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Basic Science > Adult Reconstruction > Flashcards

Adult Reconstruction Flashcards

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1
Q

What coronal deformity results in cartilage loss on the posterior aspect of the femur and tibial plateau?

What XR view shows this?

A

Valgus knees
Obtain a Rosenberg View (PA Flexion)

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2
Q

Increased radionuclide activity in bone may be a normal postoperative finding for how long after fracture repair or TKA?

A

6-12 months

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3
Q

What is the leading cause of revision TKA?

A

Aseptic loosening

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4
Q

How much penetration is recommended for cement penetration?

A

3-4 mm where if less than 1.5 is associated with radio-lucencies and 5-10 mm is concerning for thermal necrosis

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5
Q

For acetabular dysplasia, there is an acetabular index that is greater than how many degrees?

A

5 degrees

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6
Q

For acetabular dysplasia, the lateral CE angle is less than how many degrees?

A

20 degrees (vertical line and line from femoral head center to acetabular edge)

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7
Q

The crossover sign signifies what in the acetabulum?

A

That it is retroverted

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8
Q

How do you measure the femoral alpha angle?

A

On an AP of the hip, draw a line from the center of the femoral head down the middle of the neck and form an angle with another line from the center of the femoral head to the head/neck junction

Normal is 40 degrees or less

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9
Q

What is the Ficat stage for symptomatic osteonecrotic hip with crescent sign?

A

Stage 3

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10
Q

Treatment of the following necrotic hips:
-Small lesion, no crescent sign
-Medium/Large lesion, no crescent sign, less than 40
-Medium/Large lesion, no crescent sign, less than 40
-Crescent sign

A
  1. Core decompression (Do NOT offer if on chronic steroid treatment)
  2. Vascularized Fibular strut graft
  3. THA
  4. THA
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11
Q

What is the preferred optimal pore size for bony ingrowth for THA?

A

50-200 micrometers

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12
Q

The grab distance between the implant and bone in a press fit THA must be less than what?

A

50 micrometers

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13
Q

In a THA, fibrous fixation occurs when micromotion exceeds what?

A

150 micrometer fixation

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14
Q

What is the formula for hydroxyapatite?

A

Ca10(PO4)6(OH)2

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15
Q

High cobalt levels 5 times more than chromium, what am I worried about?

A

Trunnionosis

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16
Q

What head/shell combo in THA has the lowest wear?

A

Ceramic head on ceramic poly (but there is a fracture risk and squeaking)

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17
Q

What is the percentage of neurologic complications in THA?

A

1% (Often the sciatic nerve and the result of compression (hematoma))

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18
Q

HO is most common with that THA approach?

A

Lateral

PPX: 700 cGY (centigray) 24 hrs preop or up to 48 hrs postop or indocin

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19
Q

Pain and weakness with resisted hip flexion after a THA, what is the diagnosis?

A

Iliopsoas impingment

Tx: Conservative, injections
If fail conservative and cup is not prominent more than 8 mm, iliopsoas tenotomy. If cup is prominent anterior 8 mm then revise the cup

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20
Q

What is the number one reason for long term THA revisions?

A

Aseptic loosening

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21
Q

What is the name of the classification for proximal femoral bone loss in THA?

A

Paprosky
1 - metaphysis intact
2 - metaphysis loss
3. diaphysis
4. No support, both metaphysis and diaphysis not intact

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22
Q

Where is the zone of death in the acetabulum to avoid placing screws and what is at risk?

A

Anterior-Superior
External iliac artery and vein

(Also avoid anterior inferior which targets the obturator n/a/v)

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23
Q

What is the safest zone for acetabulum screws?

A

Superior posterior

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24
Q

Alpha defensin is released by what cell?

A

Neutrophils

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25
Q

Which method removes all free radicals for polyethylene? Is it annealing or melting

A

Melting (as a result decreases mechanical properties)

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26
Q

What is the best form of PE implant manufacturing? Is it ram bar extrusion, sheet molding, compression molding or direct compression molding?

A

Direct compression molding

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26
Q

Blood supply to the adult femoral head comes from ?

A

Medial femoral circumflex artery

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27
Q

What is left intact in a Bernese PAO?

A

Posterior column

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27
Q

What size mantle of cement do you want for cemented femoral stem?

A

2 mm

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27
Q

I should build more retroversion for a THA in a patient with what type of spine?

A

Flatback (stuck sitting)

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27
Q

What is yearly mortality rate for femoral neck fracture?

A

20-30 percent

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28
Q

What bearing has the highest young’s modulus?

A

Ceramic

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29
Q

What bearing has the young’s modulus closest to cortical bone?

A

Titanium

30
Q

What kind of wear is most important for PE particle generation?

A

Adhesive wear

31
Q

What is the osteolysis threshold?

A

0.1 mm/year

(The large the head the higher the volumetric wear rate which is why small heads were initially chosen but HCLPE has such low rates of wear that we are now able to tolerate larger heads)

32
Q

For THA, drive reaction time normalizes at what time postop?

A

4-6 weeks

33
Q

What muscle originates from the AIIS?

A

Rectus femoris

34
Q

Hip resurfacing requires what kind of bearing?

A

Metal on Metal (MoM)

35
Q

What is the most common early complication for hip resurfacing?

A

Femoral neck fracture

36
Q

What vessel is at risk of bleeding with a DAATHA?

A

Ascending branch of lateral femoral circumflex vessel

37
Q

What is the incidence of dislocation in THA and revision THA?

A

1-2%
5-7%

38
Q

A vertical cup results in what direction dislocation risk?

A

Posterior superior

39
Q

What is the most common legal reason for suing after a THA?

A

Nerve injury

40
Q

What angle is a good method to asses risk of collapse in osteonecrotic hips?

A

Kerboul angle

190-240 medium risk

41
Q

Who has a higher dislocation rate: THA or Hip resurfacing?

A

THA because hip resurfacing has a large femoral component

42
Q

What is my osteotomy option for a varus knee malalignment?

A

Valgus producing proximal tibia osteotomy

43
Q

What is my osteotomy option for a valgus knee malalignment?

A

Due to a lateral femoral condyle hypoplasia so do a varus producing supracondylar femoral osteotomy

44
Q

What patella deformity can result from close or open wedge proximal tibia osteotomy?

A

Patella Baja

45
Q

The distal femur cut is made perpendicular to what axis?

A

The mechanical axis (line from femoral head through knee center to the ankle center

46
Q

The maximum alteration of the joint line in TKA is how much?

A

8 mm but avoid 4 mm

47
Q

What is the biggest predictor of postoperative TKA ROM?

A

Pre-operative ROM

48
Q

What degrees is the joint line cut for mechanical versus kinematic alignment?

A

0 degrees to mechanical and 3 degrees varus for kinematic

49
Q

As a knee goes into extension, how does the tibia behave?

A

It externally rotates

50
Q

The flexion gap is controlled by what three things?

A

Posterior femoral cut
Tibial cut
PCL

51
Q

The extension gap is controlled by what three things?

A

Distal femur cut
Tibial cut
Posterior capsule

52
Q

Which nerve block is both motor and sensory for TKA? (Femoral or Adductor Nerve Block)

A

Femoral nerve block

53
Q

What area of the knee is not covered by both femoral and adductor nerve blocks?

A

Posterior knee

54
Q

What maneuver will cause a fracture if there is notching with a TKA?

A

Bending

55
Q

Where does the large arterial contribution to the patella come from?

A

Inferomedial

56
Q

What is the minimum thickness of the patella required for a TKA?

A

13 mm

57
Q

Postoperative manipulation of a TKA should occur when?

A

4-12 weeks postop

58
Q

For a TKA, the most common site for ostelysis is where?

A

Behind the posterior femoral condyle

59
Q

What is the distance from the joint line for the following in mm:
Lateral Femoral Condyle
Medial Femoral Condyle
Fibular Head

A

Medial Condyle: 28 mm
Lateral Condyle: 23 mm
Fibular Head: 14 mm

60
Q

Compared to manual UKA, robotic UKA provides what?

A

Better implant positoning and shorter hospital stay

61
Q

CR knees should be avoided if varus more than what and valgus more than what?

A

Varus more than 10 degrees and valgus more than 15 degrees

62
Q

Patient with hyper extension instability requires what type of TKA?

A

Hinge knee

63
Q

Most common cause of TKA loosening at:
<2 yrs
>2 yrs

A

PJI for < 2 yrs
Aseptic loosening >2 yrs

64
Q

What makes up the Insall-Salvati ratio?

A

Patellar tendon length / Length of the patella bone
Normal is 1:1`

65
Q

Patella clunk is unique to what TKA design?

A

PS Knee

66
Q

Adductor blocks what nerve?

A

Saphenous nerve

67
Q

What symptoms can be seen with metal toxicity?

A

Cardiomyopathy, hypothyroidism, polycythemia, neuropathy

68
Q

Alpha defensin can be falsely positive in what hip condition?

A

Pseudotumor (metal on metal hip)

69
Q

How can I measure true leg length?

A

Draw line from ASIS to Medial Malleolus

70
Q

Dislocation and Early revision are seen more with what? THA or Hemi?

A

THA

71
Q

What neurovascular structure is closest to the posterior capsule of the knee?

A

Popliteal Artery

72
Q

What knee approach has led to rotation malpositioning?

A

Quad sparring approach

73
Q

Post polio syndrome require what kind of TKA?

A

Hinge knee

74
Q

What inflammatory marker has the highest correlation to PJI?

A

IL-6

75
Q

What is the most common postoperative complication after surgical dislocation of the hip?

A

Heterotopic ossification

76
Q
A

Basic Science (10 decks)

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