Joint Arthroplasty Flashcards
Primary causes for Joint Replacement (5)
- OA
- RA
- Traumatic arthritis
- Avascular necrosis
- Fracture repair
Primary* indications for Joint Replacement (6)
- Marked, disabling pain*
- Decreased function*
- Marked impairment in ROM
- Instability and/or deformity
- Recurrent dislocation
- Failure of prior interventions/surgeries
Contraindications for Joint Replacement (3)
- Infection (biggest concern)
- Severe of uncontrolled HTN
- Progressive neurological disease
Relative Contraindications (3)
- Obesity
- Diabetes
- Age: 90
Main Complications (4)
- Venous Thromboemoblism (DVT or PE)
- Infection (acute and long-term)
- Arthrofibrosis
- Complex Regional Pain Syndrome
Metal-on-polyethylene - advantages
- Cost effective
- Evidence supports use
- Predictable lifespan
Metal-on-polyethylene - disadvantages
-Polyethylene debris may lead to aseptic loosening
Metal-on-metal - advantages
- Low friction/wear
- Lower dislocation risk
Metal-on-metal - disadvantages
- Possible carcinogenic effect of metal ions
- Metallosis
Ceramic-on-ceramic - advantages
- Low friction/wear
- Inert material
Ceramic-on-ceramic - disadvantages
- Expensive
- Requires expert insertion technique
- Possible joint noise
Uncemented Fixation - Advantages
- Lower risk of cardiovascular and VTE events
- Bone conserving
Uncemented Fixation - Disadvantages
- Increased risk of peri-prosthetic fracture
- Lack of good long-term outcome data
Cemented Fixation - Advantages
- More stable initially
- Better short and mid-term outcomes
Cemented Fixation - Disadvantages
- Longer operative time
- More difficult to revise
- Potential for adverse reaction to cement
Approaches for THA (7)
- Direct anterior
- Anterolateral
- Direct lateral
- Lateral Transtrochanteric
- Posterolateral
- Posterior mini
- Anterior mini
What is a Total arthroplasty?
New acetabulum
What is a Hemi arthroplasty?
Person’s original acetabulum
Total Hip Resurfacing (THR) - Advantages
- Moving a lot less bone
- Joint is more stable
Resurfacing - Advantages (4)
- Lower dislocation risk
- Bone conserving
- Low wear/friction
- Quicker recovery and return to high demand activity
Resurfacing - Disadvantages (4)
- Higher early failure rates
- Metallosis
- Technically difficult
- Little long-term data
- **Femoral neck fracture
Arthroplasty - Advantages (4)
- Well-studied
- Easier to perform
- Suitable for wider range of patient populations
- Better long-term outcomes
Arthroplasty - Disadvantages (3)
- Higher dislocation risk
- More difficult to revise
- More functionally limiting
Posterior-lateral approach PRECAUTIONS (3)
- Avoid adduction beyond neutral
- Avoid hip flexion > 90 degrees
- Avoid hip internal rotation