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Public knee01 ppt

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Managing Knee Pain

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Public knee01 ppt

  1. 1. Nikhil Pradhan www.nikhilpradhan.co.uk MANAGING KNEE PAIN Mr Nikhil Pradhan Consultant Orthopaedic Surgeon Special interest in hip & knee surgery Spire Cheshire Hospital
  2. 2. www.nikhilpradhan.co.uk KNEE ANATOMY • Largest joint in the body • Femur-Tibia-Fibula-Patella • Modified hinge • Flexion and Rotation
  3. 3. www.nikhilpradhan.co.uk KNEE ANATOMY Meniscus – tears, degeneration cartilage Bone
  4. 4. www.nikhilpradhan.co.uk
  5. 5. Nikhil Pradhan www.NikhilPradhan.co.uk Knee pain • Young patient- Sports Injury • Middle age -Twisting injury – meniscal cartilage tear • Arthritis
  6. 6. Nikhil Pradhan www.nikhilpradhan.co.uk Meniscal injury •Twisting injury – pain •Gradual effusion over a day •Locking and clicking •Difficulty getting up from sitting position •Difficulty climbing down stairs
  7. 7. Nikhil Pradhan www.nikhilpradhan.co.uk Meniscal injury •Knee Arthroscopy - daycase surgery •Walking home the same day •Very small 0.5cm scars •No crutches •Early return to activity and work– 2 to 4weeks •Minor surgical procedure - keyhole surgery
  8. 8. Single Chondral Defect •Micro Fracture - <3cm •MACI – cartilage repair / regeneration •Hemicap or Biopoly •Customised implants Nikhil Pradhan www.nikhilpradhan.co.uk
  9. 9. MACI – cartilage repair •Matrix induced Autologous Chondrocyte Implantation •PRP – Platelet Rich Plasma or Bone marrow
  10. 10. Nikhil Pradhan www.nikhilpradhan.co.uk Hemicap Replacement
  11. 11. High Tibial Osteotomy (HTO) • varus knee – bow leg • Medial compartment OA • Correct alignment of the bent leg and fix with plate and screws
  12. 12. www.nikhilpradhan.co.uk KNEE ARTHRITIS •Osteoarthritis- Most Common • Progressive • Degenerative • Cartilage Damage • 30-40 years old • 70 years old
  13. 13. www.nikhilpradhan.co.uk KNEE ARTHRITIS •Symptoms • -Pain • -Swelling • -Grinding • -Stiffening
  14. 14. www.nikhilpradhan.co.uk KNEE ARTHRITIS • Cartilage wears away • Bones of the joint rub together • Pain may become severe and constant • may interfere with normal activities and/or sleep
  15. 15. www.nikhilpradhan.co.uk KNEE ARTHRITIS
  16. 16. www.nikhilpradhan.co.uk KNEE ARTHRITIS
  17. 17. www.nikhilpradhan.co.uk KNEE ARTHRITIS
  18. 18. www.nikhilpradhan.co.uk BILATERAL KNEE ARTHRITIS
  19. 19. www.nikhilpradhan.co.uk KNEE ARTHRITIS - TREATMENT •What Treatments are available? •Non-Operative Treatment • Modifying activities • Lose weight • NSAID • “Pain Medications” • Glucosamine/ Chondroitin Sulphate • Physical Therapy • Hyaluronic Acid • Synvisc, Hyalgen
  20. 20. www.nikhilpradhan.co.uk KNEE REPLACEMENT Partial Knee Replacement Total Knee Replacement
  21. 21. www.nikhilpradhan.co.uk KNEE REPLACEMENT
  22. 22. www.nikhilpradhan.co.uk KNEE REPLACEMENT
  23. 23. www.nikhilpradhan.co.uk KNEE REPLACEMENT
  24. 24. PSI – Patient Specific Knee replacement
  25. 25. Mechanical Axis Mal-aligned tyre – medial wear
  26. 26. Minimally invasive I-assist TKR with enhanced recovery •USES PODS •BLUETOOTH TECHNOLOGY •ACCELEROMETERS/GYROSC OPE SENSORS •IPAD TYPE DEVICE www.nikhilpradhan.co.uk TO GET HIP-KNEE-ANKLE IN NEUTRAL ALIGNMENT
  27. 27. Minimally invasive I-assist TKR with enhanced recovery •Minimally invasive •Latest Computerised technology •Surgeon can validate and recut as required until the correct alignment is achieved. www.nikhilpradhan.co.uk
  28. 28. Minimally invasive I-assist TKR with enhanced recovery •Performed the First I-assist TKR in UK •I have one of the largest series of I-assist knee replacement in the UK over 5years •Excellent patient feedback and reviews www.nikhilpradhan.co.uk
  29. 29. Warrington Guardian
  30. 30. Daily mail
  31. 31. Freehand technique – tibia First EMEA case Dr. Pradhan CMTC Warrington Tips: • Put angle wing in saw slot while pre- positioning the guide (Pradhan-technique)
  32. 32. TRADITIONAL TKR •Drill into femoral canal •Place a rod in femoral canal •Align jigs to the rod •Decide size, rotation of your knee based on rod and surrounding bones.... •Usually an average provided by literature www.nikhilpradhan.co.uk
  33. 33. I-assist TKR •No opening of femoral medullary canal •Computer technology to align the knee •Can validate and re-correct during surgery and hence potentially reduces blood loss and minimally invasive
  34. 34. DAY ONE AFTER SURGERY LIMITED TOURNIQUET CARE OF SOFT TISSUE SPINAL ANAESTHESIA I-ASSIST TKR ENHANCED RECOVERY/REHABILIT ATION www.nikhilpradhan.co.uk
  35. 35. www.nikhilpradhan.co.uk RECOVERY TIME • Hospital 2-3 days • Intensive Physical Therapy 3-6 weeks • Drive a car at 2-4 weeks post op • Return to work 4-12 weeks
  36. 36. Thank you

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