A presentation on different techniques for shoulder joint preservation in regards to the advances in technology for rotator cuff pathology, from tendonitis to cuff tear arthropathy.
Hip resurfacing has emerged as a viable alternative to replacement for arthritis in young patients. Selected individuals will benefit by Hip resurfacing arthroplasty offered by the Madras Joint replacement center in India. See if you qualify for this procedure.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
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.
Hip resurfacing has emerged as a viable alternative to replacement for arthritis in young patients. Selected individuals will benefit by Hip resurfacing arthroplasty offered by the Madras Joint replacement center in India. See if you qualify for this procedure.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
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.
Pressure sores are localized areas of tissue breakdown in skin and/or underlying tissues that develop when persistent pressure between a bony site and underlying surface obstructs healthy capillary flow.
Constant external pressure over 70 mm Hg for 2 hours produces irreversible ischemic changes.
Synonyms : Pressure ulcer, Decubitus ulcer,
Bed sore.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes.
Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates.
For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
Update on ACL reconstruction, with information on current direction of demineralized bone matrix (DBM) use in bone tunnels and biocartilage on chondral lesions
The presentation includes new insight to rotator cuff anatomy, rotator cable, concept of force couple, different classifications of rotator cuff tear, signs and symptoms, special tests, non operative and operative management of rotator cuff tear, comparison of recent surgical modalities, management of irreparable cuff tears, post operative rehabilitation protocols, SLAP lesion, Parsonage Turner Syndrome
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
il dottor Spoliti Ortopedico illustra come curare con le Cellule mesenchimali, difetto condrale Ricostruzione con Acido Ialuronico e midollo osseo autologo Aspirare Concentrate
Platelet Rich Plasma ( PRP ) is very popular in the treatment of musculo skeletal pathologies. This ppt gives a brief introduction to platelets and in sights into developing a PRP kit.
An overview of management of articular cartilage injuries at various stages. the modalities discussed are PRP, Bone marrow aspirate concentrate, Microfracture, Mosaicplasty and ACI. the pros and cons of each method discussed and compared
Presentation at Canadian Orthopaedic Association Annual Meeting 2012 - PASTA Bridge - A New Technique in PASTA Repairs: A Biomechanical & Clinical Evaluation
E-Poster at the Arthroscopy Association of North America Annual Meeting 2012 - PASTA Bridge - A New Technique in PASTA Repairs: A Biomechanical Evaluation of Construct Strength vs. Suture Anchors
Presentation at the Western Orthopaedic Association Annual Meeting 2012 - Collagen Stuffed Sutures Enhance Healing of Full-Thickness Rotator Cuff Tears
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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1. My Techniques for Shoulder Joint
Preservation
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder & knee surgery
7. Goals of Treatment
• Decrease pain & inflammation
• Create vascular channels
• Promote stem cell migration
• Achieve healing of tissue
B
A
B
1.5
1
0.5
0
CONTROL ACP HA
LOG HAS-2 FOLD
CHANGE OVER
CONTROL
HA IN SYNOVIOCYTES
20
10
MMP 13-IN
SYNOVIOCYTES
A
B
A
0
-1
-2
CONTROL ACP HA
LOG MMP-13 FOLD
CHANGE OVER
CONTROL
A
B B
0
CONTROL ACP HA
TNF-Α (PG/ML)
TNF- Α
Fortier et al, AJSM, 2014
8. Stem Cells
Proliferation & Migration Significantly Increased with PRP
– Kakudo et al, Plast Recontr Surg 2008
– Zaky et al, J Tissue Eng Regen Med 2008
– Drengk et al, Cells Tissues Organs 2009
– Mishra et al, Tissue Eng Part C Methods
2009
– Kruger et al, J Orthop Res 2012
– Moreira Teixeira et al, Biomaterials 2012
– Murphy et al, Biomaterials 2012
– Hildner et al, J Tissue Eng Regen Med 2013
9. Platelet-Rich Plasma vs. Cortisone Injections
for the Non-surgical Treatment of Shoulder Pain
PRP > Cortisone
• Inflammatory & calcific
processes
– Tendonopathy
• Partial tears & degenerative
processes
– Tendon, ligament, muscle
• Pain relief
PRP = Cortisone
• Full thickness tears
– Rotator cuff, SLAP, instability
• Adhesive capsulitis
• Advanced DJD of shoulder
• 740 patients with injection of cortisone or PRP (ACP) under ultrasound guidance
• 208 Study (PRP) patients / 532 Control (cortisone) patients
10. Type of Tendonopathy
Will Determine Mode of Treatment
• Inflammatory (Tendonitis)
• Degenerative
• Partial tear
– Acute traumatic
– Semi-acute non-traumatic
– Chronic
• Full tear
• Peri-tendon / One
• Intra-tendon / One+
– Intra-tendon / One
– Intra-tendon / One+
– Intra-tendon / 2 or 3
• Peri-tendon / One
11. Other Considerations
• h/o Cortisone
• In season
• Out of season
• Multiple injections
• Peri-tendon / Pain control
• Attempt to heal
12. Injecting to Heal
• Degenerative tendons
– Lat / Med epicondylitis
– Patellar / Quad tendonitis
– Achilles tendonitis
• Partial tears of ligaments
– UCL
– MCL
– NOT Intra-articular ligaments
or tendons
• Calcific tendons
– Rotator cuff
– Patellar
– Achilles
20. FlexiGraft DBM Sponge
• DBM produced significantly
more fibrocartilage &
mineralized fibrocartilage at 12-
week post-op, showing a more
mature, organized tendon-bone
interface
Sundar et al., J Biomed Mater Res. 2009; 88B: 115-
122
Sundar et al., J Bone Joint Surg Br. 2009;91;(9)1257-
62
21. FlexiGRAFT with RC Repair
James Cook, DVM, PhD
• Chronic infraspinatus model
– n = 10 dogs
– Bilateral shoulders, release tendon
– Repair after 4 wks
• FlexiGRAFT / PRP vs. Direct Repair
– Modified SpeedFix configuration
• SutureTak medially
• 12 week sacrifice, outcome
measures
– MRI, Histo, and Biomechanical testing
22. FlexiGRAFT Strip with RC Repair
Standard FlexiGRAFT
T = Tendon; I = Interface; A = Anchor
Standard has more fibrous tissue at interface and is more edematous
34. ECM Patches
• Justification
– Failure rates: 20 57% reported for RC repairs
– In vivo animal studies: Support use of acellular dermal grafts for
augmentation
– Biomechanical studies: Dermal grafts superior suture retention over SIS or
BM patches
• But
– acellular significant DNA
• GraftJacket, Restore, TissueMend
Adams et al, Arthroscopy 2006.
Aurura et al, J Shoulder Elbow Surg 2007.
Coons et al, Sports Med Arthrosc Rev 2006.
35. RC Repair Augmentation
• Peer reviewed clinical studies do not support SIS grafts
• Iannotti et al, (JBJS 2006) - Randomized prospective controlled trial using (Restore) augmentation for
massive tears showing no benefit using SIS. Discontinued study early!
• Walton et al. (JBJS 2007) - 19 pts. 4 of which had severe early inflammatory rxn. 2 yr. MRI shows no
difference in failure rate vs non-augmented, abandoned study early! Porcine graft (Level 3)
• Schlamberg et al. (J Shoulder Elbow Surg 2004) All patients re-tore
• Zheng et al. (J Biomed Mater Res B Appl Biomater 2005) Adverse outcomes related to retained
cellular elements
• Dermis grafts show potential
• Burkhead et al. (Semin Arthroplasty 2007) 17 pts, GJA augmentation, 1.2 yrs F/U, improved UCLA
scores but 3 retears per MRI & no reversal of atrophy or fatty infiltration. No Control group
Iannotti et al, JBJS 2006
Walton et al, JBJS 2007
Schlamberg et al, JSES 2004
Zheng et al, J Biomed Mater Res B Appl Biomater 2005
Burkhead et al, Semin Arthroplasty 2007
36. ArthroFlex
• Ready to use
• Hydrated
• Room temperature storage
• Sterile (10-6 SAL)
• 3 year shelf life
• Biocompatible
– > 97% DNA removal
• Excellent suture retention
strength
• Intact framework
38. DNA Residuals
273
135
16
300
250
200
150
100
50
0
Alloderm GraftJacket ArthroFlex
The DNA content for the three materials averaged: Alloderm1 272.8±168.8 ng/mg; GraftJacket2 134.6 ±
44.0 ng/mg dry weight; ArthroFlex 15.97±4.8 ng/mg dry weight.3
Choe et al. J Urol. 2001.
Derwin et al. JBJS-A. 2006.
Data on file, LifeNet Health.
39. In vivo Study
Devitalized Human Dermis
• Preserved with 15% glycerol and
gamma irradiated at delivered
dose 12.8 - 17.8 kGy
• Implanted subcutaneously in
athymic mice
– In-life period was 4 weeks
• H&E Staining
Post Implantation
Arrows pointing to new blood vessels with
red blood cells in them
Lifenet. Data on file.
Capito et al, Ann Plast Surg. 2012.
40. Placement
• Dermal side
– Shiny, smooth, absorbs blood
– Applied in the down position
against the wound or most
vascularized tissue
• Basement membrane
– Dull and rough in appearance
– Repels blood
– Place in up position
– Packaged in view
45. Options for Irreparable RC Tears
Traditional
• Debridement
• Partial repair
• Biceps tenotomy
• Latissimus dorsi transfer
•
• Reverse arthroplasty
Advanced Technology
• Superior Capsular Reconstruction
46. Disadvantages to Reverse Total Shoulder
• Subject to overuse
• Too easily seen as a solution for all previously untreatable shoulder
pathologies
• Challenging surgical technique
• Requires extensive training and experience limits availability
• Arthroplasty
• Limited life span
• Wide range of complication rates
47. Intercalary Placement
• Biomechanical studies
showing equivalent load-to-failure
and mechanical
properties, but few articles
show success clinically
Snyder et al, IJSS 2007
Schlamberg et al, JSES 2004
48. Bridging vs. SCR
Conventional Patch Graft Superior Capsular Reconstruction
Courtesy of Dr. Teruhisa Mihata
50. Arthroscopic Superior Capsule Reconstruction
Teruhisa Mihata, MD
• Methods:
• 24 shoulders over 2 years
• Autograft fascia lata used to reconstruct superior capsule
• Results:
• A-H distance: 4.6 2.2 mm to 8.7 2.6 mm (p < 0.0001)
• ASES Score: 23.5 to 92.9 points (p < 0.0001)
• Twenty patients (83.3%) had no graft tear or tendon re-tear
Mihata et al, Arthroscopy 2013
53. ArthroFlex Sizes Available
• AFLEX100 3.5 cm x 3.5 cm x 1.5 mm $2,225
• AFLEX101 4.0 cm x 7.0 cm x 1.5 mm $2,650
• AFLEX103 5.0 cm x 9.0 cm x 1.5 mm $3,600
• AFLEX150 1.5 cm x 14.0 cm x 1.5 mm $2,000
• AFLEX200 3.5 cm x 3.5 cm x 2.0 mm $2,975
• AFLEX201 4.0 cm x 7.0 cm x 2.0 mm $3,600
• AFLEX301 4.0 cm x 7.0 cm x 3.5 mm $3,850
• AFLEX400 4.0 cm x 4.0 cm x 1.0 mm $2,050
• AFLEX401 4.0 cm x 7.0 cm x 1.0 mm $2,500
• AFLEX500 3.0 cm x 4.0 cm x .5 mm $1,150
73. Summary
Mihata
• Fascia lata autograft
– 180 N
• A-H distance
– 4.6 mm to 8.7 mm
• ASES Scores
– 23.5 to 92.9
• 83.3% - No graft or re-tear
Hirahara
• ArthroFlex allograft
– 550 N
• A-H distance
– 4.5 mm to 8.8 mm
• ASES Scores
– 45.3 to 82.0
• No complications yet
n = 24 patients / Follow up 24-51 mos n = 3 patients / Follow up 2-4 mos
74. for my patients?
• NO Bone Loss!
• NO Large Incisions!
• NO Prolonged
Rehabiliation
• NO Burned Bridges!
• NO Reverse Prosthesis!
• Less pain!
• Better Function!!