Which of the following templates, seen in Figures A-E, will increase the offset while keeping the leg lengths the same?
After stumbling upon the subject for the second time, I think I got it- just get the 2 red points together, as you would at a shooting range.Yes, D is confusing.Thanks!
Indian J Orthop. 2013 Jan;47(1):31-4.
A posterior cruciate retaining total knee arthroplasty is contraindicated in all of the following patients EXCEPT?
52-year-old female with severe rheumatoid arthritis of the knee
73-year-old male with post-traumatic arthritis of the knee and prior patellectomy
67-year-old male with degenerative arthritis and 10 degree valgus deformity of the knee
55-year-old male with post-traumatic arthritis of the knee 20 years after bicruciate ligament ruptures
63-year-old female with a chronic history of steroid treatment of systemic lupus erythematosus and an arthritic knee
The following article's discussion points to some older literature that showed that PCL sacrificing implants faired better than CR knees. However it also presents data to show that it is not an absolute contraindication or a contraindication at all.Midterm results of cruciate retaining total knee arthroplasty in patellectomized patients.Dahiya V, Gupta H, Rajgopal A, Vasdev AIndian J Orthop. 2013 Jan. doi: 10.4103/0019-5413.106891. pii: IJOrtho-47-31. 47. (1). :31-4PMID: 23532189 (Link to Abstract)
TKA Patellofemoral Alignment
thank yougot it
Ahmad - lateralising the prosthesis will in effect medialise the apex of the Q angle, as the prosthesis should always sit in the prosthetic trochlea. The Q angle increases then.
I can't understand why shifting the patellar prosthesis laterally will increase Q angleIt seems to me it will decrease it
Bone Cement, Cementation techniques in Arthroplasty
Orthopaedic Principles-SICOT ICL by Dr Hitesh Gopalan
Prosthetic Joint Infection
Orthopaedic Principles- SICOT ICL by Dr Hitesh Gopalan
Biomechanics of Knee and its implication in Total Knee Arthroplasty
Orthopaedic Principles_SICOT ICL by Dr Hitesh Gopalan
79 yo male, Primary THA done 2003. Never felt great, but was able to play golf up until 4 months ago. Fell from standing and presented to the ER 4 days later after pain continued to worsen. Pain before fall was only with activity localized to buttox. Pain now is only with activity but more localized to his thigh. Xrays are included. CT scan showed a non displaced spiral type fracture that stops at the tip of the femoral stem. Aspiration of hip: 2,500WBC's, 38% polys, negative cultures at 48hrs. What would your plan be?
I would have a very high suspicion for infection and agree with the other comments. I would personally proceed with the removal of all components, obtain intra-op Frozen pathology, tissue for culture and gram stain, and then consider fixing the femur with a provisional intramedullary CaSO4 construct distally with antibiotics and/or augmented by Prostalac type provisional prosthesis to help maintain length and consider cerclage if possible. Would then re-implant as a second stage. Very challenging case.
Dont forget to rule out trunion issues. Metal ions can cause that type of lysis too. That is a CoCr head.
Re-aspirate and get alpha defensin on synovial fluid.Also consider serum IL-6, as both those might narrow the sepsis question.
All of the following interventions help restore anatomic limb length following total hip arthroplasty EXCEPT:
Use of an arthroplasty system incorporating variable neck lengths
Intraoperative assessment of limb length
Use of a modular arthroplasty system that allows variable femoral offset
Clinical and radiographic preoperative assessment for limb length discrepancy
Femoral offset DOES help to restore anatomic limb length. All choices are correct.
Which of the following molecules is associated with macrophage induced osteolysis surrounding orthopaedic implants?
I'm confused with the change from the prior comment. I thought OsteoBLASTS produce RANKL. This binds to RANK produced by OsteoCLASTS. OPG is a "decoy receptor" binding to RANKL thereby preventing RANKL activation of RANK on OsteoCLASTS. So why was it not correct that OPG binds to RANKL on OsteoBLASTS?
Ipsilateral hip and knee deformity in a 70F (C2708)
70 / F - A 70 year old patient presents with the primary complaint of ongoing left knee pain that has been getting worse over the past 12 months.
The patient states that she has ambulated with a limp since childhood, but has never had surgery or any other treatment up to this point.
She states that she has been taking NSAIDs for the past 12 months which are no longer providing any relief of her knee pain.
She is now having difficulty ambulating due to the pain and has recently started using a cane for support and relief.
How would you manage this patient?
One has to address both if we are going on the operative route. Some of the pain on his knee could be comming from his hip. The hip centre needs to be restored before one can do a successfull knee replacement. Patient has got a unilateral high DDH on his left hip with false acetabulum with symptomatic arthritis. This needs to be corrected first with a total hip replacement and it will likely need shortening femoral osteotomy to get the cup in the true acetabular region. Will need long leg alignment views after THR to see the alignment of the knee. Patient has predominantly lateral compartment arthritis with knee in valgus alignment and this will likely need a total knee replacement at a later date after his THR. The type of knee implant depends on the competence of the MCL and the success with ligament balancing and we should have a posterior stabilised, semi constrained and a hinge knee available in the shelf.
Persistent pain following Total Hip Arthroplasty in a 73M (C2761)
73 / M - The patient underwent a THA 15 months ago at an outside location. Since then he feels pain on the lateral aspect of his hip (greater trochanter area).
His blood results:
CRP: 12.6 mg/dl in November 2016 and 9.9 mg/dl in January 2017.
ESR: 22 mm/h in November 2016 and 21 mm/h in January 2017.
Do you believe this is a prosthetic joint infection?
Hello, how long postoperative did the patient notice pain. Is the wound completely healed has the patient any sensory disturbances? Also do his symptoms aproximate those of bursitis of the g.trochanter?
Mr Mulder thank you for your comment. I agree on aspiration, this is maybe the next step, since he is showing some improvement.About MoM disease, this is not a MoM prosthesis, it's a MoP
new Labs CRP: 6.1 mg/dl ans ESR 31 mm/h
Aspirate to r/o infection (have lab do a manual differential as metal can throw off automated diff). Send aspirate and blood for metal levels. If not infected, looks like MoM disease.