Orthogeriatrics (Orthopaedic care of senior citizens)

Kauvery Hospital is one among the few hospitals that offers Geriatric care in Chennai. The Orthogeriatric program offered by The Kauvery Institute of Orthopaedic and Neurosciences, collaborates with the other departments such as emergency medicine and geriatrics, to provide orthopaedic and neurosciences care to the frail and aging. The Orthogeriatric and Neurosciences’ specialized services, were developed to focus on the aging population and their risk of fractures, coupled with other complexities.

The most common and most debilitating injury among the elderly are hip fractures and most patients 65 and above, generally have other medical problems, which complicates the treatment process. At our Institute of Orthopaedic and Neurosciences, our comprehensive team of Orthopaedic surgeons, Neurosurgeons, Neurologists, Physicians, Physiotherapists, Specialists and Sub-specialties like our X-ray and CT scan services all collaborate to provide the best diagnosis and treatments, from the time the patient comes through to our emergency department. We address and manage the surgical care, physical therapy, pain management and recovery aspects of care.

Geriatric patients with fractures constitute uncommon challenges because of their accompanying medical conditions, such as heart or lung diseases, diabetes, cognitive problems, malnutrition, strength and balance issues, all of which requires a comprehensive and efficient system to help these patients to recover.

The Baby Boomer generation is progressively aging though with greater life expectancy. However the risk factors from osteoporosis that lie before them are factors, like prior fractures, being extremely thin, having low bone density, having undergone steroid treatments and having additional medical problems.

  • Osteoporosis Clinic

    Bones like all the other living organs and tissues, are also living tissue that go through the same rejuvenation cycle as the cells in our body. Bone is composed of the mineral or hydroxyapatite, organic or collagen type 1, water, non-collagenous proteins and other components.

    During the bone rejuvenation process, when the production of new bone material is not in synchronization with the removal of the old bone, this causes the bone to weaken. This then causes the bones to become very brittle, so that coughing, falls, or even slight stress, such as bending over can cause a fracture. A patient with such fragile bones is diagnosed to have Osteoporosis. Fractures related to osteoporosis, ordinarily occurs either in the wrist, the hip or along the spine. It affects both men and women alike, but is predominantly seen to occur in especially older Asian and Caucasian women. Women past their menopause are in the high risk category to be affected by Osteoporosis.

    In the early stages of Osteoporosis, no symptoms reveal themselves until the bones have been weakened and you will then see signs such as:

    • A bone fracturing just like that without much force being applied
    • Occurrence of back pain due to a collapsed vertebrae or caused by a fracture
    • Stooping posture
    • Loss in height over a period of time

    The aging generation does unavoidably face certain risks that are not within their control; risks such as:

    • Human race: People of white and Asian decent are at a greater risk than people from other countries
    • The baby boomer generation is set to have a greater life expectancy than the previous generation. Consequently, the older they get, the risk of osteoporosis is greater
    • Women are much more susceptible to osteoporosis, post menopause
    • Genetically having a parent or sibling with a history of osteoporosis, subjects the aging person to be at risk, especially more so if one of their parents had had a hip fracture
    • People with a smaller build or frame size are determined, to be at a higher risk on the premise that they may have a lesser bone mass to draw from as they age
    • The cause of osteoporosis is also attributed to the balance in hormones in the body. Too little or too much puts the person at risk for osteoporosis. When the estrogen, progesterone and testosterone levels in the body are reduced, either due to menopause or due to cancer treatments, then this puts such patients at a risk. Hyperthyroidism can cause loss of bone mass. This can happen either due to an overactive thyroid or because of hypothyroidism medications, thus putting the patient at risk for osteoporosis. Osteoporosis has also been identified in patients with overactive adrenal and parathyroid glandular activity

    The causes stated above are but a few, as there are other factors such as dietary factors, consumption of alcohol, gastrointestinal surgery, low calcium, use of tobacco, lifestyle choices, gastric reflux and much more that can cause osteoporosis.

    Our multidisciplinary team at The Kauvery Institute of Orthopaedic and Neurosciences, are all skilled in diagnosing and treating patients with osteoporosis, as our team comprises of a panel of doctors best suited and equipped to treat osteoporosis. Our team:

    • Geriatricians
    • Internists
    • Orthopaedics
    • Physicians
    • Physiotherapists
    • Physicians
    • Physiatrists
    • Endocrinologists
    • Rheumatologists
  • Osteoarthritis Management

    Arthritis is of two types: Rheumatoid arthritis which is caused by inflammation and osteoarthritis, which is caused by the wear and tear at the joints such as knees, hands, spine and hips. Osteoarthritis is the most prevalent type of arthritis and is also called as degenerative arthritis or degenerative joint disease.

    Why does arthritis affect mostly our knee joints?

    Osteoarthritis develops when the protective cartilages wrapping the ends of the bones that meet at the joints, in the musculoskeletal system, wear away with age. Apart from the aging phenomenon, osteoarthritis can also occur because of demanding sporting activities, due to obesity or when suffering from injuries that occurred during the younger days. Osteoporosis in the hands is mostly genetic and through inheritance and occurs in women who are middle-aged.

    Osteoarthritis develops over a period of time and as on date no cures exist, but at The Institute of Kauvery Orthopaedic and Neurosciences, we do provide treatments that can slow down the progress of the disease and help with pain management and help improve joint function.

    Symptoms of Osteoarthritis are:

    • Curtailment of movement – you may not be able to move your limb to its fullest extent
    • When you apply slight pressure to a joint, it will feel tender to the touch (painful)
    • When you wake up in the morning or after a long period of inactivity, you will feel the stiffness in the affected joint
    • Extra bits of bones or bone spurs may form as hard lumps around the afflicted joint
    • A grating sensation may occur when you use the arthritic joint
    • There definitely will be pain before or after you use the joint causing you problems

    Factors that help cause Osteoarthritis:

    • Obesity is one of the leading causes for osteoarthritis, as the extra load bearing on knee joints and hips affects these joints. Moreover the fat tissue produces proteins that could cause harmful inflammation in and around the joints
    • Age is another factor that cause osteoarthritis and also it is frequently seen to occur more in women
    • Injuries to the joint that could have occurred through sports activities or through an accident
    • Certain occupations where a joint is frequently used and is under stress, then it is possible to develop osteoarthritis
    • Deformities or defects at birth, such as malformed joints or defective cartilage increases the risk of osteoarthritis
    • Rheumatic diseases, diabetes, rheumatoid arthritis or gout are all factors that increases the risk of osteoarthritis
    • Hereditary can also be a factor in some people who develop osteoarthritis

    The treatment options offered by our team of multi-specialists at our Kauvery Institute of Orthopaedic and Neurosciences include diagnosis, physical examinations and imaging tests such as X-rays, magnetic resonance imaging (MRI), Joint fluid analysis and blood tests. Our range of therapies include Physical and Occupational therapy, prescribed braces or shoe inserts.

    If the conservative approach has not helped relieve pain then our skilled Orthopaedic surgeons will use the following techniques to remove all traces of pain.

    • Injecting cortisone injections into the afflicted joint or joints
    • Injecting Hyaluronic acid, which is a lubricating injection and is a fluid that is similar to the one found in the joints
    • Our skilled and experienced Orthopaedic surgeons, through a procedure called Osteotomy, will surgically realign the bones
    • Arthroplasty or joint replacement surgery. In this procedure our Orthopaedic surgeons will replace the damaged joint surface with metal or plastic implants
  • Fall Prevention Clinic

    Growing old and staying physically fit may be a challenge, as you may face physical and health challenges and sometimes medications used to overcome those challenges could be the pitfall. Falls are a leading cause of injury in the generation that is aging.

    With the Baby Boomer generation all set to live long lives, the population of aging people have medically set forth in motion services that were hitherto not given any importance. Moreover, this same community of elders are also very independent and want to live in their own homes. To help this group of aging population, The Kauvery Institute of Orthopaedic and Neurosciences have launched a Fall Prevention Clinic with the aim to provide and equip older adults to physically and mentally live healthy, productive and longer lives.

    Our new initiatives and innovative care for the aging uses a neoteric approach to enhance the quality of life for the diverse older adults and their family members.

    Falling or the fear of falling often deters an older adult from performing their daily activities. Falls can lead to disastrous results in many elderly people, especially those with medical complications. Generally when older adults do fall it results either in a hip fracture or head injuries. In many cases, when an older adult does meet with a fall and has a fracture, most of them have a very hard time recovering and their health conditions progressively deteriorates, with negative consequences. Statistics show that at least 40% of the aging adult who has had a fall, cannot function independently again.

    To prevent such disastrous consequences, The Fall Prevention Clinic at The Kauvery Institute of Orthopaedic and Neurosciences has launched a program where with adequate knowledge, falls can be prevented. Our Falls Prevention Clinic is a comprehensive program that consists of a multidisciplinary team of doctors from Physical Medicine and Rehabilitation, Neurology, Geriatrics, Ophthalmology, Orthopaedic and ENT, all of who specialize in falls prevention. We provide a comprehensive diagnosis and design custom-tailored treatment plans for patients with a history of falling for unknown reasons.

    Our specialists are qualified in Fall Prevention techniques and will help you to improve the daily activities in your life, together with improving the quality of life, in general. Our multifaceted Falls Prevention program uses interventions to diminish the risk of falling tempered with physical activity. Our successful exercise programs are designed to combine adequate intensity to strengthen muscles and improve flexibility, as well as to impart dynamic balance training. Prior to beginning the treatment program we will first evaluate the patient, then direct our focus on the multiple factors that could lead to an increased fall risk. The goals of treatment will include:

    • Managing, decreasing and eliminating all factors pertaining to fall risks
    • Identifying and implementing lifestyle changes that zero in on risk factors like medication, regular vision and hearing, physical activities
    • Help build endurance and strength using a customized exercise routine
    • Provide information with reference to creating a safe environment

    Preventing falls and assuaging the fear of falling is more cost-effective and it promotes the safety and well-being of a beloved older member of your family.

  • Hip Fracture Management

    Hip fractures are a common occurrence in the old and infirm. As per statistics, one out of every ten hip fractures occur in people over 60, and in women more than in men. Hip fractures are a critical malady in the elderly and could expose the elderly person to life-endangering complications. Once broken the healing time can take anywhere from a year onwards and the health of the senior can spiral downwards, as the fracture can probably be the forerunner to other issues that could affect their immune system.

    Elderly people are prone to falling as in most cases they lose the coordination of their limbs, they have difficulty with their vision, and due to osteoporosis and weak bones. The factors that put the elderly at risk to hip fractures are:

    • Throw rugs, electrical wires lying on the floor, are tripping hazards while staircases with no handrails, unstable furniture, and poor lighting are some of the reasons for falls and hip fractures in the elderly
    • Fragile and small boned people, women of Asian and Caucasian decent are prone to osteoporosis, one of the main reasons for hip fractures
    • Eating disorders such as bulimia, anorexia and nervosa damage the bones, and poor nutrition during childhood stacks up the risks for a hip fracture
    • Certain medical conditions such as, gastrointestinal disorders, endocrine disorders (diabetes), immobility or protracted bed rest, rheumatoid disorders, depression, dementia, nervous system disorders (Parkinson’s or multiple sclerosis)

    Within 24 hours of a fall and fracture of the hip, the senior should be brought in, into the hospital, or else it could endanger the patient’s life. At our Institute of Orthopaedic and Neurosciences our multidisciplinary team specializes in performing surgeries to mend broken hip bones effectively. There are two types of hip fractures predominantly seen in the elderly – Femoral neck fracture and Intertrochanteric region fracture.

    Fracture of the Femoral Neck: The rounded head of the femur or thigh bone fits into the ball and socket joint in the pelvis (hip joint). In the event of a femoral neck fracture, the flow of blood to the broken part of the bone either stops or diminishes. Surgery is always performed to fix the break. Hemiarthroplasty or partial hip replacement surgery involves the substitution of the ball and femoral neck with prosthesis made from either chrome cobalt alloy or stainless steel. General or spinal anesthesia will be administrated prior to surgery. After making an incision our skilled Orthogeriatic Surgeon will remove the damaged bone and replace it with a new metallic prosthesis, which includes a ball and a stem. The prosthesis is cemented in and the tendons and muscles are arranged around the prosthesis, the incision is then closed. In case the patient, under the knife, is arthritic or has had a prior injury that was damaged in the recent fall, and provided that they are physiologically of sound health, then the Orthopaedic / Ortho-geriatrician may consider a total hip replacement.

    In an intertrochanteric region fracture the fracture occurs in the trochanters and the Orthogeriatric surgeon will manipulate to align the bone and then affix a large screw or a hip nail along the break, and which goes right up into the femoral head. The screw is held to a metal plate that is fixed on the outside of the thigh bone along with smaller screws. A third type of fracture called the asubtrochanteric fracture can occur though rare and is fixed in the same manner with a plate and screw as in intertrochanteric fractures. In very rare cases, where the patient has medical complications, traction and other processes are used.

  • Orthogeriatric Physiotherapy and Rehabilitation

    At The Kauvery Institute of Orthopaedic and Neurosciences, we understand the special and individual needs of elderly patients and our Ortho-geriatric Physiotherapy and Rehabilitation care is tailored to meet those unique needs. Our individualized rehabilitation plans address the functional, physical and cognitive needs of the patient while keeping in mind the possibility of their multiple medical problems, thereby we empower our elderly patients to live as independently as possible.

    Our Physiotherapy and Rehabilitation comprehensive array of services are designed to serve patients with the following medical conditions:

    • Depression, Dementia and cognitive impairment
    • Balance and coordination
    • Arthritis
    • Cardiac disorders
    • Osteoporosis
    • Joint replacements
    • Frequent falls
    • Frailty
    • Parkinson’s Disease
    • Walking difficulties
    • Pain
    • Strengthening of weak limbs, frame, etc

    The services we provide include, Inpatient and outpatient Physiotherapy, post-surgical orthopaedic rehabilitation, Physiatry (physicians specialized in physical medicine and rehabilitation), Occupational Therapy, Balance and Vestibular Therapy, Rehabilitation Psychology and Speech language Pathology, and long term wellness plans.

    Our Physiotherapists are specially trained to work with our physicians and multidisciplinary team to help in the rehabilitation and recovery of the senior. Our elderly patients will find our physiotherapists friendly, caring, knowledgeable and moreover they can expect absolute privacy during their sessions together with a one-on-one care.

    Our specially trained, dedicated and certified team of Physiotherapists, Physiatrists and other specialists, have extensive experience in treating post-surgical orthopaedic and spine patients, ensuring optimum results. In addition to the other services, our team of physiotherapists, occupational therapists and rehabilitation specialists also provide, Hip, back and Spine injury rehabilitation, and Bone and joint rehabilitation.

    Our Neurological Services include:

    • Brain injury
    • Stroke rehabilitation
    • Multiple sclerosis
    • Vestibular rehabilitation
    • Movement disorders and Parkinson’s disease
    • Balance and Fall prevention

    We provide individualized and customized program treatment plans, designed for each patient’s specific needs. Our physiotherapists are skilled in treating back pain caused by Scoliosis, acute injures (muscle pulls, accidents, and trauma), and bad body mechanics or poor ergonomics, and chronic causes such as inefficient movement patterns, and repetitive strain or overuse.

    The physical and occupational therapies offered by us are:

    • Neck and back pain
    • Postural abnormalities
    • Fear of falls
    • Gait problems
    • Deconditioning
    • Unable to go out because of pain issues
    • Difficulty with daily routine / activities
    • Limited movement

    We work with both pre and post-op joint surgery patients to help decrease the pain, increase the range of motion and to return the patient to their normal daily activities.

    Our spacious physiotherapy and rehabilitation gym housed on the second floor of our hospital, houses the most advanced equipment that include:

    • Avant-garde Cybex resistance and cardiovascular devices
    • Traction systems for cervical and lumbar spine conditions
    • Pilate reformers that help the core muscles to strengthen while exercising the limbs
    • Injury treatment systems to effectively reduce swelling, which combines the use of cryotherapy and compression
    • Cold laser to treat joint sprains, muscle strains, overuse tissue injuries and tendinitis
    • Real-time ultrasound imaging, a biofeedback equipment for neuromuscular re-education
Back to Top