Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
Unicondylar knee replacement (UKA) is a less invasive procedure than total knee replacement that replaces only the damaged or arthritic parts of one compartment of the knee. UKA aims to resurface the diseased compartment without altering knee joint kinematics by preserving the cruciate ligaments. UKA is indicated for isolated uni-compartmental osteoarthritis with pain localized to one side and intact ligaments. Contraindications include osteoarthritis in both compartments and an absent ACL. Proper technique during UKA involves avoiding overcorrection and preventing tibial spine impingement. Advantages include preserving normal knee function while allowing for quicker recovery, but disadvantages include potential secondary degeneration and loosening requiring conversion to total
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
Prosthetic management of different levels of amputationAamirSiddiqui56
In this presentation, i have covered all the basics about levels of amputation. I have mentioned the different levels of amputation and their prosthetic management. Beneficial for those who are in the field of P & O.
CORA (center of rotation of angulation)Morshed Abir
This document discusses the concept of the center of rotation of angulation (CORA) in orthopedic surgery. The CORA is the point about which a deformed bone may be rotated to achieve correction of an angular deformity without introducing a translational deformity. Proper identification of the CORA allows selection of the optimal correction axis and type of osteotomy, such as opening, closing, or dome osteotomy, to realign the bone. Correction along the bisector line passing through the CORA ensures pure angular correction without residual translation. Identification of multiple CORAs indicates more complex multi-apical or translational deformities requiring different surgical techniques.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
This document summarizes evidence on the use of Knee-Ankle-Foot Orthoses (KAFOs) and Hip-Knee-Ankle-Foot Orthoses (HKAFOs) for ambulation. KAFOs brace the knee and ankle, while HKAFOs also brace the hip. They are used to treat conditions like muscular dystrophy, polio, and stroke. The evidence shows that KAFOs and HKAFOs can improve mobility for individuals with spinal cord injuries or paraplegia when used with gait training or electrical stimulation. However, more research is still needed due to the heterogeneity of patient populations and devices. Cost can also be a limitation, with K
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
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
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
This document discusses implant selection considerations for revision total knee replacement (TKR) surgery. It begins by outlining common causes for revision TKR such as aseptic loosening and polyethylene wear. Key challenges in revision TKR are managing bone defects from osteolysis, compromised soft tissues, and restoring proper limb alignment. Implant options discussed include metaphyseal sleeves and stems to provide fixation in bone defect zones, as well as augmentations. Constraint levels from unconstrained to fully constrained implants are reviewed. Clinical cases demonstrate approaches for addressing instability, significant bone loss, and peri-prosthetic fractures in revision TKR.
Triple arthrodesis is a surgical fusion of the subtalar, calcaneocuboid, and talonavicular joints to provide hindfoot stability and alignment and relieve pain. It is used to treat conditions like rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, Charcot-Marie-Tooth disease, neglected clubfoot, poliomyelitis, and tarsal coalition. The Lambrinudi procedure is used for severe clubfoot and involves wedge resections of the calcaneum, talus, and navicular followed by fixation with K-wires, staples or screws. Postoperatively, the limb is immobilized for 6 weeks followed by ankle-foot orthosis use and weight bearing
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
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.
This document discusses ACL injuries, including evaluation, treatment options, and surgical techniques. It provides details on:
- Tests to evaluate ACL injuries like the Lachman and anterior drawer tests. MRI is recommended if initial tests are positive.
- Surgical timing - it's best to wait 1-3 weeks after injury for swelling to subside before operating to improve visualization.
- Surgical techniques for ACL reconstruction including fixation methods like interference screws and suspensory fixation devices.
- Associated injuries like PCL and MCL tears that may require staged procedures.
- Anatomical considerations like femoral footprints and the double bundle technique to reconstruct both bundles.
The document summarizes the surgical treatment of congenital and habitual dislocation of the patella. These conditions are caused by contracture of the quadriceps mechanism, which is more severe in congenital dislocation. The surgical treatment involves an extensive lateral release, medial plication to realign the patella, and transfer or lengthening of surrounding tendons like the semitendinosus and rectus femoris tendons to further optimize quadriceps alignment and prevent recurrent dislocation. The case study describes the successful surgical stabilization of a 10-year old girl's bilaterally habitually dislocating patellas using various soft tissue procedures like lateral release, medial plication, and advancement of the vastus medialis
J.R. Rudzki gave a presentation on current concepts in shoulder replacement. He discussed the anatomy of the shoulder joint and causes of shoulder arthritis. Treatment options were reviewed, including arthroplasty when conservative measures fail. Surgical techniques for hemiarthroplasty and total shoulder arthroplasty were outlined. Clinical studies showed that both procedures improve function, though total arthroplasty may provide better outcomes. Complications were noted to occur in about 5% of cases. Emerging concepts around reverse total shoulder arthroplasty for rotator cuff arthropathy were presented.
This document discusses advances in hip disarticulation prostheses. It begins by describing hip disarticulation amputation and challenges with prosthetic fitting at this level. It then covers the evolution of prosthetic designs including traditional tilting-table models, the seminal Canadian design, and more recent designs incorporating lightweight materials and anatomical shaping. Key components like the socket, hip joint, and suspension methods are examined. The document emphasizes ongoing efforts to improve mobility, comfort and long-term prosthetic use for individuals with hip disarticulation amputations.
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
High tibial osteotomies are a surgical procedure used to treat unicompartmental osteoarthritis of the knee caused by malalignment. There are several types of high tibial osteotomies including medial opening wedge, lateral closing wedge, medial opening hemicallotasis, and dome osteotomies. Complications can include recurrence of deformity, irritation or failure of implants, nerve palsy, nonunion, infection, or stiffness. Outcomes of high tibial osteotomies are generally good, though some patients may eventually require total knee arthroplasty. High tibial osteotomies can be combined with cartilage restoration procedures, though long-term outcomes of graft survival are mixed.
The quadriceps angle (Q-angle) is formed between the quadriceps muscles and the patella tendon and provides information about leg alignment. A normal Q-angle falls between 12-20 degrees, with males usually on the lower end and females higher due to wider pelvises. Excessive Q-angles can lead to overpronation and changes in quadriceps pull that may cause patella tracking issues. Pain in knee osteoarthritis arises from damage to articular structures like cartilage and subchondral bone as well as periarticular tissues, with nociceptors activating pain fibers. Cartilage degeneration leads to inflammation and sensitization of pain pathways in the peripheral and central nervous systems.
Anterior knee pain is one of the most common conditions affecting active young patients. It has many potential causes including patellofemoral imbalance, lower limb structural abnormalities, and overuse. A thorough history focused on pain location and aggravating/relieving factors is important to identify the underlying cause. Physical examination evaluates alignment, patellar tracking, and identifies tenderness. Imaging like x-rays and MRI may help diagnose conditions like patellar tendinopathy, Osgood Schlatter disease, or cartilage lesions. Treatment is usually initially conservative with physical therapy and modifications, while surgery is considered for issues like instability or advanced arthritis. A holistic approach considering multiple factors is important for managing anterior knee pain.
This document summarizes a study on outcomes of simultaneous high tibial osteotomy (HTO) and ACL reconstruction. The study included 25 patients with chronic ACL deficiency and medial compartment osteoarthritis with varus deformity who underwent combined HTO and ACLR. Results at 3 months, 6 months, and 1 year follow-up showed improved average Lysholm and knee society scores and average correction of tibial angle. Complications included 1 infection, 1 persistent pain case, and 1 hinge fracture extension of osteotomy. None required total knee replacement. The conclusion is that one-stage medial open wedge HTO with ACLR appears to be a safe and effective procedure for treating varus osteoarthritis with anterior instability.
Hip Arthroscopy in 2013: Inova Annual Sports Medicine Programwashingtonortho
This document discusses hip arthroscopy techniques and considerations in 2013. It begins with an overview of the goals of hip arthroscopy which are to relieve pain, improve function, and improve longevity by restoring hip anatomy. It then discusses various pathologies that may be addressed such as CAM lesions, pincer lesions, torn labrums, and cartilage defects. Approaches can be open or arthroscopic. The document emphasizes making the correct diagnosis and understanding concomitant issues. It provides guidance on evaluating patients through history, physical exam including various special tests, and diagnostic injections. Femoroacetabular impingement is discussed as a common cause of labral tears. Techniques for addressing pincer impingement including bony resection are outlined
This document discusses heel pain and plantar fasciitis. It covers the anatomy of the plantar fascia and its connections. Differential diagnosis is discussed. Non-operative treatments include stretching, night splints, orthotics and steroid injections. Surgery is reserved as a last resort and involves plantar fascia release. Gastrocnemius contracture is associated with plantar fasciitis and Achilles tendinopathy. Positive early results are shown for gastrocnemius lengthening (gastroc recession/posterior medial gastrocnemius recession (PMGR)) in recalcitrant cases.
This document discusses ankle fractures and provides information on:
1. The objectives of understanding radiographic parameters, surgical fixation indications, and classification systems for ankle fractures.
2. The evaluation of ankle fractures which involves clinical examination, radiographic views, and stress views to assess ligament injuries.
3. Emergency department management including addressing wounds, splinting, and providing analgesia like conscious sedation or intra-articular blocks for closed reduction.
This document summarizes osteoarthritis (OA), including its definition, epidemiology, risk factors, pathology, diagnosis, and treatment guidelines. OA is the most common form of arthritis characterized by cartilage degeneration. Risk factors include age, obesity, injury and activity levels. All joint structures are affected, resulting in symptoms like pain and stiffness. Treatment involves lifestyle changes, medications, injections, and surgeries like osteotomy or arthroplasty depending on the severity and location of OA.
This document provides guidance on preoperative planning and evaluation for total knee arthroplasty (TKA). It discusses assessing patient expectations and psychological factors, identifying radiographic views needed, evaluating alignment and deformities, differentiating knee pain sources, selecting the appropriate prosthesis based on factors like disease severity and deformity, and the surgeon's goals of recreating alignment, balancing soft tissues, and normal knee movement. Key considerations include patient factors like age, activity level, and comorbidities that may influence outcomes, and surgical factors like constraint level needed based on ligament integrity and deformity.
The role of Cement Augmentation in the Prevention of Spinal Insufficiency Fra...Winston Rennie
The Role of Cement Augmentation in the Prevention of Spinal Insufficiency Fractures. Spinal Vertebral fractures and percutaneous cement augmentation, vertebroplasty and kyphoplasty. The arguments for a role in preventing new spinal fractures and those against it. The flaws in experimental biomechanical studies and the importance of clinical spinal stability. Biplanar bipedicular percutaneous imaging approaches and formal trainig schemes to be established to train new practitioners with a biomechanically based cement placement.
BIOMECHANICAL CONSIDERATIONS IN DISTRACTION OSTEOGENESIS.pptxDr. Genoey George
The document discusses various biomechanical considerations for distraction osteogenesis of the mandible. It covers factors like device placement and orientation, the effects of biological and mechanical forces, and how intermaxillary elastics can be used during active distraction. It also addresses complications that can arise from device placement like developing anterior or posterior open bites if the vector is not parallel to the occlusal plane. Precise planning of device orientation and direction of distraction is important to achieve the desired skeletal changes and occlusal outcome.
Femoral neck fractures most commonly occur in elderly patients due to osteoporosis and osteopenia. Displaced fractures have higher rates of complications like nonunion and osteonecrosis compared to non-displaced fractures. Treatment depends on fracture displacement and patient factors, ranging from non-surgical management of non-displaced fractures to internal fixation, hemiarthroplasty, or total hip arthroplasty for displaced fractures. Large randomized controlled trials have shown that arthroplasty results in better functional outcomes and fewer reoperations compared to internal fixation for displaced fractures in healthy elderly patients.
This document discusses femoroacetabular impingement (FAI), a condition where the femoral head and acetabulum abnormally contact each other, from the perspective of a sports physiotherapist. It describes the two main types of FAI - cam impingement caused by a nonspherical femoral head, and pincer impingement caused by excessive acetabular coverage. Most cases involve a mix of both. Conservative physiotherapy management focuses on reducing inflammation, strengthening muscles, and gentle stretching. Surgical intervention like arthroscopy may be considered if conservative treatment fails to allow athletes to return to play.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
Acute complications of sickle cell disease .pdfRawanAlakwaa
This presentation displays the acute complications of sickle cell disease. It starts by presenting a real case of a child admitted to the hospital because of one of these complications…
Mind Sound Resonance Technique (MSRT)
Mind Sound Resonance Technique (MSRT) Certificate Course
Mind sound resonance technique (MSRT) is one among the advanced relaxation yoga techniques that use the mantra to come to feel the resonance, that
chiefly works through the Manomaya Kosha (2 layers
of existence) to induce deeper relaxation for each mind and body.
MSRT helps to overcome the fear of death, will increase vitality and releases you from the bondage
Cultural Components of Safer Ways of Engagement in Health ResearchCHICommunications
The George & Fay Yee Centre for Healthcare Innovation hosts monthly seminars focused on patient engagement. The series, called Patient Engagement Lunchtime Learning, is geared to all levels of learners looking to understand patient engagement and how to incorporate these best practices into their research projects.
This session was presented on June 12, 2024 by CHI's Patient and Public Engagement Lead and special guest speakers.
A price that is appropriate for massage therapy enables cost-effective healthcare access. If such treatments cost is low, it would provide more individuals with an opportunity to enjoy frequent massages which are crucial in relieving anxiety and pain. Because it is cheap, individuals may incorporate such treatments in their healthcare lifestyles without having to be concerned about how much they spend on themselves. At Malayali Kerala Spa Ajman, we are providing all types of massage services @ 99 AED. Visit us today.
The Future of Hair Loss Treatment: Harnessing Stem Cells with Dr. David GreeneDr. David Greene Arizona
Hair loss is no longer a condition that must be endured in silence. Thanks to the groundbreaking work of experts like Dr. David Greene, stem cell therapy is emerging as a powerful tool in the fight against hair loss. With continued research and development, this innovative approach holds the promise of transforming the lives of those affected by hair loss, offering a future where a full head of hair can be restored naturally and effectively.
Comprehensive understanding of arm balancing asana
Benefits of arm balancing asana
Arm balancing asanas have numerous benefits, including:
Strengthening the arms and shoulders: Arm balancing asanas require a lot of strength in the upper body, particularly the arms and shoulders. Regular practice of these asanas can help to build muscle and increase strength in these areas.
Improving balance and stability: Arm balancing asanas challenge your balance and stability, which can help to improve your overall coordination and body awareness.
Boosting confidence and concentration: Successfully mastering arm balancing asanas can give you a sense of accomplishment and help to build your confidence. Additionally, the concentration required to maintain the balance in these asanas can help to improve focus and concentration.
Stimulating the digestive system: Some arm balancing asanas, such as Bakasana (Crow Pose), can stimulate the digestive system and aid in digestion.
Energizing the body: Arm balancing asanas can help to energize the body and improve circulation, which can lead to increased vitality and overall well-being.
Developing core strength: Arm balancing asanas require a strong core, and practicing these poses can help to develop the muscles of the abdomen and lower back.
Improving flexibility: Many arm balancing asanas require flexibility in the hips, hamstrings, and other areas of the body. Regular practice can help to increase overall flexibility and range of motion.
Contraindications of arm balancing asana
Arm balancing asanas are advanced yoga postures that require strength, flexibility, and stability in the upper body. As such, they can be challenging and have certain contraindications. Some of the contraindications of arm balancing asanas are:
Wrist or shoulder injury: Arm balancing asanas can put a lot of pressure on the wrists and shoulders. If you have a history of wrist or shoulder injury, or if you are currently experiencing pain or discomfort in these areas, it is best to avoid these postures or modify them with the guidance of an experienced teacher.
High blood pressure: Some arm balancing asanas, such as headstand and handstand, can increase blood pressure. If you have high blood pressure, it is important to avoid these postures or practice them under the guidance of a qualified teacher who can help you modify them to make them safe.
Neck injury: Certain arm balancing asanas, such as crane pose and peacock pose, require placing weight on the head and neck. If you have a neck injury, it is best to avoid these postures or modify them with the guidance of an experienced teacher.
Pregnancy: Arm balancing asanas can be risky for pregnant women, especially in the later stages of pregnancy. If you are pregnant, it is important to avoid these postures or practice them only under the guidance of a qualified prenatal yoga teacher.
Inexperienced practitioners: Arm balancing asanas require a certain level of streng
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Week 8 Case of Tiana-DIAGNOSIS OF FEEDING AND EATING DISORDERS CASE STUDY.pdfReliable Assignments Help
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2025 QPP: Proposed Changes from the PFS Proposed RuleShelby Lewis
CMS has released the 2025 PFS Proposed Rule and proposed several changes to the Quality Payment Program. Here is a slideshow that highlights the key changes.
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DM Pharma is one of the top 10 antibiotic manufacturers in India, known for its dedication to quality and innovation. They produce a wide range of antibiotic medications, ensuring effective treatment for various bacterial infections. With state-of-the-art facilities and strict quality control measures, DM Pharma consistently delivers safe and reliable products. Their commitment to excellence has earned them a strong reputation in the pharmaceutical industry. As a leading manufacturer, DM Pharma continues to meet the growing demand for high-quality antibiotics, making a significant impact on healthcare in India and beyond.
Benefits:
This Mudra is useful for people to sweat a lot, this mudra helps the body to retain water.
There are no other specific uses of this Mudra.
It is found that, if you have to pee but for some reason you can’t go, performing this Mudra will reduce the bladder pressure and you can hold it in for a bit longer.
Nursing informatics represents a dynamic specialty within the field of nursing and healthcare, bridging the realms of nursing science with diverse information management and analytical sciences. At its core, nursing informatics encompasses a comprehensive approach to identifying, defining, managing, and communicating crucial elements such as data, information, knowledge, and wisdom that are pivotal to the practice of nursing. By leveraging cutting-edge technology and sophisticated data systems, nursing informatics aims to enhance healthcare outcomes and enrich patient care experiences.
This specialized field plays a vital role in optimizing nursing workflows, streamlining communication among healthcare providers, and promoting evidence-based decision-making processes. Through the effective utilization of electronic health records (EHRs), telehealth platforms, and other innovative technologies, nursing informatics empowers nurses to deliver personalized care that is both efficient and informed by the latest advancements in healthcare.
Furthermore, nursing informatics serves as a catalyst for continuous improvement within healthcare settings, facilitating the integration of best practices and standards across diverse clinical environments. By fostering collaboration between nursing professionals, IT specialists, and healthcare administrators, this discipline promotes a culture of innovation and adaptability essential for meeting the evolving needs of patients and healthcare organizations alike.
In essence, nursing informatics embodies a commitment to harnessing the power of information and technology to elevate the quality of care delivered at every stage of the patient journey, from assessment and diagnosis to treatment and ongoing management. By embracing interdisciplinary collaboration and staying abreast of emerging trends in healthcare informatics, nurses specializing in this field are instrumental in shaping the future of nursing practice and advancing the overall quality and safety of patient care.
Comprehensive understanding of hip opening asana
Benefits of hip opening asana
Hip-opening asanas can offer a variety of benefits, including:
Improved flexibility: Hip-opening asanas can help increase range of motion and flexibility in the hips and surrounding areas, such as the lower back and thighs.
Reduced lower back pain: Tight hip flexors can contribute to lower back pain, so opening up the hips can help alleviate discomfort in the lower back.
Improved posture: Tight hips can lead to poor posture, so opening the hips can help improve posture and alignment.
Stress relief: Many hip-opening asanas involve deep stretching and relaxation, which can help reduce stress and tension in the body.
Improved circulation: Asanas that stretch and open the hips can improve circulation to the area, which can help reduce inflammation and promote healing.
Increased energy: Hip-opening asanas can stimulate the second chakra, which is believed to be associated with creativity and energy. This can help increase energy levels and feelings of vitality.
Emotional release: The hips are often referred to as the "emotional junk drawer" of the body, as they can hold onto tension and emotions. Hip-opening asanas can help release these emotions and promote a sense of emotional release and well-being.
Contraindications for hip opening asana
Hip opening asanas are generally safe for most people, but there are some contraindications that one should keep in mind. Some of the contraindications for hip opening asanas are:
Recent hip or knee injury: If you have a recent injury to the hip or knee, it is best to avoid hip opening asanas until the injury has healed.
Joint instability: People with joint instability or hypermobility should be cautious while performing hip opening asanas as they may put excessive strain on the hip joint.
Hip replacement: If you have had a hip replacement surgery, it is important to avoid hip opening asanas until your doctor clears you for these movements.
Sciatica: If you have sciatica, you should avoid any hip opening asanas that aggravate the pain. It is best to consult a healthcare professional before practicing any yoga asanas.
Pregnancy: Pregnant women should avoid deep hip opening asanas or modify them under the guidance of a qualified yoga instructor.
Osteoporosis: People with osteoporosis should be cautious while practicing hip opening asanas as they may put excessive stress on the hip joint.
It is always advisable to consult a healthcare professional before practicing any yoga asanas, especially if you have any health concerns or medical conditions.
Counterpose for hip opening asana
Counterposes for hip opening asanas can vary depending on the specific pose being practiced, but some common counterposes include:
Forward folds, such as Uttanasana (Standing Forward Bend) or Paschimottanasana (Seated Forward Bend), can help stretch and release the hamstrings and lower back muscles after hip opening asanas.
kneeling asana - Comprehensive understanding of kneeling asana
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
1. Proximal Fibular Osteotomy
for Knee Osteoarthritis
- What is the evidence?
Dr Saseendar, MS, DNB, Dip SICOT,
FISOC (USA), FASS (Sing), FAPKASS, FASS (Korea),
Consultant Shoulder and Knee Arthroscopy Surgeon,
CARE Sports Injury, Chennai and Apollo Hospitals
2. Saseendar S, Kambhampati SBS, Samundeeswari S. Proximal fibular osteotomy in the
treatment of medial osteoarthritis of the knee – A narrative review of literature. Knee Surg &
Relat Res 31, 16 (2019) doi:10.1186/s43019-019-0016-0.
3. Medial osteoarthritis of the knee
• Knee - commonest site of osteoarthritis (OA)
• Significant research & advances in treatment of medial OA
• Surgical options for treatment
• High Tibial Osteotomy
• UKA
• TKA
9. Methodology
• Articles in English
• Articles which combined PFO with other surgical procedures (eg. HTO,
UKA) were excluded
• Bibliography of the articles were also searched
• Total ten articles that assessed clinical or biomechanical effects of PFO in
medial OA
• Outcomes and mechanisms proposed were studied
• Systematic review could not be done (few long-term studies)
11. Biomechanics of the varus knee
• Femur
• Functional decrease in femoral neck-shaft valgus
• Lateral bowing of the femoral shaft
• Reduction in the condylar shaft angle
• Mechanical axis shifts medially
Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, et al. A radiographic
analysis of alignment of the lower extremities--initiation and progression of varus-type knee
osteoarthritis. Osteoarthr Cartil 2015;23(2):217-23.
12. Biomechanics of the varus knee
• Tibia
• Tibial plateau compression leads to steeping of medial plateau in early OA
• Bowing of tibia occurs later
• Mechanical axis shifts medially
Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, et al. A radiographic
analysis of alignment of the lower extremities--initiation and progression of varus-type knee
osteoarthritis. Osteoarthr Cartil 2015;23(2):217-23.
13. Biomechanics of the varus knee
• Load-bearing in proximal tibia happens primarily in trabeculae rather than the peripheral cortex
Hvid I. Mechanical strength of trabecular bone at the knee. Dan Med Bull 1988;35(4):345-65.
Aging
Trabecular
osteopenia
Trabecular
collapse
Steeping
of medial
plateau
14. Origin of Proximal Fibular Osteotomy
• Yazdi et al (2014)
• Survey of joint reaction forces in cadaver knees after fibulectomy (fibula cuff resection for nonunion tibia, fibular tumor
resection, fibula graft harvest)
• Found decrease in the medial compartment pressure and
• Increase in the lateral compartment pressure
• Suggested that performing fibulectomy along with tibial osteotomies can have protective effect
Yazdi H, Mallakzadeh M, Mohtajeb M, Farshidfar SS, Baghery A, Givehchian B. The effect of partial fibulectomy
on contact pressure of the knee: a cadaveric study. Eur J Orthop Surg Traumatol 2014;24(7):1285-89.
15. Origin of Proximal Fibular Osteotomy
• Yang et al (2015)
• Published results of retrospective series of PFO surgeries performed since 1996
• Third Hospital of Hebei Medical University, Hebei, China
• Zhang, the senior surgeon attributes the idea to one of his students from a rural
hospital in China
Yang ZY, Chen W, Li CX, Wang J, Shao DC, Hou ZY, et al. Medial Compartment Decompression by Fibular
Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study. Orthopedics 2015;38(12):e1110-4.
16. Rationale behind PFO
1. Concept of nonuniform settlement
2. Too many cortices theory
3. Slippage phenomenon
4. Concept of competition of muscles
5. Dynamic fibular distalisation theory
18. Concept of nonuniform settlement
• Bone density of fibula higher than medial tibial plateau
• Osteoporosis leads to settlement
• However, fibular support does not allow lateral tibial plateau to settle
• Resultant varus deformity
Dong T, Chen W, Zhang F, Yin B, Tian Y, Zhang Y. Radiographic measures of settlement
phenomenon in patients with medial compartment knee osteoarthritis. Clin Rheumatol
2016;35(6):1573-78.
19. A - Normal knee
medial tibial load-bearing capacity =
cumulative lateral load-bearing capacity (tibial+fibular)
B – osteoporotic knee
medial tibial load-bearing capacity <
cumulative lateral load-bearing capacity (tibial+fibular)
20. Settlement value
• Height difference between highest point of lateral
tibial condyle and the lowest point of medial tibial
condyle
Dong T, Chen W, Zhang F, Yin B, Tian Y, Zhang Y. Radiographic measures of
settlement phenomenon in patients with medial compartment knee
osteoarthritis. Clin Rheumatol 2016;35(6):1573-78.
21. Settlement value
• positively related to knee varus
• positively related to Kellgren Lawrence grading of OA of the knee
22. • PFO - support of fibula is removed
• Lateral side “settles” down – Uniform settlement
C – Post PFO knee
medial tibial load-bearing capacity =
lateral load-bearing capacity (tibial + fibular)
B – osteoporotic knee
medial tibial load-bearing capacity <
cumulative lateral load-bearing capacity (tibial + fibular)
• Correction of deformity
• Relief in symptoms
23. Too many cortices theory
• Medial condyle - supported by one cortex
• Lateral condyle - supported by one tibial
cortex and two fibular cortices
• Leads to differential loading when medial
side collapses in a varus deformed knee
with intact fibula
24. Slippage phenomenon
• In varus knee, femur slides to the medial side - coronal tibiofemoral
subluxation or slippage phenomenon
• Maintains a high Knee Adduction Moment (KAM)
• Progression of varus deformity and pain
25. Concept of competition of muscles
• Uniform settlement after PFO takes time
• Can explain slow improvement in symptoms
• What is the reason for early symptomatic relief?
• Immediate improvement in HKA angle after high fibular osteotomy
• A rectified non-uniform settlement wouldn't be expected to be
evident immediately after a fibula resection
26. Concept of competition of muscles
• Nie et al analysed the activity of muscles after high fibular osteotomy
• increased in the long head of biceps femoris
• decreased in the peroneus longus
Nie Y, Huang ZY, Xu B, Shen B, Kraus VB, Pei FX. Evidence and Mechanism by which Upper
Partial Fibulectomy Improves Knee Biomechanics and Decreases Knee Pain of Osteoarthritis. J
Orthop Res 2018
27. Concept of competition of muscles
• Competition of muscles between Biceps femoris & Peroneus after
high fibular osteotomy created a vectior in the direction of valgus
28. Dynamic fibular distalisation theory
• Qin et al - 67 PFOs
• Clinical improvement proportional
• to distalisation of fibula and
• inclination angle of the proximal tibiofibular joint
• Compressive forces from distal fibula not transmitted to proximal fibula
Qin D, Chen W, Wang J, Lv H, Ma W, Dong T, et al. Mechanism and influencing factors of proximal
fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med
Res 2018;46(8):3114-23.
29. Dynamic fibular distalisation theory
• Muscles attached to proximal fibula (soleus, peroneus longus) pulled
fibular head in the distal direction - tensile force transmitted to LFC
through LCL
• Greater the distal displacement of the fibular head, better the correction
of varus deformity & the more significant the improvement in symptoms
Qin D, Chen W, Wang J, Lv H, Ma W, Dong T, et al. Mechanism and influencing factors of proximal fibular
osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res
2018;46(8):3114-23.
30. More outcomes
• Huang et al – Valgus of 5-7 degrees at three months after the operation
• Most studies –
• increased valgus of knee
• improvement in medial joint space Radiographs at one year
• Wang et al24 - 46 patients with PFO, follow up of 12 months
• Significant decrease in VAS
• Improvement of knee and function subscores of American Knee Society Score
• Increase in medial joint space
Huang W, Lin Z, Zeng X, Ma L, Chen L, Xia H, et al. Kinematic Characteristics of an Osteotomy of the Proximal
Aspect of the Fibula During Walking: A Case Report. JBJS Case Connect 2017;7(3):e43.
31. Prognostic factors for better outcome
• Liu et al - 84 patients (111 knees)
• Patients with near-normal HKA Angle
(PFO can only partially correct varus deformity of tibial plateau)
• Patients with higher settlement value
(higher the settlement value, higher effect of lateral fibula support)
Liu B, Chen W, Zhang Q, Yan X, Zhang F, Dong T, et al. Proximal fibular osteotomy to treat medial compartment knee
osteoarthritis: Preoperational factors for short-term prognosis. PLoS One 2018;13(5):e0197980.
32. • Pre and postoperative radiographs
• female 63 years old
Utomo DN, Mahyudin F, Wijaya AM, Widhiyanto L. Proximal fibula osteotomy as an alternative to TKA and HTO
in late-stage varus type of knee osteoarthritis. J Orthop 2018;15(3):858-61.
33. • Improvement in axial alignment
• 79-year-old woman
Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W, et al.
Proximal fibular osteotomy: a new surgery for
pain relief and improvement of joint function in
patients with knee osteoarthritis.
J Int Med Res 2017;45(1):282-89.
34. • Improvement in the joint space ratio
Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W, et al. Proximal fibular osteotomy: a new surgery for pain relief
and improvement of joint function in patients with knee osteoarthritis. J Int Med Res 2017;45(1):282-89.
35. Surgical Procedure
• Resect a segment of the fibula
• 6-10 cm from the fibular head
• Nie et al – b/w extensor digitorum longus & peroneus longus/ peroneus
brevis
• Yang, Liu – b/w peronei & soleus
36. Surgical Procedure
• Influenced by common peroneal nerve and its branches
• Lower half of fibula – best
• Why proximal fibula, why not distal fibula?
• Incision in proximal half
• should be posterior to the coronal plane
• avoids peroneal nerve and its branches (lie in front of the coronal plane)
Ogbemudia AO, Umebese PFA, Bafor A, Igbinovia E, Ogbemudia PE. The level of fibula osteotomy and
incidence of peroneal nerve palsy in proximal tibial osteotomy. J Surg Tech Case Rep 2010;2(1):17-19.
37. Complications
• Peroneal Nerve palsy
• Yang et al
• 1.8% common peroneal nerve(CPN)
• 1.8% superficial peroneal nerve palsy which recovered completely between 3 and
10 months
• 14.5% had weakness which returned to normal within 4 weeks
Yang Z-YY, Chen W, Li C-XX, Wang J, Shao D-CC, Hou Z-YY, et al. Medial Compartment Decompression by Fibular Osteotomy
to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study. Orthopedics 2015;38(12):e1110-4.
38. Scope for future research
• Double blinded RCTs
• Male vs female patients?
• Post traumatic varus deformity with medial osteoarthritis?
• Maximum varus angle until which the procedure can be successful?
• Combination strategies with?
• Cell-based regeneration strategies?
• Arthroscopy?
• Longevity of survival before needing TKA/ HTO/ UKA?
39. Saseendar S, Kambhampati SBS, Samundeeswari S. Proximal fibular osteotomy in the
treatment of medial osteoarthritis of the knee – A narrative review of literature. Knee Surg &
Relat Res 31, 16 (2019) doi:10.1186/s43019-019-0016-0.