For patients

AMIS (Anterior Minimally Invasive Surgery) is an innovative surgical technique used for hip replacement. Unlike traditional methods that involve larger incisions and more invasive procedures, AMIS employs a minimally invasive approach through the anterior pathway, meaning from the front of the hip. This method has gained popularity in recent years due to the numerous benefits it offers to patients.

How AMIS Works
AMIS is performed through a small incision at the front of the hip. This approach allows the surgeon to avoid cutting muscles and tendons, which remain intact. This reduces damage to the soft tissues and enables the patient to recover faster.

Advantages of AMIS
•Faster Recovery: Patients undergoing AMIS typically return to their daily activities much quicker than those opting for traditional hip surgery. The smaller incision and less intervention with the muscles mean less pain and faster healing.
•Reduced Risk of Complications: Due to the lesser damage to tissues, AMIS reduces the risk of postoperative complications, such as infections and hip dislocation. Additionally, patients experience less postoperative pain.
•Better Rehabilitation: Preserving the muscles and tendons in good condition allows patients to regain full hip functionality more quickly and with greater ease.
•Smaller Incision: The incision in AMIS is significantly smaller than in traditional surgical methods, which also means fewer scars.

Who Is AMIS For?
AMIS is suitable for patients requiring hip replacement due to arthritis, injuries, or other degenerative conditions. However, the choice of this specific technique should be made in consultation with a specialized orthopedic surgeon, who will evaluate the individual case of each patient.

Conclusion
AMIS represents a revolutionary advancement in the field of orthopedic surgery, offering patients the possibility of faster recovery with fewer complications. With the anterior approach, surgeons can achieve better outcomes, while patients enjoy a quicker return to normal life. It is important for patients to be informed about their options and choose the method that best suits their needs.

Chronic wounds, such as diabetic foot ulcers, pressure sores, and venous leg ulcers, represent a significant challenge in healthcare. These wounds often fail to progress through the normal stages of healing, leading to prolonged suffering, increased risk of infection, and higher healthcare costs. One promising and increasingly utilized treatment for these stubborn wounds is Continuous Topical Oxygen Therapy (CTOT).

What is Continuous Topical Oxygen Therapy?
Continuous Topical Oxygen Therapy involves the direct application of oxygen to the wound site, typically through a specialized device that delivers oxygen at a consistent rate. Unlike systemic oxygen therapy, which delivers oxygen to the whole body, CTOT targets the wound area specifically, providing a concentrated and controlled oxygen environment that promotes healing.

The Role of Oxygen in Wound Healing
Oxygen plays a critical role in the wound healing process. It is essential for several key functions, including:

•Collagen Synthesis: Oxygen is crucial for the production of collagen, the protein that forms the structural framework of new tissue.
•Cell Proliferation: Oxygen supports the growth and replication of cells, which is necessary for tissue regeneration.
•Angiogenesis: The formation of new blood vessels, or angiogenesis, is oxygen-dependent and vital for bringing nutrients and immune cells to the wound site.
•Infection Control: Oxygen has natural antibacterial properties and enhances the function of immune cells, helping to reduce the risk of infection.

How Continuous Topical Oxygen Therapy Works
In CTOT, oxygen is delivered continuously to the wound through a dressing or device that covers the wound site. This localized delivery ensures a high concentration of oxygen directly to the area where it is needed most, without the side effects associated with systemic oxygen therapy. The therapy can be applied in a home setting, making it a convenient option for patients with chronic wounds.

Benefits of Continuous Topical Oxygen Therapy
1.Accelerated Healing: CTOT has been shown to significantly speed up the healing process in chronic wounds by enhancing oxygen availability to the affected tissues.
2.Reduced Infection Risk: The antibacterial properties of oxygen help in reducing the risk of wound infections, which are common in chronic wounds.
3.Improved Patient Outcomes: Faster healing times and reduced infection rates lead to better overall outcomes for patients, including decreased pain and improved quality of life.
4.Cost-Effectiveness: By promoting quicker healing, CTOT can reduce the need for prolonged care and the associated healthcare costs.
5.Non-Invasive and Easy to Use: CTOT is a non-invasive treatment that can be easily administered, making it suitable for long-term management of chronic wounds, often in the comfort of the patient’s home.

Clinical Evidence and Future Directions
Numerous clinical studies have demonstrated the efficacy of CTOT in treating chronic wounds. Patients receiving CTOT often experience a significant reduction in wound size, faster healing times, and fewer complications compared to traditional treatments. As research continues, the application of CTOT may expand to a broader range of wound types and patient populations.

Conclusion
Continuous Topical Oxygen Therapy represents a promising advancement in the treatment of chronic wounds. By harnessing the natural healing properties of oxygen, CTOT offers a targeted, effective, and patient-friendly approach to wound care. As more healthcare providers adopt this therapy, it holds the potential to improve outcomes for millions of patients suffering from chronic wounds worldwide.

Chronic ulcers are wounds that do not heal normally and remain open for an extended period, usually over three months. These ulcers can occur in various parts of the body, with the most common being diabetic foot ulcers, pressure sores (decubitus ulcers), and venous leg ulcers. Chronic ulcers pose a serious health problem, as they can lead to complications such as infections and even amputation if not properly treated.

Causes and Risk Factors

The development of chronic ulcers is associated with various risk factors, including:
•Diabetes: Poor blood circulation and nerve damage (diabetic neuropathy) in diabetic patients contribute to the development of foot ulcers.
•Cardiovascular Issues: Venous insufficiency and arterial diseases can cause inadequate blood supply to the tissues, leading to chronic ulcers.
•Pressure and Friction: Pressure sores result from prolonged pressure on specific body areas, especially in patients who remain immobile for long periods.
•Infections: Infected ulcers are more difficult to heal and can lead to severe complications.

Treatment Approaches

Treating chronic ulcers requires a multi-faceted approach that includes direct wound care and addressing the underlying causes.

1.Wound Cleaning and Care
o Debridement: Systematic removal of dead tissue (debridement) is necessary to promote healing and prevent infections.
o Dressings: The use of special dressings that maintain a moist environment helps speed up healing and protect against infections.

2.Medication
o Antibiotics: In cases where infection is present, antibiotics are administered to combat bacteria.
o Topical Treatments: Creams and gels with antiseptic or anti-inflammatory properties are used to reduce inflammation and protect against infections.

3.Continuous Topical Oxygen Therapy (CTOT)
o This treatment involves the local application of oxygen to the ulcer to accelerate healing. Oxygen supports the growth of new cells and collagen production while reducing the risk of infections.

4.Pressure Relief and Offloading
o Pressure Relief: In patients with pressure sores, the use of special cushions or mattresses can reduce pressure on body areas with ulcers.
o Orthopedic Footwear: For diabetic patients, special footwear can reduce pressure on the feet and prevent the formation of new ulcers.

5.Surgical Interventions
o In severe cases, where conservative treatments do not yield results, surgical intervention may be necessary to restore blood circulation or remove the ulcer.

Prevention
Prevention is key to managing chronic ulcers. Proper diabetes management, good hygiene, avoiding prolonged pressure on specific body areas, and timely care of any wounds can significantly reduce the risk of developing chronic ulcers.

Conclusion
Chronic ulcers are a serious condition that requires a comprehensive approach to treatment and care. With proper management and prevention, patients can improve their quality of life and reduce the risk of complications.

As individuals age, their risk of falling and sustaining fractures increases significantly. Falls are a leading cause of injury among older adults, and fractures can have severe consequences for their overall health and quality of life. Understanding the factors contributing to falls, common types of fractures, and preventive measures is crucial for improving the well-being of the elderly population.

Factors Contributing to Falls in Older Adults

Several factors can increase the likelihood of falls in older adults:

1. Decreased Balance and Coordination: Aging can affect balance and coordination due to changes in the inner ear, muscles, and the nervous system. This can make it harder for older adults to maintain their stability, especially when walking on uneven surfaces or navigating obstacles.
2. Muscle Weakness: Loss of muscle strength, particularly in the legs, can reduce stability and make it difficult to recover from a stumble or misstep.
3. Vision Impairments: Deterioration of vision with age can affect depth perception and the ability to see hazards, increasing the risk of tripping or falling.
4. Chronic Health Conditions: Conditions such as arthritis, osteoporosis, and neurological disorders can affect mobility and balance, making falls more likely.
5. Medications: Some medications can cause dizziness, drowsiness, or a drop in blood pressure, contributing to falls.
6. Environmental Hazards: Cluttered living spaces, poor lighting, and uneven flooring can create tripping hazards that increase the risk of falling.

Common Types of Fractures in Older Adults

Fractures resulting from falls in older adults often occur in specific areas due to the impact of the fall and the vulnerability of aging bones:

1. Hip Fractures: One of the most common and serious types of fractures in older adults, hip fractures can occur from a fall or even from a minor impact. They often require surgical intervention and can significantly impact mobility and independence.
2. Wrist Fractures: Wrist fractures commonly occur when an individual tries to catch themselves during a fall. This type of fracture can be painful and may require immobilization or surgery.
3. Spinal Fractures: Osteoporosis can lead to vertebral compression fractures in the spine. These fractures can cause significant pain and affect posture and mobility.
4. Shoulder Fractures: Falls onto the shoulder or outstretched arm can result in fractures of the shoulder blade or upper arm bone (humerus). These fractures can impair arm movement and require rehabilitation.

Preventive Measures for Falls and Fractures

Preventing falls and fractures involves a combination of lifestyle changes, home modifications, and medical interventions:

1. Strength and Balance Exercises: Engaging in regular exercises that focus on improving strength, balance, and coordination can help reduce the risk of falls. Activities like Tai Chi and strength training are particularly beneficial.
2. Vision and Hearing Checks: Regular eye and hearing examinations can help identify and address issues that might contribute to falls.
3. Home Safety Modifications: Making the home environment safer by removing tripping hazards, installing grab bars in the bathroom, and improving lighting can reduce the risk of falls.
4. Medication Review: Regularly reviewing medications with a healthcare provider can help manage side effects that might increase fall risk.
5. Osteoporosis Management: For individuals with osteoporosis, medications and dietary changes to improve bone density can help prevent fractures.
6. Assistive Devices: Using walking aids or other assistive devices as recommended by healthcare professionals can provide additional support and stability.

Conclusion

Falls and fractures in older adults are significant concerns that can impact their health and quality of life. By understanding the contributing factors, recognizing common types of fractures, and implementing preventive measures, older adults and their caregivers can reduce the risk of falls and maintain greater independence and well-being. Regular health check-ups and a proactive approach to safety and health management are key to minimizing the risks associated with falls and fractures in older age.

Congenital hip dysplasia is a developmental condition affecting the hip joint in newborns and infants. It occurs when the hip socket (acetabulum) does not fully cover the ball portion of the upper thigh bone (femoral head), resulting in instability and potential dislocation of the hip joint.

Symptoms
•Limited range of motion in the hip joint
•Asymmetry in the folds of the skin on the thighs or buttocks
•One leg appears shorter than the other.
•Clicking or popping sounds in the hip joint
•Difficulty in spreading the legs apart.

Diagnosis
Congenital hip dysplasia is often diagnosed through a physical examination by a healthcare provider, particularly during routine well-baby checkups. Additional diagnostic tests such as ultrasound or X-ray may be performed to confirm the diagnosis and assess the severity of the condition.

Treatment
Early detection and intervention are crucial for effective management of congenital hip dysplasia. Treatment options may include:
1.Pavlik Harness: For infants under six months of age with mild to moderate hip dysplasia, a Pavlik harness may be used to gently reposition the hip joint and promote proper alignment.
2.Bracing: In cases where the Pavlik harness is not suitable or effective, a brace known as a hip abduction orthosis may be prescribed to maintain the hip joint in the correct position.
3.Closed Reduction: For more severe cases or when conservative measures are unsuccessful, a closed reduction procedure under anesthesia may be performed to manually reposition the hip joint.
4.Surgical Intervention: In some instances, surgical procedures such as an open reduction or osteotomy may be necessary to correct hip dysplasia, particularly if it is diagnosed later in childhood or during adolescence. The most innovative method consists of CT based 3D pre-operative planning and construction of 3D bone models and patient-specific cutting guides to achieve the optimal alignment of osteotomy.

Conclusion
Congenital hip dysplasia, if left untreated, can lead to long-term complications such as hip arthritis and mobility issues. However, with early detection and appropriate treatment, the prognosis for children with hip dysplasia is generally favorable. Regular monitoring and follow-up appointments with healthcare providers are essential to ensure optimal outcomes and prevent future complications. If parents notice any signs or symptoms suggestive of hip dysplasia in their child, they should promptly seek medical attention for proper evaluation and management.
By raising awareness about congenital hip dysplasia and its symptoms, we can help ensure timely intervention and better outcomes for affected children.

Charcot foot, also known as Charcot arthropathy, is a condition characterized by progressive and destructive changes in the bones and joints of the foot. It is often associated with peripheral neuropathy, a condition that causes a loss of sensation in the extremities, particularly the feet. The lack of sensation can lead to repetitive trauma or injury to the foot without the person being aware of it.

In Charcot foot, the bones and joints become weakened and can collapse, leading to deformities and instability in the foot. This condition is commonly seen in individuals with diabetes, as diabetes-related neuropathy is a major contributing factor.

The signs and symptoms of Charcot foot may include swelling, redness, and warmth in the affected foot. If left untreated, Charcot foot can result in severe deformities, ulcers, and even amputation in some cases. Early diagnosis and management, often involving offloading the foot and addressing the underlying causes, are crucial in preventing further complications.

Charcot foot reconstruction can be accomplished mainly by internal fixation, external fixation, or a combination of both, known as hybrid fixation. Given the unique nature of Charcot arthropathy in each patient, the treatment approach must be highly personalized, considering various factors. 

Burns are injuries that occur when the skin and underlying tissues are exposed to heat, chemicals, electricity, radiation, or friction. Burns are classified into different degrees based on their severity.

Types of Burns:

1. First-Degree

• These burns only affect the outer layer of skin (epidermis).
• Symptoms include redness, pain, and mild swelling.

2. Second-Degree

• These burns affect both the epidermis and the underlying layer of skin (dermis).
• Symptoms include blistering, severe pain, redness, and swelling.

3. Third- Degree

• These burns destroy both the epidermis and the dermis, sometimes reaching the underlying tissues.
• Symptoms can include charred skin, white or blackened areas, and numbness due to nerve damage.

4. Fourth Degree

• These burns are the most severe and can extend into muscles, tendons, and bones.
• The extent of tissue damage is profound.

It's important to note that burn treatment can depend on the cause and severity of the burn. Medical attention is recommended for all but minor burns, especially for second-degree and more severe burns.

Treatment

Using a bioresorbable matrix made from collagen and elastin used in wound healing and tissue regeneration. It is often utilized in the treatment of various types of wounds, including burns. It provides a scaffold for cells to grow and aids in the regeneration of new tissue. However, it's important to note that the use of specific medical treatments for burns should always be prescribed and supervised by qualified medical professionals.

Knee replacement is a surgical procedure that involves removing damaged or diseased parts of the knee joint and replacing them with artificial components. It is typically done when other treatments, such as physical therapy or medication, have failed to relieve knee pain and improve mobility.

Causes: The most common reasons for knee replacement are:

• Osteoarthritis: A degenerative joint disease that causes the cartilage in the knee joint to wear down over time, leading to pain and stiffness.
• Rheumatoid arthritis: An autoimmune disorder that causes inflammation in the joint lining, leading to pain and stiffness.
• Post-traumatic arthritis: Arthritis that develops after a knee injury, such as a fracture or ligament tear.
• Avascular necrosis: A condition where the bone tissue in the knee dies due to a lack of blood supply.

Symptoms: The most common symptoms that may indicate the need for knee replacement include:

• Persistent knee pain that limits daily activities
• Stiffness and swelling in the knee joint
• Difficulty walking or climbing stairs
• A decrease in knee mobility
• Knee deformities, such as varus or valgus

Treatment: The knee replacement surgery involves replacing the damaged parts of the knee joint with artificial components made of metal and plastic. The procedure typically takes a couple of hours, and most patients stay in the hospital for a few days to recover.

After the surgery, patients are advised to rest and gradually increase their physical activity with the help of a physical therapist. Pain medication and anti-inflammatory drugs may be prescribed to manage discomfort and swelling.

Prevention: While knee replacement cannot be prevented in all cases, there are some measures that can help reduce the risk of knee damage and delay the need for surgery, such as:

• Maintaining a healthy weight to reduce stress on the knees
• Engaging in regular low-impact exercise, such as swimming or cycling, to strengthen the muscles around the knee joint
• Avoiding high-impact activities that can put excessive strain on the knees
• Wearing appropriate footwear to support the feet and knees.

Hip replacement is a surgical procedure that involves removing damaged or diseased parts of the hip joint and replacing them with artificial components. It is typically done when other treatments, such as physical therapy or medication, have failed to relieve hip pain and improve mobility.

Causes: The most common reasons for hip replacement are:

• Osteoarthritis: A degenerative joint disease that causes the cartilage in the hip joint to wear down over time, leading to pain and stiffness.
• Rheumatoid arthritis: An autoimmune disorder that causes inflammation in the joint lining, leading to pain and stiffness.
• Avascular necrosis: A condition where the bone tissue in the hip joint dies due to a lack of blood supply.

Symptoms: The most common symptoms that may indicate the need for hip replacement include:

• Persistent hip pain that limits daily activities
• Stiffness and swelling in the hip joint
• Difficulty walking or climbing stairs
• A decrease in hip mobility
• Hip deformities, such as leg length discrepancy or hip dislocation

Treatment: The hip replacement surgery involves replacing the damaged parts of the hip joint with artificial components made of metal, plastic or ceramic. The procedure typically takes a few hours, and most patients stay in the hospital for a few days to recover.

After the surgery, patients are advised to rest and gradually increase their physical activity with the help of a physical therapist. Pain medication and anti-inflammatory drugs may be prescribed to manage discomfort and swelling.

Prevention: While hip replacement cannot be prevented in all cases, there are some measures that can help reduce the risk of hip damage and delay the need for surgery, such as:

• Maintaining a healthy weight to reduce stress on the hips
• Engaging in regular low-impact exercise, such as swimming or cycling, to strengthen the muscles around the hip joint
• Avoiding high-impact activities that can put excessive strain on the hips
• Wearing appropriate footwear to support the feet and hips.

Total shoulder arthroplasty (TSA) is a surgical procedure that involves replacing the damaged or worn-out parts of the shoulder joint with artificial components. During the procedure, the surgeon will make an incision in the shoulder and remove the damaged parts of the joint, including the humeral head (upper arm bone) and the glenoid (shoulder blade). These parts are then replaced with artificial components made of metal, plastic, or ceramic.

The benefits of TSA include:

• Reduced pain and stiffness in the shoulder joint
• Improved range of motion in the shoulder joint
• Improved function and strength in the arm and shoulder muscles
• Improved quality of life and ability to perform daily activities

ΤSA is a major surgery and requires a significant amount of rehabilitation and recovery time. Patients will typically need to undergo physical therapy and follow a strict rehabilitation program to regain strength and range of motion in the shoulder.

Shoulder arthritis is a common condition that can cause pain, stiffness, and reduced range of motion in the joint. In cases where conservative treatments are no longer effective, total shoulder arthroplasty (TSA) may be recommended as a treatment option. While TSA can provide significant benefits in terms of pain relief and improved function, it is important to understand the risks and benefits of the procedure and to work closely with a healthcare provider to ensure a successful outcome.

What is a diabetic foot?

Diabetic foot is a condition that is caused by diabetes mellitus and is caused by a disorder of the blood supply to the limbs, resulting in various complications such as ulceration, tissue infection or diabetic arterial disease.

What are the symptoms?

The main symptoms that should alarm the patient are:

• Leg ulcer
• Swollen and irritated foot
• Blisters and dry skin
• Bruised foot

How is it treated?

Proper treatment of diabetic foot requires the involvement of physicians of various specialties, with the primary role of the vascular surgeon. First, the blood sugar must be regulated and then the existing arterial lesions must be treated with modern surgical techniques. At the same time, the existing ulcers must be meticulously treated with appropriate dressings and negative pressure therapies. Neglecting and mishandling an ulcer can lead to limb amputation.
 

Hallux valgus, commonly referred to as a bunion is an anatomical deformity of the big toe. This is the most common deformity of the foot, in which the big toe deviates from its anatomical position and turns around its axis, while the first metatarsal head protrudes creating the so-called bunion, that causes medial big toe pain and difficulty with shoe wear.

The condition appears to have genetic predisposition and is more common in women. Aggravating factor is the narrow shoes, especially with high heels, which force the big toe to change its angle in relation to the other toes, while the constant pressure and friction causes redness, pain and osteophytes.

In most cases the problem is addressed surgically. The purpose of the surgical intervention is to correct the deformity, through corrective osteotomy. This means that the bone will be incised, its orientation will be corrected, and it will be held in its final position with special osteosynthesis implants.

What is osteoarthritis?  

Osteoarthritis is a degenerative disease that affects the joints. It mainly affects older people, however, it can also be caused by an injury. It is the most common form of arthritis and occurs in people all over the world. It is also known as degenerative arthropathy.

What causes osteoarthritis in the joints? 

Osteoarthritis is due to the gradual degeneration of the joints of the body. Cartilage is a tissue that facilitates the movement of the joint without friction. If it wears out completely, then the bones rub against each other and thus, the entire joint is damaged. Thus, the bone changes, the tissues that hold the joints together and attach to the bone wear out, causing inflammation in the area. 

Risk factors that increase the risk of osteoarthritis include age, previous injuries, gender (more common in women), obesity, heredity and certain metabolic diseases.

The symptoms of osteoarthritis? 

• Pain
• Stiffness
• Swelling and inflammation
• Feeling that the joint is rubbing
• The range of motion is reduced

What is the treatment for osteoarthritis? 

Different forms of treatment are recommended for each stage of osteoarthritis with the aim of relieving the symptoms.

In the first stage of acute osteoarthritis, anti-inflammatory drugs and cold compresses are given. Muscle-strengthening exercises and physiotherapy are also recommended. 

In the second stage, injections of hyaluronic acid and chondroitin are applied. These are substances that reduce bone friction and help partially regenerate damaged cartilage.

Finally in the third stage, when the wear is great, the patient undergoes total arthroplasty surgery.

The invention of total hip arthroplasty (THA) was the most radical treatment, addressing the various hip diseases and contributed significantly to the improvement of patients' quality of life, as they are given the opportunity to live an almost normal life. The pioneer surgeon of this operation was Sir John Charnley who, about 70 years ago, started the systematic treatment of osteoarthritis of the hip with total hip arthroplasty. Today we have reached the point where the number of total hip arthroplasties performed worldwide exceeds 1.3 million patients per year.

The goal of total knee arthroplasty (TKA) is to restore knee joint mobility and improve the function of the muscles, ligaments, and other soft tissues around the knee. Clinically, it also aims to reduce pain and improve patients' quality of life after ineffective conservative treatment.