B3 L34 Orthopaedic Inpatient Elective Lower Limb Surgery Flashcards
What are 3 common procedure done for osteoarthritis/rheumatoid arthritis of the hip?
- Primary total hip replacement (THR)
- Revision total hip replacement
- Salvage procedures
What are 4 common procedure done for osteoarthritis and meniscal lesions of the knee?
- Total knee replacement (TKR)
- Uni-compartmental knee replacement (UKR)
- High tibial osteotomy
- Arthroscopy- Washout, meniscal debridement, removal, repair
What is a common procedure done for ligamentous instability of the knee?
Anterior Cruciate Ligament (ACL) Reconstruction
What are 2 common procedure done for subluxing/pain patello-femoral joint?
- Lateral Release
- Tibial Tuberosity Transfer
What is common procedure done for toe deformities?
Osteotomy correction for toe deformities (bunion)
What is the goal total hip replacement (THR)?
To attain a durable, painless, functional hip
When was the THR developed? What was the problem with the older version?
- Developed by Charnley in England in the 1950’s
- Original prosthesis metal on metal - poor results due to friction and metal fragments
What is the femoral head made out of (in THR)?
Metal alloy
What is the acetabular cup made out of (in THR)?
Almost frictionless cup
Is there a difference with cement or cementless THR in post-op management?
Same post-op management

What are the 2 operative approaches of a THR?
- Posterior
- Anterior & Anterior-lateral
What is the most commonly used approach for a THR?
- Most commonly used approach is the posterior operative approach
- However, the anterior and anterior-lateral is becoming more common
What is an advantage of posterior operative approach for a THR?
easier for surgeon
What is a disadvantage of posterior operative approach for a THR?
dislocation a possibility during sitting and excessive hip flexion
What is the dislocation position of posterior operative approach for a THR?
- Flex >90°, adduction past neutral, internal rotation past neutral
- Combined flexion, adduction, internal rotation
What is an advantage of anterior and anterior-lateral operative approach for a THR?
Decreased chance of posterior dislocation as posterior capsule not affected.
What is a disadvantage of anterior and anterior-lateral operative approach for a THR?
more difficult for surgeon
What is the dislocation position of anterior and anterior-lateral operative approach for a THR?
- Forced extension
- Flex or extension with Add and ER
When would use an anterior and anterior-lateral operative approach for a THR instead of the posterior approach?
May be indicated for alcoholics or other patients who may be unable to adhere to routine hip precautions postoperatively.
What are 3 peri-operative complications of a THR?
- Sciatic nerve (posterior approach) damage can lead to short term neuropraxia and subsequent ‘foot drop’. (up to 12 months)
- Poor positioning of acetabular component could increase chance of dislocation.
- Fractured acetabulum; fractured femoral shaft; excessive blood loss.
What are 4 post-operative complication of THR?
- DVT
- Dislocation
- Infection
- Loosening of components
What does a THR dislocation look like? When is the dislocation risk high?
First 3 months (decreases over time)

What is the treatment for a THR dislocation? What position is this in?
Rocket technique- done in the theatre or emergency
Hip and knee flexion (90 degrees) with knee on doctor’s shoulders
What are the 3 goals of a THR in post-operative management?
- Independent mobility w appropriate aid
- Independent with home exercise programme
- Independent mobility on stairs














