1. The document describes the basic surgical technique for total knee arthroplasty (TKA), including the medial parapatellar approach and steps for femoral and tibial bone cuts.
2. It discusses different alignment techniques in TKA including anatomical, mechanical, and kinematic alignment. Kinematic alignment aims to restore the natural three motion axes of the knee.
3. Key steps like distal femoral cuts, flexion and extension gap balancing, and tibial rotation and slope are explained. Ten commandments for optimal TKA outcomes are also listed.
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.
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
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.
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
The hip joint is a ball and socket joint consisting of the femoral head and acetabulum. This articulation provides multiple planes of movement and is highly congruent. Articular cartilage, consisting of type II collagen, covers the majority of the femoral head. The acetabulum peripherally consists of articular cartilage while the central floor is non-articular and filled with a fatty layer termed the pulvinar. The ligamentum teres arises from both the transverse acetabular ligament and the central non-articular layer of the acetabulum and attaches to the central femoral head. It may play a role in stabilizing the hip joint.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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
6. Originally described by Von Langenback
later modified by Robert jones and Insall
* Proximal medial border of quadriceps
tendon – medial border preserved
* Point halfway between medialis
insertion and superomedial pole of patella
* Medial border of tibial tubercle
15. STEP 6 : CLEARING OF
PATELLOFEMORAL OSTEOPHYTES
+ DEBULKING
16. ALIGNMENTS IN TKR
1. ANATOMICAL ALIGNMENT
2. MECHANICAL ALIGNMENT
• MEASURED RESECTION
• GAP BALANCING
3. KINEMATIC ALIGNMENT
17. ANATOMICAL ALIGNMENT
• Hungerford and Krackow
• Anatomically recreate the joint line
• Femoral cut at 8-9°of valgus combined with the 2-3°
varus tibial cut
18. Anatomic alignment (a) attempts to mimic the natural knee by cutting the tibia at 3° varus to the mech
f the tibia and a distal femoral cut that is 9° valgus to the mechanical axis of the femur to recreate a 6°
line. Mechanical alignment (b) involves a tibial cut that is perpendicular to the mechanical axis of the ti
distal femoral cut 6° valgus to the anatomic axis (perpendicular to the mechanical axis) of the fem
19. MECHANICAL ALIGNMENT
Insall - Femoral and Tibial cut perpendicular to the
mechanical axis
Insall - 1.the knee joint aligned through the anatomical
alignment may be loaded more medially with a medial tibial
plateau fixation failure.
2. cuts perpendicular to mechanical axis
20. a. measured resection- bony
landmarks ( preserve joint line )
b. gap balancing- ligament
tension
c. combined / modern
23. ENTRY
''Starting point for femoral IM rod
insertion is made 8-10mm anterior
to the origin of the PCL,
And slightly medial to the
midportion of the
intercondylar notch''
''A correct thickness of distal
femoral cut just skims the
roof of intercondylar notch''
Operative techniques in Orthopaedic Surgery Sam W.Wiesel
(publisher) Lippincott Williams & Wilkins 1 st Edition (2011)
Tips and tricks in total knee arthroplasty
BhavukGarg*, GauravSharma**, RajeshMalhotra***
24.
25. INTRAMEDULLARY GUIDE
• AIM is for DFC to be
perpendicular to Mechanical
axis
• Identify the VCA
• General –
• Varus – 5 to 7 degree
valgus cut
• Valgus knees – 0 to 3
degree valgus cut
26. Distal Femur Cut
Anterior
Chamfer Cut
Posterior
Cut
Anterior
Cut
Posterior
Chamfer Cut
• - Distal femur cut corelates
with thickness of metallic
femoral component provides
- Varus/ valgus alignment
- Flexion/ extension
- Proximal/ distal position
33. PLACING OF THE 4 IN 1
CUTTING BLOCK
AIM – Prosthesis must be in External rotation
34.
35. • TRANSEPICONDYLAR AXIS :
Lateral epicondyle - apex of bony prominence
Medial epicondyle:
Apex of the medial prominence -Anatomical TEA
Medial sulcus -Surgical TEA .
. POSTERIOR CONDYLAR AXIS :
in 3-5 degree of IR / valgus
36. • ANTEROPOSTERIOR AXIS(WHITESIDES LINE):
1. Line connecting the lowest point of the patellar
groove and the top of the intercondylar notch.
2. Femoral component rotation is oriented perpendicular
to it
3. easily identified / reproducible
41. • COMPONENTS
– SUBPERIOSTEAL ELEVATION OF DEEP MCL
– HYPERFLEXION OF KNEE
– EXTERNAL ROTATION OF LEG
– DELIVERING TIBIA FORWARD
RANSALL MANOUVRE
RANAWAT+INSALL
42. STEP 10 : PROXIMAL TIBIAL CUT
1. AIM – Tibial cut must be made
perpendicular to the
mechanical/anatomical axis of tibia
2. Method
a) Intramedullary alignment guide
b) Extramedullary alignement guide
43. • Landmarks
– Proximal landmarks
• Anterior to origin of PCL
• Medial third of tibial tuberosity
– Distal landmarks
• Centre of ankle
• Second Metatarsal
• EHL
EXTRAMEDULLARY
ALIGNMENT GUIDE
''An aid to tibial alignment in total knee
replacement
NJ COOKE, R BURNETT''
49. POSTERIOR TIBIAL SLOPE
• Range – Between 0 to 7
degrees
• Indian population – 11.54
degrees Standard
Deviation of 4.5
Exceptions
malunited IA fractures
Post HTO
Mastering techniques in Orthopaedic surgery
Knee arthroplasty
Paul A.Lotke
Correlation of posterior tibial slope with Metadiaphyseal angle in TKA – Indian
population
Shuhrashnu S Mohanty
54. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial
third of tibial tuberosity than at the medial border
Jörg Lützner,1 Frank Krummenauer,2 Klaus-Peter Günther,1 and Stephan Kirschner1
TIBIAL PREPARATION AND
SIZING
Which Rotational Reference for Tibial Component is optimal in Total Knee Arthroplasty? + 1 Mitsuyasu, H;
1Matsuda, S; 1 Fukagawa, S; 1Miura, H; 1Okazaki, K; 1, 2Tashiro, T; 1Kawahara, S; 1 Iwamoto, Y + 1Department
of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
2Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
•Sizing – A-P of lateral plateau of tibia
•Rotation –
• Anatomic landmarks
a) Anteromedial border(if not
involved in disease process)
b) alignment
c) akagi line
d) free floating technique
58. Knee at 90 degrees of flexion and the collateral ligaments equally
tensioned using laminar spreaders. Note the transepicondylar axis
is parallel and anterior-posterior axis is perpendicular to the
resected proximal tibia.
59. Placement of the anteroposterior femoral cutting block parallel to the
resected proximal tibia with each collateral ligament tensioned to create a
rectangular flexion gap.
60. * Precise proximal tibial resection is critical when using a
gap balancing technique
* Varus tibial resection will result in increased internal
rotation of the femoral component
* Valgus tibial cut will lead to excessive external rotation
of the femoral component.
* Over- or under-resection of the femoral or tibial bone
resections can lead to a mismatch of flexion and extension
gap dimensions.
61. • Modern / combined technique-
• 1. distal femur cut
• 2. proximal tibia
• 3. balance in extension
• 4. complete femur prep.
• 5. balance in flexion
73. KINEMATIC ALIGNMENT
Kinematic Alignment in TKA: Definition, Surgical Technique, and Challenging Cases
Article · January 2012
MS Thesis Project View project
Stephen Miller Howell University of California, Davis
Maury L. Hull University of California, Davis
74. • Introduced in 2006 – Howell
• Aim is to restore the 3 axis around which
the knee moves
• Normal knee has single radius from 0-150
flexion
75. 2.The transverse axis in the femur
about which the patella flexes and
extends is proximal, anterior and
parallel to the above
1.The transverse axis in the femur
about which the tibia flexes and
extends passes through the center
of the medial and lateral femoral
condyles, which are symmetric in
the varus and valgus knee
3.Both transverse axes in the
femur are perpendicular to the
longitudinal axis about which
the tibia internally and externally
rotates on the femur
76. Cementing
1. High viscosity cement
2. Tkr – no role of antibiotic cement
3. Under tourniquet
4. Maintain ot temperature, sterility
5. Monitor for adverse reactions
6. Adequate hemostasis – closure
