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.
THA or TKA are performed not to obtain a nice and good looking new Xray. They are performed to relief the patient from acute or chronic pain. So I would definitely perform TKA to obtain a better - pain free life and I would leave the hip as is.After doing this and IF she felt any discomfort from her hip/s then I would discuss doing the THA.
Patellar Clunk Syndrome
Dr. Abbasi the diagram you put at the top is for CR TKR which not usually associated with "Patellar Clunk Syndrome".
Figure A represents a free body diagram of the hip of a patient standing on the right leg. The forces and distances are labeled on the diagram and the resulting hip joint force (J) = 1800N. What is the resultant value for J when the acetabular component is medialized given the new distances shown in Figure B?
In the text it states mechanical equilibrium equation as: " (A x My) + (B x W) = 0" (everything would just be 0). I think this is a typo and should read " (A x My) - (B x W) = 0"
A 66-year-old male is undergoing a total knee arthroplasty using a fixed bearing posterior stabilized component. During intraoperative trialing of the components it is noted that the flexion gap is loose, and extension gap is appropriate. If this is not corrected, what post-operative complication is this patient at risk of having?
Spin out of the polyethylene
Posterior knee dislocation
I think an illustration of the component would help.
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?
Problems1- Osteolysis=PE wear /ALVAL??? But femoral head centralization is seen good position. (Volumetric wear???) 2- Periprosthetic fracture =Stability of femoral stem is important (Femoral stem type is cementless 1/3 proximal fixing design)3- Culture should be wait minimum 10 day if it is negative, you should take a new one and wait 10 days again for infectionTreatmenta-no infection-check femoral stem stability under fluoroscopy if it is not stabile---- change femoral stem longer cementless design (round type, spindle type, conic type mobile or monoblok) with trcohanteric grip or plate grip and change PE line. if it is stable ----trochanteric grip with longer length for secure fissure line with cable + change PE lineb-infection++ this means subacute new infection or chronic infection.One stage revision according to culture if it is not Resistance bacteria.If it is resistance bacteria MRSE or MRSA -----TWO STAGE REVİSİON.
Should think of an ALVAL as a cause of the proximal osteolysis
A patient undergoes the procedure depicted in Figures A and B with standard components (non-gender specific). Which of the following outcomes most appropriately describes the difference in females compared to males for this procedure?
Greater implant survivorship
Decreased WOMAC scores
Increased rate of extensor mechanism rupture
Increased postoperative pain
Increased component osteoloysis
Certainly the referenced review article does suggest that women have more pain then men postop. The article also states they have greater preop pain. What you don't get from that paper is the net change from pre to post-op pain change which is really what you want to know. How much does the pain score change after surgery? As with many of these questions it can be challenging to tease out the "best answer" even though an argument may exist for some of the other answer as in this case.
Prosthetic Joint Infections (3 of 3)
Talk about prosthetic joint infections (3 of 3)
total waste of time
Prosthetic Joint infections (2 of 3)
Talk about prosthetic joint infections (2 of 3)
There are bone structures in gluteus medius. ESR and CRP are not much high. It may be heterotopic ossification.
Bone Joint J. 2013 Apr;95-B(4):554-7.