According to the 2011 American Academy of Orthopaedic Surgeons' Guidelines for the treatment of symptomatic osteoarthritis of the hip or knee, which of the following recommendations was most strongly supported?
Hyaluronic acid injections
Tramadol for purposes of pain alleviation
Please update question. There is a 2nd edition in may 2013.
Groin pain following hip resurfacing in a 38M (C2679)
38 / M - 38M presents with right-sided groin pain of 4 months duration. He states that his pain has been escalating in severity over the past 4 months. He is now limping due to pain on the right side.
The patient underwent ORIF for a posterior column fracture 6 years ago.
He had a right hip resurfacing for post-traumatic arthritis via an anterolateral Hardinge approach 4 years ago.
Based on the information provided, what is the most likely diagnosis?
One would love to know the per-operative findings. From plain radiographs there appears to be fracture of the femoral neck. which may have occurred and subsequently lead to changes around the peg. Was the head oseointegrated inside the implant, if it was HA coated?
A 71 year old gentleman underwent left total hip arthroplasty 10 years ago. Eighteen months ago he began having hip and thigh pain. Over the past 6 weeks, the pain has become excruciating and he has been unable to ambulate, even with the aid of a walker. He has mild pain with passive internal and external rotation of the hip. He is unable to ambulate in the office. Laboratory values are notable for a WBC of 10,300, CRP of 0.2, and ESR of 13. A radiograph is provided in figure A. Which of the following is the best treatment option?
Radionuclide bone scan and MRI
Open reduction internal fixation with a cable plate and allograft strut
Revision arthroplasty with a fully coated cementless stem, cable wiring, and bone graft
Revision arthroplasty with a modular, tapered stem and bone grafting of the diaphyseal fixation
Revision arthroplasty with a total femur prosthesis
How do we know it is a loose stem?
Arthroscopy. 2012 Mar;28(3):354-64.
Might be good to mention in the stem that he is willing to give up running
Catastrophic Wear & PE Sterilization
I think there is a minor mistake under the heading: articular surface design:a deeper congruous joint (deeper cut PE) without rollback -less anatomic-maximizes contact loads!! (maximizes contact surfaces not loads)-decreases contact stressThanks
J Bone Joint Surg Am. 1997 Jan;79(1):122-4.
Am J Phys Med Rehabil. 2014 Jul;93(7):609-11.
A 65-year-old male undergoes a primary total knee arthroplasty. His preoperative radiographs are seen in figures A and B. Postoperative examination reveals an inability to dorsiflex his ankle or extend his toes. Sensation is decreased along the dorsum of his foot as well as between the 1st and 2nd toes. All of the following are risk factors for this complication following total knee arthroplasty EXCEPT?
Aberrant retractor placement
Postoperative epidural analgesia
Correction of a 20 degree preoperative valgus deformity
Excessive medial release
Preoperative diagnosis of neuropathy
Another possible cause could be the constructive dressing like crepe bandage done after TKR, especially when the patient limb is numb by the effect of epidural. I remember one case when we encountered one case of foot drop on second day of surgery in a routine Tkr for varus knee. Epidural was our routine. Relieving the compressing dressing and observation was fruitful for that patient. My boss used to apply criss cross fashion of crepe bandage over thick layer of cotton. Thin cotton layer, too much crepe pressure or folding and constrictive effect of crepe were the possible causes.Fractures of the forearm complicated by palsy of the anterior interosseous nerve caused by a constrictive dressing. A report of four cases.Casey PJ, Moed BRJ Bone Joint Surg Am. 1997 Jan. PMID: 9010194 (Link to Abstract)Common peroneal nerve palsy caused by compression stockings after surgery.Güzelküçük Ü, Skempes D, Kumnerddee WAm J Phys Med Rehabil. 2014 Jul. doi: 10.1097/PHM.0000000000000086PMID: 24743458 (Link to Abstract)
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?
stem loosening, possible infection. Revise the stem and make frozen section for leucocyte count. I think it is not infected.
The medial and lateral joint surfaces have different tibiofemoral geometry. How does this affect the kinematics of normal knee movement from full extension into flexion?
Tibia will externally rotate
Distal femur will pivot about a medial axis of the knee
Distal femur will translate anteriorly on the tibia
Distal femur will pivot about a lateral axis of the knee
as asked, from extension to flexion, the distal femur translates anteriorly, so answer choice 3 is correct
Dear dr Conteduca, Trendeleburg gait or sign are absent. Thank you.
Dear dr Totkovic thank you for your comment. CT guided joint aspiration was my next step to rule out or not the infection. Thank you again.
thank you, i am new here so i had some problems with posting answer. as we all know infected until proven otherwise, crp is not normal although low. no matter what is your other differential, do not be mislead to other path ( as i was couple of times) . we are here to help each other. if you have the possibility do the leuko scan, if not, take a sample . all the best!
Dear Mr Toktovic which clues lead you to the infection scenario? Thank you.
TKA Periprosthetic Fracture
this is a hip periprosthetic fracture question, not a TKA periprosthetic question
leuko scan and biopsy