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A 65-year-old woman undergoes an uncomplicated right total hip arthroplasty as seen in Figure A. Preoperatively her right leg length was 2mm shorter than the left side. On the evening of surgery she has full motor strength and intact sensation. On the morning of postoperative day two she develops an inability to dorsiflex her ankle. There is no wound drainage and her anticoagulation levels are within normal limits. What is the next best step in treatment?
Maintain head of the bed flat with non-weight bearing restrictions
Obtain an EMG
Radiograph of the knee
Place the hip in flexion and the knee in extension
Place the hip in extension and the knee in flexion
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Immediately following a total hip arthroplasty (THA), a healthy 55-year-old patient is unable to dorsiflex her ankle or extend her great toe. After 4 weeks she continues to ambulate with a "slapping gait." Examination reveals passive ankle joint dorsiflexion to 10 degrees. What is the most appropriate next treatment option?
MRI of her spine and pelvis
Revision total hip arthroplasty
Posterior tibial tendon transfer to navicular bone
After total hip arthroplasty (THA) for osteoarthritis a patient is unable to dorsiflex her ankle or extend her great toe. She is treated conservatively with an orthosis and after 3 months on physical therapy she ambulates with a "slapping gait." What is the most appropriate next treatment option?
MRI of her spine
Continue Ankle-Foot Orthosis
Sural nerve grafting
A 45-year-old man has had the gait disturbance shown in Video A ever since a total hip replacement two years ago. Since then he has undergone physical therapy and nerve exploration without any clinical improvement. Extensive AFO bracing was attempted but was not tolerated by the patient. A recent ankle radiograph is shown in Figure A. The Silfverskiold test reveals dorsiflexion of 20 degrees with knee flexion, and 10 degrees with full knee extension. The results of muscle testing using a Cybex dynamometer are shown in Figure B. What is the most appropriate next step in in treatment.
Ankle arthrodesis in 30 degrees of dorsiflexion
Posterior tibial tendon transfer to the lateral cuneiform through the interosseous membrane
Split anterior tibial tendon transfer to the cuboid
Peroneus longus transfer to the navicular and gastrocnemius recession
Flexor hallucis transfer to the navicular and tendo Achilles lengthening (TAL)
A 65-year-old female with a history of developmental dysplasia of the hip (DDH) undergoes a total hip arthroplasty (THA) utlizing a posterior approach. Following THA, she notices an inability to dorsiflex the ankle of her operative extremity. Her pre-operative and post-operative radiographs are seen in figues A and B. Which of the following intra-operative techniques could have avoided this complication in this patient?
Utilization of an anterior approach
Use of a larger femoral head
Femoral shortening osteotomy
A 57-year-old man with a history of chronic lower back pain and right hip arthritis is postoperative day 2 from an uncomplicated right total hip arthroplasty with a spinal block. Since the procedure, he has reported persistent pain in his right leg with a focal point in the proximal lateral leg. He has had difficulty getting out of bed for physical therapy due to pain reproduced in his leg. He is voiding but has not yet had a bowel movement. Physical exam is only significant for decreased ankle dorsiflexion strength on the right. Plantarflexion strength remains 5/5 bilaterally. No point tenderness was elicited and Homan's sign is negative. His wound is unremarkable with typical post-operative swelling of the leg and no significant drainage. He has been receiving ASA 81mg PO daily since surgery and has been wearing compression stockings full-time. Postoperative repeat radiographs of the hip are unremarkable and his hemoglobin is stable. Which of the following etiologies is most likely responsible for this patient's symptoms?
Lumbar lateral recess stenosis
Acute post-operative infection
A 60 year-old man with a history of atrial fibrillation and a mechanical aortic valve replacement undergoes total hip athroplasty via a posterior approach. Post-operatively, at the recommendation of his cardiology team, he is restarted on warfarin. Four days after discharge, the patient returns to the emergency department with a 10% drop in hematocrit (now 20%) and a new complete sciatic nerve palsy. His INR is 6 and his dressing is saturated. What is the best course of action?
Reversal of INR, application of incisional wound vac, clinical monitoring of nerve palsy
Transfusion to raise the hematocrit to 30%, sequential neurovascular examinations
Reversal of INR, urgent surgical irrigation and debridement
Hold warfarin and transition to enoxaparin, application of incisional wound vac, sequential neurovascular examinations
Reversal of INR, placement of a temporary vena cava filter, exploration of the sciatic nerve
A 67-year-old woman undergoes a total hip arthroplasty. Postoperatively, she develops a complete peroneal palsy that does not improve with flexion of the knee and removal of compressive dressings. All of the following are associated with a post-operative nerve palsy EXCEPT:
Developmental dysplasia of the hip
Lengthening of the extremity
Surgeon self-rating the procedure as being a difficult intervention
Avascular necrosis of the femoral head
Risk factors for a motor nerve palsy following primary total hip arthroplasty include all of the following EXCEPT?
What percentage of patients with complete peroneal nerve palsy after total hip arthroplasty will never recover full strength?
90% to 95%
60% to 65%
40% to 45%
20% to 25%
0% to 5%
Which of the following factors increases the risk of sciatic nerve injury in primary total hip arthroplasty (THA)?
Posterior superior quadrant acetabular screw placement
All of the following are risk factors for developing a sciatic nerve palsy following total hip arthroplasty EXCEPT:
Figures A and B are pre-operative and intra-operative radiographs of a 67-year-old male that has undergone a left total hip arthroplasty under general anesthesia. The patient had no motor deficits pre-operatively. During the operation, the trial acetabular and femoral components were positioned and reduced with no complication. Intra-operative leg lengths were equal. Before implanting the real components, the surgeon and anaesthesiologist performed a wake up test, which revealed that the patient was unable to dorsiflex the left foot. What would be the most appropriate next step in the management of this patient?
Urgent electromyogram and nerve conduction study
Continue with sized trial components and observe the motor function in surgical recovery area
Remove all implants and insertion of cement spacer
Perform a shortening subtrochanteric osteotomy
Urgent neurology consult
During revision total hip arthroplasty (THA), adjunctive motor-evoked potentials (MEPs) and electromyography (EMG) are utilized to monitor the sciatic and peroneal nerves. During the procedure, a conduction abnormality arises in the sciatic nerve. Which of the following actions would decrease tension on the sciatic nerve?
Provide traction to the leg
Pulsatile irrigation in the wound to remove blood clots
Flex the hip
Extend the hip
Extend the knee