Introduction This topic includes heterotopic ossification squeaking blood transfusion pseudotumor (metal reactions) vascular injury trunnionosis Other THA Complication topics periprosthetic infection THA dislocation periprosthetic fractures aseptic loosening limb length discrepancy sciatic nerve palsy Heterotopic Ossification Introduction frequent complication that may limit functional outcome following hip replacement risk factors prolonged surgical time excessive soft tissue handling during procedure hypertrophic osteoarthritis male gender Treatment surgical excision indications severe loss of motion once heterotopic ossification is visible on radiographs, only surgical excision will eradicate technique must wait 6 months after initial procedure to allow for maturation and formation of capsule perioperative prophylaxis with perioperative radiation or NSAIDs Prophylaxis oral indomethacin radiation therapy 600-800 cGy administered ideally within 24-48 hours following procedure Postoperative Anemia Low preoperative hemoglobin is the best predictor of the need for a blood transfusion postoperatively Prevention TXA Treatment postoperative transfusion indications most centers have dropped to a hemoglobin of 7-8 Squeaking Defined as a high pitched audible sound occurring during hip movement Incidence ceramic-on-ceramic 0.5-10% metal-on-metal 4-5% incidence of revision because of squeaking is 0.5% Risks impingement edge loading component malposition loss of fluid film lubrication third body particles thin, flexible (titanium) femoral stem Pseudotumor Hypersensitivity Response Introduction caused by metal-on-metal THA relating to metallic wear With metal-on-metal THA, current recommendations are to obtain serum metal ion levels (cobalt, chromium) at long-term followup visits If any concerns, imaging of choice is MR with metal subtraction In symptomatic patients, must first rule out infection, fracture or other causes of acute or chronic pain before presuming metallic wear and ordering metal ion levels lesion, neither infective or neoplastic, which develops in the vicinity of a total hip replacement Presentation associated with pain, and bone erosion Vascular Injury Incidence 0.1%-0.2% Risk factors acetabular screw placement in anterior-superior quadrant inappropriate retractor placement Trunnionosis Introduction wear of the femoral head-neck junction Incidence 3% Risk factors Modular designs Large cobalt chrome femoral heads Metal on metal no pathognomonic serum metal ion level for trunnionosis serum cobalt >1.6 ng/ml (ppm) considered threshold for mechanically assisted crevice corrosion Treatment Revision to ceramic head with titanium sleeve and new polyethylene liner
QUESTIONS 1 of 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ13.20) A 38-year-old female patient presents to your office three years after a hip resurfacing. She complains of worsening left hip discomfort for the last 6 months. Her ESR is 12 (normal 0-20) and CRP is 1.2 (0-5). A radiograph and axial and coronal MRI scans are shown in Figures A, B, and C. What is the most likely diagnosis? Review Topic QID: 4655 FIGURES: A B C Type & Select Correct Answer 1 Infection 1% (40/4160) 2 Type I Hypersensitivity reaction 3% (133/4160) 3 Femoral neck fracture 6% (246/4160) 4 Prosthesis Loosening 10% (402/4160) 5 Pseudotumor 80% (3313/4160) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ13.270) Figure A shows a radiograph of a 62-year-old female that underwent a left total hip arthroplasty 5 years ago. She presents to your office with insidious onset of left groin and buttock pain. She denies trauma, fever or chills. On physical examination, her left hip has mild pain with range of motion. She has a normal gait cycle, normal power across the hip and her vitals signs are stable. A left hip aspirate was performed and results are shown in Figure B. What is the most likely cause of her hip pain? Review Topic QID: 4905 FIGURES: A B Type & Select Correct Answer 1 Periprosthetic bacterial hip infection 9% (287/3331) 2 Periprosthetic hip fracture 0% (11/3331) 3 Large-particle wear debris disease 15% (494/3331) 4 Pseudotumor hypersensitivity response 75% (2485/3331) 5 Abductor tendon tear 1% (33/3331) L 3 Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ13.121) A 55-year-old patient returns for followup 2 years after a left ceramic-on-ceramic total hip arthroplasty. He has no pain or symptoms of instability. The video in Figure V shows him ascending stairs. All of the following factors may contribute to this phenomenon EXCEPT Review Topic QID: 4756 FIGURES: V Type & Select Correct Answer 1 Impingement 5% (152/3200) 2 Edge-loading 8% (241/3200) 3 Loss of fluid film lubrication. 10% (314/3200) 4 Third-body particles 4% (116/3200) 5 Subclinical infection 74% (2352/3200) L 3 Select Answer to see Preferred Response SUBMIT RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ12.234) A 67-year-old female complains of anterior groin pain one year following a primary, uncemented total hip arthroplasty. The pain is exacerbated when she tries to climb stairs or get up from a seated position. She denies any recent fevers or chills. On physical exam, the pain is reproduced with resisted seated hip flexion. Laboratory analysis, including WBC, ESR, and CRP are within normal limits. Radiographs reveal that the components are appropriately positioned without evidence of loosening or fracture. Which of the following is the most appropriate at this time? Review Topic QID: 4594 Type & Select Correct Answer 1 Revision of the acetabular component 1% (26/3406) 2 Image-guided diagnostic injection of lidocaine into the iliopsoas tendon sheath 77% (2629/3406) 3 Hip aspiration 3% (117/3406) 4 Bone scan 5% (183/3406) 5 Conservative management including activity modifications, NSAIDs, and physical therapy 13% (431/3406) L 3 Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ12.164) 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. Review Topic QID: 4524 FIGURES: V A B Type & Select Correct Answer 1 Ankle arthrodesis in 30 degrees of dorsiflexion 1% (33/3402) 2 Posterior tibial tendon transfer to the lateral cuneiform through the interosseous membrane 75% (2538/3402) 3 Split anterior tibial tendon transfer to the cuboid 3% (112/3402) 4 Peroneus longus transfer to the navicular and gastrocnemius recession 6% (214/3402) 5 Flexor hallucis transfer to the navicular and tendo Achilles lengthening (TAL) 14% (479/3402) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.47) A 58-year-old patient who underwent bilateral hip arthroplasty 12 years ago now reports pain in his hips and difficulty with ambulation to the point where he now uses crutches. A radiograph of the hip and pelvis is shown in Figure 26. What is the best treatment option for this patient? Review Topic QID: 6007 FIGURES: A Type & Select Correct Answer 1 Revision hip arthroplasty with a bipolar implant 1% (2/160) 2 Revision hip arthroplasty with impaction grafting on the femoral and acetabular side 6% (9/160) 3 Revision hip arthroplasty with a cemented jumbo acetabular component 36% (57/160) 4 Revision hip arthroplasty with a cementless acetabular component 46% (73/160) 5 Acetabular component revision with a tri-flange protrusio ring 11% (18/160) L 4 Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.41) Figure 23 shows failure of the femoral stem in a patient. What is the most likely reason for the failure? Review Topic QID: 6001 FIGURES: A Type & Select Correct Answer 1 Torsional loading 4% (4/112) 2 Cantilever bending 79% (88/112) 3 Pistoning 4% (4/112) 4 Subsidence 5% (6/112) 5 Torque 4% (5/112) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.85) A 62-year-old patient is seen for routine follow-up after undergoing cementless total hip arthroplasty 2 years ago. The patient reports limited range of motion that severely affects daily activities. A radiograph is shown in Figure 51. Management should now consist of Review Topic QID: 6045 FIGURES: A Type & Select Correct Answer 1 observation only. 0% (0/109) 2 nonsteroidal anti-inflammatory drugs and protected weight bearing. 2% (2/109) 3 irradiation to the affected area. 3% (3/109) 4 surgical excision. 8% (9/109) 5 surgical excision and postoperative irradiation. 84% (92/109) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.80) Figure 49 shows a histologic section of the lung in a patient who died during total hip arthroplasty. What unexpected finding is seen in the pulmonary capillaries? Review Topic QID: 6040 FIGURES: A Type & Select Correct Answer 1 Pulmonary embolism 23% (30/132) 2 Methylmethacrylate cement 67% (89/132) 3 Hemorrhagic infarct 5% (7/132) 4 Granuloma formation 2% (2/132) 5 Amyloid 1% (1/132) N/A Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.3) A metal-on-metal bearing used for total hip arthroplasty shows which of the following properties? Review Topic QID: 5963 Type & Select Correct Answer 1 Baseline serum ion levels increase with increasing activity levels. 27% (28/102) 2 The risk of cancer is substantially increased. 0% (0/102) 3 Linear ion production increases over time. 20% (20/102) 4 Ions produced are excreted primarily through the kidney. 47% (48/102) 5 Nickel is the most prevalent ion released into circulation. 2% (2/102) N/A Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.141) The preoperative pelvic radiograph of a 63-year-old female with osteoarthritis is shown in Figure A. She undergoes an uncomplicated total hip replacement. Six weeks post-operatively she complains that her right leg is longer than her left, and an AP pelvic radiograph is obtained which is shown in Figure B. Physical exam shows normal post-operative range of motion and strength in both hips. What is the most likely etiology for this patients gait impairment? Review Topic QID: 327 FIGURES: A B Type & Select Correct Answer 1 Hip flexion contracture 3% (58/2066) 2 Excessive medialization of the acetabular component 1% (26/2066) 3 Patient's perceived leg length discrepancy 88% (1817/2066) 4 Hip adduction contracture 6% (123/2066) 5 Malpositioning of the femoral component 2% (36/2066) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 3
All Videos (3) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques The Recalled Total Hip: My Advice From Life Experience - Scott Sporer, MD (OSET 2018) Scott Sporer Recon - THA Other Complications 7/25/2019 121 views Login to View Community Videos Login to View Community Videos 2017 HSS Holiday Knee & Hip Course Management of ALTR/Trunionosis - D.S. Garbuz, MD, MHSc, FRCSC Recon - THA Other Complications 9/4/2018 255 views Upgrade to View Premium Videos Upgrade to View Premium Videos Ceramic Hip Joint Replacement Squeak Basem Attum (OB Team Editor) General - THA Other Complications 5/17/2015 1395 views ReconâȘTHA Other Complications Team Orthobullets 4 Recon - THA Other Complications Listen Now 10:16 min 10/15/2019 10 plays See More See Less
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