Cobalt Tips

Artificial replacement parts are made of strong plastic, metal, or ceramic. All knee replacements, partial or total, will have parts made of a few different materials (likely metals and plastic). In most cases, each component is built from titanium, cobalt-chromium alloys, or a titanium and cobalt mixed metal. The chosen materials must be durable, allow for some flexibility with movement and be biocompatible (meaning it will not be rejected, corrode nor react with the body).

1. Cobalt-Chromium Alloys— Chromium alloys are one of the most commonly used materials in implant components. For those with nickel allergies, some particles from this metal can get into the bloodstream and cause a reaction.

2. Titanium and Titanium Cobalt—Titanium cobalt is used as frequently as cobalt-chromium alloys in joint replacement components. Since this metal is softer, it tends to make up the tibial part of the replacement where the plastic inserts lock-in. In the tibial component, the metal choice is less important since there is little traction or rubbing during movement.

3. Polyethylene— This is a type of strong plastic found in the tibial patellar (kneecap) component and the plastic spacer. The plastic components allow the metal pieces to glide smoothly throughout the movement. This material is metal-free.

Those with Nickel Allergies-

If you have a history of skin reactions to metal jewellery or are unsure if you may be allergic, it might be worth getting formally tested by an allergist. In general, the femoral component is the only artificial component that those with a nickel allergy need to be conscious of when selecting material and manufacturer. Majority of the femoral parts are made from cobalt-chromium since it is a very tough metal. The tibial component (the other component made of metal) is usually made of softer, titanium alloy, which has very low (almost untraceable) amounts of nickel.

The golden knee replacement surgery is a blessing for the people who have a metal allergy. These knee implants have enhanced surface coating of Titanium Niobium Nitride (TiNiN). This coating gives the implant a golden coloured look (hence named golden knee) and improves the longevity and performance of knee replacement surgery. This coating also makes the implant allergy-proof.

The gold knee is one of the best implants available today and the most successful too. It not only increases the life of the implant but also prevents any allergic reactions in the patient. Regular knee implants made of chromium cobalt alloy tend to release metal ions in the body. In patients who have a metal allergy, these metal ions can cause inflammation in the knee area and eventually cause complications like infection, loosening, and persistent knee pain. Golden Knee implants do not induce allergic reaction with human tissue. Its wear and tear are very low. Hence a Golden Knee replacement surgery is generally suggested for such patients. Due to its improved longevity of up to 40 years, this implant is preferred for knee replacements in patients younger than 60 years.

However, any patient can undergo Golden knee Replacement surgery but it is preferably advisable for patients who have a metal allergy and Patients younger than 60 years.

Benefits of Golden Knee Replacement-

• Allergy-proof

• Improved longevity of up to 40 years

• Improved durability of the implant

• Better Biocompatibility

• Better surgical results

Artificial replacement parts are made of strong plastic, metal, or ceramic. All knee replacements, partial or total, will have parts made of a few different materials (likely metals and plastic). In most cases, each component is built from titanium, cobalt-chromium alloys, or a titanium and cobalt mixed metal. The chosen materials must be durable, allow for some flexibility with movement and be biocompatible (meaning it will not be rejected, corrode nor react with the body).

1. Cobalt-Chromium Alloys— Chromium alloys are one of the most commonly used materials in implant components. For those with nickel allergies, some particles from this metal can get into the bloodstream and cause a reaction.

2. Titanium and Titanium Cobalt—Titanium cobalt is used as frequently as cobalt-chromium alloys in joint replacement components. Since this metal is softer, it tends to make up the tibial part of the replacement where the plastic inserts lock-in. In the tibial component, the metal choice is less important since there is little traction or rubbing during movement.

3. Polyethylene— This is a type of strong plastic found in the tibial patellar (kneecap) component and the plastic spacer. The plastic components allow the metal pieces to glide smoothly throughout the movement. This material is metal-free.

Those with Nickel Allergies-

If you have a history of skin reactions to metal jewelry or are unsure if you may be allergic, it might be worth getting formally tested by an allergist. In general, the femoral component is the only artificial component that those with a nickel allergy need to be conscious of when selecting material and manufacturer. Majority of the femoral parts are made from cobalt-chromium since it is a very tough metal. The tibial component (the other component made of metal) is usually made of softer, titanium alloy, which has very low (almost untraceable) amounts of nickel.

The golden knee replacement surgery is a blessing for the people who have a metal allergy. These knee implants have enhanced surface coating of Titanium Niobium Nitride (TiNiN). This coating gives the implant a golden colored look (hence named golden knee) and improves the longevity and performance of knee replacement surgery. This coating also makes the implant allergy-proof.

The gold knee is one of the best implants available today and the most successful too. It not only increases the life of the implant but also prevents any allergic reactions in the patient. Regular knee implants made of chromium cobalt alloy tend to release metal ions in the body. In patients who have a metal allergy, these metal ions can cause inflammation in the knee area and eventually cause complications like infection, loosening, and persistent knee pain. Golden Knee implants do not induce allergic reaction with human tissue. Its wear and tear are very low. Hence a Golden Knee replacement surgery is generally suggested for such patients. Due to its improved longevity of up to 40 years, this implant is preferred for knee replacements in patients younger than 60 years.

However, any patient can undergo Golden knee Replacement surgery but it is preferably advisable for patients who have a metal allergy and Patients younger than 60 years.

Benefits of Golden Knee Replacement-

• Allergy-proof

• Improved longevity of up to 40 years

• Improved durability of the implant

• Better Biocompatibility

• Better surgical results

Artificial replacement parts are made of strong plastic, metal, or ceramic. All knee replacements, partial or total, will have parts made of a few different materials (likely metals and plastic). In most cases, each component is built from titanium, cobalt-chromium alloys, or a titanium and cobalt mixed metal. The chosen materials must be durable, allow for some flexibility with movement and be biocompatible (meaning it will not be rejected, corrode nor react with the body).

1. Cobalt-Chromium Alloys— Chromium alloys are one of the most commonly used materials in implant components. For those with nickel allergies, some particles from this metal can get into the bloodstream and cause a reaction.

2. Titanium and Titanium Cobalt—Titanium cobalt is used as frequently as cobalt-chromium alloys in joint replacement components. Since this metal is softer, it tends to make up the tibial part of the replacement where the plastic inserts lock-in. In the tibial component, the metal choice is less important since there is little traction or rubbing during movement.

3. Polyethylene— This is a type of strong plastic found in the tibial patellar (kneecap) component and the plastic spacer. The plastic components allow the metal pieces to glide smoothly throughout the movement. This material is metal-free.

Those with Nickel Allergies-

If you have a history of skin reactions to metal jewelry or are unsure if you may be allergic, it might be worth getting formally tested by an allergist. In general, the femoral component is the only artificial component that those with a nickel allergy need to be conscious of when selecting a material and manufacturer. Majority of the femoral parts are made from cobalt-chromium since it is a very tough metal. The tibial component (the other component made of metal) is usually made of softer, titanium alloy, which has very low (almost untraceable) amounts of nickel.

The golden knee replacement surgery is a blessing for the people who have a metal allergy. These knee implants have enhanced surface coating of Titanium Niobium Nitride (TiNiN). This coating gives the implant a golden colored look (hence named golden knee) and improves the longevity and performance of knee replacement surgery. This coating also makes the implant allergy-proof.

The gold knee is one of the best implants available today and the most successful too. It not only increases the life of the implant but also prevents any allergic reactions in the patient. Regular knee implants made of chromium cobalt alloy tend to release metal ions in the body. In patients who have a metal allergy, these metal ions can cause inflammation in the knee area and eventually cause complications like infection, loosening, and persistent knee pain. Golden Knee implants do not induce allergic reaction with human tissue. Its wear and tear are very low. Hence a Golden Knee replacement surgery is generally suggested for such patients. Due to its improved longevity of up to 40 years, this implant is preferred for knee replacements in patients younger than 60 years.

However, any patient can undergo Golden knee Replacement surgery but it is preferably advisable for patients who have a metal allergy and Patients younger than 60 years.

Benefits of Golden Knee Replacement-

• Allergy-proof

• Improved longevity of up to 40 years

• Improved durability of the implant

• Better Biocompatibility

• Better surgical results

Movement of the human body is possible through various joints which work in coordination to allow for smooth painless movement. However, with age, these muscles and tendons undergo wear and tear which gradually leads to tender swollen joints and painful movement.

The knee is the largest human joint and most of the body movements (walking, running, squatting, sitting, etc.) are only possible because of the flexible knee cap. Whether with age or with injury or trauma, if the knee is affected, then total knee replacement (TKR) would be required.

Indications: With a success rate of almost 98%, knee replacement almost seems magical for arthritis patients.

Wear and tear of the knee leading to arthritis. This causes all knee movements to be painful, which can be especially distressing at night.
Injury or trauma where the knee joint is damaged beyond repair.

What to expect during surgery?

1. Once it is decided that surgery is required, the doctor will brief you on what to expect before, during, and after the surgery.
2. The operation is done under combined signal epidural anaesthesia, so 3 days admission is required in the hospital.
3. The damaged portion of the knee is removed and this is replaced with an implant which is made up of titanium and cobalt chromium.
4. Hospital stay can vary from 3 to 5 days depending on overall condition of the person.
5. Most patients will be able to do basic movement on the very next day of the surgery.
6. Ice pack and painkillers can be applied to control swelling.
7. The pain will be completely gone within 15 days.
8. In the beginning, walking with the support of parallel bars is advised (walker). This can be followed by the use of cane for the first few days to avoid overload and damage to the knees.
9. Most people can walk the next day, though it is advisable to use a cane for the first few weeks so that knee can strengthen to support the load.
10. Regular postoperative visits should be scheduled for up to 2 months after surgery.
11. In addition, it is extremely important to draw up an exercise regimen and follow it to sustain and improve mobility.
12. In the absence of regular exercise, there could be stiffness of the joint which can set in and further aggravate the situation
13. Driving is permissible only after the doctor's advice.

Let your doctor know before going for any surgical procedure (including dental work) as people with TKR should have antibiotic coverage before any procedure.

Movement of the human body is possible through various joints which work in coordination to allow for smooth painless movement. However, with age, these muscles and tendons undergo wear and tear which gradually leads to tender swollen joints and painful movement.

The knee is the largest human joint and most of the body movements (walking, running, squatting, sitting, etc.) are only possible because of the flexible knee cap. Whether with age or with injury or trauma, if the knee is affected, then total knee replacement (TKR) would be required.

Indications: With a success rate of almost 98%, knee replacement almost seems magical for arthritis patients.

Wear and tear of the knee leading to arthritis. This causes all knee movements to be painful, which can be especially distressing at night.
Injury or trauma where the knee joint is damaged beyond repair.

What to expect during surgery?

1. Once it is decided that surgery is required, the doctor will brief you on what to expect before, during, and after the surgery.
2. The operation is done under combined signal epidural anaesthesia, so 3 days of admission is required in the hospital.
3. The damaged portion of the knee is removed and this is replaced with an implant which is made up of titanium and cobalt chromium.
4. Hospital stay can vary from 3 to 5 days depending on the overall condition of the person.
5. Most patients will be able to do the basic movement on the very next day of the surgery.
6. Ice pack and painkillers can be applied to control swelling.
7. The pain will be completely gone within 15 days.
8. In the beginning, walking with the support of parallel bars is advised (walker). This can be followed by the use of a cane for the first few days to avoid overload and damage to the knees.
9. Most people can walk the next day, though it is advisable to use a cane for the first few weeks so that knee can strengthen to support the load.
10. Regular postoperative visits should be scheduled for up to 2 months after surgery.
11. In addition, it is extremely important to draw up an exercise regimen and follow it to sustain and improve mobility.
12. In the absence of regular exercise, there could be stiffness of the joint which can set in and further aggravate the situation
13. Driving is permissible only after the doctor's advice.

Let your doctor know before going for any surgical procedure (including dental work) as people with TKR should have antibiotic coverage before any procedure.

Is Vitamin B12 Causing Your Acne?
It’s a common belief that vitamins are essential for glowing skin and shiny hairs. But are you aware that excess of vitamin B12 can trigger acne breakouts and leave you with a dull skin? Well, you have read it correctly. Recent studies have revealed that too much vitamin B12 can worsen acne. To get a better understanding of the matter, it is best to know more about vitamin B12.

What Is Vitamin B12?
It is one of the most complex vitamins. It has a very complicated chemical structure. It has an organic molecule, surrounding an atom of cobalt. Our body can use three types of vitamin B12. These types are known as cobalamin. We are also prescribed vitamin B12 supplements sometimes by the doctor. These supplements contain Cyanocobalamin, which is easily converted into methylcobalamin and 5-deoxyadenosyl cobalamin in the body. Our body needs vitamin B12 to produce certain enzymes, which are needed for making a detoxifying a substance called homocysteine and haemoglobin production.

Why is vitamin B12 essential for us?
Vitamin B12 is needed for the good health of the cardiovascular and nervous system. It promotes the production of haemoglobin and red blood cells.

According to a recent study, an excess of vitamin B12 in the body triggers the occurrence of pimples or acne breakouts. In the presence of vitamin B12, the acne producing bacteria thrives. Vitamin B12 helps these bacteria to pump out inflammatory substances that cause acne. Vitamin B12 changes the gene expression of the bacteria and causes pimples. They found that vitamin B12 changed the gene expression of the skin bacteria, which could have led to acne-promoting inflammation.

Can you use ointments and lotions with B12 for acne?
There is still no proof that creams or ointments containing vitamin B12 are useful for treating acne. It cannot be confirmed too that these creams help psoriasis. On the other hand, there is no evidence that these creams worsen acne. Therefore, it will be wrong to reject such ointments just because they have vitamin B12. It is advisable to consult your dermatologist for the best remedy.

B12 Deficiency and Acne
Acne can also be caused due to vitamin B12 deficiency. People who use retinoid drugs often need additional B12 injections to prevent homocysteine. Retinoid drugs in the form of pills can hinder in the proper functioning of enzymes, especially cystathionine-beta-synthase. Injection of vitamin B12 ensures better functioning of the enzymes and prevents your skin from any breakout. If you wish to discuss about any specific problem, you can ask a free question.

Short course radiation therapy is the one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies there is a significant visible surge in it’s applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver short course of treatment regimen with higher dose per fraction without increasing in toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acaustic schwannomas, residual low grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.

There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable to treating all tumours indicated for gamma-knife with similar accuracy.

This modern tool has some additional advantages from gamma-knife, such as

1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated.

2) Require only thermoplastic mask, no need for invasive frame.

3) Has inverse planning system, can spare critical structure.

4) There is a ‘intra-fraction’ correction technology with imaging.

5) There is no need to change the source, hence may be more cost effective.

6) Can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution.

The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities. If you wish to discuss about any specific problem, you can consult an Oncologist.

Short course radiation therapy is one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies, there is a significant visible surge in its applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver a short course of the treatment regimen with a higher dose per fraction without increasing toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acoustic schwannomas, residual low-grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.

There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable of treating all tumours indicated for gamma-knife with similar accuracy.

This modern tool has some additional advantages from gamma-knife, such as:

1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated,

2) Require only thermoplastic mask, no need for an invasive frame,

3) Has an inverse planning system, can spare critical structure,

4) There is an ‘intra-fraction’ correction technology with imaging,

5) There is no need to change the source, hence may be more cost-effective and

6) Can be used to treat extra-cranial tumours also.

CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimetre accuracy and unmatched dose distribution.

The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver an extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gamma knife radiosurgery delivery system. This machine has immense promise to treat with short-course regimens with high dose and improve local control without increasing toxicities.

Robotic Unicondylar surgery, also known as Partial Knee Replacement surgery, with the assistance of a robotic arm. In this surgery, only one part of the damaged knee is replaced either inside (medial) part, the outside (lateral) part, or the knee cap of the knee.

Surgery to replace the whole knee is known as Total Knee Replacement Surgery.

Description of Robotic Unicondylar Surgery

In this surgery, damaged tissue and the bone of the knee joint are removed. This is done when arthritis is active in only one part of the knee. The areas are exchanged with a man- made implant, called prosthetic. The rest of the knee is preserved. Under this surgery, mostly small incisions are done, hence shorter recovery time.

Anesthesia used before the surgery is as follows:

1. General Anesthesia: Patient is asleep and pain free during the procedure.

2. Regional (spinal or epidural) Anesthesia: Patient is numbed below the waist and is also given medicine to relax and make them feel sleepy.

During the surgery, the surgeon makes a cut over the knee about 3 to 5 inches long.

In the knee joint, a small 3D camera and a tiny surgical instrument is placed.

Camera enables the surgeon to see a zoomed in view of the operative area in 360 degrees.

Then after, using the device hand and foot controllers, the surgeon can move the robotic arm slightly, which is attached to the surgical instrument.

Now another surgeon places the operation table in the correct position to verify the alignment of the operative area and the surgical instrument.

Risks Involved in Robotic Unicondylar Surgery:

There are several risks involved while having and after a Robotic Unicondylar Surgery:

1. Blood Clots: In procedures like these, blood clots are likely to happen. Blood clots typically occur within two weeks of surgery. However, it can be easily cured in a few days.

2. Infections: The chances of getting an infection after the surgery are very low. If the operative area gets any exposure during surgery and proper precautions are not taken by the surgeons, then the chances of getting an infection increase. This can happen in very rare cases.

3. Allergy to the Metal Components: A few patients may suffer from a reaction due to the metal used for the artificial knee joint. The metal used in this type of surgery is generally made from cobalt-chromium-based alloy or titanium. People usually know if they have a metal allergy. This risk can easily be avoided by telling your surgeon about the allergy.

4. Knee Stiffness: Following the postoperative instructions may lower the chance of knee stiffness. This problem can also be easily resolved with the help of physiotherapy and regular exercise. Serious cases of stiffness are known as Arthrofibrosis, which may demand a follow-up procedure so that scar tissue can be broken up and the knee can be adjusted.

Benefits of Robotic Unicondylar Surgery:

There are a number of benefits for Robotic Unicondylar Surgery:

1. High Accuracy.

2. A More Natural Knee Motion.

3. Small Incisions.

4. Less Pain.

5. Minimal Blood Loss.

6. Quick Recovery.

7. No need to remove Stapes.

8. All 4 stabilizing ligaments remain intact.

Conclusion:

A Robotic Unicondylar surgery is so minimal that in most cases patients walk within hours of surgery. It is always advisable to consult a doctor before going for surgery.