This document discusses preoperative evaluation and preparation for total hip arthroplasty. It outlines factors to consider like the patient's pain level, life expectancy, general health, medications, comorbidities and risk of bleeding. Preoperative labs, discontinuing medications like blood thinners, treating infections and ensuring normal coagulation are addressed. Aspects of the physical exam like leg length, range of motion, tenderness and alternative diagnoses are touched on. Hip rating systems for evaluating pre- and post-operative status are also mentioned.
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Reconstruction of the anterior cruciate ligament (ACL) is a well-established surgical procedure. However, post-operative imaging in the early phase is not routinely performed. The rationale for performing such imaging is to provide a baseline examination for future controls, to provide immediate feedback to surgeons regarding tunnel placement, and to assess placement of fixation devices
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate ...TheRightDoctors
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate Ligament Reconstruction Using Transportal and Transtibial Approach for Femoral Tunnel Drilling-Dr. Adarsh Reddy
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
TraumaCad Orthopedic Digital Templating BrochureBrainlab
Learn more: https://www.brainlab.com/traumacad
TraumaCad® provides orthopedic surgeons with digital tools to perform
preoperative planning and simulates the expected results prior to surgery.
Using digital images on-screen, you can perform measurements, fix prostheses, simulate osteotomies and visualize fracture reductions.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Reconstruction of the anterior cruciate ligament (ACL) is a well-established surgical procedure. However, post-operative imaging in the early phase is not routinely performed. The rationale for performing such imaging is to provide a baseline examination for future controls, to provide immediate feedback to surgeons regarding tunnel placement, and to assess placement of fixation devices
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate ...TheRightDoctors
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate Ligament Reconstruction Using Transportal and Transtibial Approach for Femoral Tunnel Drilling-Dr. Adarsh Reddy
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
TraumaCad Orthopedic Digital Templating BrochureBrainlab
Learn more: https://www.brainlab.com/traumacad
TraumaCad® provides orthopedic surgeons with digital tools to perform
preoperative planning and simulates the expected results prior to surgery.
Using digital images on-screen, you can perform measurements, fix prostheses, simulate osteotomies and visualize fracture reductions.
Pelvic Fracture managemnt- Case based discussion .pptxKTD Priyadarshani
A case based approach on the management of a pelvic fracture. it is based on ATLS guideline. A brief account on anaesthetic and orthopedic point of view also included.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. • whether the pain is sufficient to justify a major elective
operation
• Is the patient’s life expectancy reasonable?
• would he or she be bedridden or confined to a
wheelchair after surgery because of some other incurable
disease?
• Is the patient’s general condition good enough to
tolerate a major operation, during which a significant
amount of blood may be lost?
3. • Comorbidities known to be inherent to elderly patients
should be considered
• cardiopulmonary disease
• Infections
• thromboembolism.
• A thorough general medical evaluation, including
laboratory tests
4. • Aspirin and other antiinflammatory and antiplatelet
medications should be discontinued 7 to 10
days before surgery
• oral anticoagulants such as warfarin should be
discontinued in sufficient time for coagulation studies to
return to normal.
• A bridging program with a short-acting
anticoagulant such as enoxaparin may be required
when discontinuing warfarin.
• Many herbal medications and nutritional supplements may
cause increased perioperative blood loss
• recommend that these medications be discontinued
preoperatively.
5. • we typically discontinue warfarin five days before
elective surgery (ie, last dose of warfarin is given on day
minus 6) and, when possible, check the PT/INR on the
day before surgery . If the INR is >1.5, we administer
low dose oral vitamin K (eg, 1 to 2 mg) to hasten
normalization of the PT/INR and recheck the following
day. We proceed with surgery when the INR is ≤1.4.
An INR in the normal range is especially important in
patients undergoing surgery associated with a high
bleeding risk (eg, intracranial, spinal, urologic) or if
neuraxial anesthesia is to be used
6. • Use of bridging preoperatively – We generally reserve
bridging for individuals considered at very high or high
risk of thromboembolism (eg, recent stroke,
mechanical heart valve, CHADS2 score of 5 or 6) if they
require interruption of warfarin. In these cases, the
bridging agent (eg, therapeutic dose subcutaneous
low molecular weight [LMW] heparin) is started three
days before surgery.
• A bridging agent may also be appropriate if there is a
prolonged period during which the patient cannot take
oral medications (eg, postoperative ileus).
7. • We suggest the use of bridging in individuals
taking warfarin for one of the following conditions:
●Embolic stroke or systemic embolic event within the previous
12 weeks
●Mechanical mitral valve
●Mechanical aortic valve and additional stroke risk factors
●Atrial fibrillation and very high risk of stroke (eg, CHADS2 score
of 5 or 6, stroke or systemic embolism within the previous 12
weeks)
●Venous thromboembolism (VTE) within the previous 12 weeks
●Recent coronary stenting
●Previous thromboembolism during interruption of chronic
anticoagulation
8. • Preoperative timing of bridging — We generally
initiate heparin bridging three days before a planned
procedure (ie, two days after stopping warfarin),
when thePT/INR has started to drop below the
therapeutic range.
• ●LMW heparin – We discontinue LMW heparin 24
hours before the planned surgery or procedure, based
on a biologic half-life of most subcutaneous LMW
heparins of approximately three to five hours .
• If a twice-daily LMW heparin regimen is given, the
evening dose the night before surgery is omitted,
whereas if a once-daily regimen is given
(eg, dalteparin 200 international units/kg), one-half of the
total daily dose is given on the morning of the day before
surgery.
9. • Pyogenic skin lesions should be eradicated.
• Urinary retention due to prostatic or bladder disease
and dental problems should be addressed before
surgery.
10. • history of previous surgery,
• purulent drainage from the hip,
• other indications of ongoing infection:
• laboratory investigation
• ESR, CRP
• nuclear scans
• a culture and sensitivity determination of an aspirate
of the hip
• suspection to Infection
• if part of the subchondral bone of the acetabulum or femoral head
is eroded
• if bone has been resorbed around an internal fixation device.
11. • the spine and the upper and lower extremities.
• The soft tissues around the hip should be inspected for
any inflammation or scarring where the incision is to be
made.
• Gentle palpation of the hip and thigh may reveal areas of
point tenderness or a soft tissue mass.
• The strength of the abductor musculature should be
determined by the Trendelenburg test.
12. • The lengths of the lower extremities
should be compared, and any fixed deformity should be
noted.
• Adduction contracture of the hip
• produce apparent shortening of the limb despite equally measured leg
lengths.
• Abduction contracture
• conversely produces apparent lengthening.
• Fixed flexion deformity of the hip
• forces the lumbar spine into lordosis on assuming an upright posture and
may aggravate lower back pain symptoms.
• fixed lumbar spine deformity from scoliosis
or AS
13. • When the hip and the knee are both severely arthritic:
• the hip should be operated on first.
• Hip arthroplasty may alter knee alignment and
mechanics.
• knee arthroplasty is technically more difficult when the
hip is stiff, and rehabilitation would be hampered.
14. • An alternative or additional diagnosis
• The complaint of “hip pain” can be brought about
by a variety of afflictions, and arthritis of the hip joint is
one of the less common ones.
• True hip joint pain usually is perceived in the groin,
sometimes in the anterior thigh, and occasionally in the
knee.
• Arthritic pain usually is worse with activity and
improves to some degree with rest and limited weight
bearing.
15. • Pain in atypical locations and of atypical character should
prompt a search for other problems.
• Pain isolated to the buttock or posterior pelvis often is
referred from the lumbar spine, sacrum, or sacroiliac
joint.
• Arthritis often in the hip and lumbar spine.
• A THA done to relieve symptoms predominantly referred from the
lumbar spine would do little to improve the patient’s condition.
• Likewise, surgical intervention in the face of mild hip arthritis
when the pain actually is caused by unrecognized vascular
claudication, trochanteric bursitis, pubic ramus fracture, or an
intraabdominal problem subjects the patient to needless risk
16. • The Harris, Iowa (Larson), Judet, Andersson, and
d’Aubigné and Postel systems for recording the status of
the hip before surgery are useful for evaluating
postoperative results.
• Pain, ability to walk, function, mobility, and radiographic
changes are recorded.
• As yet, no particular hip rating system has been uniformly
adopted.
• The Harris system is the most frequently used
17.
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24. • substantially increase local or general complications
compared with staged procedures
• Costs may be reduced by 30%.
• The major indication
•a medically fit patient
• with bilateral severe involvement
•with stiffness or fixed flexion deformity
•because rehabilitation may be difficult
if surgery is done on one side only.
25. • Elderly patients with other comorbidities, such as
heart disease, pulmonary insufficiency, or diabetes
are not suitable candidates for such a procedure.
• A documented patent ductus
arteriosus or septal defect is an
absolute contraindication.
• More intensive intraoperative monitoring, including an
arterial line, pulmonary artery catheter, and urinary
catheter, is recommended.
26. • the minimal views required
• An anteroposterior view of the pelvis showing
the proximal Femur
• a lateral view of the hip and proximal femur
• evaluate the structural integrity of the acetabulum
• estimate the size of the implant required
• how much reaming would be necessary
• Determine whether bone grafting would be required
27. • Significant protrusion or periacetabular osteophyte
formation may make dislocation of the hip difficult
• In patients with developmental dysplasia, the
pelvis should be evaluated with special care to determine
the amount of bone stock present for fixation of the
cup.
• With old fracture-dislocations, obturator and
iliac oblique views are obtained because a
significant defect may be present in the posterior wall.
• A three-dimensional CT scan also is helpful in
evaluating the acetabulum in these complex cases.
28. • The width of the medullary canal
• it may be narrow, especially in young patients, patients with
dysplasia, and dwarfs.
• a femoral component with a straight stem or a specially made
small stem may be needed.
• In Paget disease, old fractures of the femoral
shaft, or congenital abnormalities, a lateral
radiograph of the proximal femur may reveal a significant
anterior bowing that may make preparation of the canal
more difficult.
• If excessive bowing or a rotational deformity is present, femoral
osteotomy may be required before or in addition to the
arthroplasty.