Dr Pankaj Walecha, Orthopedic and Joint Replacement Surgeon

02/12/2025

LEVEL 1 : EASY

01/12/2025

A high tibial osteotomy is a procedure designed for people who have arthritis on one side of the knee, usually the inner side. Instead of replacing the joint, the surgeon changes the alignment of the bone to shift the body weight away from the damaged area. What this really does is give the worn out part of the knee a break so the healthier side can take more load.

This surgery is often recommended for younger or active patients who want to keep their natural knee for as long as possible. When done at the right stage, a high tibial osteotomy can delay the need for a total knee replacement by ten to fifteen years. It does not cure arthritis, but it can reduce pain, improve walking, and slow down the progression of joint damage.

The key is choosing the right patient at the right time. If the arthritis is limited and the knee still has good movement, this procedure can be a strong alternative before thinking about a full replacement.

30/11/2025

29/11/2025

Avascular necrosis happens when the blood supply to the ball of the hip joint drops, and the bone slowly starts to weaken. The tricky part is that the earliest stages often look silent on the outside. Pain is mild, mobility feels normal, and most people assume it is just a muscle issue. This is why stage 1 and stage 2 are such important phases. The bone is still structurally intact, so medicines, lifestyle changes, and targeted therapies can slow the disease and sometimes delay the need for surgery for years.

Once the bone begins to lose its shape, things shift. In stage 3, cracks start forming inside the bone. Daily activities become painful, and the hip may not tolerate weight the way it used to. At this point, preserving the original joint becomes difficult. When the condition reaches stage 4, the ball of the joint has collapsed enough to damage the cartilage. That is when a total hip replacement becomes the most reliable solution, because it restores movement, removes pain, and gives patients their independence back.

The goal is not just to treat the hip but to treat it at the right time. If symptoms are new, do not ignore them. If the disease is advanced, know that surgery can give excellent long term outcomes. Awareness and timing decide everything.

28/11/2025

Why This Collared Stem is a Game-Changer in Hip Replacement 🦴✨

This isn’t your average implant.

This collared stem comes with two distinct features that make early weight-bearing safer and more efficient:

🔹 1. Proximal Special Coating
This rough surface on the upper part helps the bone grip the implant better. Think of it like Velcro for bone.
It encourages quick bone integration for long-term stability.

🔹 2. Curved Design with Secure Fit
Its curvature allows the stem to align naturally with the femur, ensuring optimal positioning. Plus, the shape promotes excellent press-fit and rotational stability!
which means patients can begin walking sooner.

🧠 Bonus: The collar helps distribute stress more evenly at the neck of the femur, protecting against implant subsidence.

27/11/2025

MRI or Arthroscopy: What’s Better for ACL Diagnosis? 🦵🔍
If you suspect an ACL tear, the two main ways to confirm it are MRI and knee arthroscopy but they’re used differently.
🧠 MRI: The First StepMRI is the preferred diagnostic tool.It’s non-invasive, pain-free, and offers detailed images of soft tissues like the ACL, meniscus, and cartilage.But remember: MRI is not done just to diagnose. It’s ordered when a clinical exam points to a ligament injury.
🔧 Arthroscopy: Diagnosis + TreatmentArthroscopy is a keyhole surgical procedure is used when there’s already a confirmed or highly suspected tear that needs treatment.While it can confirm diagnosis visually, its main purpose is to fix the issue, not just look inside.
💡 So what’s best?👉 MRI first - to diagnose👉 Arthroscopy next - to treat
Both play a role, but MRI avoids surgery unless it’s really needed.

Arthroscopy orthopediccare sportsinjuryrecovery

26/11/2025

When we place a dual mobility cup in a hip replacement, we always test it before moving on. That means taking the implant through a full range - left, right, up, down and watching for even the slightest shift between the cup and the bone.
If the cup isn’t perfectly seated, you feel a tiny rock or pivot. Surgeons call that a toggle.
So when we say there’s no toggle in the superior anterior plane, it means the cup stays absolutely solid when stressed in every direction. No rocking when pushed superiorly. No subtle drift when nudged anteriorly. No tilt when moved left or right. No pivoting when we load it up or down.
In other words, the press-fit is tight, the fixation is sound, and the implant is sitting exactly the way it should. That stability matters even more in dual mobility hips because long-term success depends on zero micromotion and clean, stable bone implant contact.
A hip that doesn’t toggle is a hip ready to last.

24/11/2025

Precautions After DAA Hip Surgery

DAA (Direct Anterior Approach) hip replacement has the big advantage of zero muscle cuts , but that doesn’t mean you skip caution.

🛑 Here’s what you should avoid post-surgery:
1. Fast walking : speed stresses recovering tissues
2. Stretching your hip too far : especially sideways
3. Leg extension exercises : delay these till cleared by your physio
4. Ignoring stiffness : use cold packs to ease it early on

💡 Even though recovery is faster with DAA, your muscles still need time to adjust and strengthen. Respect your limits, follow your rehab plan, and avoid overconfidence in the first few weeks.

23/11/2025

A mobile bearing partial knee replacement has two key components :- one for the femur (thigh bone) and one for the tibia (leg bone):
🔹 Tibial Component (Bottom Part):
* Smooth on top to let the bearing glide
* Has cement pockets and a central fin for strong fixation
* Designed to hold a mobile plastic meniscal bearing that moves with the knee
🔹 Femoral Component (Top Part):
* Double-pegged design, fits into the medial (inner) side of the femur
* Shiny, smooth surface where the bearing glides
* Cemented for stability
* Precisely contoured for natural movement
🛠️ The mobile bearing between the two acts like a cushion, reducing wear and improving flexibility.
🎯 This design is ideal for early-stage arthritis that only affects one side of the knee and helps preserve natural joint movement.



22/11/2025

How is AVN Diagnosed Early?

If you’re feeling unexplained groin pain or your hip movements are becoming painful, don’t ignore it! the issue might not be muscular.

🎯 The best test to detect AVN early is an MRI (Magnetic Resonance Imaging)
It can catch AVN at Stage 1 or 2, before the bone collapses or surgery becomes necessary.

🚨 What often goes wrong:
Many patients treat it as sciatica or nerve pain for months. By the time they reach an ortho, the AVN has already reached Stage 3 or 4 when joint damage is usually permanent.

💡 Red Flags:

🚩 Groin pain without injury

🚩 Hip stiffness

🚩Difficulty getting up from sitting

🚩History of steroid use or alcohol

🚩 No relief with back treatments

An MRI at the right time could mean saving your natural hip and avoiding surgery altogether.

20/11/2025

Suspected ACL tear? Here are the red flags to watch for: a pop at the moment of injury rapid swelling knee instability pain with pivoting and limited motion. These signs mean it’s time for a proper exam and MRI to confirm what’s going on. Early assessment helps protect your long term knee health.