patient awareness kolkatta new
TRANSCRIPT
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Osteoarthritis
Dr A V Gurava ReddyDNB, M.Ch, F.R.C.S(Ed), F.R.C.S(Glas)
Chief joint replacement surgeonManaging director
Sunshine hospitals hyderabad
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Osteoarthritis
• Typically affects
• Knees
• Hips
• Spine
• And small joints of fingers
• Mostly commonly affects knees in Indian
population
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OSTEOARTHRITIS KNEE
• Chronic, degenerative disorder
• multifactorial aetiology
• loss of articular cartilage
• periarticular bone remodelling
• large weight-bearing joints
• Common in older patients but can occur in
younger patients ( genetic mechanism , previous
joint trauma )
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• hinge joint
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Incidence
• Incidence increases with age
• In india - 80-90% above 65 suffer with primary OA
• After age 55 years, the prevalence increases in women in
comparison with men
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prevalence
• Equivalent prevalence occurs in men and women
aged 45-55 years (↑dramatically after the age of
50 years in women)
• Most adults older than 55 years show radiographic
evidence of osteoarthritis
• No significant correlation exists between incidence
of OA and race
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Causes
Primary OA
• Idiopathic
• Defective gene
• AGE RELATED WEAR AND TEAR
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Causes
Secondary OA
– Obesity
– Repetitive use (ie, jobs requiring heavy labor
and bending)
– Previous trauma (ie, posttraumatic OA)
– Infection
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Causes
– Crystal deposition
– Acromegaly
– Previous rheumatoid arthritis (ie, burnt-out
rheumatoid arthritis)
– Heritable metabolic causes (eg, alkaptonuria,
hemochromatosis, Wilson disease)
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Causes
– Hemoglobinopathies (eg, sickle cell disease,
thalassemia)
– Underlying orthopedic disorders (eg, congenital
hip dislocation, slipped femoral capital
epiphysis)
– Disorders of bone (eg, Paget disease,
avascular necrosis)
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History
• Insidious throbbing arthralgias with activity
• Initially, resting relieves the pain
• Eventually, the pain occurs even at rest
• Morning stiffness ≥ 30 minutes
• Intermittent joint swelling
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Symptoms
• Pain
• Stiffness
• swelling
• Instability
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Signs
• Pain
• Tenderness
• Swelling
• Effusion
• Crepitus
• Limitation of movement and muscle
wasting
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Deformities
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Imaging
• Plain radiographs
• Bone scans may be helpful in early
diagnosis of OA of the hand
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• The space between the bones of the upper and lower leg is smaller
• Bony spurs (osteophytes)
• Increase bone density at the margin of the joint
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x-ray
findings– Joint space narrowing
– Osteophytes
– Subchondral sclerosis : ↑ bone density,
frequently found adjacent to joint space
– Subchondral cysts : fluid-filled sacs which
extrude from the joint
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Radiographs
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Diagnosis
• On the basis of the initial history
and examination
• X-rays
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Manage
ment
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Goals of
managing OA
• Pain control
• Prevent stiffness and secondary deformities
• Limiting functional impairment
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Treatment
• Education and behavioural intervention
• Weight loss
• Physiotherapy
• Splints
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Treatment
• Analgesics
- Acetaminophen (Tylenol®) is a mild pain
reliever with few side effects
- Anti-inflammatory medication, such as
ibuprofen and aspirin
- COX-2 inhibitors
- Glucosamine and Chondroitin sulfate
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Treatment
• Intra-articular injection
- Glucocorticoids injection
- Hyaluronic Acid (HA) and similar
hyaluronan preparations (eg, Synvisc)
………. Debatable
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Treatment
• Surgery
- Arthroscopy (including debridement,and lavage/irrigation)
- Proximal Tibial Osteotomy
- Total Knee Replacement
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Case 1
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CASE 2
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Case 3
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CASE 4
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MOBILE BEARING KNEE- RESULT
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HI-FLEX
KNEE
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Young –19 /m
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All four joints replaced in a young patient with ochronotic arthropathy
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MOTTO
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Achievements
• Established as a patient friendly hospital in 2009
• The second largest Joint replacement center in Asia
• Well equipped and biggest trauma care facility in the state of Andhra Pradesh
• Availability of all Super specialists under one roof
PATIENT FIRST
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Sunshine Hospitals is South East Asia’s 2nd largest joint replacement centre to a
pioneering multi-super specialty hospital
3000+ successful joint replacements every year
A state-of-the-art healthcare destination unrivaled for its service, quality of
deliverables and empathy
Investing relentlessly in people, equipment, technology and research
PATIENT FIRST
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About Sunshine Hospitals
• 400 Bed Facility
• Centrally Located at Paradise circle Secunderabad
• Exceptional Ambience
• Spacious Parking area
• Well trained Patient care Coordinators
• Choice of occupancy(Royal Suite… General ward)
PATIENT FIRST
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About Sunshine Hospitals
• 40 critical care beds with central monitoring systems
• Dedicated floor and In House critical care team to handle all Emergencies
• 1:1 Nursing ratio in critical care areas
• Treatment and patient care protocols as per international standards and
guidelines
• Specialized equipment and expertise Consultant team to handle complex
procedures
PATIENT FIRST
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About Sunshine Hospitals
• 14 World class operating Theatres having global quality standards with laminar
airflow, Hepa Filters, High end microscope and other latest surgical equipments.
• Well equipped patient centered central monitoring systems ICCU’s with special
trained staff and consultants 1:1 Nursing staff
• 2 Flat panel digital catheterization lab
• 150 seat Auditorium with latest AV system
• 2 Digital 7900 flurostar C-Arm
• 1.5 Tesla MRI and Spiral CT
• Dedicated floor for OT with pre and post operative ICU care
PATIENT FIRST
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• State of art Radiology services( MRI, CT, ECHO, Ultrasound, Doppler, TMT,
digital x-ray etc)
• Fully automated laboratory services( Pathology, Microbiology, Biochemistry,
Genetics)
• Special Health checkup packages
• Continuous learning programs for doctors and paramedical staff( internal and
external)
PATIENT FIRST
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CT / MRI 1.5 Tesla
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PATIENT FIRST
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PATIENT FIRST
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PATIENT FIRST
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20
09
Our VisionTo create a world-class medical facility where patients are treated with compassion.
Our MissionTo create a world-class medical facility where patients are treated with compassion .To offer qualitative and comprehensive services in a patient-friendly environment focused on clinical excellence, safety, dignity and transparency, while staying affordable and accessible to every patient in need.
Our Values• Compassion• Teamwork• Transparency• Process-driven
PATIENT FIRST
AUGUST,
SUNSHINE HOSPITALS: The beginning
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Arthroplasty surgeries
PATIENT FIRST
96 3
1
2010: A promising start..
5 Beds
321
0
210
5 Shoulder, Arthroscopy & Shoulder
surgeries 500
Trauma surgeries
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Arthroplasty surgeries
PATIENT FIRST
27 7
1
2013: The Journey till now..
0 Beds
603
1
040
5 Shoulder, Arthroscopy & Shoulder
surgeries 500
Trauma surgeries
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2014: Well placed to grow..
PATIENT FIRST
2ASIA’s LARGEST
Joint replacement Centre
nd
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2014: Well placed to grow..
PATIENT FIRST
1stRanked
Worldwide Achievers & Headlines Today
HEALTHCARE EXCELLENCE AWARD 2013
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Other specialities
• Trauma
• Arthroscopy and sports medicine
• Orthopedic oncology
• Spine
• Hand surgery
• Pediatric orthopedics
• Ilizarov and reconstructive surgery
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Trauma team
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Spine unit
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Hand surgery
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Arthroscopy and sports medicine
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Orthopedic oncology
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Pediatric orthopedics
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Reconstructive and ilizarov
surgery
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Our Anaesthesia Team
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Our Physiotherapy Team
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Our Support Team
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PATIENT FIRST
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PATIENT FIRST
THE SUNSHINE ADVANTAGE Sunshine Big hospitals without Specialty focus
Single Specialty hospitals
Volumes3000 joint replacements in a year
✔
Round the clock availability of Specialists, Resident in
the campus 24 X 7
DM Cardiologists ✔
MS Orthopedics doctors ✔MD Anaesthesiologist ✔MD General Medicine ✔Intensive care Specialists ✔
Infrastructure
Cardiac cath labs ✔CT Scan ✔MRI ✔Dialysis Machines ✔Modular theatres Laminar airflow with HEPA filters
✔
Support Services
Dedicated Pain Control Nurses working under a Consultant Anaesthesiologist
✔
Exclusive Infection control team headed by Consultant Microbiologist
✔
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Is the time out?