OUR MISSION:  “TO STOP ARTHRITIS BEFORE IT STOPS YOU”

‘WE DO WHAT OTHERS DO AND WE ALSO DO WHAT OTHERS DON’T DO”

TOTAL KNEE RESTORATION OR TOTAL KNEE REHABILITATION (TKR) IN OSTEOARTHRITIS OF THE KNEES

BY

DR JOHN EBNEZAR

THIS IS AN INTEGRATED TREATMENT PROGRAM INVOLVING THE BEST OF MODERN MEDICINE (ALLOPATHY) AND THE BEST OF TRADITIONAL MEDICINE (YOGA,AYUERVEDA AND OTHERS).THIS IS A MODERN THINKING REHABILITATION THERAPY FOR OSTEOARTHRITIS OF THE KNEE JOINTS.


EVERYONE MAKES A TALL CLAIM THAT THEIR TREATMENT METHOD IS THE BEST. BUT THE FACT IS NONE OF THE TREATMENT METHODS WHETHER IT IS MODERN MEDICINE OR TRADITIONAL MEDICINE ARE COMPLETE BY ITSELF AS THE OA KNEES IS TOO COMPLEX TO BE CONQUERED BY ANY ONE TREATMENT METHODS. THE TREATMENT WORKS BEST WHEN THEY ARE COMBINED TOGETHER.

TKR IS AN EVIDENCE BASED SCIENTIFIC TREATMENT PROGRAM UNLIKE VARIOUS HIGH SOUNDING TREATMENT PROGRAMS LIKE PULSED MAGNETIC THERAPY AND OTHERS WHICH MAKE TALL CLAIMS WITHOUT ANY SCIENTIFIC BASIS.

 

INTRODUCTION

 

Osteoarthritis is the commonest type of arthritis and is seen in 10% of the World Population.  In India too it is a leading public health problem on par with diabetes, AIDS etc.  It is a wear and tear disease of the joint liners called the articular cartilage and is mainly a degenerative disease though of late it is increasingly being seen as a life style disease too.  It is also called as the Old Age arthritis.

This is how your knee joint looks inside (God created joint looks so beautiful inside)

CAUSES

 

It is a multifactorial disease and though it is a old age arthritis,it is influenced by various risk factors:

 

Non Modifiable Risk Factors: (Cannot be changed with treatment)

·         Age:  Seen in old age

·         Sex:  It is a disease of the females (3:1)

·         Race:  Common in Asian population

Modifiable risk factors:  (This can be changed with treatment)

·         Obesity

·         Sedentary life styles

·         Smoking

·         Alcohol

·         Injuries

·         Lack of exercises

Obesity and female sex are the Non modifiable risk factors In OA Knees

 

HOW DOES THE DISEASE DEVELOP AND PROGRESS

The disease first starts in the articular cartilage as a small crack,slowly it starts destroying the cartilage further.  Then slowly other internal structures of the knees like the bone ends,synovium,capsules,joint fluids started getting affected.  With the continuing insults to the knee joint due to misuse,obesity etc the disease spreads further and affects the muscles,ligaments and tendons around the knee joint. Due to restricted mobility now the muslces of the entire lower limb, later the muscles of the entire body becomes weak. Advacing age further adds to the insult.  Hence the entire knee gets affected (Global Knee Disease)and then this involves the entire body (Global affection).  Not the reduced mobiolity createsphysical problems like increasing weight,loss of aerobic capacity,mental problems like depression and social problems due to inability to move around freely.  Thus what started as a  disease of the articular cartilage slowly engulfs the whole body.

 

In OA Knees, the inside articular cartilage is damaged like this,

 

This is how your damaged knee looked inside when seen through an arthroscope

This is the live picture of your damaged articular cartilage during surgery

PRESENTATION

 

Predominantly a disease of the females (Male: Female Ratio is 3:1) it cases pain, reduces mobility, early morning stiffness, limp, crepitus, mild swelling and in the late stages deformities called the bow leg deformities.  It has been well said that Mobility is life and Life is Mobility.  OA knees affects this very mobility of a person leading to weakness of the muscles, reduced aerobic capacity, increasing body weight and depleting calcium reserves from the bones. 

This chart shows the presentation of OA knee patient

 

ASSOCIATED MEDICAL PROBLEMS

 

And moreover osteoarthritis being a disease of the elderly adds to the list of already existing medical co-morbidities like diabetes, hypertension, ischemic heart disease, osteoprosisi, asthma, depression, anxiety etc.  Lack of mobility due to OA worsens these pre-existing diseases. 

 

ASSOCIATED MUSCULOSKELETAL PROBLEMS

 

As if this is not enough, a knee is also associated with other co-Musculoskeletal old age conditions like low backache, cervical spondylosis, shoulder pain, heel pain etc.  Thus the consequences of OA Knees are far more than mere pain in the knees.

 

ASSOCIATED MENTAL,EMOTIONAL,SOCIAL AND FINANCIAL PROBLEMS

 

Moreover a geriatric patient in addition to the load of the above physical diseases has mental and emotional problems too to tackle.  Financial resources have dipped to a precarious low state and there is lack of support from the children.  Even social they seem to be ostracized due to lack of mobility.  Hence their cups of woes are full.  In an age when they need to be mobile, they are forced into immobility due to OA Knees.

 

This shows the whole spectrum of OA Knees

ROLE OR MODERN DAY STRESS IN OA KNEES

 

Modern day stress affects all structures in the body and also the knees.  Increased stress hormones afect the metabolism and brings about premature ageing.  And a depressed person loses

interest in life, stops socilaising and reduces his activities to a very great extent thereby causing wasting and weakening of the body muscles.  A sick mind will lead to a sick body and later

to a sick knee joint. 

 

 

Modern day stress is known to cause or worsen the Osteoarthritis Knee

 

 

 INVESTIGATIONS

 

Laboratory tests are usually normally.  X-rays will show reduction in joint space, formation of new bones called osteophytes, scleoris, deformities, and rarely swelling.  MRI and CT scan are rarely required to diagnose rot rat this condition.

This is the X-ray picture of the damaged internal structures in OA Knees

 

TREATMENT OPTIONS:

·         Drugs are usually pain killers and do not have a long term role.  On the contrary it may lead to side effects and complications like gastrtitis, renal and liver toxicity.

·         Physiotherapy alone may not be of much use

·         Therapeutic exercises of the knees though useful cannot address all the problems of OA knees

·         Steroid injections into the joint are not very helpful.

·         Surgery like Total Knee Replacement surgeries are reserved only for end stage arthritis which is seen only in 5% of the population.  That too they are expensive and cannot be done if there are medical and anesthetic risk factors.

·         Alternative medicines like acupuncture,acupressure,naturopathy at best are only symptomatic and lack of scientific evidence

Arthroscopic procedures in OA Knee are not commonly done

Total Knee Replacement Surgery is only for End Stage Arthritis seen in only 5% of the cases

 

WHY ARE TODAY’S TREATMENT METHODS FAILING?

 

·         Osteoarthritis of the knee is a global joint disease though it first begins in the articular cartilage.  The knee muscles, the capsules, the ligaments, the synovial, and the entire joint are affected.  Due to this there is reduced mobility and this weakens the lower limb muscles, the abdominal and back muscles and the muscles of the entire body.  This affects the entire body.

 

·         Moreover osteoarthritis is a degenerative joint disease and only the knee joints have not aged but all the 65 joints in the body are aged and so is the spine, lower back, and  neck. 

 

·         As said earlier OA is associated with geriatric medical problems like diabetes, hypertension, obesity etc which has cause and effect relationship. 

 

·         Then we also need to take into consideration the mental, emotional, social, and financial woes of a patient associated with OA knees. 

 

·         Modifiable risk factors needs to be addressed and corrected.

 

None of the treatment methods described above, addresses all these problems associated with OA knees and hence end up as a big failure in cornering this problem.

This is a toxicity profile which shows a high complication rate for drugs and surgery and a very little complication rate in exercises and health education

 

SO WHAT IS THE EFFECTIVE SOLUTION?

 

Thus the treatment to be effective should address the global knee joint problem and also help tackle all the secondary effects over the body due to OA knees.  It has to also take care of the modifiable risk factors associated with OA Knees. This is what Dr John’s Innovative concept of Total Knee Rehabilitation does and is emerging as the most effective tool to combat this gigantic problem.

 

NOW LOOK AT THESE SITUATIONS

 

If your answer to any of these following questions is a yes, then you are a person who needs Dr John’s Total Knee Restoration or Rehabilitation Technique:

·         Arthritis is a crippling disease and Affects quality of life.

·         Are you a victim of arthritis?

·         Have you tried various treatment methods and failed?

·         Are you averse to take drugs or suffered side effects?

·         Have you been suggested Total Knee Replacement Surgery and you cannot afford it or you do not want or are not fit for the surgery?

·         Have you been told there is no effective alternative for patients who cannot undergo Total Knee replacement?

·         Have you been told that there is nothing that can done for your arthritis due to its severity, co-morbidities etc?

·         Do you feel dejected, desperate, and lost hope?

 

EMERGENCE OF DR JOHN’S TOTAL KNEE RESTORATION TECHNIQUE

 

There is hope for you.  Dr John Ebnezar an Internationally renowned Orthopedic Surgeon with a PhD in Arthritis after extensive clinical research about the various treatment options for osteoarthritis has come out with a path breaking innovative treatment method called TOTAL KNEE RESTORATION (TKR).

 

Acting upon the recommendations of the American College of Rheumatology which is an internationally acclaimed arthritis body which states that treatment for arthritis has to be individualized with various treatment options available depending upon the co-morbidities., Dr John Ebenezer for the first time in the world has come out with TKR which complies with the ACR Recommendations.

 

After an extensive research involving the largest randomized controlled train in the world on 250 patients wherein  Dr John  subjected a control group of patients with a regular conventional treatment method and a study group comprising of Integrative Non Pharmacological and other therapies has shown that people who took this method of treatment showed vast improvements in all the clinical, radiological and other generic parameters like pain, early morning stiffness,movements,walking time, knee disability scores etc.  Even he also demonstrated with his experiment that this method of treatment has made huge difference in the quality of life of arthritis patients.  He also demonstrated that the Stress Indices has also shown considerable improvement with this method.

 

His study included 26 parameters which are the largest series in the world thus exploring physical, mental, social, economical, spiritual aspect of arthritis.  Seldom has been a study done in the world covering so many parameters in arthritis.  So with this research background a new treatment method called the TKR is born.  And this is proving to be a great discovery which could revolutionize the way arthritis is being treated all over the world.

 

Patients with co morbid conditions like hypertension, diabetes,obesity,osteoporosis,asthma,showed improvement in these above conditions with a vast reduction in the number of medicines taken for the treatment of these conditions.

 

WHAT IS TKR?

 

Simply speaking TKR means a patient specific treatment for arthritis.  This is not a blanket therapy but an individualistic therapy which takes into account each patient individualistic characteristic.

 

That means this approach is tailor made for each patient.  It is like buying a cloth and stitching it to a person’s bodily measurement rather than buying designer readymade clothes.

 

Hitherto the biggest cause for failure of the treatment method for arthritis was trying to treat all patients with a similar approach without taking into consideration the degree of arthritis involvement, other associated co-morbid and co-musculoskeletal conditions and ignoring age, sex, and racial backgrounds of each patient.

 

Co-morbidities were either ignored or were not given due consideration.  Bowing to the western influence an effort is being made to surgically treat the patients when it is clearly mentioned that surgery should be the last option and is indicated in miniscule of 3-5% of the arthritis patients.

 

This approach has caused more harm than good for patients with arthritis.  Worse still there is no effort at prevention of arthritis.  Why, when it has always been said that “Prevention is better than cure.”  All these lacunae’s are overcome by the Dr John’s TKR therapy.

 

HIGHLIGHTS ABOUT TOTAL KNEE RESTORATION TECHNIQUE (TKR)

·         This is an Evidence Based Scientific Procedure

·         This is a Non-Invasive, Non-Drug and Non-Surgical Method

·         Outpatient procedure, no need to take off from work

·         For all Stage arthritis from mild to severe

·         Cheap, Simple, Effective with no contraindications

·         No side effects, complications, adverse effects

·         Boon for patients who cannot afford, who do not want or who are not fit for knee replacement surgeries

·         It is a highly specialized individualized multimodal therapy

·         Has both preventive and curative effects

·         Helps control associated co-morbid conditions like diabetes, hypertension etc

·         Helps control associated co-musculoskeletal conditions like low backache, neck pain, hip pain, shoulder pain etc

·         Suitable to all varieties of patients and all stage arthritis

·         It aims at Total Knee Rehabilitation and not just pain relief

·         Improves Mobility, reduces pain, improves overall quality of life

 

APPROACH OF TKR

 

·         Each patient is put into a thorough clinical evaluation

·         A detailed history is to be documented.

·         Demographic data is compiled.

·         First degree and second degree clinical parameters are assessed scientifically.

·         Tentative Diagnosis is arrived at

·         Co-morbidity and other associated co-musculoskeletal problems are thoroughly evaluated.

·         Important generic scores like SF-36 for Quality of life and STAI I and II for Stress and Depression are analyzed.

·         Appropriate Investigations like laboratory tests, Plain X-rays and Occasionally MRI are done.

·         Thorough Radiological evaluation done and the disease is staged and graded.

·         Final clinical diagnosis is arrived taking into consideration the knee and associated Co-musculoskeletal and Co-morbidities.

·         Best treatment options are then planned by choosing from a pool of Non-Pharmacological therapies, therapeutic exercises, pharmacological options, and alternative therapies.

·         Patient is explained about the diagnosis and best treatment combinations.

·         Here a unique patients choice is introduced wherein in we seek the opinion and expectations of the patients unlike enforcing our treatment options on them.

·         After ascertaining and satisfying all the above said criteria a final treatment plan is drafted.

·         Combination and duration of the treatment is then decided upon.

·         Patient is subjected to treatment under strict observation and guidance at the center.

·         At the end of the treatment and in between the treatment all the parameters are again assessed to know the efficacy of the approach.

·         Follow ups ranging from 3, 6,912.18 and 24 months are done.

·         Patient is kept in touch through telephonic contacts to oversee the regularity of the treatment at their homes.

·         Patient is invited to be a member of the ARTHRITIS FORUM and share their experiences with other people with arthritis.

·         Involvement of family members in treatment is compulsory.

·         Lots of emphasis is given on health education.

·         Our research has shows a nearly 100% success rate with the TKR therapy in all forms and varieties of arthritis with various permutations and combinations of associated Co- morbid and Co-MS Conditions.

·         In the rare event of the patient failure with the TKR therapy we advise patients other treatment options like the conventional pharmacological and surgical options.

·         TKR reduces the dependence on pharmacological therapies

 

TOTAL KNEE REHABILITATION MODALITIES

 

Each patient is different and so is the arthritis.  All patients cannot be treated the same due to different stages of the diseases,different co-morbid conditions,life style etc.  Hence the treatment

for each patient has to be customised to his or her needs.  This is the recommendations of the International Body in Arthritis,the American College of Rheumatology.

 

DR JOHN'S TKR FOLLOWS THIS INTERNATIONAL RECOMMENDATION.

It is an individualised Multimodal therapy and the selection of the treatment modalities is done based on the stage of osteoarthritis of the knees and the existing co-morbidities in each patient

With such powerful treatment choices all varities of OA Knees can be successfully tackled and the disease can be completely cornered.

 

RESULTS OF TOTAL KNEE REHABILITATION

·         Reduces Pain

·         Reduces Swelling

·         Improves Movements

·         Reduces Stiffness

·         R Educes Deformity (As Seen In The Reduction Of The Intercondylar Distance)

·         Reduces Limp

·         Improves The knee Disability Score

·         Improves The Quality Of Life

SOME OF THE CASE STUDIES IN VERY DIFFICULT AND ADVANCED OA KNEES

PLEASE NOTE:   WE ARE NOT AGAINST TOTAL KNEE REPLACEMENT SURGERIS AND IN FACT WE RECOMMEND AND DO IT IN OUR CENTERS FOR STAGE IV ARTHRITIS.  IF THE PATIENT DOES NOT WANT SURGERY, THEN NO NEED TO DESPAIR, WE OFFER HOPE WITH OUR TKR WHICH IS QUITE EFFECTIVE IN ALL STAGE ARTHRITIS.  All these cases are Stage 4 OA knees who required Total Knee Replacement and were not willing to undergo the same for various reasons.

 

Case No1: 

 

This patient had severe pain and disability due to OA Knee.  Had tried all treatment methods and failed.  She later underwent Dr John’s TKR and this is the result.

Movements of the knee joint

Before Treatment                                                                    After treatment

Squatting activity

Before Treatment                                                                    After treatment

 

Changes in the X-rays –

 

 

Increases  the joint space, corrects the deformity, reduces the sizes of the osteophytes, improves the joint alignment.

Before Treatment                                           After treatment

Before Treatment                                        After treatment

 

Case2:  

This was a 77 years old patient with severe OA Knees.  Though his children wanted him to undergo Knee replacement and he could well  afford it, he was strictly against surgery and underwent a 3 weeks course in my center.  This is the result.

Improves knee flexion

 

Before Treatment                                                                    After treatment

 Improves squatting

Before Treatment                                                                               After treatment

Case 3: 

This patient was morbidly obese,diabetic,hypertensive,IHD and severe bilateral OA Knees with low back and neck pain.  Not willing for Surgery.  This is the result of our treatment.

 Improves pain,swelling,flexion and squatting

 

 

Before Treatment                                                                    After treatment

 

2.  Reduces the joint deformity (Fall in the Inter-condylar distance)

Before Treatment                                                                    After treatment

Case 4: 

Again a 70 year lady with severe OA Knees, unwilling for surgery.

Corrects the joint deformity

 

Before Treatment                                                                    After treatment

Case 5:

Another severe OA Knee case who could not afford knee replacement surgeries and had tried and failed with other treatment methods. 

 Improves joint movements and reduces the joint swelling

Before Treatment                                                                    After treatment

 

Improves movements and allows the patient to squat

Before Treatment                                                                    After treatment

 

 

Case 6:  Another Stage 4 OA Knees who could not afford knee replacement surgery

Reduces the joint swelling,improve the joint mobility and allows the patient to squat

Before Treatment                                                                    After treatment

 

MORE THAN 5 YEAR FOLLOW UP AFTER THE TREATMENT

All These Patients Are Still Doing Well And Have Progressed To Lead A Reasonable Good Life Without Surgery.  Prior To Our Therapy They Had No Hope And Were Condemned To Lead A Desperate Life.  Nobody Was Willing To Offer Them Any Treatment And Any Hope Saying That The Disease Is Too Advanced And All The Conservative Methods Have Failed. 

 

OUR LONGEST FOLLOW UP CASE

CASE No7: 

Seen first in 2005, this 77 years old patient had severe bilateral OA Knees and required Knee replacement surgery.  Despite several counseling she was totally against surgery as she had seen the replacement surgery in her sister in law go wrong and did not want to undergo the same fate. She underwent Dr John’s TKR and is still going strong.

PRESENTATION IN 2005

 

 

 

 

 

PRESENTATION IN 2011 AFTER 6 YEARS:  Even now the patient does not want to undergo knee replacement surgery.

 

61 year old Male with Severe Bilateral Tricompartmental OA Knees
Seen first in 2015, this 61 years old patient had severe bilateral OA Knees and required Knee replacement surgery. Suggested by one of the reputed orthopedic surgeons in Bangalore  Despite several counseling he was against TKR. Had taken several rounds of physiotherapy,alternative medicines, homeopathy etc. All the treatments had failed and patient visited me through a reputed homeopath for a last suggestion and non-operative treatment. He was put on 3 weeks of Wholilstic Knee Treatment and the patient was very happy with the outcome. Reduction in 50% of pain, fall in disability index from 78% to 57%, was able to squat and the knee movements also improved considerably. Patient was very happy with the result.

GOOD NEWS FOR ARTHRITIS VICTIMS

 

WHEN THE RESULTS WITH DR JOHN’S TKR ARE SO GOOD FOR SUCH SEVERE ARTHRITIS THEN IT IS LOGICAL THAT THE RESULTS ARE EXCELLENT IN MILD TO MODERATE OSTEOARTHRITIS.  THE RESULTS ARE ALSO EXCLLENT IN OA KNEES WITH MULTIPLE CO-MORBID CONDITIONS AND OBESITY WHEREIN THE TRADITIONAL TREATMENT METHODS ARE A FAILURE.

 

ADVERTISEMENT IN THE TIMES OF INDIA DATED 12TH OCTOBER 2012 ABOUT TKR


EXCLUSIVE INTERVIEW OF DR JOHN EBNEZAR BY ROOPA OF THE MOST POPULAR KANNADA NEWS PAPER "PRAJAVAANI" ON OSTEOARTHRITIS


SWAASTHYA HEALTH FOUNDATION FREE CAMP ON ARTHRITIS PUBLISHED ON 14/10/12 IN THE MOST POPULAR KANNADA NEWS PAPER "PRAJAVAANI"


SWAASTHYA HEALTH FOUNDATION FREE CAMP ON DIABETES AND ARTHRITIS PUBLISHED ON 14/11/12 IN THE MOST POPULAR ENGLILSH NEWS PAPER "THE TIMES OF INDIA"

FOR APPOINTMENTS WITH DR JOHN EBNEZAR,PLEASE CALL:
Telephone: 080-26583117
Telefax: 080-26581231
Mobile: 09986015128
email: pshospital@drjohnebnezar.com
johnebnezar@gmail.com

FOR INDIVIDUAL PATIENT RESPONSES AFTER UNDERGOING DR JOHN'S KNEE REHAB PROGRAM,PLEASE CLICK HERE

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