Regional anaesthesia has become a routine part of orthopedic surgery. When performed optimally, it offers patients an alternative method of intra-operative pain control. However, the manner in which it is implemented is an evolving practice. How it can be integrated within the typical surgical workflow such that said flow remains smooth and efficient remains to be seen. #anaesthesia #operatingroom #operatingroomlife #surgery #surgeonsoftiktok

Are There Different Tyoes Of Knee Replacements? Although there are several ways in which the various types of knee arthroplasty implants differ from one another, the main difference lies in the degree of constraint that the implants offer. There are basically two types of knee replacement implants: Constrained and Unconstrained. Unconstrained implants are designed in such a way that there is less of a restraint on the movement available to the implants of the arthroplasty. These implants allow not only flexion of the knee, but also rotation of the implant around the axis of the leg, or in other words pivoting. Constrained implants offer much more restraint to motion generally allowing only flexion of the knee. Constrained implants which sacrifice the anterior and posterior cruciate ligaments during surgery, are much more stable than their counterparts, but they tend to move less naturally. Unconstrained implants which generally sacrifice the anterior cruciate ligament but retain the posterior cruciate ligament, on the other hand, are less stable, but they move much more naturally and feel much more like a native knee. Which implant is appropriate for you depends on your age, your physical condition, your activity level, and the status of your bone and tissues around the implant. You can determine which implant is best for you by discussing this with your surgeon before hand. #orthopedicsurgery #kneepain #knee #kneereplacement #kneepainrelief

Manipulation Under Anaesthesia Occasionally, when we perform a knee surgery, patients will end up with stiffness in their knee despite compliance and appropriate rehabilitation. We are unable to predict in which patients this might occur. Normally, we encourage these patients to maximize all non-operative means to restore range of motion. This includes additional physiotherapy, a home exercise program, occasionally analgesic medication, and sometimes also massage. In rare circumstances, all of these modalities are not effective. If these cases we will have to perform a manipulation under anesthesia. Generally, this will include taking the patient to the operating room and giving them a general anesthetic. Once sedated, I will slowly but firmly take the joint through a full range of motion, slowly breaking down adhesions until a normal, functional range of motion has been restored. On some occasions, when the range of motion restriction has been long-standing, additional work is required. In these cases, an arthroscopy is performed first to eliminate any intra-articular fibrotic tissue, which may contribute to the lack of movement and stiffness. Then, once the fibrotic tissue and adhesions have been debrided away, then the manipulation is performed. I am always reticent to perform this procedure largely for two reasons. First, when we perform this procedure, we are causing some inflammation to occur. This means that the tissues around the knee will become quite reactive. So, although we have restored the range of motion to the knee, there is only a very small window of opportunity for the patient to maintain this range of motion before further inflammation, and potentially additional tightness occurs. Second, I performing this maneuver at a joint that has previously been stiff and which does not want to move. There is always a risk that we can fracture either the femur, or the tibia when we do this technique. And if you were wondering, that would be bad. Bottom line: make sure that you do your Physio after knee surgery so that we don’t have to do this to you. Share with someone who will be having knee surgery and give them the warning.⚠️

I frequently tell my patients that everyone should lift, all the time. As lean muscle mass is a proxy for health and wellness as we age, it is imperative that we do whatever we can to maintain muscle mass as a primary goal. Resistance training is the only proven method to do this. Hence, we all should be weight training. All. Of. Us. Always. Whether you use resistance bands, barbells, machines, kettlebells, or simply bodyweight, if you are not routinely exerting yourself against gravity and something heavy, you are doing yourself a disservice. And, while runners and those who engage in long distance or endurance exercise are fit from a cardiovascular exercise, if they are not also regularly engaging in resistance training, then they are not nearly as healthy as they believe. Running is a repetitive exercise that places significant loads on the skeletal structure of the body, with loads ranging between three and six times bodyweight being commonplace. This is not to say that people should not be running. On the contrary. It is a great exercise modality for cardiovascular exercise that can be incorporated into a larger training regimen. However, how many runners do you know who can squat, or even stand underneath, even twice their bodyweight. Unless you are a competitive athlete who earns a living from their sport, training should serve to improve health, wellness, functionality, and wellness. As Pat McNamara once told me, training should allow you to do four things: 1. Protect yourself; 2. Protect those you love; 3. Kick ass; and 4. Live long. Strength training is an integral part of that paradigm and should be a part of everyone’s fitness training. Everyone lift. All the time. Period. Even runners. Follow for more health and wellness-related content. For longform content about medical topics and orthopedic surgery check out my broadcast channel. For ideas and tips about strength training, follow @Human 2.0 . #running #weightlifting #weighttraining #strengthtraining #longevity

As a science-based content creator, I often find myself discussing or reacting to content that has been posted by others. Sometimes, my position or viewpoint is different than the original poster. When this is the case, I try to fall back to current science to determine which position is supported by empirical data, not because I am seeking to be right in a debate, but rather because I want to know the truth, the reality of the issue at hand. In my most recent longform post about the most recent buzz in bodybuilding, Sam Sulek, many of the commenters complained that people should be able to whatever they want if they are not harming anyone with their actions. Generally, I agree, and this is certainly the case with Sam Sulek. However, my belief in his autotomy to self govern his own behavior does not negate the physiologic ramifications of his behavior. When I comment about what he is doing, I am speaking from the perspective of a medical professional assessing the benefits and the potential consequences of those actions. Discussing the potential consequences of his behavior is not a personal attack, but rather a description of what the literature tells us about these actions. The results from the literature do not guarantee that Sam will suffer a poor outcome, but they illuminate a potential path that might not otherwise be open to him. And just because you might be enamored with Sam, that doesn’t mean that his behavior has no consequences. If you disagree with anything I post, that is fine. But it you want to tell me I am wrong, bring your data.