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NPTE Musculoskeletal > Orthopedic Surgical Procedures and Considerations > Flashcards

Orthopedic Surgical Procedures and Considerations Flashcards

1
Q

What is the advantage of cemented versus cementless fixation with regards to THR?

A

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.

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2
Q

What is the primary indication for cementless fixation?

A

A young active individual

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3
Q

What is the average lifespan of a total hip and knee arthroplasties?

A

15-20 years

Younger individuals will most likely need revisions

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4
Q

List 7 possible complications for total hip arthroplasty.

A 
DVT
Infection
Pulmonary embolism 
Heterotopic ossification
Femoral fractures
Dislocation
Neurovascular injury
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5
Q

What are the hip precautions for a THR done using an anterolateral approach?

A

No hip flexion past 90 degrees
No extension
No Adduction
No external rotation

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6
Q

What are the hip precautions for a THR done using an lateral approach?

A

No hip flexion past 90 degrees
No extension
No Adduction
No external rotation

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7
Q

What are the hip precautions for a THR done using an posterolateral approach?

A

No flexion past 90 degrees
No adduction
No internal rotation

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8
Q

What is the most commonly performed surgery for advanced arthritis of the knee?

A

Total knee arthroplasty

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9
Q

What ways can a TKA be classified?

A

Can be classified by:
Number of compartments replaced
Degree of constraint

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10
Q

Describe the different types of TKA classifications based on compartments replaced.

A 
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
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11
Q

Describe the different types of TKA classifications based on degree of constraint.

A

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

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12
Q

List 7 possible complications for total knee arthroplasty.

A 
DVT
Infection
Pulmonary embolism
Peroneal nerve palsy 
Restricted ROM
Periprosthetic fracture 
Chronic joint effusion
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13
Q

What is a laminectomy? When is it typically performed? What is the difference between a complete and partial laminectomy?

A

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
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14
Q

List 2 most likely post op restrictions a patient undergoing a laminectomy may have.

A 
Lifting restrictions 
AROM restrictions (especially extension)
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15
Q

List three indications for spinal fusion.

A

Axial pain with unstable spinal segments
Advanced arthritis
Uncontrolled peripheral pain

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16
Q

What site in the body is bone most typically harvested from for a spinal fusion?

A

Iliac creast

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17
Q

What surgical approach is typically taken for lumbar versus cervical fusions?

A 
Cervical = anterior approach
Lumbar = posterior approach
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18
Q

What does a spinal fusion inherently lead to?

A

Hypermobility at the segments above and below the fusion to compensate for lack of mobility at the fused segments

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19
Q

List 2 of the most common indications for total shoulder arthroplasty.

A

Advanced arthritis

Secondary to fracture or rotator cuff arthropathy

20
Q

In what case will a REVERSE total shoulder arthroplasty be selected over a traditional total shoulder arthroplasty?

A

When the patient has a dysfunctional rotator cuff

21
Q

What muscle is most commonly detached for easier access to the GH joint during a total shoulder arthroplasty?

A

Subscapularis

22
Q

When is a subacromial decompression typically performed?

A

In cases where shoulder impingement has not responded to conservative treatment

23
Q

What muscle is responsible for controlling movement at the GH joint after a REVERSE TSA?

A

Deltoid

24
Q

What are the 2 ways in which rotator cuff repairs are classified?

A

Depth (partial versus full)

Width

25
Q

If deltoid repair was performed along with a rotator cuff repair, which motion is avoided initially to prevent stress on the repair site?

A

Passive extension

26
Q

What is a capsular shift procedure? When is it typically performed? What area of the capsule is most commonly shifted?

A

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

27
Q

What structure is repaired using a Bankart repair? What structure is repaired during a SLAP repair?

A 
Bankart = anterior labrum
SLAP = superior labrum
28
Q

What positions should be avoided following an anterior GH capsule repair?

A

External rotation
Extension
Horizontal abduction

29
Q

What positions should be avoided following an posterior GH capsule repair?

A

Internal rotation
Flexion
Horizontal adduction

30
Q

What should be avoided following a SLAP repair?

A

Contracting or stretching the biceps because it is attached to the superior labrum

31
Q

Where do proximal hip fractures most commonly occur?

A

Femoral neck

Intertrochanteric region

32
Q

What conditions are more likely to develop with femoral neck fractures as compared to fractures that occur in the intertrochanteric region?

A

Osteonecrosis and non-union

Why?: femoral neck fractures are intracapsular and thus may lead to disruption of blood supply to the femoral neck

33
Q

What is the gold standard graft for ACL reconstruction surgery? Why?

A

Bone-patellar tendon-bone graft is gold standard

Why?: Uses bone to bone healing and is considered a stronger graft with good fixation

34
Q

List 6 criteria that individuals with ACL reconstruction must achieve in order to return to sport.

A

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

35
Q

What is the difference between a meniscectomy and a meniscal repair? When are these procedures typically performed?

A

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)

36
Q

List 2 of the most common reasons lateral ankle reconstruction is performed.

A

Chronic ankle instability

Complete tear of ATFL or CFL ligaments

37
Q

What is the most common site that an autograft is taken for lateral ankle reconstruction?

A

Peroneus brevis

38
Q

If an autograft is needed for Achilles tendon repair, what are the 3 most common sites a graft might be taken?

A

Plantaris
Flexor hallucis longus
Peroneus brevis

39
Q

What is an avulsion fracture?

A

A portion of the bone becomes fragmented at the site of tendon attachment due to a traumatic and sudden stretch of the tendons

40
Q

What is the difference between a closed vs compound fracture?

A

Closed = break in the bone where the skin of the bone remains intact

Compound = break in the bone that protrudes through the skin

41
Q

What is a comminuted fracture?

A

A bone that breaks into fragments at the site of injury

42
Q

What is a greenstick fracture? What population is this most commonly seen in?

A

A break on one side of a bone that does not damage the periosteum on the opposite side

Most commonly seen in children.

43
Q

What is a nonunion fracture?

A

A break in a bone that has failed to unite and heal fter 9-12 months

44
Q

What is a stress fracture?

A

A break in a bone due to repeated forces to a particular portion of the bone

45
Q

What is a spiral fracture?

A

A break in a bone shaped like an ā€œSā€ due to torsion and twisting

NPTE Musculoskeletal (32 decks)

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