Cirugía de reemplazo de hombro en Delhi / Shoulder Replacement Surgery In Delhi

http://www.delhiarthroscopy.com/arthritis-shoulder-replacement.html

Shoulder Replacement Surgery In Delhi

Cirugía de reemplazo de hombro en Delhi

Sobre su hombro

La articulación del hombro es una articulación de rótula . La mayor parte de los movimientos del hombro ocurre cuando la pelota en la parte superior del hueso del brazo ( húmero) encaja en el zócalo ( gleniod ), que es una parte de la escápula ( omóplato) . Artritis del hombro se desarrolla cuando lisas , superficies de deslizamiento de la bola y el zócalo están dañados.

¿Cuáles son los síntomas de la artritis del hombro conjunta?

Hombro artritis conjunta suele estar presente como el dolor y la rigidez de la articulación del hombro . El paciente tendrá dificultad para levantar el brazo y tendrá problema en el desempeño de su día a día las actividades . En la artritis avanzada , el paciente puede tener dolor incluso en reposo y perturbará su sueño también.

¿Por qué la junta necesita ser reemplazado ?

La razón más común para la sustitución de la articulación del hombro son para la artritis, ya sea osteoartritis ( desgaste) o la artritis reumatoide. También puede ser necesario después de una mala fractura . Con la artritis de la articulación se vuelve doloroso y difícil de mover . A veces la capa profunda de los músculos ( manguito de los rotadores ) que controlan los movimientos del hombro también puede estar desgastada o dañada . En la cirugía de reemplazo de hombro , la articulación dañada se reemplaza con dispositivos compatibles con bio que proporcionan suave y sin dolor rango de movimiento. La razón principal para hacer la operación es reducir el dolor en el hombro . En última instancia, es posible que tenga más movimiento en el hombro. Esto depende de la rigidez en la articulación de la era antes de la operación y si los músculos alrededor del hombro se dañan y no pueden trabajar normalmente.

About your Shoulder

Shoulder joint is a ball and socket joint. Most of shoulder movements occur where the ball at top of your arm bone (humerus) fits into the socket (gleniod) which is a part of shoulder blade (scapula). Arthritis of the shoulder develops when smooth, gliding surfaces of the ball and socket are damaged.

What are the symptoms of Shoulder joint Arthritis?

Shoulder Joint arthritis usually present as pain and stiffness of the shoulder joint. The patient will have difficulty in raising his arm and will have problem in performing his day to day activities. In advanced arthritis the patient may have pain even at rest and will disturb his sleep too.

Why the joint needs replacement?

The most common reason for replacing the shoulder joint are for arthritis, either osteo-arthritis (wear and tear) or rheumatoid arthritis. It may also be necessary following a bad fracture. With arthritis the joint becomes painful and difficult to move. Sometimes the deep layer of muscles (rotator cuff) which control shoulder movements can also be worn or damaged. In shoulder replacement surgery, the damaged joint is replaced with bio-compatible devices that provide smooth and painless range of motion. The main reason for doing the operation is to reduce the pain in your shoulder. Ultimately you may also have more movement in your shoulder. This depends on how stiff the joint was before the operation and if the muscles around the shoulder are damaged and unable to work normally.

Reverse Shoulder Arthroplasty is a special type of Joint replacement done for arthritis due to long standing Rotator Cuff tear.

http://hollandboneandjoint.com/shoulder.html

Shoulder Arthroscopy

Daños en el hombro puede ocurrir en los huesos, el cartílago o los ligamentos. Si el dolor de este daño se convierte en grave y no responde a los tratamientos no quirúrgicos, la artroscopia puede ser una opción. La artroscopia es una alternativa a "abrir" la cirugía que expone completamente la articulación del hombro. 

La artroscopia se puede recomendar para problemas en el hombro, tales como: 

Un desgarro del manguito rotador (los tendones del hombro especializados) 

Un espolón óseo o inflamación alrededor del manguito de los rotadores 

Pinzamiento del hombro, para quitar el espolón "pellizcar" 

Un anillo roto o dañado el cartílago (labrum) o ligamentos 

La inestabilidad de hombro, en la articulación del hombro está suelta y se desliza alrededor demasiado o se disloca (se sale de la articulación de rótula) 

Un tendón del bíceps roto o dañado 

Inflamación o daño en el revestimiento de la articulación, a menudo causada por la artritis reumatoide 

Artritis de la clavícula 

Extracción de tejido suelto

Damage to the shoulder can happen in the bones, cartilage or ligaments. If pain from this damage becomes severe and does not respond to nonsurgical treatments, arthroscopy may be an option. Arthroscopy is an alternative to “open” surgery that completely exposes the shoulder joint.

Arthroscopy may be recommended for shoulder problems such as:

• A torn rotator cuff (the specialized shoulder tendons)
• A bone spur or inflammation around the rotator cuff
• Shoulder impingement, to remove the "pinching" spur
• A torn or damaged cartilage ring (labrum) or ligaments
• Shoulder instability, where the shoulder joint is loose and slides around too much or becomes dislocated (slips out of the ball and socket joint)
• A torn or damaged biceps tendon
• Inflammation or damaged lining of the joint, often caused by rheumatoid arthritis
• Arthritis of the collarbone
• Removing loose tissue

Arthroscopic Total Shoulder Resurfacing with Osteochondral Allograft

http://www.jomi.com/article/1/Arthroscopic-Total-Shoulder-Resurfacing-with-Osteochondral-Allograft


Resumen
Existen opciones limitadas de tratamiento para la osteoartritis glenohumeral en un paciente joven y activo. Para tratar el dolor y la limitación de la osteoartritis significativa, evitando una artroplastia total de hombro (TSA), hemos estado utilizando una técnica mínimamente invasiva para resurgir tanto la glenoides y la cabeza del húmero mediante aloinjertos osteocondrales. Después de identificar las áreas de mayor daño condral grave durante una artroscopia diagnóstica, un túnel transhumeral se perfora con una aguja guía transfemoral. A través del túnel de las zonas donantes de aloinjertos son preparados por retrógrada escariado la cabeza del húmero y anterógrada escariado la cavidad glenoidea. Construcciones aloinjertos son de tamaño y se cortan dentro de la cirugía en una mesa del fondo, insertado a través del portal anterior y se fija en los sitios de injerto utilizando dardos condrales de la glenoides y un ajuste a presión de la cabeza del húmero.

una publicación de Victor Ravens.

Arthroscopic Total Shoulder Resurfacing with Osteochondral Allograft

Samuel Dubrow, Ruben Gobezie

1Cleveland Shoulder Service, University Hospitals of Cleveland, Case Medical Center

• Text
• Outline

Abstract

Limited treatment options exist for glenohumeral osteoarthritis in a young and active patient. To address the pain and limitation of significant osteoarthritis while avoiding a total shoulder arthroplasty (TSA), we have been using a minimally invasive technique to resurface both the glenoid and the humeral head using osteochondral allografts. After identifying the areas of most severe chondral damage during a diagnostic arthroscopy, a transhumeral tunnel is drilled using a transhumeral guidepin. Through this tunnel the allograft donor sites are prepared by retrograde reaming the humeral head and antegrade reaming the glenoid socket. Allograft constructs are sized and cut intra-operatively on a back table, inserted through the anterior portal and secured into the graft sites using chondral darts for the glenoid and a press fit for the humeral head.

Case Overview

Clinical presentation

This is a 53 year old right hand dominant male with right shoulder pain gradually worsening over the past three years. His pain is worse at night and with overhead motions and rates his pain as a 7-8 out of 10 at its worst. He has slightly decreased range of motion, most notably in internal rotation, and pain upon overhead lifting and forward flexion above 140 degrees. His pain interferes with his work as well as his quality of life, interfering with restful sleep.

He reports no loss of strength or numbness. Past history is significant for Type 2 Diabetes Mellitus and hypertension. He has had 2 corticosteroid injections which resulted in minimal pain relief. Treatment options were discussed with the patient, including observation, activity modification, repeat injections, occupational therapy and total shoulder replacement versus arthroscopic surgery to resurface the shoulder with allograft. Risks and benefits were discussed in detail with the patient and he requested the arthroscopic resurfacing procedure.

Physical Exam

On exam, he reported a pain severity of 7 out of 10 on forward flexion above 120 degrees. The shoulder is stable with a negative lift off test and there was no weakness appreciated to the rotator cuff upon static strength testing. There is mild loss of motion in all planes, with forward elevation to 160 degrees, external rotation to 40 degrees and internal rotation to L5. Passive range of motion is comparable to active range of motion with stiff end points in all planes. He has positive impingement signs, a positive speeds test and tenderness to palpation over the anterior aspect of his shoulder in the region of the proximal biceps tendon. He is neurovascularly intact distally to his right upper extremity with full range of motion to his right elbow, wrist and hand.

Imaging

Pre-operative AP and axillary radiographs reveal severe narrowing of the glenohumeral joint space and subchondral sclerosis

Anterior-Posterior ViewAuxillary View

Natural history

Without intervention the expected natural clinical progression consists of worsening pain, increased severity of osteoarthritis, and further decreased shoulder range of motion.

Options for treatment

The options for treatment at this time include a repeat corticosteroid injection, physical therapy, NSAIDs, a total shoulder replacement, arthroscopic debridement and a resurfacing procedure with allograft.

Rationale for current procedure

This procedure avoids a total shoulder replacement in a relatively younger and active patient. Advantages include a shortened recovery period, no loss of strength, the subscapularis is kept intact and the relatively high risk of TSA implant failure in younger patients is avoided. As opposed to an open procedure, arthroscopy is less traumatic, has less risk of joint infection and allows for complete visualization of the shoulder joint.

Special considerations

The larger size of this patient's shoulder makes for a slightly challenging case. If the osteoarthritis was more extensive, the patient was not particularly active and over the age of 60 years, a total shoulder replacement would have been recommended.

Care needs to be taken when placing the transhumeral guide pin; the axillary nerve should be identified and kept clear of pin placement by blunt dissection down to the humeral cortex.

In a larger shoulder such as in this case, it is especially important to take care when inserting the allograft through the anterior arthroscopic portal not to lose control of the graft as retrieval would be potentially difficult.

Discussion

Glenohumeral arthritis remains a challenging issue to treat in the active young patient. This is due in most part to concerns regarding the longevity of a stable total shoulder prosthesis, specifically loosening, failure, and the eventual need for revision surgery. Young patients that wish to maintain a high level of activity may not be suited for traditional total shoulder replacement because of this concern of implant durability. Arthroscopic biologic total shoulder resurfacing with osteochondral allograft can be a promising alternative for the treatment of arthritis in a young individual. It also allows for bone conservation, so should the arthritis progress, a standard total shoulder replacement can readily be performed at a later date, if necessary.

This procedure has been performed by the senior author (RG) on 22 patients with a 2 year follow-up. Results have been promising with improvements in mean visual analog pain scores improving from 6 to 1. Range of motion in forward elevation has improved on average from 128 degrees to 137 degrees. The mean American Shoulder and Elbow Surgeons score in this patient population has also improved from 40 to 83. However, long term outcomes are not yet available.

Disclosures

Disclosures R.G is a consultant for and receives support from Arthrex, Naples FL

Statement of Consent

Informed consent was obtained from the patient and all staff present in the operating room to be filmed and are aware that portions of this video will be published and freely available online.

Equipment

1. Arthroscope - Stryker, Kalamazoo MI
2. Chondral Dart System - Arthrex, Naples FL
3. OATS system - Arthrex, Naples, FL

Special Acknowledgements

The authors would like to thank Ian Fein for his videography and the Operating Room staff for their help in making this video.

Citations

1. Boyd Jr, Allen D., et al. "Total shoulder arthroplasty versus hemiarthroplasty: indications for glenoid resurfacing." The Journal of arthroplasty 5.4 (1990): 329-336.
2. Wallace, Andrew L., et al. "Resurfacing of the Glenoid in Total Shoulder Arthroplasty. A Comparison, at a Mean of Five Years, of Prostheses Inserted with and without Cement*." The Journal of Bone & Joint Surgery 81.4 (1999): 510-8.
3. Burkhead Jr, W. Z., and Kirk S. Hutton. "Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder." Journal of Shoulder and Elbow Surgery 4.4 (1995): 263-270.
4. Gobezie, Reuben, et al. "All-arthroscopic biologic total shoulder resurfacing."Arthroscopy: The Journal of Arthroscopic & Related Surgery 27.11 (2011): 1588-1593.
5. Millett, Peter J., Gobezie, Reuben and Boykin, Robert E. "Shoulder osteoarthritis: diagnosis and management." Am Fam Physician 78.5 (2008): 605-611.
6. Dubrow, Samuel, Gobezie, Reuben. “Alternative options to traditional shoulder replacement: arthritis in the young patient.” Current Orthopaedic Practice 24.4 (2013): 370-375.
7. Dubrow, Samuel, Shishani, Yousef, Gobezie, Reuben. “Arthroscopic alternatives to total shoulder arthroplasty.” Seminars in Arthroplasty 24 (2013): 2-6

Congress_ISAKOS_2015_PRELIMINARY_PROGRAM

Fracturas acetabulares en pacientes con edades> 55 años / Acetabular fractures in patients aged > 55 years

http://www.bjj.boneandjoint.org.uk/content/96-B/2/157.abstract

Acetabular fractures in patients aged > 55 years

A systematic review of the literature

+ Author Affiliations

Resumen


El aumento de la prevalencia de la osteoporosis en una población que envejece ha contribuido a los pacientes mayores se conviertan en el grupo de más rápido crecimiento que presentaban fracturas de acetábulo . Se realizó una revisión sistemática de la literatura que implica una serie de bases de datos para identificar los estudios que incluyeron el resultado del tratamiento de las fracturas acetabulares en pacientes de > 55 años. Una búsqueda inicial identificó 61 estudios , después de la exclusión por dos revisores independientes , se consideraron 15 estudios para cumplir con los criterios de inclusión. Todos eran series de casos. La puntuación media de Coleman para la evaluación de la calidad metodológica fue 37 (25 a 49) . Había 415 fracturas en 414 pacientes. El análisis agrupado reveló una edad media de 71,8 años (55 a 96) y un seguimiento medio de 47,3 meses ( 1-210 ) . En siete estudios se presentaron los resultados de la reducción abierta y fijación interna ( RAFI ) : esto se combina con el reemplazo de cadera simultánea (THR ) en cuatro, y un estudio tuvo una mezcla de estas estrategias. Los resultados de la fijación percutánea se presentaron en dos estudios , y un solo estudio revelaron los resultados del tratamiento no quirúrgico .


Con la fijación de la fractura , la tasa media global de la conversión a THR fue de 23,1 % ( 0 % a 45,5 % ) . La tasa media de complicaciones no mortales fue del 39,8 % ( de 0% a 64 %) y la tasa de mortalidad media fue de 19,1 % (5% a 50 %) con una media de 64 meses ( IC 95% 59,4-68,6 ; rango 12-143 ) . También se analizaron los datos adicionales que se ocupan de la clasificación de la fractura, el abordaje quirúrgico utilizado , el tiempo quirúrgico , pérdida de sangre , los resultados funcionales y radiológicos.


Este estudio pone de relieve que, de las muchas formas de tratamiento disponibles para este grupo de pacientes , se observa una tendencia al aumento de las tasas de complicaciones y la necesidad de cirugía adicional en comparación con los resultados del tratamiento de las fracturas acetabulares en pacientes más jóvenes .

Abstract

The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment.

With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed.

This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.

Cite this article: Bone Joint J 2014;96-B:157–63.

"Reparar cartílago es esencial hacerlo bien y descartar todos los otros problemas" ”Cartilage repair is crucial do it right and rule out all the other problems”

• Group: ICRS - International Cartilage Repair Society
• Subject: Early Bird Reminder (March 30,2014): Focus Meeting- The Knee

Register now with Early Bird Fees!
Limited seats available (120), early registration is advised.

ICRS Focus Meeting - The Knee
FIFA Auditorium Sonnenberg - Zurich, Switzerland
July 3 - 4, 2014

Preliminary Programme -> http://bit.ly/1b4wSxY 
Early Bird Registration -> http://bit.ly/10WcMOS 
Testimonials-> http://bit.ly/1exYLeR 
Industry Partners: http://bit.ly/1gevavV 

Top International Faculty: http://bit.ly/1geHkVB 

Mats Brittberg, SE - Stefano Della Villa, IT - Jiri Dvorak, CH, Christoph Erggelet, CH - Jack Farr, USA - Alan Getgood, CA - Alberto Gobbi, IT – Michael Hartmann, CH - Anthony Hollander, UK - Roland Jakob, CH – Elizaveta Kon, IT - Christian Lattermann, USA – Philipp Lobenhoffer, DE - Jos Malda, NL - Bert Mandelbaum, USA – Kai Mithoefer, USA – Norimasa Nakamura, JP - Stefan Nehrer, AT - Philipp Niemeyer, DE - Alex Nieper, CH - Lars Peterson, SE - Stefan Preiss, CH - Jose Romero, CH - Gian Salzmann, DE - Daniël Saris, NL - Tim Spalding, UK - Peter Verdonk, BE - Ken Zaslav, USA

Hot Topics:

• Do we need Cells for cartilage repair?
• Allografts vs. Synthetics for meniscus reconstruction
• High Tibial Osteotomies
• When and how to do an MPFL Reconstruction
• Distraction Arthroplasty for the Knee
• The Hoffa Fat Pad – What do we know?
• 3D - Printing of Cartilage Constructs?
• The Postoperative Stiff Knee
• Rehabilitation Concepts
• Nutritional Supplements & Prevention
Take the opportunity and register with highly reduced early bird fees until March 30,2014 at noon CET
________________________________________
The ICRS Focus Meetings in Zurich concentrate every year on a different joint, the Knee in 2014, following the idea, that a complete and in-depth understanding of joint function and associate pathologies is a prerequisite for successful cartilage repair. The knee in orthopaedics and sportsmedicine – it seems that everything has been said and done. Or maybe not?

How many of our patients and athletes are not satisfied with the result of our treatments?! There is still room for improvement. Maybe the smaller things make the difference? Are there pathologies we have overlooked? The ICRS Focus Meeting – The KNEE – will showcase an update on the standard procedures and highlight a topics and approaches off the beaten path – critically presented and discussed by a world class faculty. Elite athletes will discuss the implications of knee problems for their career. The very personal atmosphere of the FIFA Auditorium Sonnenberg in Zurich enables vivid discussions, direct networking and support for specific cases. Industry representatives will demonstrate the latest developments in the field.

Looking forward to seeing you in Zurich this summer

Christoph Erggelet, Course Director
International Cartilage Repair Society
Posted By Lei Ji

http://kidshealth.org/teen/nutrition_fitness_center/nutrition_fitness_center_esp/knee_injuries_esp.html

Lesiones de rodilla

(Knee Injuries)

Si te has lesionado alguna vez la rodilla, sabrás que necesitas tener sanas las rodillas para practicar muchas actividades y deportes, y que lesionártelas puede suponer tener que estar apartado del campo de juego durante cierto tiempo. Afortunadamente, hay muchas formas de prevenir las lesiones de rodilla.

¿Qué hay dentro de la rodilla?

Para entender en qué consisten las lesiones de rodilla, antes tienes que entender cómo funciona la rodilla. La rodilla es una articulación, lo que significa que es el punto de contacto entre huesos adyacentes. De hecho, se trata de la articulación más grande del cuerpo. Las rodillas proporcionan estabilidad y flexibilidad al cuerpo, al tiempo que permiten flexionar, girar y enderezar las piernas.

La rodilla consta de varias partes, como huesos, cartílago, músculos,ligamentos y tendones, todas ellas funcionando como si fueran una. O sea que, cuando hablamos de una lesión de rodilla, puede estar dañada o sobrecargada cualquiera de estas partes.

La rodilla se encuentra en medio de tres huesos: la tibia (el hueso de la espinilla), el fémur (el hueso del muslo), y la rótula (el hueso que está en el centro de la articulación). La rótula es un hueso plano y redondo que protege la articulación de la rodilla.

Los extremos del fémur y la rótula están cubiertos de cartílago articular (piensa en la parte blanca que rodea el extremo de una pata de pollo). El cartílago articular actúa como una especie de almohadón, impidiendo el rozamiento entre el fémur, la rótula y la tibia. En la parte superior de la tibia, unas almohadillas adicionales de cartílago, denominadas meniscos, ayudan a absorber el peso del cuerpo. Cada rodilla tiene dos meniscos: el interno (medial) y el externo (lateral)

Músculos

Los músculos que hay alrededor de la rodilla incluyen el cuadriceps (un grupo de cuatro músculos ubicado en la parte anterior del muslo) y el isquiotibial, ubicado en la parte posterior del muslo. El cuadriceps ayuda a enderezar y extender la pierna, mientras que el isquiotibial ayuda a flexionar la rodilla.