1. EPIDUROSCOPY : AN INTERVENTIONAL PAIN MANAGEMENT FOR POST
LAMINECTOMY PAIN - A FIRST CASE REPORT - FROM INDIA
DK Baheti, A Deshpande,
V Patil
This report describes the first epiduroscopy
done in India, to perform adhesinolysis for relief of backache and radiculopathy
in a patient of post laminectomy pain. There was adequate pain relief and definite
improvement in functional capacity after the procedure. Post laminectomy pain
or failed back syndrome with its resultant chronic low back pain is estimated
to occur in 20% to 50% of the patients. Soft tissue pathology is not easily
examined so it is often overlooked as a potential cause of some types of back
pain syndrome.
2. PHYSIOTHERAPY MANAGEMENT FOR VERTIGO
Albert K Mendonca, RB Patel
We have taken into account 20 patients who
have complained of vertigo and of different diagnosis.
Out of these 20 patients 10 were diagnosed as cervical spondylosis and seven
as middle ear infection and 3 as cerebral infarction.
These 10 patients with cervical spondylosis got good benefit after the Cawthorne-Cooksey
exercises, neck muscles strengthening exercises and atlanto-axial mobilization.
In about 3-4 weeks times they got fully recovered and the seven patients with
the middle ear disease got recovered only through Cawthorne-Cooksey exercises.
They too got total recovery in about 6-10 weeks time. And the patients with
cerebral infarction the recovery was a bit slow and it took about
8-15 weeks to get complete recovery.
3. BLOOD MANAGEMENT
IN TOTAL KNEE ARTHROPLASTY
Narayana Prasad, Vinod Padmanabhan, Arun Mullaji
A prospective study was done at Bombay
Hospital for 6 months, to reach a conclusion regarding the blood loss and
blood transfusion incidence in Primary Total knee arthroplasty (TKA).
It was found that gender has a role in total blood loss during TKA. The diagnosis
of the disease (OA/RA) does not have any role in total blood loss. The indication
for transfusion was mainly low pre-operative haemoglobin value rather than
intra-op blood loss.
4. PHYSIOTHERAPY IN KNEE ARTHROPLASTY
Shilpa Mitgaonkar, Asha Andyal
It is defined as replacement or reconstruction
of a joint using an artificial prosthesis.
Their types being - Total, Partial and Excision.
AIMS for doing Arthroplasty of knee joint are-
1. To relieve pain.
2. To improve mobility as well as provide stability.
3. To correct any deformity if present.
Pre-requisites for Knee Arthroplasty
a) Biological compatibility.
b) High resistance to wear and tear.
Combination of plastic with metal is used to decrease coefficient of friction,
high resistance to corrosion, therefore implant will have a longer time i.e.
durability is longer.
Pre-requisites are pertaining to the biomechanics of knee joint. Implant that
one uses must give (1) near (M) range of movement in all the planes. (2) Prosthesis
used should mirror the mechanics of the original joint only then it will be
stable i.e. femoral condyles glide and slide on the tibial condyles at the
same time they rotate.
5. ACCURACY OF INTRAMEDULLARY ALIGNMENT
SYSTEM IN TOTAL KNEE ARTHROPLASTY
Vinod Padmanabhan, Arun Mullaji
The angle formed between the femoral anatomic
axis and the femoral prosthesis was measured on radiographs of 206 consecutive
total knee arthroplasties to evaluate the efficacy of intramedullary guide
rods for achieving coronal alignment and to identify the factors that predispose
to unacceptable distal femoral cuts. In this prospective study, the radiographs
of knee with distal femur were taken on 14 inches x 17 inches cassette and
only those with good centring without rotations were included. Intramedullary
femoral alignment system was used in all cases.
The mean femoral component angle relative to femoral anatomic axis was 4.9o
valgus with a standard deviation of 1.5o and a range of 1o to 9o valgus. 186
(90.3%) knees had a femoral component angle of 3o-7o valgus, which is considered
to be ideal 20 (9.7%) knees had a femoral component angle that was â 2o valgus
or ô 8o valgus which is considered to be less than ideal. 3 case had distal
femoral bowing that caused an excessive valgus cut. 5 cases had wide femoral
canals that caused inaccurate cuts due to eccentric placement of intramedullary
guide rod.
Pre-operative full-length hip-to-ankle radiographs should be done to identify
significant anatomic variations, in which errors are more likely. We conclude
that intramedullary alignment system for the distal femoral cut is an excellent
method for most cases.
6. QUADRICEPS TENDON RUPTURE AFTER TOTAL
KNEE ARTHROPLASTY - A CASE REPORT
Vinod Padmanabhan, Narayana Prasad, Arun Mullaji
A 74 year old female who had undergone
left total knee arthroplasty (TKA) 6 months ago elsewhere, presented with
difficulty in walking and inability to extend her knee since then. She had
been walking with a knee brace without pain for the past 6 months. On examination,
there was a dimple in the suprapatellar region; range of movement 0-90 and
no active extension was possible. Knee score was 73 and Function score was
5. X-rays showed loosening of femoral and tibial component, osteolysis and
patella baja (low lying patella).
Patient was taken up for revision surgery. Discontinuity in the quadriceps
tendon was found just above the patella and it had retracted proximally by
about 4 cm. Femoral and tibial components were revised with TC3 implant system
along with contained bone grafting while patella was not revised. Repair of
the quadriceps tendon was done by Codivilla's procedure in which an inverted
'V' flap was mobilized from the muculotendinous junction and end-to-end repair
done. Post-operatively, lower limb was immobilized in a POP slab with knee
in 20 degrees flexion. Gentle knee flexion was started on 2nd post-operative
day (POD) along with static quadriceps exercises and electrical stimulation.
Full weight bearing walking with rigid knee brace was started on 7th POD and
active knee extension on 14th POD. Patient had an extension lag of 15 degrees
at 3 weeks post-operatively when she was discharged. At 3 months follow-up,
patient had full extension actively, no instability and range of movement
0-90.
7. MANAGEMENT OF LYMPHOEDEMA
R Deshpande, R Ginwalla, K Khadalia, V Tambwekar,
SR Tambwekar
Lymphoedema develops as a result of an
imbalance between the lymphatic transport capacity and the lymphatic load.
Primary lymphoedema due to lymphatic malformations may manifest at birth or
even after 35 years of age. Secondary lymphoedema can be caused by filariasis,
tuberculosis, circumferential limb trauma, circular amniotic bands, malignancies,
following - radiation, block dissection of lymph nodes, venous stripping,
lipectomy, peripheral vascular surgery or following lymphangiosis caused by
bacteria, fungi, insects or geochemical irritants and it may even be brought
about by self-mutilation.
Various surgical procedures have been described to reduce the lymphatic load,
increase lymphatic transport capacity or to improve the drainage.
Based on the MRI Venography findings Venolysis of the femoral vein was performed
in eight cases over the last ten years. There was a significant reduction
in the oedema during the fortnight following surgery. The results were maintained
by continued implementation of the conservative measures.
