I-Assist guided Verilast Knee replacement- Knee replacement that lasts for 30 years
Knee replacement in young patients can now last for a long time, thanks to the novel combination of a smart device, ‘I-Assist’ and a durable implant, the ‘Verilast knee’.A procedure involving an I-assist device to implant a Verilast knee, was performed for the first time in the world on a thirty two year old woman in Chennai, India by noted orthopaedic surgeon, Dr.A.K.Venkatachalam.
Case Report-
Ms Payal, a thirty two year lady from Gujarat was suffering from a rare condition called ‘Avascular necrosis’ of the knee and had suffered extensive damage. Although, she was very young for a knee replacement, the extent of the damage left no option for Dr.A.K.Venkatachalam. He had recently introduced the I-Assist device for another patient and was working with Verilast knee technology that had shown to reduce up to 81% of wear as compared to traditional materials.
He decided to go ahead with a knee replacement procedure for Ms Payal using the Verilast CR knee and the I-Assist. It was first time in the world that the I-Assist tool was used to implant a Verilast knee. The I-Assist tool uses electronic components in a palm sized device. With this, the surgeon can align and validate implant positioning during the knee replacement.
After the procedure, the patient was very happy with the results.
About the Verilast Knee Technology
The durability of the Legion CR knee with Verilast technology is based on laboratory testing.
In a laboratory, the LEGION CR knee with VERILAST Technology was compared with a similar knee made from conventional materials (cobalt chrome and standard plastic). The results showed that after five million cycles, or simulated steps, the LEGION CR knee reduced 98 percent of the wear experienced by the other knee made of conventional materials. After 45 million cycles,it was noted with the LEGION CR knee with Verilast technology, that the wear reduced to 81% in comparison to the conventional knee implant. That's equal to around 30 years of actual use.
VERILAST technology uses advanced, low-friction surfaces on both sides of the joint, the femur bone of the thigh, and the tibia bone of the leg. It combines Smith & Nephew’s award-winning OXINIUM™ Oxidized Zirconium metal alloy and a “cross-linked” plastic component (XLPE), which together has been proved in the laboratory to double the wear of a conventional knee.
OXINIUM™, Oxidized Zirconium is a tough, smooth metal with a ceramic surface 4,900 times more abrasion resistant and 20 percent lighter than the cobalt chrome metal used in conventional implants.
• The ceramic surface is created through a manufacturing process where oxygen is naturally diffused into the zirconium metal as it is heated in air. The original metal surface is transformed into a ceramic coating which is integrated with and part of the underlying metal ; It is not an externally applied coating
• With no detectable amount of nickel, the metal most associated with allergies, OXINIUM™ is a biocompatible material for implants.
• This proprietary material has been used in more than 250,000 knee implants.

About the I-Assist Smart Tool
‘I-Assist’ is a smart tool designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person’s unique anatomy. The outcome is very predictable as perfect alignment is achieved intra operatively and raises the chances of favorable outcomes. Perfect alignment correlates positively with survivorship or durability of the implant.
Which type of knee replacement patients’ benefit most from this combined technology?

It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement perfectly aligned. There is a correlation between the alignment and survivorship of the implant. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
In addition, a sizeable number of these young patients have additional complications that make a knee replacement difficult. Mal-united thigh and leg fractures secondary to previous accidents rule out the use of traditional instruments. Bony deformities within and outside the knee preclude use of all other modes of instrumentation and navigation.
Before this novel procedure, surgeons including Dr.Venkatachalam used “Patient specific instruments’ and ‘computer navigation’ to implant the Verilast knee. These are not applicable to difficult primary knees with bone loss.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.

In summary, the I-Assist tool allows the full survivorship potential of the Verilast CR Oxinium™ knee to be harnessed in primary and difficult cases. Young patients can return to their normal lives without the fear of a redo or revision surgery later on in their lives.

About the author:
Dr. A.K. Venkatachalam specializes in joint replacements and keyhole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques. With numerous surgeries and years of experience combined with innovative and pioneering technologies, he has helped many patients to regain full mobility of knees and hips.

All mothers who are on the verge of motherhood have one common fear. The fear is of acute labor pain during the time of childbirth. The quantum of pain varies from one mother to another mother. Some has very less labor pain and the pregnancy is easy and many have long delayed labor pain.

Labor pain is severe for most women who do not receive pain relief. With advent of modern medicine and availability of techniques with skilled practitioners, it is now possible to relieve the pain of labor. Management of pain is the most crucial thing in the delivery of baby and painless delivery techniques are providing respite from excessive pain, be it in normal deliveries or caesarean (that need operations). The technique of painless delivery called as Epidural Analgesia or Epidural Anesthesia is a popular technique used by women, if advised by the doctor, during labor. The technique is not only cost-effective, but also gives relief from unbearable labor pain during deliveries. Such deliveries have registered 6-7% rise in the past two-three years.

It is estimated that out of every 25 deliveries, there are around 8-10 painless deliveries. In fact most of those going for it are educated and come from well-off families. As threshold to bear labor pain among women has reduced, they prefer to go for epidural anesthesia. Most of patients come to us after knowing about it from friends and relatives. With women postponing motherhood till late thirties and conditions like obesity and hypertension, chances for normal delivery become less. As one grows old, threshold to bear pain also reduces but epidural anesthesia increases chances of having normal deliveries, doctors say. With women postponing motherhood till late thirties, with conditions like obesity, diabetics and hypertension becoming common, chances for normal delivery were becoming less.

In an Epidural procedure a small injection is placed in your lower back, through which a fine tube (epidural catheter), the size of a thread, is passed into your back. Drugs can be injected through this tube to relieve the pain of labor. These drugs are local anesthetics which cause numbing of the nerves and pain sensation without affecting the ability to move. These drugs are also very safe for the baby. With an epidural in place, you may feel the contractions, but they will not be painful. It provides respite to expectant mother from unbearable pain during delivery. The anesthesiologist and your nurse will check that the epidural is working well.

Pain is the reason to have epidural and whenever your pain is significant you can request for an epidural. All women in labor who need pain relief can have an epidural, except those on blood thinning drugs or abnormal blood tests. Epidural is not necessary for you to have delivery, but it can be beneficial in reducing the pain of labor. You only need to be in established labor, but there is no need to wait for a particular dilatation of the cervix. Also in those very anxious or keen to have an epidural, it can be placed at a convenient time before the labor pain is too bad, so that your cooperation is better.

Advantages: There are quite a few advantages of administering Epidural Analgesia. A few are listed below:

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Disadvantages: Disadvantages of epidural anesthesia include its potential for contributing to uncommon minor complications such as persistent positional headache afterwards, shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating. Epidural makes pushing more difficult and additional medications or interventions may be needed such as forceps or cesarean.

Who should have an epidural?

WHO should not have an epidural?

Can an Epidural Fail?

Get all the details and read more ...........

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Your obstetrician and anesthetist will discuss these with you.

Occasionally, epidural may not work as well as we would like it to. If this happens, the anesthesiologist will help by giving extra doses or changing your position or the catheter position. If it still does not work, the procedure has to be repeated (by placing the epidural catheter again).

Do epidurals increase the chance of a cesarean section?

A large amount of research has been done on this topic and it is clear that epidural per se does not influence the rate of cesarean section. A proportion of women planning normal delivery will end up having a cesarean section. This proportion remains the same with or without an epidural.

Seeking pain relief methods for child birth is mother’s choice. This is discussed beforehand only with the doctor in charge of delivery at the clinic. Moreover, a well informed patient is usually more cooperative and adaptive during labor and delivery. Hence, prenatal pain-relief education should work and mutually benefit parties, the patients as well as the care providers. Not every woman needs an epidural and not every woman wants an epidural. But women who are interested shouldn't wait. Rupal Hospital for Women in Surat is a one stop place for all Gynaec and Obstetrics problems and our expertise lies in providing affordable Laparoscopic surgeries and difficult cases of infertility. Rupal hospital is renowned for its comprehensive services under one roof for all your Obstetric need like Painless Normal Deliveries and Caesarean Deliveries and Post natal care and advice. We have one of the best facilities of painless delivery using epidural analgesia in Surat. For the backup, we have the most sophisticated sonography machines at our disposal.

You can contact the team of our doctors at http://www.rupalhospital.com/obstetrics_maternity.html or at http://www.rupalhospital.com

A HOLISTIC PRESCRIPTION: DR SHRINIWAS JANARDAN KASHALIKAR

As we go on evolving; we begin to appreciate that a doctor’s prescription has to be HOLISTIC. It has to be aimed at healing an individual as well as a society; because; the health of an individual affects the health of a society; and the health of a society in turn; affects the health of an individual.

But this is not all!

The prescription can be holistic only if, it ensures complete and permanent health!

What is this complete and permanent health?

The complete and permanent health is actually an experience of ever effulgent benevolent bliss and vitalizing vitality! In other words; this is a state where there is no trace of pain, fear, worry, anxiety, insecurity, frustration, indolence, apathy, indifference, agitation, jealousy, hatred, viciousness, anguish, vindictiveness, revengefulness, selfishness, meekness, possessiveness and so on!

Hence ideally; the prescription should include all the guidelines about the preventive, curative and rehabilitative measures; applicable to; an individual’s health and also to; the health of a society. Thus the instructions should include all the international, national, regional and local policies, plans and programs; in every field of life!

This is especially essential as; the patient may be a lay person; medical student, a medical teacher, a practicing doctor, a paramedic. He or she may be even a policy maker, a leader or a health minister. He or she may be a scientist, a philosopher, a writer, an artist, whose thoughts, feelings, instincts and behavior influence; directly or indirectly; the international, national, regional and local policies, plans and programs in education, agriculture, industry, health care. All these are crucial determinants of the health of the society. The health of the society in turn; influences the health of an individual!
However; if we aim to include all such details in a prescription, then it would be impractical. A doctor is usually not trained in holistic health, holistic medicine and holistic medical practice. Moreover; even if a doctor is very well trained; and can include all such details, it would be extremely time consuming and the prescription would too huge!

In such a situation; how can we make a prescription holistic without having to train the doctors in holistic medicine? How can we make a prescription holistic, without having to write all the details? How can we make a prescription without spending excessive time? How can we make prescription holistic without making the prescription clumsily big and difficult for the patient; to read, understand and comply with?

The answer to this question is; to add an essential core to every prescription!

What kind of essential core?

The essential core should be such that it would add the holistic essence and make the prescription a holistic one! The criteria of such an essential core are;

1. It should nurture and evolve all the levels of consciousness.
2. It should be safe.
3. It should be noninvasive.
4. It should not involve technicality.
5. It should not involve skills e.g. singing.
6. It should not involve intellectual labor.
7. It should not involve learning a new language.
8. It should be inexpensive for the participants.
9. It should be acceptable to all cultures.
10. It should require minimum of classroom training
11. It should not interfere with daily routine.
12. It should be easy for compliance.
13. It should be accessible even to the individuals with handicaps such as physical, visual, auditory, vocal and so on.

The essential core of a holistic prescription that fulfills all the above criteria and is practiced across the cultures for millennia; is called NAMASMARAN, the synonyms of which are JIKRA, SUMIRAN, SIMARAN, JAP and JAAP.
The concept of NAMASMARAN actually involves remembering the true self; as NAMA actually implies the true self. Remembering the NAMA is actually trying to reorient and reunite with one’s true self; because; this true self is usually inaccessible to one’s thinking, feeling and sensing!
This true self or innate core of an individual is traditionally referred to; as God or omniscient, omnipotent and omnipresent eternal truth.
From physiological point of view; NAMASMARAN involves:
1. Gradual central anchorage, control, regulation, progress, evolution and sublimation of the belligerent infatuations, whims, fancies, ideas, thoughts, feelings and instincts.
2. NAMASMARAN heals us by rectifying our physical needs, passions, feelings, motivations, thoughts; and vision (perspective) and behavior.
3. This is characterized by victory of over the dualities of thoughts, emotions and passions. But it does not stop here. There is triumphant ascent through the opposing nervous activities (e.g. sympathetic and parasympathetic), opposite thoughts, antagonistic emotions, conflicting passions; contra posed motivations and even the duality of anabolism and catabolism!
4. Later the NAMASMARAN is associated with the realization of being one, with the immortal and true self.
5. This is a difficult to conceive; as we are entrained to believe our beginning and end; in the end of our body. Moreover; the fact that we are immortal; is only experienced by only few; and we have no experience of it. Hence not only world consensus; but even the world literature in general; including scientific; does not uphold the idea of immortality.
6. Lastly; this is a protracted journey, but the most appropriate one! Moreover; while the other components of a prescription ensure prevention, cure and rehabilitation in concrete manner; NAMASMARAN ensures immortality! It is not concrete. It is not tangible. It is abstract! But what can be a more successful culmination than the state of immortality; of preventing, preempting or treating any disease?
7. NAMASMARAN is traditionally practiced for millennia and is centered on this state of immortality called Sat (True, Eternal) Chit (Vital, Living) Anand (Bliss); and normalizes the responses to internal and external stressors as one of the many byproducts. Hence it is safe as well as sure. It would prove to be central and crucial to a prescription; in preventing, preempting, or treating hundreds of other diseases and ailments; in terms of not either annihilating them, or overpowering and conquering; and thus getting freed from their sinister spell!

HEART DISEASE: THE BASELESS HYPOTHESIS! DR. SHRINIWAS KASHALIKAR

About twenty years ago I had sent a working hypothesis (a guesswork or conjecture) to a medical journal. In that hypothesis I had suggested stress as a root cause; in essential or idiopathic hypertension and ischemic heart diseases (apart from many others).

The hypothesis was rejected as baseless.

Today I wish to reiterate that hypothesis; in this article for free download; so that everyone can read and decide if it makes sense or not.
The hypothesis is:

The cardiovascular dysfunction; manifested in essential hypertensive pathophysiology and/or ischemic pathophysiology; is due to acute or chronic stress; either symptomatic (associated with; acute or chronic; restlessness, anxiety, conflicts, suffocation, fear, insecurity) or asymptomatic and without any symptoms. The underlying mechanisms of this stress could be:

a) Excess of adrenergic and nor adrenergic response or associated with tonic or phasic arteriolar spasms, increase in myocardial pumping, increase in all the catabolic products including those, which are produced by direct microscopic and molecular damage caused by increase in the catabolism/anabolism ratio!

b) Excess of simultaneous adrenergic, noradrenergic, cholinergic, non adrenergic, non noradrenergic; and non-cholinergic response; leading to disruption of the synergy and/or complementarity (e.g. actions on GIT smooth muscles and sphincters) , and phased out opposing actions (+ ve and – ve inotrophic, bathmotropic, dromotropic and chronotropic actions on heart) and exhausting one another

c) Metabolic changes corresponding to catabolic excess and/or anabolic exhaustion in terms of increases in the fatty acids, cholesterol, triglycerides, glucose, amino acids

d) Constriction of the vessels of kidneys resulting in increase in rennin angiotensisn activity and subsequent increase in blood pressure

e) The root cause of spasms in coronary (heart) blood vessels is also acute and/or chronic over activity of sympathetic nervous system; due to acute or chronic stress.

f) The root cause of atherosclerosis; is the increased friction and mechanical damage and roughening of the constricting vessels; especially arterioles due to over activity of sympathetic nervous system.

It is agreed that some people would be genetically more prone to stress and subsequent ischemic heart disease and blood pressure. But that does not disprove or even create a doubt about the hypothesis of stress as a root cause of bad lipids, spasms and atherosclerosis and subsequent ischemic heart disease and essential (idiopathic) hypertension.

g) One can read the pathophysiology text books and then think about confirming or ruling out (through statistical surveys, clinical studies, experimental work etc.) this hypothesis.

h) However; till then; we can apply common sense and reason out; how stress and its inappropriate management can disturb the metabolic, endocrine, neuroendocrine, autonomic nervous and central nervous activities and influence various tissues including heart vessels and other blood vessels in body.

i) It is important to remember that the damaging stress is often subconscious; and is present even during sleep and embryonic life and hence goes unnoticed.

The conclusion of this brief hypothesis; is that the first line preventive as well as healing measure (treatment) for ischemic heart disease and essential hypertension (and several other diseases mentioned in my book on Total Stress Management); is the practice of NAMASMARAN, which is the core of Total Stress Management!

MODI, SWACCHATA ABHIYAN AND NAMASMARAN: DR. SHRINIWAS KASHALIKAR

There are signals of serenity and happiness at personal level and holistic renaissance at global level; in the form of global unity and harmony.
Global conscience and consensus is being inspired and motivated towards it. In accordance the vision, policies, plans, programs and their appropriate implementation; are being shaped.

The mass movement of cleanliness; apparently initiated by Mr. Narendra Modi is actually a small reflection of this.

However; the degree of purity of body and mind; has direct implication; on our needs, requirements, whims and fancies; and their harmful or beneficial effects on; an individual, society and the environment. These effects are either direct or through the associated industries, trades and activities, which produce different types of wastes/pollution.

Hence this movement (SWACHATA ABIHIYAN) is bound to be far more successful; than what it is now; by integrating it with the idea of purity of body and mind. Even as it may not be feasible or appropriate; to enforce coercive measures of purity of body and mind; it would be more than advisable for the government to assist us in progressing towards the purity of body and mind.

This can be best done by the government and all the agencies associated with the SWACCHATA ABHIYAN; by simultaneously introducing and highlighting along with it; the principles and practice of NAMASMARAN.

This would not only help the SWACCHATA ABHIYAN to be far more effective; but also engender the serenity and happiness at personal level; and holistic renaissance at global level!