Total knee replacement is a salvage procedure in orthopaedic surgery to provide a painless, mobile and stable knee joint to improve quality of life of patients suffering from afvanced painful arthritis commonly osteoarthritis, rheumatoid arthritis and rarely post-traumatic arthritis. Damaged cartilages and bones are carefully removed by measured resection and the collateral ligaments are preserved and balanced for creating a equal gap both in knee flexion as well as in knee extension for restoring anatomy. the main indication for doing total knee replacement is pain relief. The overall functional outcomes in terms of functional results are good after total knee replacement. Wound infection must be prevented by strict aseptic precautions during surgery.
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.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
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.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
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
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
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
The slide is about the prosthetic devices. how they are design and implemented along with the relation with the biomechanics. We have also discuss about the scenario in context of nepal.
>Prepared by the Biomedical Engineering Student Nepal
Successful knee replacement surgery India by experienced highly qualified surgeons & latest advanced surgical techniques with the help of Tour2india4health.
The first knee replacement was performed in 1968. Since then, improvements in material selection and techniques have greatly increased its effectiveness.
The study of biomaterials by biomedical engineers has led to advancements in more accurate sizing, the option of patella femoral replacement, better instrumentation as well as components that allow an increased range of motion and a lower wear rate have since been developed and implemented. During this period the collaboration between surgeons and engineers produced many developments in the design of the prosthesis. Today this procedure is safe and established even if in continuous development. The progress in technologies and the use of new materials let researches try again old-fashioned techniques from the past in order to be improved.The most common reason for knee replacement is that other treatments (weight loss, exercise/physical therapy, medicines, injections, and bracing) have failed to relieve arthritis-associated knee pain. The goal of knee replacement is to relieve pain, improve quality of life, and maintain or improve knee function
Scope
Possible disadvantages of knee replacement surgery include replacement joints wearing out over time, difficulties with some movements and numbness. A replacement knee can never be quite as good as a natural knee – most people rate the artificial joint about three-quarters average (Marian et al.,2021)
Most knee replacements aren’t designed to bend as far as your natural knee. Although it’s usually possible to kneel, some people find it uncomfortable to put weight on the scar at the front of the knee. There may be some numbness at the outer edge of the spot. This usually improves over about two years, but it’s unlikely that the feeling will ultimately return to normal. A replacement knee joint may wear out after a time or may become loose.
, total knee replacement can help relieve pain that emanates from arthritis restoring the normal mobility of an individual. The procedure involves removing the damaged bone and cartilage from the thigh bone, shin bone, and kneecap and replacing it with an artificial joint made of metal alloys, high-grade plastics and polymers. However, despite having its advantages, total knee replacement surgery carries several risks such as infection, blood clots in the leg veins or lungs, heart attack, stroke and nerve damage. The artificial knee can also wear out due to excessive use. Excess glue is squeezed out to the side as the element is pressed into place and removed. The cement hardens quickly, the incision is closed using several layers of sutures, and a bandage is applied
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
Currently favored Biomaterials in total hip replacementsBhaskarBorgohain4
It was Sir John Charnley who popularized total hip replacement after his phenomenal success using PMMA cold curing bone cement to perform cemented hip replacements. His method of fixation still remains the gold standard for component fixation especially for the femoral stem. Over the years cementless or uncemented designs have come into application to avoid risk of cement related complications. Similarly metal on polyethylene articulation has been criticized for PE wear and aseptic osteolysis. This led to increasing use of ceramic head on highly cross linked PE cup articulation. Metal on metal designs came and gone due to the problem of metalosis and pseudotumors. Ceramic on ceramic articulation is reportedly best in terms of wear rates. Hybrid hip replacements are also increasing especially in younger patients of AVN. Accelerated biotechnological developments are happening in this field to improve long term outcomes and implant survival.
Bone substitutes and void fillers in managing Cystic bone tumors and tumor li...BhaskarBorgohain4
In clinical settings there are several fairly common bone tumors or tumor like conditions that can causes a pathological bony cavity. These cavity can lead to pathological fracture. Giant cell tumors, simple bone cyst( SBC, UBC), fibrous dysplasia, giant cell tumors (GCT), aneurysm bone cysts( ABC) are well known entity. Autologous bone grafting , allograft or various bone substitutes are being increasingly used to fill up such voids or cavity after curettage to provide immediate cavity obliteration, provide mechanical support and promote long term healing the cavity.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
Sports injury epidemiology: Its Treatment and Prevention in the Northeast India BhaskarBorgohain4
Love for sports is innate to youths of the north east India. the north eastern region of India is a sports talent pool. Mary Kom from Manipur captured the imagination of the nation by her boxing skills, Somdev Devvarman from Tripura by his tennis, Shiva Thapa by boxing...so on and so forth. There is a felt need but there is no regional sports injury management centre in the north eastern region. Sports injury surveillance is required for understanding, monitoring and formulate prevention strategy.
Once you have completed your research work the next important thing is to publish your work. you need to communicate your finding scientifically but while doing so you need to keep it short , precise, interesting, easy going and story like to have a wider scientific and public interest and appeal. The classical approach to present your work as a manuscript by follow the well known IMReD protocol: Introduction, Methods, Results and Discussion. Every section is unique in its own right but all section must be cohesive and flowing from one section to the next like a flowing river of continuity and lucidity to sustain interest of the reader. The title of the manuscript is like the trailer of the movie. The abstract is the summary of the story in the movie. Originality, novelty, rigorous attention to details of methodology, appropriateness of statistical method, clarity and good language skills are a big advantages in avoiding pitfalls of manuscript in scientific and biomedical writing for research publications.
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
How to do a Literature search for your research and scientific publication BhaskarBorgohain4
In the age of information boom it may be challenging task to find relevant information for your research work. its like finding a needle in a haystack. After initial readings from textbooks and library journals you may want to first search in Wikipedia, google, google scholar and then go to Pubmed, Medline, science direct , wileyonline, science.gov, cochrane library etc to formulate your keywords based on your research question. read a medical dictionary to find synonyms of the keywords and brainstorm with your supervisor, peers, friends etc to get more key words to search again and find the right search strategy. do not forget to look for Grey literature like unpublished Thesis works from reputed universities, proceedings of conferences of reputed professional associations as well. keep records using a software like end-note, Rayyan etc. References of authors must be recorded as you go along.
Neurorobotics and Advances in rehabilitation engineeringBhaskarBorgohain4
Advances in robotics,mechatronics,cyborgs and disruptive technologies for heptics, brain machine interfaces and neurorobotics are bringing a sea change to the field of rehabilitation engineering. Carbon fibre cheetah blades, Bionic arms, c legs are helping the amputees to the extent that amputees can now run in competitive sports at the level of summer Olympics.
Common Musculoskeletal (orthopedic) disorders in elderlyBhaskarBorgohain4
elderly and geriatric old age people tend to suffer many orthopedic disability due to common functional limitations and mobility issues as a result of pain from osteoarthritis, osteoporotic fractures, low back pain and degenerative spinal disorders like lumbar spondylosis and vitamin D and nutritional deficiencies. early diagnosis , prevention, timely surgical interventions and optimum rehabilitation are paramount to bring elderly to pre-injury state of functional independence.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
5. Knee is that largest joint in the body
Hyaline type cartilage ends
Femur & tibia are joined by a complex ligaments,
muscle-tendon units
Patella: serves as a bony fulcrum for to slide over
and amplify strength and torque
Complex hinge joint: Knee can not only bend and
flex, it can twist and rotate
6. Total knee replacement (TKR) is one of the
most successful surgeries of modern time in
Orthopaedics.
The goals of the surgery are complete pain
relief and improve function of the affected
joint.
Deformity correction, increase bending of the
knee joint due to improved range of motion,
besides pain relief is also possible.
7. The NEIGRIHMS orthopaedic department
started performing Total hip replacements
since 2007 and Total knee replacements since
2010.
Since then, these state of the art surgeries are
being performed successfully and with
negligible infection rates.
8. We do both cemented (traditional) as well as
cemmentless (advanced) total hip replacement
and time tested fixed bearing total knee
replacements.
These surgeries are first of its kind in the state
of Meghalaya and some of these are performed
even for the very first time in North-East India.
9. Osteoarthritis causes pain, deformity and loss of
function.
Usually done > 65 years so that single surgery serves
the lifetime of a person.
TKR is indicated in advanced osteoarthritis of knee,
which can be primary or secondary to rheumatoid
arthritis, gout, post-traumatic degenerative arthritis
and rarely in painful but healed tubercular arthritis etc.
TKR is indicated when the pain is severe enough to
affect the activities of daily living (ADL) significantly
requiring regular painkiller.
11. Replace with appropriate sized metallic components.
The metallic implants are held secured to the bones
by using PMMA bone cement.
The implants are metal alloys and a polyethylene
insert is inserted in-between the metals to reduce
friction during movements of walking.
Tight ligaments are released to correct any deformity.
Sometimes the undersurface of the patella also needs
replacement
12.
13. Metal implants made from nickel chrome alloys
Though there is toughness in these systems, they tend
to roughen and scratch over time
Scorpio NRG
Knee Flexed ™
Triathlon PS
Knee System ™
Scorpio TS Revision
Implants Front View ™
ADVANCE STATURE®
Knee
16. Current consensus among knee surgeons is.....
Flexion contractures should be corrected to the maximum extent
possible at the time of surgery.
Aim: Balanced the “ flexion – extension gap”
24. A 79 year old diabetic gentleman from Manipur with severe painful
OA of Both knee; Father of a pharmacist: both knee surgery done at
NEIGRIHMS
He could go back home walking with a single walking stick after stitch removal.
25. The artificial components inserted into the knee are not
linked to each other
Rely exclusively on the body’s muscles, ligaments, and
tendons to keep the kneecap in place.
no stability built into the system.
Most common type of replacement
26. Many patients can walk a bit by second or third day
with support from the trained physiotherapist.
Most patients have an uneventful post operative
period.
But certain patients have a higher risk of post operative
wound complications like patients with diabetes
mellitus, rheumatoid arthritis, malnutrition and elderly
etc.
27. • Physical Therapy
• Gradually return to normal
activities
– Walking, climbing stairs
– No running, playing tennis
as it may wear the artificial
joints
• Doctors recommend a CPM
(Continuous Passive
Motion)
– It slowly and smoothly
bends and straightens your
knee
• Stationary Bicycle – regain
strength in knee and leg
muscles
• Swimming
28. Early active quadriceps strengthening
Aggressive full extension of knee
3-4 sessions of stretching recommended/day as many of these
patients were accustomed to maintain the knee in a flexed
position prior to surgery.
Discourage patient from putting pillow behind knee/ sitting in
reclined chairs
Knee immobiliser/ night splints for those who lack extension,
obese patients and those who sleep in fetal position with knees
flexed
Evaluation for ROM at 6 weeks, 3 months and 1 year – slow
progressers may require MUA
Excellent post-op analgesia
29. • Used when the knee is highly unstable : the person's
ligaments unable to maintain stability
• Severely damaged knees
• The two metalic pieces are connected with a hinge-like
device that keeps the joint in-line & support proper
alignment for function.
– Though It doesn’t last as long as the other knee
replacements
30. COVENTIONAL TKR is possible and appropriate in:
MODERATE CASES with NORMAL LIGAMENTS
UKR- Unicondylar knee
Hinged
knee
31. • Used when the knee is highly unstable : the person's
ligaments unable to maintain stability
• Severely damaged knees
• The two metalic pieces are connected with a hinge-like
device that keeps the joint in-line & support proper
alignment for function.
– Though It doesn’t last as long as the other knee
replacements
32. It is performed if the damage is limited to one
side of the joint only with the remaining part of
the knee joint being relatively spared
The incision is only three inches compared to 8
inches for a total knee replacement
Less invasive and more successful
33. Dislocation of knee after surgery can happen due to error:
Poor ligament balancing or incompetent ligaments
These are not our cases – but needs to be aware of this problem
34. postoperative infection
With more awareness among people about TKR
number of patients is bound to increase
Overall high cost of the implants / accessories until
recent NPPA Guidelines, only limited the number of
beneficiaries.
With increasing coverage under various health
schemes like RANS / Government sponsored health
insurances, more and more elderly with painful
arthritis are likely to get benefits of TKR in the future.
35. All OT staff, Nursing personnel in successfully
conducting successful surgeries
Anesthesia team for their support
Physiotherapy unit
NEIGRIHMS Admin
Faculty colleagues
All SRDs, orthopaedics
