Showing posts with label M.S.. Show all posts
Showing posts with label M.S.. Show all posts
Total Knee Replacement in Severly Deformed Rheumatoid Knee: A Case Study
Monday, August 3, 2009
Rheumatoid arthritis is a well known systematic inflammatory disease wherein arthritis of synovial joints is a major component. This disease is common in females and affects during third, fourth and fifth decades of their life. Initially the disease starts with pain and joint stiffness in small joints of hand and later involves big joints like hip, knee, shoulder and elbow. In an advanced rheumatoid arthritis all the joints of the body are involved.
Treatment of rheumatoid arthritis is ideally to be done by rheumatologist. Start with NSAIDS and later go on to combination therapy of DMARDS (steroids, methotrexate, leflunomide, sulfasalazine chloroquine and oral gold salts).
An Orthopedics role comes only after joint pain/ swelling and deformity are not controlled by medical treatment.
Indication of joint replacement in rheumatoid arthritis.
1. Severe pain in joints
2. Inability to do daily activities
3. Progressing deformity
4. Joint stiffness
Advantages of joint replacement
1. Painless and stable joints
2. Good functional movements of joints
3. Improvement in quality of life
4. Better disease control after surgery
With advent of new implants, good operation theatres, laminar flow and surgical expertise, it is possible to perform joint replacements even in severely deformed joints which was thought impossible previously.
Knee Replacement on a patient with severe Rheumatoid Arthritis
A 58 year old female patient consulted us with severe knee pain for four years. She was a known case of rheumatoid arthritis on medical treatment,she was unable to stand or walk and had severe pain on bending the knee.
This lady was poorly nourished and anemic. Local examination of both knees revealed that she has wind-swipe deformity. Right knee was in 30 varus deformity and range of movement was 0-90. Left knee was in 40 valgus and further valgus till 70. Range of movement was 0-30. X-ray of right knee showed severe varus deformity with medical tibial condyle defect and lateral subluxation of tibia. Left knee - severe valgus deformity with central tibial bone defect and lateral patellar subluxation.
Patient was admitted and complete pre-operative work done. The team of Orthopaedic surgeons headed by Dr. Sanjay Pai, Rheumatologist .A total knee replacement was done in a staged manner. First the right knee with varus deformity was operated using a revision total knee replacement implants. After five days, the left knee with severe valgus deformity was operated. Post operative period was uneventful and without complications.
The patient was mobilized on the third day with walker and was discharged on the sixth day. On the 12th day, the patient was able to walk without support, able to climb stairs and do her daily activities.
With Good surgical expertise along with highly efficient support staff now available in India and , these patients can get back their normal daily life style which was thought impossible in the past.
Courtesy: Dr. Sanjay Pai, M.S.
Dr. Srinivas J V, M.S.
Dr. Vasudev N Prabhu, M.S.
Department of Orthopaedic Surgery Wockhardt Hospitals, Bangalore
Minimally Invasive Ligament Construction in Children
Tuesday, July 21, 2009
Anterior Cruciate Ligament injuries are becoming increasingly common in the young active individual. MRI has also contributed significantly to the early diagnosis of these injuries. Treatment of ACL (Anterior Cruciate Ligament) injuries in the child and young adolescent remains controversial. This is especially so in the case of small children whose skeletons are yet to mature.Any treatment plan must consider an assessment of the patients’ physical maturity, level of functional instability and identification of associated injuries. While a trial of non operative treatment may still be upheld by some, most reports of non operative treatment have demonstrated poor results. The natural history of the ACL deficient knee is one of recurrent episodes of giving way with resultant multiple meniscal tears and early degenerative arthritis.
Arthroscopic Reconstruction Transphseal Hamstring Graft
Arthroscopic ACL reconstruction is an elegant solution to this problem.Physeal sparing techniques have yielded poor results and therefore transphyseal techniques is one of the best solution to the problem.
The Hamstring tendon graft using semi tendinosus and Gracilis tendons or quadruped semi tendinosis graft provides an exceptionally strong and reliable graft. It has the added benefit of being harvested through a small unobtrusive incision. There is no post operative morbidity (as with B.T.B. graft) and the tendons grow back in time.
A quadrupled hamsting tendon provides 250% strength of the normal A.C.L. The most contemporary concept of double bundle grafting can only be affected with Hamstring tendon grafting.
Graft selection is the corner stone upon which optimal intra-articular ACL reconstruction is built; however graft fixation is important to allow early aggressive rehabilitation post operatively. Excellent initial graft fixation strength is essential for good graft tunnel bonding and therefore contributes immensely to the final outcome of this surgery. The first weeks are especially critical.
At the WOCKHARDT KNEE CLINIC we have been using the BIOTRANSFIX system for Femoral tunnel fixation with Bio-interference screw for tibial fixation with excellent results in 77 patients so far. The procedure is especially safe for young children who have significant growth left.
Dr. Gautaum Kodikal, M.S.
Consultant Orthopedic Surgeon
Department of Bone & Joint Care
Wockhardt Hospitals, Bangalore
Dr. Gautaum Kodikal, M.S.
Consultant Orthopedic Surgeon
Department of Bone & Joint Care
Wockhardt Hospitals, Bangalore
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