal at the N K Aggarwal Joints and Spine Centre is not just to fix the joint—it’s to restore your life and your peace of mind.
PRP vs. Total Knee Replacement: The Definitive Choice Between Repair and Relinquishment
For those suffering from the relentless agony of knee osteoarthritis (OA), the medical path often presents a dramatic fork: the definitive, irreversible act of Total Knee Replacement (TKR), or the intelligent, biological leap toward Platelet-Rich Plasma (PRP) therapy. This is not a choice between two equals; it’s a profound decision between surgical forfeiture and sophisticated self-repair, and a deeper look at the data particularly the hidden surgical risks compels a re-evaluation of the standard treatment hierarchy.
1. The Heavy Truth About Total Knee Replacement
TKR, at its core, is a major, life-altering surgery – a dramatic reconstruction where the damaged joint is literally amputated and substituted with artificial components of metal and plastic. This is an option one can never undo.
Patient Dissatisfaction
Despite technical success, the ultimate metric fails: Apart from about a 5% failure rate, a staggering 20-25% of patients report being unhappy post-TKR. This profound dissatisfaction often stems from persistent stiffness, residual pain, and the chronic, unnerving sensation of an “insensate” or foreign joint—a permanent disconnect between mind and limb.
Drawback of Replacement
Drawback of Replacement The Alarming Statistics & Implications
The Fracture Risk
Even primary surgery holds inherent risks, including the rising incidence of Peri-prosthetic Fractures around the implant, an event that can complicate recovery significantly and occur in up to 5 – 25% of cases (Pellegrino et al 2022, Canton et al 2017).
The Burden of Revision Surgery
While the primary implant may last a decade or more, the chance of needing a Revision TKR is astonishingly high, cited up to 38% in published literature (Benkovich et al 2020). Crucially, these subsequent surgeries are technically grueling, characterized by notably decreased success rates and substantially higher rates of complications.
The Mortality Factor
Perhaps the most chilling statistic is the documented one-year mortality rate following a revision TKR, which ranges alarmingly between 11% and 44.8% (Pezzella et al 2020). This alone should elevate TKR from a simple medical procedure to a last-resort measure carrying non-trivial life risks.
2. PRP: Embracing the Body’s Intelligent Solution
In sharp contrast, Platelet-Rich Plasma (PRP) therapy introduces a powerful, minimally invasive strategy rooted in regeneration. Though it can not correct severe deformities which can sometimes develop in advanced osteoarthritis of the knee, it is a highly effective biological intervention that respects and utilizes your body’s inherent capacity for healing.
How is this achieved? A small quantity of the patient’s own blood is drawn and spun rapidly to isolate a potent concentration of platelets—tiny powerhouses loaded with hundreds of growth factors and specialized signaling proteins. This concentrated solution is then precisely injected into the damaged area of the knee.
Minimally Invasive: PRP is an office-based injection; it demands no general anesthesia, no hospital stay, and zero large incisions. Consequently, the patient is back on their feet and resuming normal life activities within a day or two, not months.
The Healing Mechanism: Unlike a replacement, PRP actively works to reduce the destructive inflammation that fuels OA progression while simultaneously encouraging chondrocytes (cartilage cells) to repair and produce new, native cartilage matrix. The goal is simple: restore, not replace!
Preserving the Natural Joint: The profound advantage of PRP is the preservation of the patient’s original, biomechanically perfect knee. By retaining natural anatomy and function, PRP completely bypasses the risk of the “insensate” knee and the long-term, devastating surgical complications detailed above.
A Strategy for Time: For the majority of patients, especially those in their 40s or 50s who stand a very real chance of outliving a typical TKR implant and thus facing a highly dangerous revision surgery, PRP is the essential delaying maneuver. It provides crucial years of pain relief and function without crossing the surgical Rubicon. It can often help avoid TKR, if treatment is started early and combined with other supplementary treatments and lifestyle modifications.
The Definitive Verdict: When Is Which Appropriate?
The era of simply recommending TKR as a default option must end. The data on patient dissatisfaction and surgical risk demands a more conservative approach.
TKR is an option for the unsalvageable: It should be strictly reserved for patients suffering from absolute, end-stage, “bone-on-bone” arthritis where the joint structure is completely compromised, joint deformed and every other non-surgical avenue has failed. It is the final answer, not the first.PRP is the intelligent, first-line answer: For the vast majority of patients struggling with mild to moderate OA, and also for patients who do not want to go through the risks of surgery, the path forward should unequivocally involve PRP. It offers a powerful, low-risk, biological intervention that harnesses the body’s own power to heal, offering profound pain relief and mobility without incurring the severe risks, guaranteed downtime, and high potential for dissatisfaction associated with total joint replacement.
Sources used for statistics:
Statistic Referenced
Source Link (Journal Article/Review)
Revision Surgery Rate (up to 38%) and Mortality Risk
High Mortality Following Revision Surgery (11-44% range)
Differences in mortality and complication rates following revision knee arthroplasty performed for urgent versus elective indications. Kazi et et al. PubMed. 2021. https://pubmed.ncbi.nlm.nih.gov/34587801/
Risk and Epidemiology of Periprosthetic Knee Fractures After Primary Total Knee Arthroplasty: A Nationwide Cohort Study. PubMed. 2024. https://pubmed.ncbi.nlm.nih.gov/38759816/
The 5-Minute Daily Routine That Will Re-Align Your Spine
Poor posture is a common concern, often leading to issues such as back pain, muscle tension, and even digestive discomfort. Modern lifestyle factors like prolonged desk work and excessive screen time have only intensified the problem. The encouraging news is that improving your posture doesn’t require a drastic lifestyle change. With just a few mindful minutes each day, you can begin to counter years of unhealthy habits. Simple adjustments to your workstation, daily breaks, and even sleep patterns can significantly reduce strain, support joint health, and help maintain a strong, healthy spine potentially minimizing the need for advanced intervention from a spine specialist in Ludhiana.
Here is a quick 5-minute daily routine designed to improve posture and promote spinal wellness.
1: Fix Your Work Setup
Since most of us spend hours sitting, your desk is the first place to start. Getting your setup right prevents strain before it begins.
Monitor Height: Your monitor should be at arm’s length, and the top of the screen should be at or slightly below eye level. This keeps your head from tilting forward or backward.
Chair Depth and Support: Sit all the way back in your chair so your lower back is fully supported. Your feet should be flat on the floor, and your hips should be slightly higher than your knees.
Keyboard and Mouse Placement: Keep your keyboard and mouse close to your body. Your elbows should rest comfortably at your sides, bent to about a 90-degree angle. This keeps your shoulders relaxed and prevents muscle strain.
2: The Essential Stand and Stretch Break (Every 30-60 Minutes)
Sitting is the enemy of good posture. Every 30 to 60 minutes, stand up and perform these quick movements:
Shoulder Rolls: Roll your shoulders up, back, and down 5 times. This loosens the muscles tightened by typing.
Chin Tucks: Gently pull your chin straight back toward your throat (like you’re making a double chin). Hold for 5 seconds and release. This simple exercise directly combats the forward head posture known as “tech neck”.
Simple Chest Opener: Stand in a doorway, place your forearms on the frame, and gently lean forward until you feel a stretch across your chest. This counteracts the hunched position that compresses the chest cavity.
3: Optimize Your Nighttime Posture
Posture problems don’t stop when you lay down. Your mattress and pillow are critical for maintaining spinal alignment while you sleep.
Mattress: Choose a medium-firm mattress that provides good support without being rock hard. It should support the natural curve of your spine.
Pillow: Your pillow should fill the gap between your neck and the mattress.
Side Sleepers: Use a thick pillow to keep your head aligned with your spine.
Stomach Sleepers: Try to avoid this position, as it forces your neck into an unnatural twist.
Back Sleepers: Use a thinner, flatter pillow.
4: Fixing Your Phone Posture
This simple tip addresses the most common modern posture killer:
Bring the Phone to Your Eyes, Not Your Eyes to the Phone. Hold your device up closer to eye level. This minor adjustment instantly keeps your head from dropping forward and prevents the uneven pressure that causes stiffness in muscles and pulls the spine out of alignment.
Don’t Wait for Pain to Act
Fixing your posture is the key to preventing long-term problems, including the lasting damage to the spine that increases the risk of conditions like slipped discs. Consistency is everything. Commit to these small, 5-minute changes, and your body will thank you.
(Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.)
It’s easy to dismiss a little slouch as just a bad habit. Maybe you are hunched over your laptop or curled up on the couch scrolling through your phone. But here is the thing: ignoring poor posture isn’t just about looking awkward; it’s a direct ticket to serious, long-term health issues that affect your entire body.
Over time, that hidden strain on your joints and muscles can impact everything from your breathing to your digestion. Long-term effects can even include serious spinal damage. Let’s dive into the health problems caused by poor posture and why you shouldn’t wait to fix it.
The Domino Effect: How Poor Posture Impacts Your Health
1. Chronic Back and Neck Pain:
This is the most common issue. When you slouch or let your head drift forward (“tech neck”), your spine carries an uneven, heavier load. This pulls your spine out of its natural alignment and leads directly to stiffness and chronic pain.
2. Tension Headaches:
Tightness in the neck and shoulder muscles restricts blood flow and strains the nerves around your head. This tension often causes dull, persistent headaches, especially after long screen time sessions.
3. Breathing Difficulties and Fatigue:
A hunched-over position literally compresses your chest cavity, making it harder for your lungs to fully expand. This shallow breathing reduces the oxygen getting to your body, leading to fatigue and lower concentration.
4. Digestive Issues:
Slouching squeezes your stomach and intestines, slowing down the natural digestive process after meals. This can cause uncomfortable issues like bloating, heartburn, and constipation.
5. Joint Strain and Pain:
Poor alignment stresses joints like the shoulders, hips, and knees, leading to wear and tear. If you’re dealing with persistent knee pain treatment Ludhiana, poor posture might be a contributing factor.
6. Poor Circulation:
Sitting incorrectly, especially with crossed legs or a slouched position, restricts blood flow. This can cause numbness, tingling, and even raise the risk of varicose veins or DVT over the long term.
7. Increased Risk of Spinal Damage:
This is the scariest part. Over years, uneven pressure on the spine dramatically increases the risk of serious conditions like slipped discs, spinal arthritis, and nerve compression. Once these problems develop, they are difficult to reverse and often require medical treatment.
Take the Next Step for a Pain-Free Life
If you’re ready to stop ignoring the signs and address the root cause of your chronic pain, don’t wait until it’s too late.
(Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.)
Why Your Posture Is Getting Worse: The 5 Habits That Are Hurting Your Spine
If you have noticed yourself slouching more often, you are in good company. In the age of screens, most of us are fighting a losing battle against gravity and poor habits. But your posture is not just about looking tall; it’s the foundation of your long-term health. When you ignore it, you invite chronic pain and unnecessary stress on your body.Poor posture forces your body’s support system, your spine, muscles, and ligaments to constantly strain. Over time, this struggle leads to nagging neck aches, persistent back pain, and even headaches. If you want to fix your posture, you first need to identify the enemy.
The Big 5: Core Reasons Your Alignment is Slipping
1. The “Tech Neck” Epidemic
This is the modern posture killer. Every time you tilt your head forward to look at a phone or tablet, you effectively multiply the weight your neck has to support. This sustained forward position creates painful tension, tightens the muscles in the front of your chest, and weakens the vital stabilizing muscles in your upper back.
2. Lack of Core and Glute Strength
Good posture is a full-body effort. If your core muscles (abs and lower back) and glutes are weak from prolonged sitting, your spinal column lacks its natural internal support. When these muscles fail, your smaller neck and back muscles have to compensate, leading quickly to fatigue, slumping, and an unhealthy lower-back curve.
3. Your Non-Ergonomic Workstation
The furniture and devices you use daily are either your friends or your foes. If your computer monitor isn’t at eye level, your chair lacks lumbar support, or your feet can’t rest flat on the floor, your body is trained to hold an unhealthy position for the majority of your day. The environment shapes posture.
4. Carrying Imbalanced Loads
Whether it’s a heavy purse constantly slung over one shoulder or a backpack worn on a single strap, habitually carrying uneven weight throws your spinal alignment off-center. Your body is forced to continuously compensate by hiking one shoulder or twisting your torso, creating chronic tension and muscular imbalance.
5. Simple Muscle Fatigue and Forgetfulness
Sometimes, the reason is the most straightforward: you’re tired, and you give up. When your muscles are fatigued, they can’t sustain the effort required for proper posture. These small, repeated acts of “letting go” and defaulting to a slouchy, comfortable position solidify poor alignment into your everyday muscle memory.
Taking the Next Step
If these reasons sound familiar, it’s time to seek expert guidance. Posture problems should never be ignored, as they often worsen over time.
For professional assessment and comprehensive care, consider reaching out to Dr. N. K. Aggarwal, a highly experienced Spine Specialist in Ludhiana and leading Orthopedic surgeon in Ludhiana. He and his team at the N K Aggarwal Joints and Spine Centre specialize in diagnosing the root cause of spinal and postural issues and developing tailored treatment plans to help you stand taller, move better, and live pain-free.
News Insights: 5th International MAAFIM Conference Malaysia
On September 18, 2025, the 5th International MAAFIM Conference convened in Malaysia, drawing a distinguished audience of industry leaders and subject-matter experts. Dr. N.K. Aggarwal delivered a keynote address that provided a comprehensive overview of “Let Us Save Our Knees – Managing OA Knee without Knee Replacement”. We are pleased to present the full text of this address, a valuable resource for professionals seeking to understand the critical trends and strategic imperatives shaping our industry.
Keynote Speech Transcript
Good evening, everyone, respected chairpersons and friends. I am going to talk about osteoarthritis of the knee. Now how are we managing our osteoarthritis of the knee today? Before knee replacement for quite a few years, our prescription remains the same. In different stages of osteoarthritis and the prescription is pain relief supplements and maybe some physio. For quite a few years we do this before it turns into a tricompartmental arthritis and we advise total knee replacement and after total knee replacement the patient is happy and the doctor is happier. But my question to myself and to my colleagues is, is this victory or defeat? I believe this is a defeat of orthopedics and there are many others who believe that it is a defeat of orthopedics, medicine and science. We rather take pride in changing our tools from power tools to patient-specific instrumentation to computer navigation to robots and now humanoid robots with AR, VR and AI. Now what I am thinking is, is our focus more on machines and less on biology? Should we not be working on stopping the progression of disease? And that is what I am going to talk about.
The focus in my talk and my call is to save our knees. Let us save our knees. My talk will be mostly science with a flavor of common sense. And the purpose is to stimulate a thought process in my fraternity. We all know osteoarthritis is a painful and disabling disease. It is predicted to be the most common musculoskeletal condition around the world in the next 10 to 15 years. Still, we don’t have any tool to predict onset or risk of osteoarthritis and we have no medications approved as disease modifying agents for osteoarthritis. I have divided this talk into a few parts.
Let’s review the present treatment again and as I said it is just analgesic, physio, brace and maybe intra-articular injection and we keep on waiting for TKR and this journey can be 5 to 15 years. To make this journey short, we are advising TKR sooner and sooner. Is that the right approach? Having done knee replacement for close to 34 years I have realized there are some downsides of total knee replacement. Number one it becomes an insensate knee. Though we claim that there is 95% survival of the implant but up to 25 patients are unhappy with this and more importantly the periprosthetic fractures are becoming a common sight. Such fractures are becoming a common sight with increasing frequency. What is more concerning is that one year mortality after a periprosthetic fracture can be up to 45%, so it is a serious condition. Also, revision surgeries have been increasing at the rate of 600% over 15-20 years in the West, and we are not lagging behind. These surgeries are increasing in incidence with decreasing success rates and very high complication rates.
So we need to look at alternatives to knee osteoarthritis. Now to look at alternatives, we need to deep dive into the disease process. What is etiology? Is it just the aging or is it a multifactorial etiology? All aging knees are not the same. The etiology of Knee OA is an interplay of multiple risk factors which predisposes a person to osteoarthritis. These factors can be local or can be general. They can be mechanical or they can be biological. Some of these factors are modifiable and others are not modifiable. All this is well documented in literature. Once we know the factors, what is then the pathogenesis of the Knee osteoarthritis? A landmark article published from Stanford School of Medicine about 15 years back changed the total paradigm about pathogenesis of osteoarthritis. It brought out three main findings, three main observations. The first, they said just like rheumatoid arthritis, osteoarthritis is also driven by a very, verylow grade inflammatory process. The second observation was that the inflammatory enzymes and proteins are secreted in less quantity as compared to rheumatoid arthritis. So the tests remain negative. And one very important prediction they made was that if we could target this inflammatory process early on, someday we will be able to prevent osteoarthritis. These findings have been confirmed by studies after studies in the last 15 years. Many studies have confirmed and added to the same pathway. Just last year in JBJS, a review article and system meta-analysis was published. They again confirmed this, that in osteoarthritis, like in rheumatoid arthritis, the NLR and PLR ratio is increased. So they have a similar pathological process. So in brief, the pathology of osteoarthritis is a chronic, low-grade, inflammatory, slowly progressive immune-mediated process. Osteoarthritis knee is a local manifestation of this chronic systemic inflammatory disease. In other words osteoarthritis and rheumatoid arthritis are two ends of the same spectrum of disease process. Since the markers are not raised in osteoarthritis the tests remain negative. What are the structures involved? If you think it is just wear and tear of cartilage, no it’s not just that. All the structures in and around the joint have been shown to be involved with this inflammatory process. What is then the cause of pain? Because cartilage has no nerve endings. The cause and source of pain we need to know so that we can target that for our treatment. The cause of pain is inflammation, ischemia, AVN, micro-fractures and bone marrow lesions. And the source of pain is again all the tissues in and around the joint. We need to target them as a part of our treatment as an alternative to knee replacement.
So what can be the proposed treatment? Well the best would be prevention but as yet no prevention is available and documented. So the goals of treatment in our osteoarthritis needs are pain relief, deformity correction, improved mobility and delayed progression of osteoarthritis. How do we achieve this? Since it is a local manifestation of a systemic inflammatory process, our treatment has to be both local and systemic. In the last 15 years, a lot of work has been done on local treatment. A variety of agents have been used to control the local inflammation, to help restore the cartilage and to improve the function. Regenerative medicine and Orthobiologics are established newer branches of medicine and orthopedics. The systemic treatment, however, has not evolved that much as yet, but a lot of work is going on and very soon we will have a well-defined systemic treatment as well.
So what is the local treatment? It has two components: biological to control the inflammation to help restoration of the cartilage and mechanical to restore the malalignment or correct the deformity. There are a variety of drugs which are being used around the world in different phases of clinical trials to control local inflammation, to target the cartilage breakdown, to help promote cartilage regeneration. Many of them have shown very good results, but some of them are in routine clinical practice around the world. What are these? At the moment, platelet-rich plasma or the growth factor concentrates and mesenchymal cells from autologous bone marrow and fats. They are being routinely used around the world with good results and they are approved drugs. Ozone is another molecule which is being increasingly used intra-articular for its anti-inflammatory and regenerative properties. As far as the mechanical part of the treatment, the conservative option remains shoe wedges and the offloader brace. The surgical options are proximal fibular osteotomy, closed wedge osteotomy and open wedge high tibial osteotomy. We all are doing this. Very recently, a couple of years back, a new implant has been approved by the FDA. It is an implantable shock absorber which is implanted on the medial side like an internal brace and it helps avoid rubbing of the joint surfaces on the medial side so helps promote regeneration and restoration of cartilage. So now we offer intra-articular treatment like mentioned. We also do thorough knee wash because that reduces the inflammatory load. We also do synovectomy if there is synovial hypertrophy and realignment. We do all the procedures that I mentioned and the recent introduction to our realignment philosophy is needleplasty which has been popularized by Dr. Jignesh Patel from Surat. Under local anesthesia we do pie crusting of the tibial attachment of medial collateral ligament in the anterior one-third under local anesthesia, give a valgus thrust and see how beautifully it restores the medial joint space and then we maintain it with physiotherapy and braces.
Systemic treatment, what has to be the systemic treatment? We target systemic inflammation and we control other comorbidities, metabolic imbalance and osteoporosis along with lifestyle changes. This was an article published last year in JBJS where in one group of hypertensive patients who were given non-selective beta blockers, there was 54% reduction in total knee arthroplasty risks. Very important observation and this really set me thinking. This also pointed out that there could be new treatments to delay progression of osteoarthritis, some medications. And when looked into the literature, there are a variety of drugs being used in different stages of clinical trials and in clinical practice in different centers to target systemic inflammation, to target subchondral bone remodeling, to target angiogenesis. And nerve growth receptors have also been used. All this is on the premise that osteoarthritis and rheumatoid arthritis have similar underlying disease process. They are both inflammatory diseases. There is a huge lot of evidence to support this statement. Just a few months back, in JBJS this year, a literature review of all the clinical trials has been published which have targeted systemic inflammation as treatment for osteoarthritis. And they have come out that DMARDs are likely to achieve desirable outcomes. A variety of DMARDs and biologics have been shown to be beneficial in osteoarthritis including low dose prednisone. There is something called the steroid paradox. The low dose long term use is safe and effective in osteoarthritis. The lack of positive diagnostic tests as I said have usually deprived the patients of appropriate treatment. We now know from the literature that DMARDS can be helpful. What is not known is that the dose, frequency, combination of various drugs, duration of treatment, exact drug regime and its safety has not yet been worked out and not yet published in literature. A friend of mine, Dr. Aroop Mukherjee, some of you might know him, has successfully used and perfected a drug regime for systemic treatment of osteoarthritis over the last three decades. I have used it for the last couple of years with very promising results. It has been adopted by hundreds of colleagues around the country. This is basically low dose, low frequency DMARDs with different incubation periods with their neutralizing medications next day so that there are no side effects. Then there are supportive medications and co-morbidity treatment. For example, methotrexate is given 2.5 mg on alternate days followed by folic acid so that there are no side effects and there are other drugs mentioned here along with supportive treatment and supplements which are necessary and it is personalized and customized for each patient. Systemic treatment, our philosophy now is to target systemic inflammation with this Mukherjee regime.
Our experience is very good and we have to counsel the patient that like other chronic conditions such as hypertension, diabetes, rheumatoid, hypothyroid, the treatment of osteoarthritis, the systemic treatment has to continue lifelong. The doses can vary depending on the response in each patient. We have to remember that we can’t prevent aging, but we can definitely improve quality of life. We have treated about 50 patients over the last 20 months. Some minor side effects, if occur, can be easily managed. There is some issue about compliance and patient dropout because there are multiple drugs about seven eight drugs every day. We are working our way around this and we should be able to convince the patients about this.
So now if the patient comes to us in different stages of osteoarthritis, our basket of treatment options, both local and systemic, biological and mechanical, are huge. And we customize this to fit into the requirement of each patient and we offer this to each patient as is necessary and patients are very happy and grateful. And of course, if a patient comes at this stage, very late, with fixed deformities, bone loss, we know TKR is the only thing they need. And of course, systemic treatment we can add and excellent results can be achieved with TKR provided it is done judiciously.
Friends, in future and very soon there will be personalized targeted therapy for different Knee phenotypes. Intra-articular gene therapy has shown very promising results in clinical practice. With the use of certain newer lab tests, machine learning and artificial intelligence, we will be able to predict osteoarthritis in individuals and so we should be able to prevent it. So my prediction is that in the next 5 to 10 years, both local and systemic treatment for osteoarthritis knee will be more evolved with the objective to help restoration of cartilage and slow the progress of disease and put it into remission. In the next 10 to 15 years, the number of knee replacement surgeries will significantly go down just like what happened to rheumatoid arthritis. In rheumatoid arthritis today, only 2.4% patients need knee replacement whereas in osteoarthritis, more than 50% still need knee replacement.
In summary, osteoarthritis is not only due to aging. It is not just wear and tear of cartilage. It is a local manifestation of a systemic, slowly progressive immune-mediated inflammatory process. Treatment has to be local and systemic. Local treatment has to be biological and mechanical. And systemic treatment has to be low dose, low frequency DMARs with mitigation of the side effects and other lifestyle changes and treatment of metabolic imbalance, osteoporosis and co-morbidities. Targeted therapy based on knee phenotype, gene therapy and even prevention should be possible in the not too distant future. This can help us save our sensate knees.
So friends, my message for you today is Can we prevent OA? Not yet, but maybe in the future. Can we slow progression of osteoarthritis? Yes. Can we help cartilage restoration? Yes. Can we put the disease into remission? Yes. Can we postpone knee replacement? Definitely yes. We are doing it in our practice. Can we avoid knee replacement? Should be possible in most cases if they come to us early. Thank you very much for your patient hearing.
Closing Statement:
Dr. N.K Aggarwal’s speech was a highlight of the 5th International MAAFIM Conference. It set a high standard for the discussions that followed, and we will be featuring more content in the coming weeks. Be sure to check back for additional transcripts, summaries.
Are you having a hard time with knee pain that affects your quality of life? The pain can be almost debilitating. If you are searching for non-surgical knee pain treatment in Ludhiana Punjab, you are not the only one. There are many patients that want something less aggressive than a knee replacement.
This is where PRP derived growth factor therapy along with necessary medications comes into play. This therapy is one of the most advanced non-surgical approaches for osteoarthritis of the knee, knee ligament tears, and other knee degenerative disorders. If you are looking for alternatives of replacement, PRP derived growth factors combined pharmacotherapy is a good option.
So, what is this PRP treatment for knee pain?
It is one of the most advanced techniques that works with the body. It puts a small sample of your blood in a centrifuge in order to separate the blood and concentrate the platelets and growth factors. These are then placed into the painful knee. These growth factors will help with inflammation and repair damaged tissues, and promote the repair of worn-out cartilage. Along with this the medications help slow down progression of disease.
This form of non-surgical therapy is very safe and less aggressive; therefore, the benefits are many. All the serious risks, complications and side effects of surgery can be avoided.
The benefits go well beyond simply not needing an operation room:
Nonsurgical: PRP derived growth factor therapy is far less invasive than having a joint replacement. There are no sizable cuts, no anesthesia, no stays at the hospital, and no worrying about leaving with a gaping hole. It happens in an outpatient setting, meaning you arrive and leave enhanced – far less scary than the alternatives.
Little Recovery Time: Unlike the months of rehabilitation expected after a joint replacement, PRP therapy needs the patient to rest for only a day or two and is then free to resume their daily lives. Many patients are surprised with the speed they are able to return to their desk jobs.
Naturally Safe: Because PRP derived growth factors is a form of autologous blood therapy, a patient is virtually guaranteed to not have to worry about allergic reactions, or infectious disease transmission. Uniquely, therapy is biological and works with the body to aid in the restoration of damaged tissues in the knee.
Efficient Pain Relief and Mobility: Patients with knee pain get relieved of pain with this therapy and this improves the patient’s quality of life.
Proven Efficacy for Pain Relief and Mobility: PRP derived growth factors’ injections lead to improvement in the overall function of the joints and range of motions due to reduction of pains and stiffness. During the treatment regime of the knee pain treatment using PRP derived growth factor, the patient is able to walk, climb stairs and perform daily activities quite comfortably.
Aims to Heal, Not Just Replace: This approach is the cornerstone of knee pain treatment without knee replacement. The technique aims to restore the degenerated joint. Replacing the damaged joint does not offer a long term solution and does not affect the activity of the disease process. It is possible to put off surgery for many years, or even avoid having the surgery, if we start treatment early, by encouraging your body to produce healthier tissues to surround the natural joint.
For any patient who wants to know the best orthopedic hospital in Ludhiana for specialist and sophisticated treatment, there are some important points he should first know. A patient is assured of having been attended to in the finest of the specialist Orthopedic hospital in Ludhiana if he receives a treatment in a Centre dedicated to this kind of practice, the patient receives the best and state of the art treatment customized and personalized for his unique condition.
N.K. Aggarwal Joints and Spine Centre is known for biological treatments in Ludhiana Punjab. Designed to help patients who don’t want to live with pain and want to restore mobility without major surgery and associated risks, our dedicated support team will develop a custom treatment.
When you need an orthopedic surgeon, you’re not just looking for a doctor; you’re looking for someone who can help you regain your life. In Ludhiana, many patients turn to the N. K. Aggarwal Joints and Spine Centre, which has earned a reputation for its high success rates. But what’s the secret behind this remarkable performance? It’s a combination of expertise, technology, and a deep commitment to patient care. Here are five key points that set them apart.
1. Decades of Specialized Expertise
Dr. N. K. Aggarwal’s qualifications and decades of experience are a major factor in the centre’s success. With advanced training from prestigious institutions in the UK and USA, including the University of Liverpool, he brings a global standard of care to India. His specializations in hip replacement surgery, knee replacement, and spine surgery mean he has a profound understanding of these complex areas.
2. Comprehensive Approach to Joint and Spine Issues
Instead of a one-size-fits-all approach, the centre focuses on treating a wide range of conditions, from common back pain to complex spinal deformities. The team at N K Aggarwal Joints and Spine Centre is known for exploring all options, including non-surgical treatments and physical therapy, before recommending surgery. This patient-first philosophy ensures that the chosen treatment is the most appropriate and effective for the individual.
3. State-of-the-Art Technology and Facilities
The hospital is equipped with cutting-edge technology to ensure precise diagnoses and successful outcomes. From advanced diagnostic tools to a fully-equipped operation theater, they have everything needed to perform complex procedures like spine fixation and joint replacements with high accuracy. This modern infrastructure supports the surgeon’s skills and enhances the overall safety and effectiveness of the treatment.
4. Patient-Centric Care from Start to Finish
Success isn’t just about a successful operation; it’s about the entire patient journey. The staff at N K Aggarwal Joints and Spine Centre are widely praised for their cooperative and caring attitude. Patients feel comfortable and well-cared for, from the initial consultation through to post-operative recovery and rehabilitation. This compassionate environment plays a vital role in a patient’s healing process.
5. Renowned as a Top Orthopedic Hospital in Ludhiana
The centre has received numerous accolades, including awards for “Excellence in Joint Replacement and Spine Surgery” and “Outstanding Clinical Care in Orthopedics.” These awards, combined with a 91% patient recommendation rate, highlight its standing as a leader in orthopedic care in Punjab and beyond. These external validations confirm the high standards and consistent positive outcomes at the center.
Conclusion: Your Partner in Joint and Spine Health
When your well-being is on the line, choosing a trusted orthopedic surgeon in Ludhiana, Punjab, is a critical decision. The N. K. Aggarwal Joints and Spine Centre stands out not only for its impressive success rates but also for its commitment to patient care. Dr. Aggarwal and his team combine extensive experience with advanced technology and a compassionate approach, making them a leading choice for anyone dealing with joint or spinal issues. If you are seeking an orthopedic doctor in Punjab or a specialist for a complex procedure, consider them for a world-class experience right here in Ludhiana.
