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ABOS Part 2 > Joints flashcards > Flashcards

Joints flashcards

1
Q

percent of THA in 2012 that are cementless

A

93%

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2
Q

How to calculate Dorr

A

radio of canal diameter 10 cm distal to midportion of lesser trochanter / inner canal diameter at midportion of lesser trochanter

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3
Q

Dorr Type A

A

Ratio <0.5 (canal is less than half the thickness 10 cm distal to lesser troch than the canal at the troch itself). Cortices seen on both AP and Lateral XR. Uncemented is good.

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4
Q

Dorr Type B

A

0.5-0.75. Thinning of posterior cortex on lateral XR. Uncumeneted

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5
Q

Dorr Type C

A

> 0.75, thinning of cortices on both views. Cemented fixation (bad case if you do uncemented.

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6
Q

how does cement act

A

acts as grout by interlocking fit between surfaces

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7
Q

stovepipe femur is also known as

A

Dorr C femur. enlarged metaphysis and lack of supporting isthmus.

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8
Q

cementing the cup?

A

not as good, higher failure rate, cement resists shear poorly

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9
Q

1st generation cement technique

A

Hand mix, finger packed cement, no canal preparation or cement restrictor

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10
Q

2nd generation cement technique

A

Cement restrictor, cement gun, femoral canal preparation with brush and dry

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11
Q

3rd generation cement technique

A

vacuum-mixing to reduce porosity, cement pressurization, femoral canal preparation with pulsatile lavage.

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12
Q

Porosity good or bad for cement

A

bad, more points of stress if high porosity

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13
Q

Cement mantle thickness

A

> 2mm to decrease risk of mantle fractures

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14
Q

Mueller type prosthesis difference

A

French paradox, it aims for a press fit mediolaterally so the cement mantle is <2 mm, but it has shown to have good results as well.

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15
Q

stiff femoral stem for cement

A

titanium is bad, flexes too much

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16
Q

stem centralizatier for cement

A

avoid malpositioning

17
Q

Smooth femoral stem

A

sharp edges increase stress concetration

18
Q

Varus or valgus for cement

A

want to avoid either, especially varus

19
Q

Barrack and Harris garding system for cement

A

….do I need to know…

20
Q

Good indication for cementless THA

A

younger patient, older patient with good bone stock, revision THA (cemented is not good for revision)

21
Q

Indications for cemented THA

A

poor acetabular bone stock, irradiated bone - very rare though

22
Q

Biologic fixation Pore Size

A

50-300 microm (preferable 50-150)

23
Q

biologic fixation porosity

A

40-50%, if too porous leads to shearing of metal

24
Q

biologic fixation gaps

A

<50 um (distance between bone and prosthesis)

25
Q

micromotion biologic fixation

A

<150 um (leads to fibrous ingrowth)

26
Q

grit blasted is what kind of surface

A

onlay, EXTENSIVELY COATED

27
Q

onlay vs. inlay

A

onlay is weaker, which means you need greater surface coating

28
Q

hydroxyapatite effect on bone

A

osteoconductive (not osteoinductive)

29
Q

signs of a wellxed cementless femoral component

A

spot welds (new endosteal bone that contacts porous surface of implant. No radiolucenet lines around porous portion of femoral stem, proximal stress shielded in extensively coated stems is good, absence of stem subsidence on serial radiographs

30
Q

signs of well fixed cementless acetabular component

A

no migration on serial xrays, no progressive radiolucent lines, intact acetabular screws

31
Q

aseptic loosening cause

A

poor initial fixation, mechanical loss of fixation over time, particle induced osteolysis

32
Q

loose acetabular component symptoms

A

groin/buttock pain

33
Q

femoral loosening symptoms

A

thigh pain and startup pain

34
Q

how to eval for aseptic loosening

A

sequential xrays adn bone scan

35
Q

risks for stress shielding

A

stiff femoral stem is the most important, extensively porous coated stem (in a revision stem scenarior - not an extensively coated ongrowht but an ingrowth extensivelyc oated stem). Large diameter stem. greater preop osteopenia

36
Q

causes of aseptic loosening

A

poor initial fixation, loss of fixation over time, particle induced osteolysis

37
Q

treat stress shielding?

A

no

38
Q

unstalbe fmeur fracture intraop treatment

A

remove prosthesis, stabilize fracture, reinsert new stem that bypasses fracture by two cortical diameters

39
Q
A

ABOS Part 2 (10 decks)

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