indian population is prone for osteoarthritis of knee. also in indian children due to rickets genu varum is common. high tibial osteotomy is a procedure to correct the deformity & resolve unicompartmental arthritis
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
The Principe of high tibial osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia.The
total knee arthroplasty on this tibia with a “malunion” presents technical difficulties related to the initial approach, the presence of osteosynthesis material, the presence of malunion and the change of bone density. The objectives of this study are to determine the clinical and radiographic results of patients undergoing Total Knee Arthroplasty (TKA) after High Tibial Osteotomy (HTO). This is a retrospective descriptive study including patients undergoing Total Knee Arthroplasty (TKA) after an High Tibial Osteotomy (HTO) at the Hospital of Mont de Marsan (France) from 2008 to 2017 with a minimum follow-up of 12 months. Thirty knees (27 patients) were recruited. The sex ratio was 1.72. The average age was 70.33 years (54years-88years). The average time between High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) was 10.83 years (1 year-26 years). The medial opening was 63.33% and lateral closure for the rest. Clinical improvement was observed, with an average gain of 24.97 points for pain, 1 point for stability, 1 point for knee mobility and 5 points for walking distance. The clinical result was perfect in 13.33%, excellent in 42% and medium in 36.67% of cases. The alignment was obtained in 76.67% of cases (p = 0.0039). The posterior tibial slope, epiphyseal varus, patellar height were corrected in 80% of cases respectivly (p = 0.000011, p = 0.44, p = 0.15). Residual pain was observed in 26.66%, joint stiff ness in 16.66%, skin healing disorder in
16% and infection in 6.66% of cases. Total knee arthroplasty made it possible to recover the failure of an high tibial osteotomy.
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
The Principe of high tibial osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia.The
total knee arthroplasty on this tibia with a “malunion” presents technical difficulties related to the initial approach, the presence of osteosynthesis material, the presence of malunion and the change of bone density. The objectives of this study are to determine the clinical and radiographic results of patients undergoing Total Knee Arthroplasty (TKA) after High Tibial Osteotomy (HTO). This is a retrospective descriptive study including patients undergoing Total Knee Arthroplasty (TKA) after an High Tibial Osteotomy (HTO) at the Hospital of Mont de Marsan (France) from 2008 to 2017 with a minimum follow-up of 12 months. Thirty knees (27 patients) were recruited. The sex ratio was 1.72. The average age was 70.33 years (54years-88years). The average time between High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) was 10.83 years (1 year-26 years). The medial opening was 63.33% and lateral closure for the rest. Clinical improvement was observed, with an average gain of 24.97 points for pain, 1 point for stability, 1 point for knee mobility and 5 points for walking distance. The clinical result was perfect in 13.33%, excellent in 42% and medium in 36.67% of cases. The alignment was obtained in 76.67% of cases (p = 0.0039). The posterior tibial slope, epiphyseal varus, patellar height were corrected in 80% of cases respectivly (p = 0.000011, p = 0.44, p = 0.15). Residual pain was observed in 26.66%, joint stiff ness in 16.66%, skin healing disorder in
16% and infection in 6.66% of cases. Total knee arthroplasty made it possible to recover the failure of an high tibial osteotomy.
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
Hello ...im dr zamin abbas...i completed my residency from shifa international hospital islamabad...these are one of my presentations i want to share with other colleagues
Fracture shaft of tibia is a very common injury which we deal as a trauma surgeon
T y elbow treatment by cross k wire techniquedocortho Patel
T Y elbow fractures are very complicated and most times communited intra-articular fractures. we had done surgeries in these cases with k wires & TBW in many patients.& achived fantastic results. this technique is specially very helpful in countries like india where pts are not affrordable & still u can achive full range of motions without compromise
Special cases we encountered at our hospitaldocortho Patel
very intresting cases that we came across in our practice. at that time generally we are confused what to do..presenting here few of same which confused us too..ur valuable feedback are most welcome
shoulder instability is quite common because shoulder have highest range of motion but at the cost of stability. here discussing anatomy around the shoulder & treatment of shoulder instability
Pathophysiology of shoulder rotator cuff instability and repairdocortho Patel
sport injuries or trauma or dislocations of shoulder cause rotator cuff instabilty. here presenting detail about rotator cuff anatomy & treatment options.
Knee injuries in sports medicine & arthroscopydocortho Patel
knee ligaments injuries are so incresing in sports persons & even in accidental trauma.here providing you basic knowledge of these injuries & arthroscopy treatment
Children have tendency to fall frequently. and most commony got injured around elbow joint.presenting you injuries around elbow and treatment modalities
Distal end radius fractures are one of the commonest fracture we encountered in our practise. here presenting various treatment surgeries that we have done at our hospital.hope it helps to you in your practice
clavical fractures are most controversial in case of treatment modalities in orthopaedics. it is one of the common fracture of all ages. so we are explaining our point what to do or not?
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
2. INTRODUCTION
• High tibial osteotomy is effective for managing
a variety of knee conditions, including
1) gonarthrosis with varus malalignment
2) osteochondritis dissecans,
3. ..
Goals of osteotomy include pain relief, functional
improvement, and increase the life span of the
knee joint
With appropriate patient selection, accurate pre-
operative planning, modern surgical fixation
techniques and rapid rehabilitation, osteotomy
around the knee is now an effective biological
treatment for degenerative, deformity, knee
instability
4. …
The fundamental goals of the procedure are
to unload diseased articular surfaces and to
correct angular deformity at the tibiofemoral
articulation.
the procedure remains very useful in
appropriately selected patients with
unicompartmental knee disease.
5. WHAT HISTORY SAYS…
• JACKSON IS CREDITED BEING THE 1ST
PERFORMING PROXIMAL (HIGH) TIBIAL
OSTEOTOMY TO TREAT OSTEOARTHRITIS OF
THE KNEE
• JACSON’S CONCEPT THEN ADOPTED BY
COVENTRY ET AL & INSALL ET AL, WHO
REFINED & POPULARIZED LATERAL CLOSING
WEDGE HTO
6. ..
• OSTEOTOMY OF THE PROXIMAL TIBIA HAS
BEEN USED FOR MORE THAN A CENTURY TO
CORRECT ANGULAR DEFORMITY IN
RICKETS
POLIOMYELITIS
POST TRAUMATIC CONDITIONS
7. Reasons For Renewed interest in
high tibial osteotomy
• The prevalence of physiologically young active patients
presenting with medial compartment osteoarthritis;
• the advent of new techniques for performing the
procedure (ie, improved instrumentation and fixation
plates for medial opening wedge osteotomy, dynamic
external fixation for medial opening wedge osteotomy,
& improved instrumentation for lateral closing wedge
osteotomy)
• the need to concomitantly correct malalignment when
performing chondral resurfacing procedures
(ie,autologous chondrocyte transplantation,
mosaicplasty, and microfracture).
9. OSTEOARTHRITIS PTS. WITH VARUS
LIMB ALIGNMENT
• MOST COMMON INDICATION
• ISOLATED MEDIAL COMPARTMENT
DEGENERATIVE JOINT DISEASE WITH
ASSOCIATED VARUS TIBIOFEMORAL
MALALIGNMENT
• IDEAL PT. IS YOUNG & ACTIVE
10. CONTRAINDICATIONS
• The principle contraindications to valgus-
producing HTO are
(1) lateral compartment degenerative joint
disease,
(2) loss of a significant portion of the lateral
meniscus
(3) symptomatic patellofemoral degenerative
joint
disease,
(4) Patellofemoral osteoarthritis
11. …
• >20% DEGREES OF CORRECTION NEEDED
• KNEE FLEXION LESS THEN 90 DEGREES
• FLEXION CONTRACTURE OF MORE THAN 15
DEGREES
• LATERAL TIBIAL SUBLUXATION OF MORE
THEN 1 CM
13. LATERAL CLOSING WEDGE
OSTEOTOMY
• USED BY COVENTRY ET AL AND INSALL ET AL
• ADVANTAGE OF PRODUCING APPOSITION OF
2 BROAD METAPHYSEAL SURFACES,THUS
OPTIMIZING STABILITY & HEALING POTENTIAL
• IT IS MADE NEAR THE DEFORMITY
• IT PERMITS EXPLORATION OF THE KNEE
THROUGH THE SAME INCISION
14. ..
• More recently calibrated cutting guides, rigid
internal fixation devices,& early
mobilizationhave produed improved results &
low complication rates after lateral closing
wedge osteotomy
15. MEDIAL OPENING WEDGE
OSTEOTOMY
• USED TO TREAT MEDIAL COMPARTMENT
OSTEOARTHRITIS SINCE 1951
• FIXATION IS ACHIEVED BY EITHER A MEDIAL
DISTRACTION PLATE OR EXTERNAL FIXATOR
• IT IS TECHNICALLY EASIER FOR SURGEON TO
ACHIEVE PRECISE DESIRED AMOUNT OF
ANGULAR CORRECTION THEN LATERAL
CLOSING HTO.
16. MERITS & DEMERITS
• INCLUDES LESS SURGICAL DISSECTION & LACK OF
PROXIMITY TO PARONEAL NERVE
• NO NEED TO MOBILISE PROXIMAL FIBULA
• MEDIAL WEDGE COSTRUCTS ARE RELATIVELY UNSTABLE SO
1) LOSS OF FIXATION
2) NON UNION
3) DELAYED UNION
ARE MORE FREQUENT THEN AFTER LATERAL
CLOSING HTO.
• IMMEDIATE WEIGHT BEARING IS NOT POSSIBLE AFTER
MEDIAL OPENING HTO AND DELAYED FOR 6 TO 8 WEEKS.
17. DOME OSTEOTOMY
LESS COMMONLY USED
TO BE A MORE TECHNICALLY DEMANDING
OPERATIONBECAUSE OF CHALLENGES OF
CREATING A CURVE OSTEOTOMY & AVOIDING
IATROGENIC TRAUMA TO PATELLAR TENDON
ADVANTAGE OF INTRAOPERATIVE FLEXIBILITY
WHICH ALLOWS THE SURGEON TO ACHIEVE
PRECISE AMOUNT OF DESIRED ANGULAR
CORRECTION.
18. OUR EXPERIENCE
• CASE NO. 1 :
PT.CAME WITH H/O TRAUMA ON
7/11/2011 AND HAD C/O OF PAIN &
RESTRICTED MOVEMENTS…AFTER 2
YEARS PT. SUBSEQUENTLY DEVELOPED
POST TRAUMATIC OSTEOARTHRITIS &
ADVICED FOR HTO…
25. CARTILAGE REGENERATION AFTER HTO
• BRUCE ET AL DOCUMENTED DECREASED MEDIAL
COMPARTMENT SCINTIGRAPHIC UPTAKE
FOLLOWING VALGUS PRODUCING HTO
• ODENBRING ET AL DETECTED FIBROCARTILAGE
PROLIFERATION & INCREASED CELLULARITY OF
HYLINE CARTILAGE AFTER HTO
• REGENERATION IMPROVED WHEN HTO
COMBINED WITH ABRATION ARTHOPLASTY
28. Conclusion
Realignment osteotomy is a good option in active
patients with symptomatic medial compartment
osteoarthritis of the knee with varus deformity
The key to success after osteotomy is careful
patient selection combined with skillful surgical
technique
Accurate and appropriate pre-operative planning
is critical for HTO