Orthopedic Surgical Procedures and Considerations Flashcards
What is the advantage of cemented versus cementless fixation with regards to THR?
Cemented typically allows for earlier weightbearing, often immediately after the procedure because the cement dries within 15 minutes.
Cementless fixation relies on bone growth and may dictate PWB and NWB initially.
What is the primary indication for cementless fixation?
A young active individual
What is the average lifespan of a total hip and knee arthroplasties?
15-20 years
Younger individuals will most likely need revisions
List 7 possible complications for total hip arthroplasty.
DVT Infection Pulmonary embolism Heterotopic ossification Femoral fractures Dislocation Neurovascular injury
What are the hip precautions for a THR done using an anterolateral approach?
No hip flexion past 90 degrees
No extension
No Adduction
No external rotation
What are the hip precautions for a THR done using an lateral approach?
No hip flexion past 90 degrees
No extension
No Adduction
No external rotation
What are the hip precautions for a THR done using an posterolateral approach?
No flexion past 90 degrees
No adduction
No internal rotation
What is the most commonly performed surgery for advanced arthritis of the knee?
Total knee arthroplasty
What ways can a TKA be classified?
Can be classified by:
Number of compartments replaced
Degree of constraint
Describe the different types of TKA classifications based on compartments replaced.
Unicompartmental = only the medial or lateral joint surface was replaced Bicompartmental = the entire surface of the femur and tibia were replaced Tricompartmental = replacement of the femur, tibia and patella
Describe the different types of TKA classifications based on degree of constraint.
Unconstrained design = offers no inherent stability and relies on soft tissue integrity for stability
Semiconstrained = offers some degree of stability without restricting mobility (most common)
Fully constrained = offers the most stability by restricting one or more planes of motion
List 7 possible complications for total knee arthroplasty.
DVT Infection Pulmonary embolism Peroneal nerve palsy Restricted ROM Periprosthetic fracture Chronic joint effusion
What is a laminectomy? When is it typically performed? What is the difference between a complete and partial laminectomy?
Removal of the lamina
Typically performed in the presence of disc protrusion or spinal stenosis
Complete = removal of the lamina, spinous process and ligamentum flavum associated with that disc Partial = removal of only the lamina
List 2 most likely post op restrictions a patient undergoing a laminectomy may have.
Lifting restrictions AROM restrictions (especially extension)
List three indications for spinal fusion.
Axial pain with unstable spinal segments
Advanced arthritis
Uncontrolled peripheral pain
What site in the body is bone most typically harvested from for a spinal fusion?
Iliac creast
What surgical approach is typically taken for lumbar versus cervical fusions?
Cervical = anterior approach Lumbar = posterior approach
What does a spinal fusion inherently lead to?
Hypermobility at the segments above and below the fusion to compensate for lack of mobility at the fused segments
List 2 of the most common indications for total shoulder arthroplasty.
Advanced arthritis
Secondary to fracture or rotator cuff arthropathy
In what case will a REVERSE total shoulder arthroplasty be selected over a traditional total shoulder arthroplasty?
When the patient has a dysfunctional rotator cuff
What muscle is most commonly detached for easier access to the GH joint during a total shoulder arthroplasty?
Subscapularis
When is a subacromial decompression typically performed?
In cases where shoulder impingement has not responded to conservative treatment
What muscle is responsible for controlling movement at the GH joint after a REVERSE TSA?
Deltoid
What are the 2 ways in which rotator cuff repairs are classified?
Depth (partial versus full)
Width
If deltoid repair was performed along with a rotator cuff repair, which motion is avoided initially to prevent stress on the repair site?
Passive extension
What is a capsular shift procedure? When is it typically performed? What area of the capsule is most commonly shifted?
Involves tightening of the joint capsule by cutting the capsule and overlapping the ends to reduce capsular redundancy
Typically performed in the presence of chronic shoulder instability
Anterior capsule is most commonly tightened because anterior shoulder instability is the most common
What structure is repaired using a Bankart repair? What structure is repaired during a SLAP repair?
Bankart = anterior labrum SLAP = superior labrum
What positions should be avoided following an anterior GH capsule repair?
External rotation
Extension
Horizontal abduction
What positions should be avoided following an posterior GH capsule repair?
Internal rotation
Flexion
Horizontal adduction
What should be avoided following a SLAP repair?
Contracting or stretching the biceps because it is attached to the superior labrum
Where do proximal hip fractures most commonly occur?
Femoral neck
Intertrochanteric region
What conditions are more likely to develop with femoral neck fractures as compared to fractures that occur in the intertrochanteric region?
Osteonecrosis and non-union
Why?: femoral neck fractures are intracapsular and thus may lead to disruption of blood supply to the femoral neck
What is the gold standard graft for ACL reconstruction surgery? Why?
Bone-patellar tendon-bone graft is gold standard
Why?: Uses bone to bone healing and is considered a stronger graft with good fixation
List 6 criteria that individuals with ACL reconstruction must achieve in order to return to sport.
No pain or effusion
Full ROM
No instability
Quadriceps strength that is 80-95% of the opposite leg
Hamstring strength that is 90-100% of the opposite leg
Functional testing that is 85-90% of the opposite leg
What is the difference between a meniscectomy and a meniscal repair? When are these procedures typically performed?
Meniscectomy = the torn piece of the meniscus is removed (done on older individuals or when the tear is on the inner 1/3 of the meniscus where healing capacity is poor)
Meniscal repair = the tear is sutured back together (younger patients or when the tear is on the outer 1/3 of the meniscus)
List 2 of the most common reasons lateral ankle reconstruction is performed.
Chronic ankle instability
Complete tear of ATFL or CFL ligaments
What is the most common site that an autograft is taken for lateral ankle reconstruction?
Peroneus brevis
If an autograft is needed for Achilles tendon repair, what are the 3 most common sites a graft might be taken?
Plantaris
Flexor hallucis longus
Peroneus brevis
What is an avulsion fracture?
A portion of the bone becomes fragmented at the site of tendon attachment due to a traumatic and sudden stretch of the tendons
What is the difference between a closed vs compound fracture?
Closed = break in the bone where the skin of the bone remains intact
Compound = break in the bone that protrudes through the skin
What is a comminuted fracture?
A bone that breaks into fragments at the site of injury
What is a greenstick fracture? What population is this most commonly seen in?
A break on one side of a bone that does not damage the periosteum on the opposite side
Most commonly seen in children.
What is a nonunion fracture?
A break in a bone that has failed to unite and heal fter 9-12 months
What is a stress fracture?
A break in a bone due to repeated forces to a particular portion of the bone
What is a spiral fracture?
A break in a bone shaped like an āSā due to torsion and twisting
