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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
Figure A displays the preoperative radiographs of a 67-year-old obese, diabetic woman undergoing total knee arthroplasty. Following the bone resections, a PCL-substituting trial implant is placed. At full extension, 30 degrees of flexion, and 90 degrees of flexion, the knee is found to be tight laterally and loose medially. Sequential releases are made until the IT band, popliteus, and LCL have all been released, and a larger polyethylene trial is placed, but the knee continues to demonstrate medial laxity and lateral tightness. Which of the following should be done to achieve a successful outcome?
Surgical release of the lateral retinaculum
Surgical release of the lateral retinaculum and reconstruction of the medial patellofemoral ligament
Imbrication of the MCL and augmentation with allograft
Convert to a constrained TKA design
Recut the tibia in valgus to improve balance
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A 45-year-old woman is scheduled to undergo a TKA. Which of the following implant designs theoretically reduces poylethylene wear and reduces bone-implant-interface stress?
Posterior stabilized fixed bearing TKA
Cruciate retaining fixed bearing TKA
Mobile-bearing hinged TKA
A 57-year-old man complains of knee pain that is exacerbated with weight bearing and ambulation. He underwent surgery on his knee 10 years ago following a motor vehicle collision. On physical exam he has medial and lateral joint line tenderness and no instability. Radiographs are provided in figures A and B. Conservative therapy with NSAID's and viscosupplementation is initiated. If he continues to develop further degenerative changes and needs arthroplasty what type of implant should be utilized?
Unicompartmental mobile bearing knee arthroplasty
Posterior cruciate retaining total knee arthroplasty
Posterior stabilized total knee arthroplasty
Constrained nonhinged total knee arthroplasty
Constrained hinged total knee arthroplasty
In total knee arthroplasty, what would be a difference with use of the tibial component shown in Figure A compared to Figure B?
Increased ductility of the polyethylene
Increased wear on the articular side of the polyethylene
Less wear on the articular side of the polyethylene
More wear at the backside of the polyethylene
Less wear at the backside of the polyethylene
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
Which of the following types of prosthetic designs, seen in figures A-E, has been shown to have a high rate of loosening secondary to overconstraint?
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
A 55-year-old female with a long history of diabetes mellitus presents for evaluation of chronic knee pain. A current radiograph is shown in Figure A. Which of the following knee prostheses, shown in Figures B through E, would be most appropriate in the initial treatment of this patient?
Figure A demonstrates a total knee prosthesis design. Which of the following motions is constrained in this particular design:
Complete anterior-posterior translation constraint only
Partial varus-valgus angulation constraint only
Partial varus-valgus angulation and partial internal-external rotation constraint
Complete internal-external rotation constraint only
Complete varus-valgus angulation and anterior-posterior translation constraint
HPI - 59 yo iron worker with recalcitrant right knee pain and interested in TKA. CT scan obtained to detail large tibia plateau cyst.....CT scan shows that it breaks through the cortex. patient denies constitutional symptoms or prior knee injury.
Would you obtain further studies prior to TKA?
HPI - Long standing knee OA symptoms - neglected - patient sustained a medial condyle fracture of the right knee 3 months ago which was fixed with interfragmentary screws and an antiglide plate. she wishes to proceed with knee replacement now due to the pain she experiences in both knees.
she is due to have a CT scan of her knees next week before a TKR. I am planning to do the left side first and then the right after 6 - 12 weeks once she is rehabilitated. My plan is to do a PS femur and a stemmed tibia with wedges for the medial tibial plateau defect.
How would you sequence the TKR of each knee?