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OITE Prep Fredericks > Adult Recon > Flashcards

Adult Recon Flashcards

1
Q

Proximal Dissection of GLutues Medius in Modified Hardinge apporach ( direct lateral)?

A

Superior gluteal artery is 5cm proxmal in gluteus medius

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2
Q

Where is the center of gravity of body commonly referred to?

What is normal JRF?

A

Anterior to S2

3X body weight

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3
Q

The most common artery supplies the femoral head?

A

Medial femoral circumflex arter

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4
Q

Kerboul Angle Measurement?

A

Mid Saggital MRI
Mid Coronal MRI

Summation of angles <190 190-240, >240 high pprobabilty of collapse

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5
Q

Alpha Angle on CAM view and angle?

A

MOdified DUNN

angle should be LESS thatn 55d

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6
Q

Hip Arthroplasty performed through anterior approach uses the plan between that nerves?

A

Superior gluteal and femoral

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7
Q

What artery do you have to watch out for ( near piriformis tendon) when dooing surgical dislocation of hip to avoid femoral head AVN?

A

Inferior gluteal artery

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8
Q

Fusion Position of the Hip ?

A

0-30 of ER
20-25 FF
NEUTRAL ABDUCTION- AVOID ABD and IR

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9
Q

When templating- What mistakes are made if femur is flexed and externally roated ?

A
  • Canal diameter looks samller
  • Neck looks more valgus
  • Offset looks less

Flexion contracturers can lead to OVER estimation of leg length descrepancy

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10
Q

Excursion Distance in Femoral Head Neck Ratios?

A

The ED is 1/2 the diameter of the femoral head

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11
Q

How much poly do you needt ohave at least in Hip replacement?

A

5.0 mm

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12
Q

What could be a consequence of increasing plus sizes of femoral head to get offset at H/N JXN?

A

As you go up on plus sizes, you may need to have a SKIRTED Turnion to engage head. That will compromise you h/n ration in decrease your excusrion distance

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13
Q

What can you use contrainsed liner for ?

A

Needs to be abductor insufficiency

HAS no be stable cup

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14
Q

Cementless Metaphyseal Fit Implants

FLAT WEDGE TAPER

A

Stryker- Accolade
Tri-Lock- Depuy

Fit and fill stems; Depuy- Summit

Proximal Modular: Depuy- SROM

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15
Q

What does cementless metaphyseal engaging stems help with compared to cementless diaphyseal engaging for cemented?

A

LESS proximal stres sheilding

Also higher rates of intra-operative fracture

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16
Q

Types of Diaphyseal fitting non cemented stems?

A

Non-modular tapered
Modular tapered ( Arcos, Res Mod,
Extensively porous coated stems ( AML,

TENDENCY TO FAIL DUE TO SUBSIDENCE. People are afraid to break femur so they undersize

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17
Q

Non Cemented Femoral Stems fixation by ?

A

Bone INGROWTH- Depends on Pore depth

Bone ON GROWTH- Depends on Surface Roughness

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18
Q

Ankylosing Spondylitis THA considerations?

Loss of Lumbar lordosis

A
  • Increased Acetabular anteversion
  • Increased anteiror instability
  • INcreased Post OP Heterotopic Ossification
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19
Q

What is the most common portion of Sciatic nerve that is affected with too much lengthening?

A

Peroneal division ( closer to the acetabulum)

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20
Q

Only Indication for primary cemented cup?

A

Radiation necrosis

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21
Q

Metal on Metal ions?

A

Cr 3+
Lymphocyte based reaction
Possible cancer risk
Crosses the placenta

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22
Q

Contra indications for femoral resurfacing?

A

Cysts in the Head
LLD
Osteoporosis, Osteonecrosis >50% of head
Neck Shaft <120

23
Q

Linear Wear rate should be?

A

<0.1mm/year
Increased Head size DECREASES Linear wear
Increased Head size INCREASE volumetric wear

24
Q

What is best technique for PE molding?

A

Direction compression molding

Decreases backside wear

25
Q

How much cup UNcoverage can you accept in acetabula component?

A

30-35%

26
Q

Heterotopic Ossification Risks in THA?

A

DIRECT LATERAL
Ankylosising Spondylitis

ONLY consider on OPerating on HO that BONE scan shows HO is MATURE

27
Q

Metal on Poly Osteolysis is mediated by what cell?

A

Macrophage

28
Q

Must Know facts about Extended Trochanteric Osteotomies (ETO)

A
  1. 95% healing rate
  2. needs 4-6 cm distal to osteotomy for scratch fit in diaphysis
  3. template Out osteotomy
  4. Keep soft tissues attached to bone
29
Q

Are Acetabular revision cups usually cemented or cementless ?

A

CEMENTLESS

30
Q

Paprosky Classification of Acetabular Bone Loss

A 
Type I: Undistorted Hemispherical Acetabulum
Type II (A/B/C): Distorted acetabulum but Intact columns
Type III (A/B): NOn-suportive columns
31
Q

Column Support in Revision THA

A
  1. Anterior superior

2. Posterior Inferior

32
Q

Paprosky II Types

A

IIA- Superior Migration
IIB Superior Lateral Migration
IIC: MEDIAL migration

33
Q

Paprosky III Types ( Lack of column support)

A

IIIA: UP AND OUT
IIIB: UP and IN _ cup and cage/Triflange

34
Q

One thing to remember with acetaabular and femoral componenet revision?

A

CEMENTLESS REVISION of both the femur and the acetabulum

35
Q

Articulating Spacer versus static spacer. What do you need for articulating spacer?

A 
BLTS
Bone stock good
Ligaments good 
Tendons ( extensor mechanism)
Soft tissue coverage

NO difference in infection irradication
Less time in OR for revision in articulating spacer

36
Q

What complication with TKA is associated with flexion gap instaiblity ?

A

Patellar instability

37
Q

IN a CR knee if the PCL ruptures what can happen?

A

Flexion instability

38
Q

Classic indications for UKA

A

Intact ACL
<10d varus, <5 d valgus
Correctable deformity
Flexion contracture less than 15d

39
Q

The CDC defines that a surgical site infection happens within what time frame?

A

365 days (implants, hardware, and joint arthroplasty)

40
Q

CR and PS Associations?

A

CR: catastrophic PCL rupture and flexion instability

PS: Patellar clunk

41
Q

WHen do you want to do a MUA on TKA? Before when?

A

3 months

Risk: Femurs fracture ( osteoporosis) , return of stiffness

42
Q

What is patellar clunk associated with?

A

PS Knee ( posterior stabilized)
Smaller Femoral Components
Smaller patellar components
VALGUS knee

43
Q

TXA MOA?

A

Prevents the breakdown of FIBRIN

Prevents plasminogen from breaking down fibrin

Attaches to LYSINE on Plasmiogen and prevents conversion to pLASIM

44
Q

Clopidogrel MOA

A

BLocks ADP receptor on platelets

45
Q

What is factor II and what is an inhibitor ?

A

Thrombin

Dabigatran- direct thrombin inhibitor

46
Q

What is half life of warfarin?

A

36-42 hours

47
Q

What factors promote osteolysis cascade around orthopaedic implants?

A

IL-6
IL-1
TNF-A

48
Q

What does polyethlylene irradiation do to 1. wear propoerties 2. Fracture toughness

A

INCREASE (better) wear propterties

DECREASES fracture toughness

49
Q

What is the difference in wear particles in hip repalcement versus knee replacment

A

wear particles in TKA are LARGER and LESS reactive thant THA

50
Q

Trunionosis reisk factors ?

A
  1. Larger metal heads

2. Higher offset

51
Q

What cell type is responsible for Metal allergy in Ortho implants?

A

T Lymphocyte

LTT Lymphoctyte Transfer Test
Most sensitvities are cobalt, chrome, nickel

52
Q

Patient with pagets disease, what can you adminster to decrease blood lose following elective arthroplasty

A

PAMIDRONATE

Bisphosphonates

53
Q

What orthopeadic biomateral has highest rates of bacterial adherence ?

A

Titanium ALLOY

54
Q

What is usual only remaining blood supply to patella after 1. Medial parapatellar approach
2. Fat pad and lateral meniscus removal?

A

SUPERIOR LATERAL GENICULATE

OITE Prep Fredericks (15 decks)

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