BRIEF CV Associate Director, Orthopaedic Department 417 NIMTS, athletics. Master in Hip Surgery, Knee Reconstruction and Orthopaedic Oncology at the Royal National Orthopaedic Hospital, Stanmore, London, UK. Member of the European Society of Knee Surgeons, Sports Medicine and Arthroscopic Surgery. Member of the Greek Society of Orthopaedic Surgery and Traumatology Member of Greek Arthroscopic Assosiation Member of Greek Spine Society Member of the Greek Society for the Study of Bone Metabolism. DESCRIPTION OF PRODUCT-SERVICE Arthroscopic Surgery, Sports Injuries ACL Reconstruction Chondrocyte transplantation Adult-Pediatric Traumatology Reconstructive Surgery-Reconstruction of Joints Total Hip and Knee Arthroplasty Unicompartmental knee replacement Hip resurfacing Spine Surgery Hand Surgery-Microsurgery Control and Treatment of Osteoporosis WHAT IS ARTHROSCOPY The word arthroscopy comes from the words and articulation skopein (look, look). With this surgical technique is capable of verification and inspection of the interior a joint or a body cavity using special equipment. To make an arthroscopy is necessary to use a special camera with a diameter up to 5 mm or less in small joints, cold lighting system, apparatus for fluid and various other devices with which it is possible to conduct surgeries. Arthroscopic image is displayed on a monitor, which monitors the surgeon to perform the surgery. Diagnostic and Surgical arthrskopisi place in almost all joints of the body where there is therapeutic interest of the small joints of hand and foot to the shoulder and spine. Conducting an arthroscopic surgery requires special training and competence of the Orthopaedic Surgeon-arthroscopic. The majority of arthroscopic knee surgery takes place and then the shoulder. Rarely intervening in the elbow, wrist, hip and ankle. LESIONS OF THE KNEE CARTILAGE AND METHODS FOR RECOVERY The increased number of people involved in sport at amateur or professional basis and from an early age, makes sports injuries and in particular damage the articular cartilage of the knee, common in orthopedic practice Traumatologic. These lesions if not promptly and properly addressed, lead to the occurrence of early posttraumatic arthritis, namely the premature destruction of the joint. The articular cartilage is an opaque, smooth, white tissue, which is inserted in the joints, prosdidontas these unique biomechanical properties of support, strength and movement. The 65% -80% of the total volume consists of water, while 50% of dry weight consists of collagen II with the remaining 50% of chondrocytes. Not having its own vessels and nerves, nourishment takes place through the phenomenon of diffusion into the joint by synovial fluid, which depends primarily on the synovium, which produces it. Normally, the cartilage is subject to wear due to age by reducing the thickness, leading to friction between bones forming the joint. Unfortunately, the ability to automatically rebuilding and healing (self-healing) is limited due to the incapacity of chondrocyte proliferation. For this reason, the application of timely and appropriate treatment of symptomatic cases of traumatic lesions of articular cartilage of the knee is imperative in order to avoid or at least delay the onset of degenerative - traumatic osteoarthritis in the near future of the patient. CHONDROPLASTICS The most modern therapeutic interventionist trend today is to replace the injured area or piece of articular cartilage with biological materials that mimic the structural and mechanical properties of the maximum possible (Chondroplastiki). The approach of the affected area are generally carried out atraumatically through arthroscopy of the knee, ie through small holes, from which, using a special camera, everyone performed the surgical manipulations. The therapeutic approach includes all the modes of relief and rehabilitation, taking into consideration criteria and parameters related to the level of activity of the patient's age, and of course the degree and extent of the lesion itself. Finally, the ultimate goal is to achieve a normal painless joint, able to meet both the demands of daily activity and rehabilitation of various sports. The main clinical signs and symptoms, leading the patient-specific orthopedic arthroscopic, is the pain and limping gait that accompanies him. The radiological assessment includes plain radiographs, CT scans (the draw on a greater sensitivity and accuracy to the emergence of bony structures-faults) and magnetic resonance imaging (MRI). The MRI has a special place to highlight the morphology of cartilage defects, and has high specificity for the diagnosis of cartilage deficit and subsequent treatment strategy. The therapeutic arsenal, the orthopedic-arthroscopic has four solutions for the rehabilitation of these cartilage defects: 1. Arthroscopic washout of the joint with degenerative cleaning items. 2. repair through the articulation of endogenous factors, namely through the activation of regenerative capacity of cells in the bone marrow (drilling, microfracture) 3. Bioremediation using autologous graft-implant by: a) plastic recovery through the technique of "patchwork" system or osteochondral autologous transplantation b) autologous chondrocyte transplantation at 2 years; 4. a recent transplant allograft (ie graft from another person). The autologous chondrocyte The technique of autologous chondrocyte transplantation, flourished in the late 90's and developed by PETERSON in 1994. Already in large, specialized centers abroad, as the Royal National Orthopaedic Hospital, Stanmore, London, this technique counts over 11 years of implementation, with very good results in many patients. Indications AMCH (autologous chondrocyte transplantation): • symptomatic, localized, unilateral, total thickness cartilage defects scale of 2-10 t.ek. • extensive damage to young people • under 2 years of symptoms • athlete • a second surgery after a previous failure. The method of SDD includes 2 stages. In the first phase, an initial arthroscopic assessment which provides information in relation to the morphological data of cartilage defects (depth-extension) while taking part of healthy cartilage from non-loaded surface. In second year, is the implantation of chondrocytes, after laboratory cultivation and propagation, or arthoskopiki technique, either with small arthrotomy techniques and periosteal retention (first generation), or other methods and other biological materials (second generation). The third generation of chondrocyte implantation, is the form of pellets, cultivated in the laboratory, the attachment of which is arthroscopically through the adhesive properties have these beads, the level of damage. Contraindications AMCH: • generalized osteoarthritis • cruciate ligaments ruptures • previous meniscectomy • Turnip rape-deformation vlaisogonyas • abnormal patellofemoral scrolling (mal-tracking) • inflamed knee • arthroinosi • neurological disorder • autoimmune disease • malignant obesity • pregnancy • addiction to substances From a scientific standpoint, the theoretical AMCH has a comparative advantage over creating a better hyaline cartilage over time. But technically demanding surgical needs 2 times and the cost is still high. Course necessary condition for success is the implementation by an experienced and specially trained Orthopaedic Surgeon. It requires continuous and long physiotherapeutic rehabilitation program. The overall program of recovery, is completed in approximately 18 months. Questions on joint replacement Questions about the hip Q: Who should undergo hip replacement surgery? A: The hip replacement surgery is appropriate for patients with chronic joint pain due to arthritis that complicates everyday activities, eg walking, exercise, relaxation and recreation. The aim of surgery is to relieve pain, restore independence and permit work and perform other daily activities. Q: What effect has joint replacement? A: After a total hip replacement surgery, many patients experience decreased pain, increased mobility and improved quality of life. The performance and lifetime of an implant depends on many factors, including pre-operative physical condition of the patient anatomy, weight, physical activity and willingness to meet the surgeon's instructions before and after surgery. The joint surgery is potentially dangerous and requires some recovery time. Individual results may vary and only one orthopedic surgeon can determine if surgery is right for you. Q: What are the possible complications of a total hip replacement surgery? A: Although it is uncommon, complications can arise during and after surgery. Complications include, but not limited to, infections and blood clots. To avoid these complications, surgeons can take several precautions, including the administration of antibiotics and blood thinners before and after surgery. Although implant surgery notes outstanding success in most cases, some patients may still feel pain and stiffness. Factors such as postoperative activity and weight of the patient may affect the longevity of the implant. It is best to discuss these risks with your surgeon, who is able to answer any questions you may employ. Q: When should I do this type of surgery? A: Your doctor will decide whether you are a suitable candidate for this surgery. Decisions will be based on your medical history, examination and x-rays. Q: I'm too old for this surgery? A: Generally, age is not a problem if you are in relatively good health and have the desire to continue to live actively. You should see your doctor for an opinion on the general state of health and fitness for surgery. Q: How long typically remain patients who underwent arthroplasty in the hospital? A: In the past, a patient typically expect to stay between 3-7 days, followed by six weeks or more difficult recovery before returning to normal activities. With a minimally invasive surgery, some patients can be discharged in just two days and significantly faster return to normal activities, as well as less postoperative pain. Q: What kind of activities should expect that patients will be able to operate after arthroplasty? A: This depends on many factors, including type of surgery, the state of your health and healing capacity. Typically, patients can return to certain activities in low-demand dynamics within weeks after surgery. It is advisable for patients to seek high-dynamic requirement activities such as running and endurance and strength.
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