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Miller Review > Recon (355-423) & Review > Flashcards

Recon (355-423) & Review Flashcards

1
Q

Acetabular dysplasia classical definitions: CE angle, Anterior CE angle and Acetabular Index

A

CE Angle 5 degrees

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2
Q

Acetabular dysplasia classically lacks what coverage?

A

Anterolateral

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3
Q

Acetabular retroversion - two signs?

A

Crossover, ischial spine

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4
Q

Acetabular overcoverage for dysplasia?

A

Excess anterolateral coverage, downsloping aceetabular index >5 degrees downward

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5
Q

Proximal femoral dysplasia - two types?

A
  1. Head-neck dysplasia - alpha angle 40 degrees or less 2. Altered neck version - excess ante or retroversion
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6
Q

FAI - where is the abnormal impingement occuring?

A

Anterosuperior zone of acetabulum

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7
Q

FAI can be caused by pincer and cam. Whats the difference?

A

Pincer - anatomic aberration between retroverted socket and normal femoral neck creates a mechanical block, pinches acetabular labrum Cam - Raised proximal femoral neck, slips under labrum and impinges articular surface, chondral acetabulum gets damaged

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8
Q

Surgical Treatment of FAI?

A
  1. PAO
  2. Anterior hip decomopression
  3. Proximal hip osteotomy
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9
Q

PAO?

A

Corrects tilt and version

Allows for medialization

Correct AI to 0

Head coverage to lateral CE <20

No crossover sign

Advantages:

No abductor, no posterior colum, early WB, low complication rate

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10
Q

Anterior hip decompression as treatment for FAI?

A

Will not correct shallow socket

Femoral neck, acetabular osteoplasty

Repair soft tissue tears, labrum, chondral flap

Trochanteric slide (vastus and medis attached)

Anterior dislocation

Z capsulotomy

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11
Q

When do you use a proximal hip osteotomy for FAI?

A

Correction of proximal femoral retroversion or excessive anteversion

Significant coxa valga with decreased lateral offset

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12
Q

4 Non-op hip arthritis treatment

A
  1. Activity modification
  2. NSAID
  3. Joint injetions
  4. Assist device (can in OPPOSITE hand)
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13
Q

Hip arthroscopy, 3 most common nerve injuries?

A
  1. Pudendal
  2. LFCN
  3. Femoral
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14
Q

Hip fusion salient points?

A

Young male, unilateral

You get adjacent joint OA

Position, 20 flex, neutral add/ab, 0-10 ER

Indication for fusion take down? Ipsilateral knee pain, back pain, contralateral hip pain

Do the abductors work? EMG, If not constrained THA

If no abductors your get a lurch gait

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15
Q

4 indication for THA for hip fracture

A
  1. High activity level
  2. Age greater than 70
  3. Supcapital or high neck fracture
  4. No risk factors for dislocation
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16
Q

Osteonecrosis of hip. What vessels are affected?

A

May be result of hypercoagulable state in idiopathic cases.

Juxtaarticular sinusoids

17
Q

What percentage of hip osteonecrosis cases are bilateral?

A

50% so image both hips

18
Q

What staging system do we use for osteonecrosis of the hip?

A

Ficat.

0-4 MRI and Bone scan positive only

0-1 Xray neg, 2 positive no crescent, 3 crescent, 4- collapse, DJD

Asymptomatic in only stage 0

19
Q

Treatment for osteonecrosis of hip?

A
  1. Non-op - Bisphosphonates
  2. Surgical - start before crescent

Prognostic features?

Head collapse, young age, irreversible etiology, extent of head involvement (volume)

Head involvement % on ap x % on lateral

Therefore:

  1. Young with crescent - THA
  2. Young no crescent - Core decompression, vascularized fibular strut, curretage and bone grafting
20
Q

What coating allows for bone ingrowth? Ongrowth?

A

Porous - Ingrowth

Grit - Ongrowth

21
Q

Successful cemeting technique requires 5 steps

A
  1. Porosity reduction - vaccum
  2. Pressurization
  3. Pulsatile lavage
  4. Stem centralization - avoid mantle defect
  5. Stiff stem
22
Q

Biologic fication of bone ingrowth require pore size (um) and porosity of %? Can you think of other factors?

A

Between 50 and 150 um

Porosity of 40-50%

Pore depth

Minimize distance between prosthesis and bone <50um

Minimal micromotion

Cortical contact

Viable bone

23
Q

Two techniques of rigid fixation of cementless implants.

What are they, where do fractures occur?

A

Line to line, press fit

Line to line relies on extensive porous coating and frictional “scratch fit”

Line to line - distal

Press fit - proximal

24
Q

What is the role of hydroxyapetite?

A

Osteoblasts adhere to HA and grow toward bone shortening time to biologic fixation

25
Q

Femoral stress shielding is explained by stem stiffness and Hoek’s law. Why?

A

Hoek’s law two springs one stiff one soft, stiff takes more so if THA is way stiffer than bone, proximal bone doesn’t take any weight and you get stress shielding

26
Q

What is the safe zone for screws? What are the dangers in each quadrant?

A

Posterior Superior - Safe zone

Anterior superior - zone of death, external iliac a and v

Posterior Inferior - Sciatic, Internal pudendal and gluteal

Anterior inferior - Obturator

27
Q

Segmental and cavitary defects of femur in revision THA what is the rule for how much further the new stem should go?

A

Two cortical diameters

28
Q

Concerning osteolysis in THA what are the types of bearing wear?

A

Adehesive, Abrasive, Third body particles

29
Q

Where is the most osteolysis seen in proximal femoral coated stems?

A

Distal to tip, around smooth area fluid will move in path of least resistance

30
Q

What is the basic science with respect to PE wear causing osteolysis?

A

PE particles are phagocytosed by macrophages which in turn release cytokines (TNF A, TGF B IL 1,6 and PDGF)

PDGF causes the osteoblast to express RANK which binds to RANK L on the osteoclast activating it

What modulates this Osteoprotegrin which binds RANK and stops it from binding RANK L on osteoclast

Fun fact so do bisphosphonates which straight up inhibit osteoclast activity

31
Q

What is the vancouver classification of periprosthetic fracture?

A

All about location

A - around GT
B - Around Stem or just distal BUT

1) Well fixed
2) Loose
3) Loose and no proximal bone stock

C - Distal to tip

32
Q

Risk factors for dislocation

A
  1. Female
  2. THA for osteonecrosis
  3. Posterolateral approach
  4. Smaller head size
  5. GT non-union
  6. Revision THA
  7. Obesity
  8. Alcoholism
  9. Neuromuscular conditions
33
Q

List 5 surgical options for the dislocated THA

A
  1. Implant revision
  2. GT advancement
  3. Constrained acetabular socket
  4. Conversion to bipolar hemiarthroplasty
  5. Resection arthroplasty
34
Q

List factors influencing polyethylene wear:

A

Poly factors

  • lower wear with highly cross linked
  • lower wear with high articular surface conformity design
  • Excessive free radical formation with irradiation in oxygen (as opposed to oxygen reduced environment with argon or nitrogen)
  • Use of ram-bar extrusion followed by machining leads to higher wear than direct compression molding
  • Long shelf life potentially leads to oxidation and more wear

TKA Factors

  • Thinner poly increases wear (<8mm)
  • Micromotion between insert and tibial tray (backside wear)
  • Presence of debris (third body wear)
  • Cam-Post impingment

THA Factors

  • Femoral head size (smaller head increases linear wear; larger head increases volumetric wear)
  • Looseness of components
  • Malposition of components

Patient Factors

-Younger patient = more wear

35
Q
A

Miller Review (4 decks)

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