Friday, January 31, 2020
Total Knee Arthroplasty Essay Example for Free
Total Knee Arthroplasty Essay Etiology and Pathology            The knee functions as a type of biological transmission whose purpose is to accept and transfer range of loads between and among the femur, patella, tibia, and fibula without causing structural or metabolic damage. Arthritic knees are like living transmissions with worn bearings that have limited capacity to safely accept and transmit forces. Arthritis of the knee can be restricted to a monoarticular clinical manifestation, or it may be a part of an oligo-or polyarticular disease. A careful anamnesis and clinical examination will allow the clinician to classify the clinical presentation of arthritis of the knee into disease groups such as osteoarthritis, rheumatoid arthritis spondyloarthropathy, or miscellaneous arthritic diseases. Infectious arthritis presents typically as an (sub) acute inflammatory monoarthritic disease. Up to 90 % of infectious arthritis cases present as monoarthritis. The only exception is gonococcal arthritis, which presents more commonly as a migratory polyarthritis. If the condition is unrecognized, joint destruction will occur rapidly. In confronting the athlete who will undergo the operation it is important for me to discuss a working hypothesis and ultimately critical to arrive to the most likely diagnosis. The clinical history of the patient is to be well studied it is a demanding task and a lot of circumstantial evidence can evolve from a full history of the current problem , past medical conditions, and the family history. Kinds of Pain The nature of the pain that he might encounter and the reason he needs to undergo TKA belongs to â€Å"the basics†, whether it is mechanical, inflammatory, neuropathic, or poorly defined.  Mechanical pain occurs when the joint is used; walking becomes difficult and especially climbing stairs causes problems. On resting, there is less pain. Starting pain and stiffness are very characteristics of a more advanced mechanical pain pattern. Inflammatory pain typically presents at night. More specifically, the second part of the night become troublesome, and patients need to go out of bed and move. They experience morning stiffness for at least one hour, and this stiffness diminishes progressively as the pain begins to move. When pain is neuropathic in origin, a typical distribution pattern corresponding to the innervations’ is found. Psychosomatic pain has no typical presentation or distribution. Complaints are always more impressive than the clinical findings.            Consider asking the patient of how long the knee problem has existed, when pain and swelling have been present for less than 6 weeks, the problem is acute. Beyond 6 week’s duration, the term chronic is used and implies that spontaneous healing of the arthritis is unlikely.  It is also important to look for circumstantial evidence. Did the trauma occur just before the knee swelling began? Did the patient have an episode of fever such as angina, gastroenteritis, or arthritis? Does the patient have other clinical conditions that could be linked to the knee arthritis, such as skin problems (psoriasis, erythema nodosum), chronic diarrhea as seen inflammatory bowel disease, and eye problems such as uveitis or scleritis? In this setting a complete familial history can also add useful information. Advantages of Total Knee Arthroplasty Consistent reproducible results Correction of mechanical alignment Addressing all knee compartments Long term (greater than 90%) 10 year survivorship Drawbacks Postoperative pain which can endure for months Prolonged recovery sometimes inferior Patient satisfaction With extensive exposure required to align and implant the total knee arthroplasty, there is significant damage to the quadriceps muscle both in cutting into the musculature itself as well as damage with eversion of the patella and prolonged stretch to the quadriceps mechanisms intraoperatively. Muscle damage is permanent and can limit postoperative strength and/or function. Surgical Procedure            Before the surgery is performed usually blood count, electrolytes, APTT and PT to measure blood clotting, chest X-rays, ECG, and blood cross matching for possible transfusion. Accurate X-rays of the knee are needed to measure the size of components which will be needed. Medications such as warfarin and aspirin will be stopped some days before surgery to reduce the amount of bleeding. The athlete may be admitted on the day of surgery if the pre-op work up is done in the pre-anesthetic clinic or may come into hospital one or more days before surgery. Recent improvements in technology have led to a confusing spectrum of choices for both the patient and surgeon in treating monocompartmental knee arthritis. The obvious need to get the surgery done right, there are now pressures to â€Å"do it quickly†and with a minimal scar and reduced disability time. The combination of patient’s demands and expectations with actual surgical possibilities may be challenging. To this end, a logical structuring of options is in this order: Osteotomies Unincompartmental knee arthroplasty Total knee arthroplasty The indications and more importantly, the contraindications of the surgical procedures often results in overlap of options that must be considered for any given clinical situation. The appropriateness of any of these procedures should be considered in light of their relative indications and problems. These include patient age, activity level, expected longevity of the procedure, reliability of the procedure to bring about the expected goal, and ease of revision in the event of failure. Of equal importance are the contraindications to the procedures including contracture, deformity, ligament contracture or insufficiency, and bone deficiency. The relative value of an osteotomy stands in inverse proportion to the patient’s age. Younger patient’s demands on an implant that will not stand the test of time, with failure due to wear or fixation failure. Considering that the patient is an athlete, athletic activities after the operation such as jumping and running are associated with surface loads in excess of the limits of the polyethylene.  The hazards of heavy or repetitive loading, deep knee bending and the lifting activities that accompany a variety of occupations and activities may loosen or damage prosthesis. Research Probability on Different methods on Knee Surgery Long term results of osteotomy show a gradual decline in function and recurrence of deformity. Hungerford et al reported that on ninety-two knees with a good or excellent rating after osteotomy at two years. At ten years only fifty-eight knees (61%) maintained this level 13. Parvizi et al reported on fifty-eight patients with a mean fifteen year follow up. There were only 55% good to excellent results. Twenty-six patients formed subsets that have been reviewed previously. At eight years, there were 73% good to excellent results, declining to 46% at eighteen years. Technical Problems            Technical problems of total knee arthroplasty after closing wedge osteotomy include: difficulties in gaining exposure, bony deficiencies necessitating grafts or wedges, difficulties in attaining ligament balance, prolonged surgical time and increased blood loss. Lonner et al recommended reserving the procedure for young, active overweight patient only 15.            Justification for the procedure in high demand patients is more difficult. Bellemans and Co author have reported range of motion between 120 and 130 degrees with enhanced functional potential for activities of daily living including stair climbing and transfer function.            Osteotomy has some contraindications including: various deformities greater that 10 degrees, flexion contracture more than 20 degrees, limited range of motion, ligament insufficiency including the anterior cruciate, and patellofemoral (Kurtz, 2004). Unicompartmental arthroplasty shares similar contraindications. Surgical treatments include tissue repair approaches, arthroscopic lavage and debridement, osteotomy, and unicompartmental and total knee replacement. There is little or no evidence that surgical reconstruction of torn cruciate ligaments or the meniscus prevents the development of the knee OA. It remains to be seen whether cartilage repair procedures prevent or slow down knee OA. The combination of tissue repair, such as the repair of cartilage defects, with an osteotomy, performed on the right patient and by a trained surgeon. In the case of knees with advanced degenerative arthrosis which undergo joint replacement surgery, the principle of functional restoration may be more properly stated as maximization of the functional capacity of the knee. As effective as current joint replacement techniques are at achieving pain relief and often associated increases in muscle strength and control, knees that have had joint replacement surgery do not replicate the functional status of a healthy, uninjured, adult joint. After the joint replacement the patient should avoid in running marathons or play tackle football. The structure of the knee is complex, and its behavior can be unpredictable even in the most experienced hands. However, the task of replacing the bone surfaces and balancing the ligaments can be made manageable by following a logical plan based on correct alignment throughout the arc of flexion and ligament release based on the function of each ligament. Optimal knee function requires correct varus-valgus alignment in all positions of flexion. This requires reliable anatomical landmarks for alignment both in flexion and extension. The long axes of the femur and tibia and the anterior and posterior axis of the femur are highly reliable and provide the guidelines for establishing stable alignment of the joint surfaces by placing the tibia and patellar groove correctly in the median anterior-posterior plane trough the entire arc flexion.  Knowing their function and testing their tension provides the information necessary to release only the ligaments that are excessively tight, leaving those that are performing normally. Fractional release does not destabilize the knee, because other ligaments are retained, and because the peripheral attachments of the ligament to other soft tissue structures such as the peristeum or synovial capsular tissue allow the released ligament to continue to function. Ligament release does not cause instability. Failure to align the knee and release the tight ligaments, however, does not cause instability, unreliable function, and excessive wear. With this knowledge, good instruments, and sound implants, the surgeon can align, balance, and stabilize the knee even when severe bone destruction and ligament contracture are present. CT scanning is an accurate way of measuring the component malrotation. Assessment of the rotatory alignment of the femoral component and the axial rotational relationship of the femoral and tibial components is part of the Perth CT protocol which is used routinely in total knee replacement surgery. The athlete will have preoperative clinical investigation and a radiological examination with standardized coronal long leg stance X-ray and standard lateral X-rays, adapted from the technique. Intraoperative complications will be recorded. The radiological evaluation was repeated between the 6th and 12th postoperative weeks by an independent observer at each center. The athlete should perform straight leg raises by the first postoperative day, by the second postoperative day research shows that 90% of patients have straight leg rise which suggest s good control of the quadriceps mechanism. On the third postoperative day the athlete should be able to independently transfer from a bed to a chair and on fourth postoperative day the athlete is able to navigate up and down stairs with assistance, and the mean postoperative discharge is 2.8 days.  The athlete is discharged to physical therapy which he will perform on his own home. Athlete should be averaging 10 days on a walker, 1 week on a cane, and independent ambulation is averaging approximately 3.5 weeks.  Rehabilitation Protocol To have the ability to perform physical actions task, and activities related to self-care is improved: Care is coordinated with patient, family, and other professionals.  Case is managed throughout episode of care  Integumentary integrity is improved  Knowledge of behaviors that foster healthy habits its gained Placement needs are determined  Risk factors are reduced  Risk of secondary impairments is reduced  ROM is increased  Standing balance is improved, stress is decreased To achieve this outcome, the appropriate intervention for this patient is determined. This will include coordination, communication, and documentation.  Is there evidence of total contact? If the person has a pelite liner, total contact maybe checked by putting a little ball of play dough at the end of the socket, the patient stands and bears weight and the displacement of the play dough indicates the extent of total contact, Too little contact may cause may cause distal end skin problems and a stretching pain. Too much may cause excessive pressure at the end of the stump and pressure pain. Is suspension maintained when patient’s lifts leg off the floor? Check that there is no excessive movement of the prosthesis away from limb when weight is removed. On weight bearing, make a small pencil mark at the anterior socket brim or, if sleeve or shuttles locks suspension, place lightly at edge of socket. Too much movement between residual limb and socket creates abrasions and may lead to toe drag on swing. CONCLUSION            Joint replacement surgery is designed to expand the entire envelope of function of symptomatic arthritic knees as safely and predictably as possible. Properly utilized, total knee replacement surgery is capable of substantial increases in the functional capacity of a given arthritic joint, but it is not designed to restore the full physiological function of a normal, uninjured adult knee. Future developments in the therapeutic management of arthritic knees may eventually involve biological approaches that could result in further improvements in maximizing the post treatment envelope of function over what can be achieved with the current technique of using artificial components. By tracking the loss of osseous homeostasis in knees starting at a time prior to the development of overt radiography identifiable degenerative changes Most patients can easily readily grasp the concept of the envelope and therefore can have a better understanding of what function is to be expected postoperatively. By this method they can more readily understand the joint replacement surgery is not designed to restore a knee to full, normal physiological function. Patients have responsibilities, as well to do all they can ( by participating in pre- and post operative physical therapy, for example_ to maximize their envelope and, once3 this is achieved, to not exceed the functional capacity of the joint following surgery by avoiding activities associated with supraphysiological loading. Cited Literature Hungerford MW, Mont MA. 2000. Nonoperative treatment of knee arthritis. In Insall JN, Scott NA (ed.). The Knee. CV Mosby, NY. Robertsson O. 2000. Unicompartmental arthroplasty. Results in Sweden. Orthopade 2000; 29 Suppl 1:S6-8. Lonner JH, Hershman S, Mont M, Lotke PA, 2000.Total knee arthroplasty in patients 40     years of age and younger with osteoarthritis. Clinical Orthopedic pp. 380:85-90. Mont MA, Chang MJ, Sheldon MS, Lennon WC, Hungerford DS, 2002. Total knee arthroplasty in patients less than 50 years old. J Arthroplasty 17: pp. 338-343. Romanowski MR and Repici JA. 2002. Minimally invasive unicondylar arthroplasty. Eight year follow-up. J Knee Surgery 15: pp. 17-22. Parvizi J, Hanssen AD, Spangehl MJ, 2003.  Total knee arthroplasty following a prior proximal tibial osteotomy. A long-term study identifying risk factors for failure. J Bone Joint Surgery (In Press). Hungerford, D. S. Kenneth A., Krackow, Kenna R.V. 1994. Total Knee Arthroplasty: A Comprehensive Approach. Williams and Wilkins. Kurtz, S.M. 2004. The UHMPE Handbook Ultra-High Molecular Weight Polyethylene. Academic Press. Rodriguez, E. C. 2003. The Haemophilic Joints: New Perspective. Blackwell Publishing. Delloye, C. and Bannister, G. 2004. Impaction Bone Grafting in Revision Arthropplasty. Published Informa Health Care. Bono, J.V., Scott, R.D. 2005. Revision Total Knee Athroplasty. Springer. Dutton, M. 2004. Orthopedic Examination, Evaluation, and Intervention. Mc Graw Hill Professional. Sculco, T.P., Martucci, E.A., 2001. Knee Arthropplasty. Springer Publising. Moffat, M. Rosen, E. Rusnak-Smit S., 2006. Muscuskeletal Essentials: Applying the Physical Therapist. SLACK Incorporated. Callaghan, J.J., 2003. The Adult Knee. Contributor Harry E. Rubash. Lippincott Williams Wilkins.
Wednesday, January 22, 2020
Technology The End Of Mankind :: essays research papers
Technology: The End of Mankind TECHNOLOGY The human race is slowly, but surely, contributing to its own demise. This sub-conscious suicide is being carried out in more than one way, but the most apparent one is technology. Technology is advancing at a pace so rapid that it will eventually lead to the self-extinction of the human race.      The most current and pressing issue that falls into this category is the infamous Y2K bug. This is the virus that is going to cause every computer in operation to go haywire when the year 2000 comes around. Some of the things will be effected by this are personal computers, ATM’s, air traffic control and street and traffic lights. Even if none of these theories pan out, the hype alone that is being created by the media is predicted to cause enough chaos and pandemonium by itself. In a recent survey, it was proven that over 50% of the American people are afraid of the bug and what it will do. If this matter is not addressed soon it will be responsible for many casualties.      Another branch of technology that has caused casualties in the past and is bound to cause many more in the future is weapons. The weapon that has had the most impact is the gun. It has killed millions, not only in wars, but in everyday life as well. In addition, there is the atomic bomb that killed thousands at Hiroshima. More recently there is the nuclear missile that is capable of wiping out an entire major city. Moreover, there are many inventions that have been built with the intent to improve life only to repeatedly take it away from people. Some such inventions are cars, planes and nuclear power plants. Something must be done to hinder the advancement of technology in these areas before we are all dead.      Lastly, technology is the biggest source of pollution. This pollution poses the largest threat of all to the world. Not only will it eventually lead to a genocide of the entire human race, but it is destroying everything else on the planet. The increase in the population has compounded this effect leading to more cars on the road and more waste, hence, more pollution. If pollution keeps up at this rate something bad is going to happen. Everyone will die of either cancer, due to holes in the ozone, starvation, because all of the animals were wiped out by pollution, or some other illness obtained from contaminated food and water. Technology The End Of Mankind :: essays research papers Technology: The End of Mankind TECHNOLOGY The human race is slowly, but surely, contributing to its own demise. This sub-conscious suicide is being carried out in more than one way, but the most apparent one is technology. Technology is advancing at a pace so rapid that it will eventually lead to the self-extinction of the human race.      The most current and pressing issue that falls into this category is the infamous Y2K bug. This is the virus that is going to cause every computer in operation to go haywire when the year 2000 comes around. Some of the things will be effected by this are personal computers, ATM’s, air traffic control and street and traffic lights. Even if none of these theories pan out, the hype alone that is being created by the media is predicted to cause enough chaos and pandemonium by itself. In a recent survey, it was proven that over 50% of the American people are afraid of the bug and what it will do. If this matter is not addressed soon it will be responsible for many casualties.      Another branch of technology that has caused casualties in the past and is bound to cause many more in the future is weapons. The weapon that has had the most impact is the gun. It has killed millions, not only in wars, but in everyday life as well. In addition, there is the atomic bomb that killed thousands at Hiroshima. More recently there is the nuclear missile that is capable of wiping out an entire major city. Moreover, there are many inventions that have been built with the intent to improve life only to repeatedly take it away from people. Some such inventions are cars, planes and nuclear power plants. Something must be done to hinder the advancement of technology in these areas before we are all dead.      Lastly, technology is the biggest source of pollution. This pollution poses the largest threat of all to the world. Not only will it eventually lead to a genocide of the entire human race, but it is destroying everything else on the planet. The increase in the population has compounded this effect leading to more cars on the road and more waste, hence, more pollution. If pollution keeps up at this rate something bad is going to happen. Everyone will die of either cancer, due to holes in the ozone, starvation, because all of the animals were wiped out by pollution, or some other illness obtained from contaminated food and water.
Tuesday, January 14, 2020
Atlantic Slave Trade: Social and Cultural Impact on the Society Essay
In The Atlantic Slave Trade Herbert Klein attempts to go into great detail of the inner workings of the slave trade: how it came to be, the parties involved, as well as the social and cultural impacts it had on the society. When thinking of the slave trade previous to this class, I would think to myself how low we as a humanity once became, and how many of African Americans were exploited to this awful set of events. After reading the book, those same thoughts still remained, however, due to Klein my understanding of the knowledge gave me greater insight into how complex the slave trade really was. How Portugal was one of the leaders in the slave trade, how countries turned against each other, and how much of the world was involved in this horrific set of events were all news to me while reading. Because of this complexity, no matter how clear the author was, the multitudes of information seemed to overwhelm me through my reading. Herbert Klein organized the book in a way that made all the information very precise, however, with all the numerical data I had a hard time keeping track. â€Å"The Chesapeake became the primary tobacco producer for the world, exporting 38 million pounds by 1700 †¦ holding some 145,000 slaves by 1750 †¦ absorbed 40,000 slaves by midcentury. By 1790 there were an impressive 698,000 slaves†¦Ã¢â‚¬ (44). This was all in the matter of a couple of sentences, for myself I could never retain the information that was provided in the first sentence. This quote does however go into precise figures, and is actually well laid out as a whole. Without having a deep prior knowledge though, it is very difficult to follow the what’s all going on. If someone was to read this with prior knowledge of the subject, I’m sure they could weed out a lot of the information and take away more from the book. This book is definitely not for some general educated reader to pickup. It requires a decent understanding of the geography, slight prior knowledge of the subject, as well as the full interest into the subject. â€Å"The first region encountered by the Portuguese as they rounded Cape Bojador and arrived in the western Sudan just south of the Sahara, was the area called Senegambia, which took its name from the Senegal and Gambia Rivers, its two most prominent features†(60). This quote proves as an example, and a simple one at that, that one must know at least where everything is to fully gather the information that is provided in Klein’s book. Without it, one may surely get lost in the reading. Even if a specialist were to read the book, I feel that due to how compact the book is, that they may get lost while reading as well. I don’t feel as though one could read through the book just once and honestly say, â€Å"I understood the majority of the information thro ughout the book,†without getting lost somewhere in the book. Entering this project, nothing really interested me while looking at the end â€Å"Selected Sources†of each chapter. Slavery was the only thing that seemed remotely interesting, not only because it’s such a huge part of history, but also because I didn’t know much about it. I had no clue that so many countries were so directly involved in this business of sorts, that Portugal was the origin of the slave trade, and that the power’s shifted so much in this horrific tragedy that happened in the new world. The book has increased my knowledge of the events that happened during the slave trade, but not necessarily my interest. I never found myself deeply engaged in the book unfortunately, and I found that surprising. I still strongly believe that the slave trade was wrong, but I have neither gained, nor lost interest in it. The importance of the subject is made clear with all the information inside of it. I may not understand every detail as they are going through, but the way the book is organized in a way where the importance of the subject is definitely shown. The importance of the book is to show us readers what the Atlantic Slave trade was all about. The chapter titles, and the information that is reflected in each chapter really shows this. Chapter titles beginning with â€Å"Slavery in Western Development,†and ending with, â€Å"The End of the Slave Trade,†really show how the author wanted to really concentrate on the bigger picture, rather than one specific moment in the Atlantic Slave Trade. Throughout the book, I don’t believe there were any major inconsistencies. I actually felt that Klein went deeper, and was most precise in his book. â€Å"If the slave trade was profitable and the Africans were put to productive use in the Americas, then why did Europeans begin to attack the trade at the end of the eighteenth century and systemically terminate the participation of every European metropolis and American colony or republic in the nineteenth century?†(188). Klein frequently used this strategy of posing a question at the beginning of the chapter, and then answering the same question throughout the rest of the chapter. Using this strategy, any inconsistencies were very infrequent, if none at all. All in all, there wouldn’t be anything in the book that I would need explained more, the author presented the question himself, and provided enough information where I felt he answered the question, and more. Because of how tough this book was to read for myself I probably wouldn’t recommend it to someone who wanted to just read a book. If someone was interested in learning the intricacies, and the numerical data that came along with the Atlantic Slave Trade I would definitely recommend this one. It’s just one of those books that if you don’t have the want, or motivation to read it, then it won’t be enjoyable, and you’ll likely become lost in the plethora of information the book presents.
Monday, January 6, 2020
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