Term
| Total Hip Replacement (THR) aka |
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Definition
| Total Hip Arthroplasty (THA) |
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Term
| How many THA/R performed each year in the US |
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Definition
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Term
|
Definition
Anterolateral
Direct Lateral
Posterolateral
Direct Anterior
Minimally Invasive |
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Term
| THA/THR: Factors determining which approach is used (5) |
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Definition
surgeon familiarity
surgeon comfort
pt activity level
age
scars from previous surgery |
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Term
| Indications for THA/THR: (5) |
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Definition
pain
functional limitations
loss of mobility
positive radiographic findings
failure of conservative measures
"you'll know when it is time" |
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Term
| inidications for THA/THR: positive radiographic findings include (5) |
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Definition
OA
aseptic necrosis
congenital abnormalities
RA
Paget's disease |
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Term
| Surgical contraindications (Absolute and relative) to THA/THR: (8) |
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Definition
active infection
inadequate bone stock or peri-articular support
younger age
obesity
planned return to high impact sports
arterial insuffiency
neuromuscular disease
mental illness |
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Term
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Definition
acetabular shell
polyethylene liner
femoral component (stem) |
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Term
| THA/THR: components: what is the acetabular shell made of |
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Definition
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Term
| THA/THR: components: whta is the role of the polyethylene liner |
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Definition
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Term
| THA/THR: what is the femoral component/stem made up of |
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Definition
metal
ceramic
composites
alloys |
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Term
| THA/THR: Surgical approaches: how is the posterolateral approached performed |
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Definition
splits the glut max, dislocates femur posterio
releases external rotators |
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Term
| THA/THR: Surgical approaches: which approach is the most vulnerable to dislocation |
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Definition
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Term
| THA/THR: Surgical approaches: Posterolateral contraindication to motions (3) and duration |
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Definition
For 6 weeks avoid
hip flexion >90
adduction beyond neutral
Internal rotation |
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Term
| THA/THR: Surgical approaches: Anterolateral approach |
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Definition
approach hip casule through interval between glute medius and TFL
Hip is dislocated anterior |
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Term
| THA/THR: Surgical approaches: has a low incidence of dislocation, has an increased antalgic gait |
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Definition
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Term
| THA/THR: Surgical approaches: motions to avoid with anterolateral approach (4)? for how long? |
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Definition
for minimum 6 weeks
extension
adduction
external rotation
abduction |
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Term
| THA/THR: Surgical approaches: why must abduction be avoided with the anterolateral approach |
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Definition
| to let the muscles cut heal |
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Term
| THA/THR: Surgical approaches: Direct lateral approach |
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Definition
| leaves posterior portion of gluteus medius capsule intact |
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Term
| THA/THR: Surgical approaches: benefit of the direct lateral approach |
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Definition
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Term
| THA/THR: Surgical approaches: direct lateral approach is preferred for what pt population |
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Definition
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Term
| THA/THR: Surgical approaches: anterior approach |
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Definition
accesses the jt from the front
posterior capsule and mm are not cut |
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Term
| THA/THR: Surgical approaches: benefit of anterior approach at time of surgery |
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Definition
| allows the surgeon to work between the mm without detaching them from the femur |
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Term
| THA/THR: Surgical approaches: benefit of anterior approach post-surgery |
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Definition
| by keep mm attached to the femur it is believed it will help prevent post-surgical dislocations |
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Term
| THA/THR: Surgical approaches: minimally invasive goal |
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Definition
| minimze the amount of soft tissue damage compared to traditional THR |
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Term
| THA/THR: Surgical approaches: benefits of minimally invasive |
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Definition
less pain
quicker healing
shorter recovery time
smaller ncisions (2-4 instad of 12-18) |
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Term
| THA/THR: Surgical approaches: minimally invasive cons |
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Definition
| lack of visualization of structures |
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Term
| THA/THR: Criteria for Long-Term outcomes: types of fixation |
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Definition
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Term
| THA/THR: Criteria for Long-Term outcomes: cemented (methyl methacrylate cement) allows for what |
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Definition
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Term
| THA/THR: Criteria for Long-Term outcomes: higher incidence of what with cemented fixation |
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Definition
| higher incidence of loosening in young active pt |
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Term
| THA/THR: Criteria for Long-Term outcomes: cementless allows for what |
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Definition
| porous shell allows bone ingrowth in first 6 weeks |
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Term
| THA/THR: Criteria for Long-Term outcomes: cementless and WB |
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Definition
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Term
| THA/THR: Criteria for Long-Term outcomes: cementless pt population |
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Definition
| used in younger active individuals |
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Term
| THA/THR: Criteria for Long-Term outcomes: what are the 3 criteria |
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Definition
fixation
strenth and wear resistance
biological compatibility |
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Term
| THA/THR: Criteria for Long-Term outcomes: what does strength and wear resistance refer to |
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Definition
| improved metal processing and use of ceramic femoral head to decrease polyethylene wear |
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Term
| THA/THR: Complications: (5) |
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Definition
DVT
Heterotrophic Ossification
Femoral fx
Dislocations
Neurovascular injury |
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Term
| THA/THR: Complications: DVT |
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Definition
| period of increased risk up to 3 months post-op |
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Term
| THA/THR: Complications: femoral fx rsk factors (5) |
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Definition
female
RA
osteopenia/osteoporosis
revisions
loosening of stem |
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Term
| THA/THR: Complications: dislocations |
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Definition
| 85% occur within 2 months of THA |
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Term
| THA/THR: Complications: neurovascular injury |
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Definition
| peroneal division of sciatic in 80% of nn injury case |
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Term
| Hip Resurfacing: made of what |
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Definition
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Term
| Hip Resurfacing: primary population |
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Definition
under the age of 55
active lifestyle
require a THA/THR but may outlive the 15-20 yr viability of a THA |
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Term
| Hip Resurfacing: research behind it |
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Definition
in use since 1997 globally
in use since 2006 in USA
no clear long term results |
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Term
| Hip Resurfacing: pros and cons vs THA/THR |
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Definition
Pros: Spares much of femur
Cons: Same risks as THA/R |
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Term
| Hip Resurfacing: use in females |
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Definition
| questions about failure rate in females postmenopausal as bone quality critical to function of device |
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Term
| Hip Resurfacing: post op complications (5) |
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Definition
CVA
blood clots
pulmonary embolism
infection
death |
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Term
| THA/THR: Post Surgical Rehab: typical hospitalization |
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Definition
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Term
| THA/THR: Post Surgical Rehab: after hospitilization where will the pt go? for how long? |
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Definition
| home or subacute facility for 4-7 days |
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Term
| THA/THR: Post Surgical Rehab: Pre-op pt education programs standard and important for addressing (3) |
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Definition
procedure
post op expections (meds, therapies, pain levels)
discharge planning and home support mechanisms |
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Term
| THA/THR: Post Surgical Rehab: Immediate Post Op Care (7) |
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Definition
pt re-assurance/CBT
Monitor for infection
Education in hip precautions
Prevention of DVT
Transfer training/Bed mobility
Gait training on level surfaces and stairs
Foam ABD pillow/wedge for sleeping |
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Term
| TKA/TKR: how many done per year in the US |
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Definition
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Term
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Definition
medial parapatellar
midvastus
subvastus
lateral parapatellar
minimally invasive
bialteral |
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Term
| TKA/TKR: approach based on what (5) |
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Definition
surgeon preference
prior incision
degree of deformity
patella baja
pt obesity |
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Term
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Definition
pain
loss of function
correct instability
correct LE alignment
isolated severe patellofemoral disease |
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Term
| TKA/TKR: contraindications (absoulte and relative) [7] |
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Definition
active knee flexion
significant genu recurvatum
severe obesity
return to high impact sports
arterial insuffiency
mental illness
neuropathic jt |
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Term
| TKA/TKR: components and materials (3) |
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Definition
femoral component (metal - cobalt chrome)
tibial component (usually metal -cobalt chrome)
patellar component (plastic/polyethylen) |
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Term
| TKA/TKR: Medial Perapatallar/Anterior approach (4) |
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Definition
anterior midline longitudinal incision
compromises the extensor mechanism
familiar for most ortho surgeons
excellent exposure med/lateral even in challenging cases |
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Term
| TKA/TKR: Midvastus approach (2) |
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Definition
spares VMO insertion
accelerated Rehab |
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Term
| TKA/TKR: subvastus approach (3) |
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Definition
uses midline incision but maintians quad mechanism
decreased pain and earlier funcitonal recovery
limited exposure |
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Term
| TKA/TKR: lateralperapatellar (3) |
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Definition
lateral to the patella and through the medial edge of gerdy's tubercle
felt to be superior for correction of valgus deformity
technically demanding |
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Term
| TKA/TKR: bilateral (3) types |
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Definition
simultaneous
sequential
staged |
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Term
| TKA/TKR: bilateral simultaneous |
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Definition
| two surgeons performing the bilateral TKA at the same time |
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Term
| TKA/TKR: bilateral sequential |
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Definition
| one surgeon performing one tak and then the contralateral TKA under one anesthetic |
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Term
| TKA/TKR: bilateral staged |
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Definition
one surgeon performing each TKA under a separate anesthetic.
timing ranges from 3 days to one year in between each side |
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Term
| TKA/TKR: minimally invasive (3) |
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Definition
often need special instruments for exposure and implant insertion
technically demaning
short term data suggests more rapid recovery |
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Term
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Definition
PCL may be retained as primary stabilizer or substituted with a posterior stabilier in pt's with end stage OA with valgus or varus malalginment and flexion contractures
patellar resurfacing controversial |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: how many done per eyar |
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Definition
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: aka |
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Definition
minimally invasive partial knee
mini knee |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: utilized to manage what conditions? |
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Definition
| unicompartmental degenerative changes (lateral, patellar, medial) |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: what is a salvage procedure |
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Definition
| spares bone to allow revision to total knee if needed |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: expected viability |
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Definition
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: indications (5) |
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Definition
degenerative changes localized to one compartment
Low BMI
age under 60 (relative, not absolute)
Lower impact activity
Absence of significant knee deformity |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: benefits |
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Definition
less tissue trauma allowing for more rpaid recovery and maintenance of ROM and strength
minimal rehab needed |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: vs TKR |
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Definition
| if procedure is selected appropriately for the pt, partial is a good option |
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Term
| Unicompartment Knee Arthroplasty/Partial Knee: technology |
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Definition
| computer assisted tech improving outcomes by developing better anatomic fit |
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Term
| TKA/TKR: complicaitons (9) |
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Definition
DVT
fat embolism
poor wound healing
periprosthetic fx
peroneal nn palsy
vascular compromise
arthrofibrosis
disruption of the extensor mechanism |
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Term
| TKA/TKR: complications: arthrofibrosis: what is it? effects what structure? what is important? |
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Definition
like a window shade where the individuals blinds have fused together, preventing motion
effects suprapatellar pouch
patellar mobs important |
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Term
| TKA/TKR: post surgical mgmt: CPM |
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Definition
variable use following surgery, depends on physicain, facility, approach used
data is variable on benefits of use |
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Term
| Post op pharmacologic considerations: 4 major categories |
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Definition
anticoagulant therapy
opiod analgesics
NSAIDS
Local anesthetics/injections after surgery |
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Term
| Post op pharmacologic considerations: anticoagulant therapy (3) |
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Definition
lovenox
warfarin
monitoring blood level after discharge can be problematic |
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Term
| Post op pharmacologic considerations: opiod analgesics (4) |
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Definition
oral, intra-MM, intravenous (PCA's)
side effects (drowsiness, confusion, nausea, constipation, itching)
pt fears about dependency
Dosing/timing in relation to rehab services |
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Term
| Post op pharmacologic considerations: NSAIDS (2) |
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Definition
questions about effect on healing process
when to transition from opiods to NSAIDS |
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Term
| Post op pharmacologic considerations: local anesthetic/injecitons after surgery |
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Definition
| questions about exercise intensity if pain response is blunted |
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