Rotator cuff is a vital structure of glenohumeral joint, the dysfunction of which leads to debilitating pain and restricted movement. Arthroplasty using unconstrained anatomical prosthesis for treating these conditions have not been successful in the past. Reverse Shoulder Arthroplasty (RSA) is a novel technique specifically designed to address end stage glenohumeral arthritis in rotator cuff deficient joint. Short and mid-term studies have demonstrated a significant improvement in pain and range of motion of the shoulder joint. However there is a very high complication rate in comparison to total and hemiarthroplasty of shoulder joint. Over the years, there has been a steady increase in RSAs performed, both in volume and the indications for its use. This article discusses the biomechanical aspects, indications and critically reviews the clinical outcome following Reverse Shoulder Arthroplasty.
Extensor disruptions of the knee following the total knee replacements are uncommon. We describe a case of postoperative bilateral simultaneous extensor mechanism disruption following simultaneous bilateral total knee replacement. On both sides, the patient sustained open wounds. The extensor mechanism was successfully repaired on both sides, but the outcome is less than satisfactory.
Purpose To analyse the incidence of additional soft tissue releases with the lateral parapatellar approach, and the clinical and radiological outcomes of total knee arthroplasties performed using the lateral parapatellar approach for valgus arthritic knees. A review of the existing literature on valgus arthritic knees undergoing knee replacement was performed and our results compared. Materials and Methods This is a prospective cohort study of 50 patients operated by this approach. Operation and clinical records were assessed to determine the number and sequence of soft tissue releases. Functional outcome was measured using the Oxford Knee Score. Radiological assessment included measurement of alignment and implant positioning. Results 46 patients included. Mean follow-up of 4 years. Additional lateral releases were performed in 11 (24%) cases. Mean valgus alignment corrected from 13.1 degrees pre-operatively to 5.7 degrees post-operatively. Oxford Knee Score improved from a mean pre-operative score of 11.9 to a mean post-operative score of 38.3 at final follow-up. Radiographs revealed lateralisation of the tibial component in 4 patients. No immediate or late post-operative wound complications, late instabilities or revisions were observed. Conclusion Lateral parapatellar approach is highly effective in correcting the valgus deformity with a low incidence of additional soft tissue releases. Medium-term results indicate an excellent functional outcome with no complications.
Turbulent market changes and fierce technological competition is impelling organizations to generate knowledge & learning faster than competitors to achieve a high market share, productivity, super fast economic growth and expansion etc. Learning inputs are core for foundation of learning in an organization and positively affect innovation. Based on the sample of 138 employees of public and private General Insurance Companies in J&K, the study found positive impact of commitment to learning, open mindedness, shared vision, knowledge management infrastructure, reward, communication & embedded system and trust on innovation in the organization. To encourage learning climate , managers must understand and predict employees and customer needs, welcome new ideas, pay much attention to the cause & effects of subordinate actions and detect & correcting errors, build teams, improve communication technologies, encouraging interdependence of employees to makes them feel safe in displaying proactive behavior, synchronizing personal objectives with organizational goals, organizing mentoring or apprenticeship program and rewarding outstanding performances of employees.
Background: The concept of a fast track (Enhanced Recovery After Surgery, ERAS) was introduced to colorectal surgery in Denmark by Kehlet in 1999 which improved the quality of the care and reduced the length of hospital stay following major colorectal surgery. The same principles of ERAS have been applied to the orthopaedic surgery particularly the hip and knee replacement surgery and fracture neck of femur surgery. It is a relatively new approach in orthopaedics to the preoperative, intraoperative and postoperative care of the patients undergoing surgery. Methods: We have compared the length of inpatient stay, day of mobilisation, postoperative blood transfusion and adverse outcome for the patients undergoing hip or knee replacement by a single surgeon (KS) between ERAS and NON ERAS patients. Results: A total of 138 patients underwent hip or knee replacement, hip resurfacing arthroplasty or oxford unicompartmental arthroplasty between July 2011 and June 2012 with ERAS protocol. In the Non-ERAS group, 140 patients underwent hip or knee arthroplasty, resurfacing or oxford uni-compartmental knee replacement in the previous year (July 2010 to June 2011) by the same surgeon. Average hospital inpatient stays for the ERAS patients was 4.12 days with 73.10% of the patients having an inpatient hospital stay of less than or equal to 5 days. The average hospital inpatient stays for the NON-ERAS patients was 8.34 days with only 24.08% of the patients being discharged in less than or equal to 5 days. Conclusions: Our study shows that the implementation of the ERAS protocol in hip and knee replacement surgery is associated with improved patient experience, faster recovery and shorter hospital inpatient stay with no increase in complication.
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