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Minimal invasive approach to treat unicompartmental arthritis

Monitor News Bureau

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A 50 year old housewife recently came with the complaints of difficulty in walking due to inward angulation of her knee joints. Her knee joints used to collapse with every step. Her walking distance was significantly reduced and experienced difficulty in day to day house hold chores. On conducting a complete check up, she was diagnosed with having arthritis in only the inner part of the knee joint and her anatomy & alignment was well preserved. Due to this condition her walk was very painful. As the patient was young (less than 60 years old) and the disease was only limited to the one compartment of the knee, she was prescribed unicompartmental knee replacement. Surgery was done with a minimally invasive technique ?says Dr. Pradeep Moonot.?
The joint was exposed through a small incision(3 inch), the diseased condylar(round prominence at the bone end) surfaces were excised and after adequate preperations a unicondylar femoral (thigh bone) and tibial (bone from knee to ankle) component was fixed. The beauty was this implant lies in its floating meniscus with increased durability and dependability. This polyethylene component moves with movement of femoral condyle and continues to change its weight bearing axis.
Post operation, the lady started weight bearing exercise and was able to walk comfortably the next day itself. Within 3rd day the patient was able to walk independently more than 50 metres or to the washroom unassisted. She had minimal pain and swelling of hte knee joint because of hte minimal invasive nature of the surgery. She did not require any blood transfusionor physiotherapy post operatively. Without losing her ACL (which is crucial for her movement arc), her varus deformity which was 10 degree was corrected and her pain was vanished. She feels happy and does her daily chores comfortably.
Unicompartmental knee replacement is a very successful procedure in young arthritics where the disease is confined to the medial compartment of the knee. Added advantage of the procedure is that the knee can still be converted to a full replacement if for any reason a revision surgery is envisaged. The polyethylene articular insert is mobile and hence allowed to freely float on top of the tibial base which absorbs the sheer stress and protects the bone interface. As it is mobile, the design can be customized conforming to the curve of the femur to spread the weight bearing capacity evenly thereby reducing its wear and stress.
What is Unicompartmental arthritis?
When affects any one of the three compartments of the knee, it is referred to as Unicompartmental arthritis. A knee joint is divided into three compartments – medial (inside), lateral (outside) and the Patellofemoral (kneecap joint). In most of the cases only the medial or lateral compartment is affected, unlike arthritis where it affects all the three of them. If diagnosed at early stage, it can be treated with medications, but when the symptoms have crossed the extreme stage, surgery is the only option left. Full knee replacement has been the most common and the conventional method for treating arthritic knee. This is useful and necessary only when all the three compartments are involved, and can prove to be a disadvantage in case of Unicompartmental arthritis. This is where Unicompartmental knee surgeries are helpful.
In extreme cases, the pain is so much elevated that it requires an immediate surgery. This is when all the three compartments of the knee are involved. Full knee replacement, is the most common and conventional method which has become the ‘Gold standard’ operative procedure for treating arthritic knee.
But when sometimes the problem is limited to just one of the knee compartments, there are options to only replace them.
How is it diagnosed?
Orthopaedic surgeon and sports medicine specialist needs to perform physical examination along with the help of imaging technique like X – rays. This will help in evaluating the degree of deformation and the alignment of the knee which indicates the uneven load distribution across the joint. The details of each compartment are obtained through any imaging technique that include joint space narrowing, bone spur formation, and increased density of the bone adjacent to the overloaded compartment.
A history of pain limited to the medial compartment with swelling in the joint and stiffness is suggestive enough to visit the doctor.
What are the treatment options?
Surgeon takes the decision whether to opt for surgical treatment or to continue with medication depending upon the age, degree of symptoms, history of other diseases and the patient’s activity level.
Non-Surgical Methods
1. Injections – corticosteroid injections decrease the inflammation and relieve the associated pain, which lasts for upto 6 months. These contain natural components of the joint fluid that helps to lubricate and absorb shock to protect the damaged cartilage.
2. Bracing – these are known as off loader braces which helps in correcting the Malalignment of the knee and distribute the weight evenly across the joint
Surgical Methods
1. Articular Cartilage Restoration Procedures – surgical procedures are required to restore the articular cartilage as it does not heal on its own.
2. Osteotomy – a wedge of bone is cut out from either tibia or femur to adjust the angulation to straighten the knee. This relieves the uneven distribution of the weight across the joint and prevents progression.
3. Total Knee Replacement – this involves all the three compartments. The surgeon removes the damaged cartilage from the femur and tibia and replaces it with metal and plastic.
4. Unicompartmental Knee Replacement – Unlike the total knee replacement this procedure is minimally invasive and replaces only the damaged portion of the joint.
Why do people prefer Unicompartmental replacements?
The main advantage of the Unicompartmental knee replacement is that it preserves the ACL which is a crucial ligament for movement and knee stability unlike in the case of total knee replacement where it is sacrificed. As this follows the minimal incision approach, a faster recovery, rehabilitation and quick return to full fledged activities is seen in all patients. Because the ligaments are kept intact, the patient feels the replaced portion of the knee as a natural part itself.
Dr. Pradeep Moonot, Orthopaedic Surgeon & Podiatrist, Sir HN Reliance Foundation, Mumbai


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Health

Weight Loss Tips Recommended by Personal Trainers

The Kashmir Monitor

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Weight loss is something that we all struggle with. Sometimes we are successful in reducing our weight but more often than not, the number in the weighing scale slowly creeps back up. Most of us have already tried the latest diet trend in the hopes that it will lead us to a better looking us, but then, life happens and we forget that we are on a diet or that we feel frustrated with the lack of results. Still, we keep on finding ways to get rid of the excess pounds that we are carrying. With that being said, it might be a good idea for us to stop for a while and take stock of what personal trainers have got to say about losing weight. Who knows? We might pick up a thing or two about their weight loss tips that we can apply in our day to day lives. Here are some suggestions that you might want to consider.

Stay away from booze and sugar

If you really want to lose weight then ditch the sugar and booze. These two are known to be calorie-laden which is why they contribute to weight gain. If you can’t stay away from drinking alcoholic beverages, you can limit to a glass for girls and two glasses for men. As for the refined sugars, there are natural sweeteners available such as honey and stevia.

 

Don’t go more than 3 hours without eating

Although the exact science for this is still being studied, it appears that eating snacks in between meals can help keep your blood sugar levels steady. This means that your energy level will remain stable throughout the day and less sugar or carb binges which can cause weight gain on your part.

Mix your exercises up

Another tip that personal trainers have given with regards to losing weight is to mix your fitness routine as much as possible. Sticking to the same program for months will cause you to hit a plateau in your progress which can make you feel frustrated with the lack of improvement. A better option would be to mix your exercises so that your muscles will remain guessing as to which muscle group will be tested. The best part is that you are constantly strengthening and conditioning your muscles for a more even looking physique.

Drink plenty of water

Who would have thought that even the simplest act can do your weight loss goal a whole lot of good? Drinking water constantly can help flush the toxins from your body while ensuring that your skin remains properly hydrated. Water can also help improve digestion so that your body will be able to absorb nutrients from the food that you eat better.

These are just a few tips that you might want to consider the next time you are planning on shedding weight. What’s great about these fitness tips is that they are simple enough to follow but will get you amazing results in no time.

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Health

Study: Dietary supplements won’t help you live longer

The Kashmir Monitor

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Doctors at Tufts University in Massachusetts, the US, say it’s pretty clear that supplement use has no benefit for the general population and is not a substitute for a healthy balanced diet.

Their research found that vitamins A and K, magnesium, zinc and copper were linked to a lower risk of death from heart disease or stroke — but only when they came from foods, abc7news.com wrote.

Coauthor Fang Fang Zhang, an associate professor of epidemiology at the Tufts University Friedman School of Nutrition Science and Policy, said getting nutrients in the right quantities from food was associated with a longer life.

 

In fact, Zhang said some supplements even appear to have health risks. People who took high doses of calcium supplements had a 53 percent higher risk of dying from cancer than people who were not taking supplements,

However, if you have been diagnosed as deficient in a certain nutrient, don’t stop taking it without talking to your doctor first.

The research team used data from 30,000 US adults who participated in a National Health and Nutrition Examination Survey from 1999 to 2010.

The research was published in the Annals of Internal Medicine.

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Health

Whitening products may damage teeth:Study

The Kashmir Monitor

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Teeth whitening products – that promise to make your smile brighter – may also be causing tooth damage, a study has found.

Scientists at Stockton University in the US found that hydrogen peroxide, the active ingredient in over-the-counter whitening strips, can damage the protein-rich dentin tissue found beneath the tooth’s protective enamel.

The tooth is made of three layers: the outer tooth enamel, an underlying dentin layer and connective tissue that binds the roots to the gum.

 

Most studies of whitening strips have focused on tooth enamel, which contains very little protein.

The team focused on dentin, which makes up most of the tooth and has high levels of protein, most of which is collagen.

It is well established that hydrogen peroxide can penetrate the enamel and dentin. Previous work by the researchers showed that collagen in the dentin layer decreased when teeth were treated with whitening strips.

“We sought to further characterise what the hydrogen peroxide was doing to collagen. We used entire teeth for the studies and focused on the impact hydrogen peroxide has on the proteins,” said Kelly Keenan, associate professor at Stockton University.

The researchers demonstrated that the major protein in the dentin is converted to smaller fragments when treated with hydrogen peroxide.

In additional experiments, they treated pure collagen with hydrogen peroxide and then analysed the protein using a gel electrophoresis laboratory technique that allows the protein to be visualised.

“Our results showed that treatment with hydrogen peroxide concentrations similar to those found in whitening strips is enough to make the original collagen protein disappear, which is presumably due to the formation of many smaller fragments,” Keenan said in the statement.

The researchers point out that their experiments did not address whether collagen and other proteins in the teeth can be regenerated, so it is unknown if the tooth damage is permanent.

Next, they plan to further characterise the protein fragments released when collagen is treated with hydrogen peroxide and determine if hydrogen peroxide has the same impact on other proteins in the teeth.

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