This document discusses how advertising portrays and exploits women's bodies and sexuality in harmful ways. It summarizes that advertising uses women's bodies and sexuality to sell all kinds of products. This gives women unrealistic standards of beauty and implies consumer products can fix defects, causing insecurity. It also reinforces stereotypes of women as sex objects.
Oro-facial-digital syndromes are a rare group of genetic disorders that affect around 1 in 50,000 people and have similar features. They are caused by mutations in different genes and are classified into eight types. Common signs include digital anomalies of the hands and feet, facial abnormalities such as frontal bossing and wide-set eyes, and oral features like cleft lip and high arched palate.
The document summarizes the anatomy of the orbit, including its development, walls, contents, surgical spaces, and age-related changes. Key points:
- The orbit develops around the eyeball from cranial neural crest cells that form the frontal, maxillary, and lateral nasal processes. Bones differentiate and ossify during fetal development.
- The orbit has medial, lateral, floor, and roof walls formed by several bones including the frontal, ethmoid, maxillary, zygomatic, sphenoid, and palatine. It contains the eye, extraocular muscles, nerves, vessels, lacrimal gland, and fat.
- There are subperiosteal, subtendon's
1. The orbit is a pyramidal cavity containing the eyeball and associated structures. It has openings for nerves, vessels and muscles. The walls are formed by several bones with thin medial wall.
2. The optic nerve passes through the optic canal to enter the orbit. Several nerves like oculomotor and abducens also pass through openings to innervate extraocular muscles.
3. The ophthalmic artery is the main artery supplying the orbit and eye. It gives off branches like lacrimal and supraorbital arteries. Veins drain via superior and inferior ophthalmic veins.
This document provides information on dental implants including:
1. It defines a dental implant as an artificial titanium fixture surgically placed into the jawbone to replace a missing tooth and root.
2. Implant dentistry/implantology is concerned with replacing missing teeth and supporting structures with prostheses anchored to the jawbone.
3. Common implant designs include parallel or tapered, threaded screw-shaped implants which are the most commonly used type today.
Eyelids: Different Layer, Nerve Supply, Vascular Supply & Functions of LidsMero Eye
The document describes the anatomy of the eyelids. It discusses the embryology, layers, muscles, glands, nerve and blood supply of the eyelids. The eyelids are derived from surface ectoderm and have multiple layers including skin, muscle, fibrous tissue and conjunctiva. The main muscles are the orbicularis oculi and levator palpebrae superioris. Important glands are meibomian, zeis and moll glands. The eyelids receive motor innervation from cranial nerves and sensory innervation from the trigeminal nerve. Blood supply is from branches of the ophthalmic artery.
The document provides information on several cranial nerves:
- The olfactory nerve can cause CSF leakage through the nose if fractured in the anterior cranial fossa. Complete anosmia can result if all filaments on one side are torn.
- The oculomotor nerve supplies most extraocular muscles except the superior oblique and lateral rectus. It also supplies levator palpebrae superioris and parasympathetic fibers to the eye.
- The trigeminal nerve has large sensory and small motor roots. Its branches include the ophthalmic, maxillary, and mandibular nerves which provide sensory innervation to the face and motor innervation to the muscles of mastication.
This case report describes the treatment of a 22-year-old female patient with a unilateral cleft lip and palate using distraction osteogenesis (DO) followed by orthognathic surgery. The patient had midface deficiency, a class III malocclusion, and a retrognathic maxilla. Treatment involved using a RED device to perform DO for 7mm of maxillary advancement. This was followed by Lefort I osteotomy, mandibular setback, and genioplasty. Post-treatment, the patient's profile and occlusion were improved with good stability after 2 years. The report concludes that DO is an effective treatment for severe cleft-related maxillary deficiency.
This document discusses how advertising portrays and exploits women's bodies and sexuality in harmful ways. It summarizes that advertising uses women's bodies and sexuality to sell all kinds of products. This gives women unrealistic standards of beauty and implies consumer products can fix defects, causing insecurity. It also reinforces stereotypes of women as sex objects.
Oro-facial-digital syndromes are a rare group of genetic disorders that affect around 1 in 50,000 people and have similar features. They are caused by mutations in different genes and are classified into eight types. Common signs include digital anomalies of the hands and feet, facial abnormalities such as frontal bossing and wide-set eyes, and oral features like cleft lip and high arched palate.
The document summarizes the anatomy of the orbit, including its development, walls, contents, surgical spaces, and age-related changes. Key points:
- The orbit develops around the eyeball from cranial neural crest cells that form the frontal, maxillary, and lateral nasal processes. Bones differentiate and ossify during fetal development.
- The orbit has medial, lateral, floor, and roof walls formed by several bones including the frontal, ethmoid, maxillary, zygomatic, sphenoid, and palatine. It contains the eye, extraocular muscles, nerves, vessels, lacrimal gland, and fat.
- There are subperiosteal, subtendon's
1. The orbit is a pyramidal cavity containing the eyeball and associated structures. It has openings for nerves, vessels and muscles. The walls are formed by several bones with thin medial wall.
2. The optic nerve passes through the optic canal to enter the orbit. Several nerves like oculomotor and abducens also pass through openings to innervate extraocular muscles.
3. The ophthalmic artery is the main artery supplying the orbit and eye. It gives off branches like lacrimal and supraorbital arteries. Veins drain via superior and inferior ophthalmic veins.
This document provides information on dental implants including:
1. It defines a dental implant as an artificial titanium fixture surgically placed into the jawbone to replace a missing tooth and root.
2. Implant dentistry/implantology is concerned with replacing missing teeth and supporting structures with prostheses anchored to the jawbone.
3. Common implant designs include parallel or tapered, threaded screw-shaped implants which are the most commonly used type today.
Eyelids: Different Layer, Nerve Supply, Vascular Supply & Functions of LidsMero Eye
The document describes the anatomy of the eyelids. It discusses the embryology, layers, muscles, glands, nerve and blood supply of the eyelids. The eyelids are derived from surface ectoderm and have multiple layers including skin, muscle, fibrous tissue and conjunctiva. The main muscles are the orbicularis oculi and levator palpebrae superioris. Important glands are meibomian, zeis and moll glands. The eyelids receive motor innervation from cranial nerves and sensory innervation from the trigeminal nerve. Blood supply is from branches of the ophthalmic artery.
The document provides information on several cranial nerves:
- The olfactory nerve can cause CSF leakage through the nose if fractured in the anterior cranial fossa. Complete anosmia can result if all filaments on one side are torn.
- The oculomotor nerve supplies most extraocular muscles except the superior oblique and lateral rectus. It also supplies levator palpebrae superioris and parasympathetic fibers to the eye.
- The trigeminal nerve has large sensory and small motor roots. Its branches include the ophthalmic, maxillary, and mandibular nerves which provide sensory innervation to the face and motor innervation to the muscles of mastication.
This case report describes the treatment of a 22-year-old female patient with a unilateral cleft lip and palate using distraction osteogenesis (DO) followed by orthognathic surgery. The patient had midface deficiency, a class III malocclusion, and a retrognathic maxilla. Treatment involved using a RED device to perform DO for 7mm of maxillary advancement. This was followed by Lefort I osteotomy, mandibular setback, and genioplasty. Post-treatment, the patient's profile and occlusion were improved with good stability after 2 years. The report concludes that DO is an effective treatment for severe cleft-related maxillary deficiency.
The orbital cavity contains the eyeball and associated structures. It is formed by 7 bones and has dimensions of approximately 50mm deep, 40mm wide, and 35mm high. There are several openings including the superior and inferior orbital fissures, optic canal, and ethmoidal foramina. The walls are lined with periosteum and consist of a roof, floor, medial and lateral walls. Knowledge of the orbital anatomy is important for understanding orbital pathology and surgical planning.
This document provides an overview of osteology and cranial bones. It begins with an introduction to osteology and the cranium. It then discusses the embryology of cranial bones, including that the cranium forms from paraxial mesoderm and neural crest cells. It develops through either intramembranous or endochondral ossification. The document outlines the anatomy and articulations of major cranial bones like the frontal, occipital, sphenoid, and others. It provides details on their embryological origin, parts, ossification, and clinical relevance. In conclusion, it reviews osteology and development of the cranial bones.
Temporomandibular joint dr sherif hassan oral biology Azhar Univ. and uqudentsherifsayed65
This document discusses the temporomandibular joint (TMJ), including its anatomy, histology, and age-related changes. Specifically, it describes the glenoid fossa, articular eminence, condyle, types of joints, movements, ligaments, articular disc structure and composition, blood supply, and how the bone compartments and disc change with age. The document is authored by Dr. Sherif Hassan, an associate professor of oral biology at Azhar University and Uqudent KSA.
Anatomy of Orbit and its clinical importanceAshish Gupta
It's a presentation of Anatomy of Bony Orbit and its applied aspects. It's been made by compiling images from many sources and includes almost all the information needed for a postgraduate .
This document discusses the epidemiology of malocclusion and orthodontic treatment needs. It begins with an introduction on the importance of epidemiological studies to assess prevalence of malocclusions and plan orthodontic treatment resources. It then discusses key topics like the definition of epidemiology, aims of epidemiology studies, methods of recording malocclusion for epidemiological data, factors that contribute to variations in malocclusion reporting, prevalence of malocclusion in different populations and regions of India. It also discusses various orthodontic indices used to record severity of malocclusion and determine treatment needs. Both qualitative and quantitative methods of recording malocclusion are described.
The orbit is a quadrilateral pyramid socket that contains the eyeball and its surrounding structures. It develops from neural crest cells that migrate around the developing eye. The orbit has thin walls made of bone, with the medial wall being the thinnest. It contains several openings and canals for nerves and vessels. The orbit is divided into surgical spaces that tumors commonly involve. Fascia and septa within the orbit help suspend and divide the structures. The extraocular muscles originate from the common tendinous ring and insert in specific locations to move the eyeball.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. The document describes the anatomy of the brain, skull, and associated blood vessels and sinuses.
2. It discusses the arterial supply to the brain from the internal carotid and vertebral arteries and the venous drainage from the brain through cerebral veins, sinuses, and eventually the internal jugular vein.
3. It also describes the layers of the skull, including the bones, membranes, veins, and sinuses located both within and on the surface of the skull.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
The document discusses two muscles of the eye - the levator palpebrae superioris and the orbicularis oculi. The levator palpebrae superioris originates from the lesser wing of the sphenoid bone and elevates the upper eyelid. It has a collection of smooth muscle fibers that help maintain eyelid elevation. The orbicularis oculi has two parts - the palpebral part that closes the eyelids gently and the orbital part that closes the eyelids forcefully. Both parts originate around the orbit and insert into the eyelids and are innervated by the facial nerve.
Enamel is the hardest tissue in the human body and forms a protective covering on the tooth. It is composed primarily of inorganic hydroxyapatite crystals with a small amount of organic material. Enamel has a highly organized microscopic structure of enamel rods (prisms) that extend from the enamel-dentin junction to the enamel surface. The direction of the rods helps provide strength to the enamel. Between the rods is interprismatic enamel cementing the rods together. Disruptions during enamel formation and maturation can result in enamel abnormalities.
The document provides information about the anatomy and development of the orbit and eye. It discusses:
- The development of the eye from the optic vesicle, lens placode, and other tissues.
- The anatomy of the orbit, including the bones that form it and openings like the optic canal.
- The anatomy of the eyeball and its layers like the sclera, choroid, retina. It also discusses the chambers of the eye.
- Other structures like the extraocular muscles, blood and nerve supply, and clinical terms like glaucoma and cataracts.
The document describes the anatomy of structures in the submandibular region of the neck, including muscles, salivary glands, nerves and vessels. It discusses the digastric muscle, mylohyoid muscle, stylohyoid muscle, geniohyoid muscle, genioglossus muscle, hyoglossus muscle, submandibular gland, sublingual gland and lingual nerve. Relationships between these structures are defined, along with origins, insertions, nerve supply and actions of the muscles.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of orbital and ocular anatomy. It describes the bones that make up the orbit, including the frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal and palatine bones. It details the structures within the orbit, including the extraocular muscles, optic nerve, blood vessels and cranial nerves involved in vision. The anatomy of the eyeball is also summarized, including the cornea, as well as the pathways of the visual system from the retina to the visual cortex.
5. alveolar bone in health part a dr-ibrahim_shaikhDrIbrahim Shaikh
The document provides an overview of alveolar bone structure and function. It begins with definitions of key terms like the periodontium and alveolar process. It then discusses the classification, composition, development and typical morphology of alveolar bone. Specific structures are described like the alveolar bone proper, cortical and spongy bone, bundle bone, and lamina dura. The final section outlines some common radiographic features seen in alveolar bone like the lamina dura, alveolar crest, and trabecular patterns. In summary, the document serves as a comprehensive review of alveolar bone anatomy and histology.
In this slide i am sharing introduction to E Textile and thier application in daily life .
An e-textile is a fabric developed with electronics in it to
enable conductivity and the use of various technologies.
• Electronic textiles may be embedded with sensors, batteries
LEDs and hands-free computing devices.
• The field of electronic textiles combines the worlds of
textiles and electronics, and explores techniques that
redefine construction methods .
• They usually contain conductive yarns that are either spun
or twisted and incorporate some amount of conductive
material to enable electrical conductivity.
E-Textile Applications
There are several applications of e-textiles,
ranging from healthcare to consumer goods.
Health Monitoring :
The most well-researched application of
e-textiles is medical. Specifically, the
monitoring of health conditions.
Currently, there are medical wearables
that have been invented to monitor
several aspects of a person’s health, such
as blood pressure, heart rate, and
symptoms of disease.
Worker Safety :
Occupational safety is another area where e-textiles
can provide a great deal of service. One hypothetical
use is for construction workers who are working
outdoors late at night. LED lights can be affixed to a
uniform and automatically turn on when it gets dark
outside, improving visibility.
A favorable feature among drivers is heated seats. Who
doesn’t like being blanketed in warmth while driving?
While it is often a luxury, heated seats and steering
wheels are essential for drivers in frigid temperatures.
The orbital cavity contains the eyeball and associated structures. It is formed by 7 bones and has dimensions of approximately 50mm deep, 40mm wide, and 35mm high. There are several openings including the superior and inferior orbital fissures, optic canal, and ethmoidal foramina. The walls are lined with periosteum and consist of a roof, floor, medial and lateral walls. Knowledge of the orbital anatomy is important for understanding orbital pathology and surgical planning.
This document provides an overview of osteology and cranial bones. It begins with an introduction to osteology and the cranium. It then discusses the embryology of cranial bones, including that the cranium forms from paraxial mesoderm and neural crest cells. It develops through either intramembranous or endochondral ossification. The document outlines the anatomy and articulations of major cranial bones like the frontal, occipital, sphenoid, and others. It provides details on their embryological origin, parts, ossification, and clinical relevance. In conclusion, it reviews osteology and development of the cranial bones.
Temporomandibular joint dr sherif hassan oral biology Azhar Univ. and uqudentsherifsayed65
This document discusses the temporomandibular joint (TMJ), including its anatomy, histology, and age-related changes. Specifically, it describes the glenoid fossa, articular eminence, condyle, types of joints, movements, ligaments, articular disc structure and composition, blood supply, and how the bone compartments and disc change with age. The document is authored by Dr. Sherif Hassan, an associate professor of oral biology at Azhar University and Uqudent KSA.
Anatomy of Orbit and its clinical importanceAshish Gupta
It's a presentation of Anatomy of Bony Orbit and its applied aspects. It's been made by compiling images from many sources and includes almost all the information needed for a postgraduate .
This document discusses the epidemiology of malocclusion and orthodontic treatment needs. It begins with an introduction on the importance of epidemiological studies to assess prevalence of malocclusions and plan orthodontic treatment resources. It then discusses key topics like the definition of epidemiology, aims of epidemiology studies, methods of recording malocclusion for epidemiological data, factors that contribute to variations in malocclusion reporting, prevalence of malocclusion in different populations and regions of India. It also discusses various orthodontic indices used to record severity of malocclusion and determine treatment needs. Both qualitative and quantitative methods of recording malocclusion are described.
The orbit is a quadrilateral pyramid socket that contains the eyeball and its surrounding structures. It develops from neural crest cells that migrate around the developing eye. The orbit has thin walls made of bone, with the medial wall being the thinnest. It contains several openings and canals for nerves and vessels. The orbit is divided into surgical spaces that tumors commonly involve. Fascia and septa within the orbit help suspend and divide the structures. The extraocular muscles originate from the common tendinous ring and insert in specific locations to move the eyeball.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. The document describes the anatomy of the brain, skull, and associated blood vessels and sinuses.
2. It discusses the arterial supply to the brain from the internal carotid and vertebral arteries and the venous drainage from the brain through cerebral veins, sinuses, and eventually the internal jugular vein.
3. It also describes the layers of the skull, including the bones, membranes, veins, and sinuses located both within and on the surface of the skull.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
The document discusses two muscles of the eye - the levator palpebrae superioris and the orbicularis oculi. The levator palpebrae superioris originates from the lesser wing of the sphenoid bone and elevates the upper eyelid. It has a collection of smooth muscle fibers that help maintain eyelid elevation. The orbicularis oculi has two parts - the palpebral part that closes the eyelids gently and the orbital part that closes the eyelids forcefully. Both parts originate around the orbit and insert into the eyelids and are innervated by the facial nerve.
Enamel is the hardest tissue in the human body and forms a protective covering on the tooth. It is composed primarily of inorganic hydroxyapatite crystals with a small amount of organic material. Enamel has a highly organized microscopic structure of enamel rods (prisms) that extend from the enamel-dentin junction to the enamel surface. The direction of the rods helps provide strength to the enamel. Between the rods is interprismatic enamel cementing the rods together. Disruptions during enamel formation and maturation can result in enamel abnormalities.
The document provides information about the anatomy and development of the orbit and eye. It discusses:
- The development of the eye from the optic vesicle, lens placode, and other tissues.
- The anatomy of the orbit, including the bones that form it and openings like the optic canal.
- The anatomy of the eyeball and its layers like the sclera, choroid, retina. It also discusses the chambers of the eye.
- Other structures like the extraocular muscles, blood and nerve supply, and clinical terms like glaucoma and cataracts.
The document describes the anatomy of structures in the submandibular region of the neck, including muscles, salivary glands, nerves and vessels. It discusses the digastric muscle, mylohyoid muscle, stylohyoid muscle, geniohyoid muscle, genioglossus muscle, hyoglossus muscle, submandibular gland, sublingual gland and lingual nerve. Relationships between these structures are defined, along with origins, insertions, nerve supply and actions of the muscles.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of orbital and ocular anatomy. It describes the bones that make up the orbit, including the frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal and palatine bones. It details the structures within the orbit, including the extraocular muscles, optic nerve, blood vessels and cranial nerves involved in vision. The anatomy of the eyeball is also summarized, including the cornea, as well as the pathways of the visual system from the retina to the visual cortex.
5. alveolar bone in health part a dr-ibrahim_shaikhDrIbrahim Shaikh
The document provides an overview of alveolar bone structure and function. It begins with definitions of key terms like the periodontium and alveolar process. It then discusses the classification, composition, development and typical morphology of alveolar bone. Specific structures are described like the alveolar bone proper, cortical and spongy bone, bundle bone, and lamina dura. The final section outlines some common radiographic features seen in alveolar bone like the lamina dura, alveolar crest, and trabecular patterns. In summary, the document serves as a comprehensive review of alveolar bone anatomy and histology.
In this slide i am sharing introduction to E Textile and thier application in daily life .
An e-textile is a fabric developed with electronics in it to
enable conductivity and the use of various technologies.
• Electronic textiles may be embedded with sensors, batteries
LEDs and hands-free computing devices.
• The field of electronic textiles combines the worlds of
textiles and electronics, and explores techniques that
redefine construction methods .
• They usually contain conductive yarns that are either spun
or twisted and incorporate some amount of conductive
material to enable electrical conductivity.
E-Textile Applications
There are several applications of e-textiles,
ranging from healthcare to consumer goods.
Health Monitoring :
The most well-researched application of
e-textiles is medical. Specifically, the
monitoring of health conditions.
Currently, there are medical wearables
that have been invented to monitor
several aspects of a person’s health, such
as blood pressure, heart rate, and
symptoms of disease.
Worker Safety :
Occupational safety is another area where e-textiles
can provide a great deal of service. One hypothetical
use is for construction workers who are working
outdoors late at night. LED lights can be affixed to a
uniform and automatically turn on when it gets dark
outside, improving visibility.
A favorable feature among drivers is heated seats. Who
doesn’t like being blanketed in warmth while driving?
While it is often a luxury, heated seats and steering
wheels are essential for drivers in frigid temperatures.
La prothèse de hanche par voie antérieure mini-invasiveDidier DHONDT
Amélioration de la technique chirurgicale
Voie d’abord antérieure mini-invasive
Sans aucune section musculo-tendineuse
Permet une récupération rapide :
- Une vie normale en quelques jours
- Sans aucune limitation des mouvements
- Majorité des Sports au bout de 2 mois
- Une hospitalisation de 2 jours
Spine Unit Lombalgies et Radiculalgies des Guidelines à la pratiqueMichel Triffaux
Matinée scientifique du CHWapi
Invitée Dr P Jonckheer: trajet de soins national KCE
Prise en charge aux urgences, Place de la Médecine Physique, Place du kinésithérapeute, Place de la Pain clinic, Place de la Radiologie, Place de la chirurgie et Spine Unit mode d'emploi.
Présentation par différentes disciplines de la Spine Unit du CHwapi.
Reconstruction of Severely Resorbed Jaws with the New Metalfree Material IsoSS
PEEK and an adapted New Design of Implants avoiding increased Morbidity by Augmentation Grafts
Spahn F. P.
Cabinet de Chirurgie Maxillo-Faciale
Hasselt, Belgique
This document discusses the use of dual mobility cups (DMC) in total hip arthroplasty (THA) for all cases. It summarizes the results of a comparative study of DMC in patients under 55 years old (n=119) over 10 years compared to patients over 55 (n=444). The results show no dislocations or revisions in either group at 10+ years follow up, with excellent survival rates of 98.4% for both groups. The document concludes that DMC is a relevant surgical option for young patients, with no increased risk compared to older patients. It suggests that with modern DMC designs, THA could benefit almost all eligible patients.
This document discusses rotating hinge knee arthroplasty indications and results, focusing on patellar complications. Rotating hinge implants connect the femoral and tibial components with a rotating hinge to compensate for ligament deficiencies. Indications include primary TKA for valgus/varus deformity, revision for bone loss or instability. Analysis of 43 patients found 65% had optimal patellar positioning, 28% were tilted, and 7% subluxated/dislocated. Secondary procedures were needed in 5% to address patellar issues. Rotating hinge implants represent 25% of revision TKA indications at the author's hospital, with satisfactory flexion but some patellar complications.
This document presents a new method for assessing patellar height before and after total knee arthroplasty (TKA).
Previous methods of measurement were inaccurate. The new Caton-Deschamps index measures the ratio of the articular surface to a tibial reference point, eliminating errors from abnormalities. Testing showed good intra- and inter-observer reliability. Results found the patella was lower after TKA in most cases due to femoral and tibial cuts. Moderate lowering did not affect function, but higher positioning or major lowering required further study to understand functional consequences. The new index allows detecting true versus pseudo patella infera to better understand TKA outcomes.
This document discusses the use of dual mobility cups (DMC) in total hip arthroplasty (THA) for all cases. It summarizes the results of a comparative study of DMC in patients under 55 years old (n=119) over 10 years compared to patients over 55 (n=444). The results show no dislocations or revisions in either group at a mean 14 and 15.5 years follow-up respectively. The document concludes that with modern DMC designs, DMC can provide excellent outcomes for THA in almost all eligible patients, not just higher risk cases.
The document discusses different means to prevent dislocation after total hip arthroplasty (THA), including surgical techniques, implant designs, and clinical studies. It describes approaches like anterior or Hardinge to avoid medialization and offset loss. Implant options mentioned are long posterior wall cups, retentive cups, tripolar cups, and double mobility cups. Clinical studies show dislocation rates ranging from 0-2.85% with various dual mobility cup designs at up to 12 years follow-up. The conclusion of one study presented found that dual mobility cups reduce dislocation rates compared to conventional implants for femoral neck fractures.
2013 023. Apport de la navigation pour la pose de prothèse de hanche modulaire
2017 034. La novelle prothèse “tout céramique” comment? pourquoi? / L Sedel (Paris)
1. Un genou « tout céramique »
: le genou oublié
Pourquoi?
Comment?
laurent.sedel@wanadoo.fr
2. Pourquoi?
• La prothèse totale du genou : une intervention courante
• 80000 en France/ an
• 880000 aux USA
• 2 millions : world.
• Représentant un marché mondiale de 8,4 milliards de Dollars
3. Pourquoi une nouvelle prothèse?
• Plus de 500 modèles différents
• Et donnant des résultats non satisfaisants dans la moitié des cas : Responsiveness
of patient reported outcome measures in total joint arthroplasty patients. SooHoo
NF, Li Z, Chenok KE, Bozic KJ.J Arthroplasty. 2015 Feb;30(2):176-91
• Chez les patients de moins de 65 ans : un Taux d’échec élevé
• 27% de reprise avant 10 ans.
• Principales causes d’échecs
• Douleurs
• Instabilité,
• Infection
• 10% seulement peuvent pratiquer un sport
• 10% peuvent s’accroupir.
• Comportant tous au moins une pièce en plastique : polyéthylène: réactions
macrophagiques à corps étrangers.
4. Par contraste la prothèse de hanche tout
céramique
• Donne des résultats excellents à plus de 20 ans
• Permet la reprise du sport
• Avec des inconvénients négligeables
• Taux de fracture < 1/10000
• Bruits fréquents (15%) mais peu gênants.
• Des réinterventions rares : 10% après 20 ans
5. Since 1997 : modern materials might
improve the results.
• Rough titanium alloy
• Liner in excess
• Angle : 5°40’
• Head diameter : 32 mm
( 28mm available)
6.
7. Une prothèse du genou tout céramique devrait
apporter les avantages connus pour la hanche
• Très peu d’usure
• Un matériau idéal pour un coefficient de frottement très bas.
• Suffisamment résistant : taux de fracture < 1/10000
• Biologiquement inerte
• Créant un tissu fibreux dense qui stabilise l’articulation
• P.Hernigou, X Roussignol, J.Delambre, A. Poignard, CH Flouzat-Lachaniette Ceramic –on-ceramic THA associated with fewer dislocations and less muscle
degeneration by preserving muscle progenitors. Clin.Orthop.and rel. Res. Vol 473, issue 12/December,2015.
• Pitto RP, Garland M, Sedel L. Are ceramic-on-ceramic bearings in total hip arthroplasty associated with reduced revision risk for late dislocation? Clin
Orthop Relat Res. 2015 Dec; 473(12):3790-5.
• Et qui diminue par deux le risque d’infection:
• Pitto RP, Sedel L. Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface
Type? Clin Orthop Relat Res. 2016 Oct; 474(10):2213-8.
• Pour une durée longue (plus de trente ans pour la hanche):Thirty years experience with
alumina-on-alumina bearings in total hip arthroplasty . Hannouche D, Zaoui A, Zadegan F, Sedel L, Nizard R : ..Int
Orthop. 2011 Feb; 35 (2):207-13.
8. D’ou
• Possibilité de faire du sport :
• Diminution du risque de descellement (27% chez la population en
dessous de 65 ans)
• Possibilité de s ’accroupir : « marchés asiatiques »
• À l’instar de la prothèse de hanche : un genou « oublié »
9. Historique
• L’idée n’est pas nouvelle
• H Oonishi en 1983 : prothèse céramique/ polyéthylène/ céramique cimentée .
• Série publiée en 1993 dans clinical orthopaedics et plusieurs fois depuis
• Pas de fracture
• Résultats meilleurs si pièces cimentées
• Pas d’avantage notable
14. Toutes ces tentatives ont des points communs
• Remplacement en céramique d’une ou deux pièces
• Les formes sont celles de pièces en métal
• L’usure du polyéthylène reste le problème à long terme
• Insuccès attribué à
• Cout élevé
• Pas d’avantages mesurés
15. Comment?
• Un dessin particulier
• Formes congruentes
• Plateau mobile ultra congruent
• Donc deux surfaces de contact
• Pièces cimentées
• Mais un matériau bien connu
• Alumine de qualité médicale :
• Pure , dense , a taille de grains de l’ordre de 1 µ
• Difficile à produire
16. Le plateau mobile
• Inspiré du dessin de la prothèse Tri CC de Dedienne (maintenant Serf)
• Plateau rotatoire et mobile d’avant en arrière
• Que nous avons implantée pendant 15 ans : Thèse de Slimovic
17. L’innovation repose sur des éléments déjà validés
17
1. Les pièces fémorales et tibiales en céramique fixées dans l’os : Oonishi (Japon) depuis 1983, Ceramtec
Allemagne depuis 2011
2. le concept du plateau mobile : essai clinique sur 100 patients de la prothèse du genou avec un plateau mobile
en polyéthylène ultra-congruent.
Conclusion: stabilisation par le tissu fibreux cicatriciel de l’articulation et absence de tiroir (thèse Sulimovic, 2013)
Images avec un recul de 14 ans
18. Une Technique chirurgicale similaire
• 5 pièces fémorales, 4 tibias , 4 hauteurs de plateau. Pas de rotule
• Des Suites opératoires un peu différentes
• Orthèse articulée
• Rééducation douce
• Mais course et saut après 6 mois.
19. Partenaires industriels
• Société SCT (Tarbes) pour le développement et la fabrication
• Société Ceraver (Roissy) pour la conception et la fabrication des
appareils ancillaires et la fourniture des produits terminés.
• Dassault System pour l’analyse virtuelle des pièces.
20. Étapes déjà réalisées
• Modélisation des pièces sous efforts croissants, et selon des angles de
flexion (en collaboration avec la société Dassault System (Velizy) : travail livré
en aout 2016. Rapport disponible.
21. Conclusion de cette phase virtuelle
• Optimisation des formes
• Des efforts jusqu’à 10 KN n’entrainent pas de risques de fractures
22. Conclusion
• Une réelle innovation : aucune depuis 25 ans en Prothèse totale du
genou
• Doit améliorer significativement la qualité de vie , la durée
d’implantation , la possibilité de réaliser certains gestes ou de faire
certaines activités.
• L’innovation doit s’accompagner d’une gestion anticipée des risques
• Fractures
• Bruits,
• Stabilité
• Performances mesurées.
• Avec un cout raisonnable
laurent.sedel@wanadoo.fr
24. A la levée des risques
• Accès facile au marché reposant sur la rupture technologique
• La demande des professionnels
• Avec à terme
• Une cession/partenariat avec une entreprise du domaine
• Ou bien un développement en propre.
25. CC/Contact : l’équipe
• Laurent Sedel : Chirurgien retraité:
• ancien chef de service orthopédie Hôpital Lariboisière , Professeur Paris 7
Denis Diderot.
• Ancien Directeur UMR 7052 : B2OA CNRS et Université Denis Diderot.
• CEO CC/Contact
• Jérôme Becquart management. Spécialiste du management de
l’innovation en Biotechnologies et Santé. 20 années d’expérience en
R&D pharmaceutique (Aventis). Ingénieur de l’Ecole Centrale de Paris
et docteur en biochimie.
26. Conseils , experts,
• Pascal Bizot chirurgien : PUPH hôpital Lariboisière Paris
• Richard Minfelde, Société Bpath : conception et dossier technique.
Réglementaire.
• Autres chirurgiens
• Remi Nizard : chef de service hôpital Lariboisière Paris
• Didier Hannouche, PUPH hôpital cantonal de Genève Suisse. Chirurgien.
• Professeur Gilles Pasquier : PUPH CHU de Lille
• Docteur Edouard Van Gaver : chirurgien orthopédique à l’hopital Américain
Neuilly/s/Seine)
• Alain Meunier, conseiller technique, ancien chercheur CNRS, mécanicien,
collaborateur de 25 ans.
• Laboratoire de biomécanique ENSAM Paris : Professeur Philippe Rouche
27. Etudes connexes déjà lancées
• Etude du tissu fibreux autour de prothèses de hanche : caractérisation mécanique : en
collaboration avec l’ENS Cachan Département de mécanique ; (Elisa Budyn professeur de
mécanique) : publication sous forme de E-poster à l’ISTA Boston octobre 2016
• Mesures selon un modèle in vitro des propriétés comparées des différents matériels de
frottement selon leur caractère inflammatoire (travail de Master de Alexandre Hardy B2OA) Paris.
• Mesures cliniques et radiologiques chez des patients porteurs de prothèse du genou : P.Bizot.
• Etude d’un protocole biomécanique quantifié de tests sur patients porteurs de prothèse du
genou. Ceci dans l’optique de comparer les porteurs de prothèses céramique aux autres. Projet à
mener au laboratoire de Biomécanique de l’ENSAM professeur Rouche.
• Mesures par Echographie et IRM dédiée de l’épaisseur des capsules articulaires autour de
prothèses implantées(Service du Professeur Laredo . Hôpital Lariboisière)
28. Plan de développement
• Phase 1 : Développement des prototypes avec la société SCT (Tarbes)
• Tests de rupture et simulation sur bancs d’essais
• Phase 2 : Développement de la gamme et essai clinique pilote sur 30
patients en vue du marquage CE
• Tests cliniques biomécaniques comparés sur 30 patients
• Obtention du POC : proof of concept
• Phase 3 : Lancement commercial
• France
• International : Corée , USA , Chine, Europe
30. Plan de développement
• Propriété industrielle :
• Nous avons déposé en 2013 une première demande de brevet WO2015018854 (A1) protégeant notre
invention : KNEE PROSTHESIS WITH CERAMIC-ON-CERAMIC FRICTION COUPLING AND MOVABLE
CERAMIC PLATE. Inventeur: Laurent Sedel
• N° demande internationale : PCT/EP2014/066877 6 août 2014. Date de priorité : 6 août 2013.
FR3009492 (A1).
• Afin de renforcer la protection de notre invention, nous avons déposé une
deuxième demande de brevet en février 2015.
• Incubation par Paris Biotech Santé (PBS) de mai 2014 à mai 2016
• Première levée de fonds en Octobre 2015 : 242000 euros auprès de 14 associés