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BOARD PREP > Recon > Flashcards

Recon Flashcards

1
Q

what complication Is increased with quad sparing TKA

A

quad tendon laceration

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2
Q

tx of open wound over TKA patella tendon

A

rotational gastroc flap

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3
Q

which pcl fibers are usually tight for balancing

A

anterolateral bundle of PCL

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4
Q

anteromedial vs posteromedial OA

A

PM OA is seen with ACL incompetent knees

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5
Q

AAOS CPG grade for pharm/scd for vte propjhylaxis

A

MODERATE

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6
Q

fatigue wear shows as what on tibia poly

A

pitting and delamination

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7
Q

adhesive and abrasive wear on tibia poly is seen on

A

tibia BACKside

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8
Q

what image is needed before UKA

A

valgus stress to evaluate for correction AND lateral joint space

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9
Q

UKA vs TKA survivorship

A

lower for UKA at 10 years

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10
Q

what is consequence of patella baja in TKA

A

anterior knee pain

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11
Q

what does high Co ion ratio to Cr mean

A

trunionsis (vs MoM has EQUAL rise in ions)

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12
Q

what is head liner swap for ATLR

A

ceramic head with Ti sleeve

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13
Q

after femoral nerve block for TKA make sure to use

A

Knee immobilizer

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14
Q

osteotomy for early OA

A

if valus -distal femur; if varus - prox tibia

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15
Q

requirements for distal femoral osteotomy for valgus

A

12-15valgus and at least 15-90 motion

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16
Q

tibia periprosthetic frx classification

A

type 1 - plateau; type 2 next to stem, type 3 is distal to stem - A is well fixed, B -loose. Type 4 is tubercle, C is intra-op

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17
Q

complication of navigation TKA

A

femoral shaft fracture from array pins

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18
Q

what is protocol for tib tubercle osteotomy for TKA

A

WBAT and ROM as tolerated

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19
Q

risk factor for failure of cementless femoral stem

A

osteoporosis

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20
Q

main risk of radiation to cementless surgery

A

poor ingrowth

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21
Q

tx of nondisplaced GT fracture

A

PWB 4-6 weeks

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22
Q

osteonecrosis of femoral head -ok to resurface?

A

only if < 40% involved; avoid for large femoral head lesions

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23
Q

tx of charcot knee in poor candidate

A

amputation; even knee fusion is not best option

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24
Q

what size micron for histiocytic response in osteolysis

A

SUBMICRON .1-1micron

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25
Q

when was tranistion to high cross link Poly

A

2001-2002

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26
Q

which conditions do you avoid pharamcologic dvt ppx

A

Acute liver disease and hemophiia

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27
Q

excess femoral flexion in PS knee leads too

A

cam-post impingment and wear of the post

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28
Q

most important factor for stress sheilding

A

poor bone quality

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29
Q

major and minor criteria for PJI

A

major - draining sinus, 2 positive cultures same org; minor - high SYNOVIAL WBC, high PMN percentage; high ESR/CRP; high WBC on HPF frozen, SINGLE positive culture

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30
Q

MSIS infection if how many criteria are met

A

1 major or 3/5 minor

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31
Q

what is considered acute time frame for TKA, THA

A

6 weeks for PJI; use CRP cut off of 100 or Synovial WBC > 10k; ESR does not have a number

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32
Q

what is at risk with antermedial hip approach

A

obturator artery

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33
Q

nitrogen containing bisphos

A

alendranate - farnesyl transferase

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34
Q

early failure of cementeless TKA look for

A

aspetic loosening

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35
Q

patellar fracture with TKA and extensor lag

A

do NOT ORIF patella - revise it all

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36
Q

early acetab loosening seen with which liner

A

OFFSET liner; NOT constrained

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37
Q

tx of uncontained prox tibia defects

A

tantalum cones

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38
Q

innervation of sup and inf gluteal nerves

A

inf gluteal coveres Glut MAX; sup glut covers medius and minimus

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39
Q

cell count in setting of metallosis

A

needs a manual count - automated can be high bc particles seen as cells

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40
Q

which paprosky is most common in revision THA

A

IIIA - exntesnive proximal and diaphyseal bone loss BUT with > 4cm diaphysis left

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41
Q

acute tka pji cuttoff

A

30000 for acute (6 weeks)

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42
Q

timing of etanercept

A

stop 1 week before and resume 2 weeks after

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43
Q

best recommendatio for knee OA

A

tramadol

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44
Q

does popliteus affect static knee balance

A

NO

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45
Q

alpha defensin is test from what fluid

A

SYNOVIAL -not a serum test

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46
Q

paprosky acetab classification

A

I - minimal bone loss; II is 2cm or less, III is more than 3cm bone loss/hip migration

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47
Q

patients in 80s have lower femoral fracture risk with

A

cemented stem

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48
Q

how much acetab can be uncovered in THA

A

30-40% before worrying about aseptic loosening

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49
Q

how much deformity can you correct in TKA via bone cuts

A

10-20 coronal, up to 20 sagittal

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50
Q

tha revision with discontinuitiy tx with

A

CAGE or triflange - no allograft

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51
Q

risk factors for patella clunk

A

valgus; PS knees; smaller patellar component; large increased posterior condyle offset (Smaller femurs; fixed flexion femurs or thick Poly can also contribute)

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52
Q

line for acetab quadrants

A

ASIS to ischial tuberosit is first line then 90 deg perpendicular

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53
Q

what is modified Kerboul method

A

combined coronal and mid sag angle < 190 no collapse; moderate risk in 190-240; and > 240 collapse

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54
Q

acetab frx with THA cup. - what next

A

orif and revise cup

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55
Q

what is tx of intraop MCL injury

A

repair and BRACE - do NOT switch to PS

56
Q

post capsule repair for dislocations

A

failure of repair leads to increased disocation rate up to 6.4%

57
Q

what positivity rate of bone scan after TKA

A

20% at 1 y; 12% at 2y - thus lots of false positives

58
Q

what is benefit of spinal anesthesia for EBL

A

lower EBL with hypotensive spinal anesthesia

59
Q

tx of local injection induced asystole

A

20% fat emulsion

60
Q

when to use jumbo cup in revision hip

A

if > 50% bone left and no major bone loss; other wise use augments; if discontinuity then go to cup cage or triflange

61
Q

tx of late instability from abductor damage

A

revision to constrained liner

62
Q

tx of scarred patella in revision setting

A

lateral release; can also consider Tib tubercle osteotomy?

63
Q

zirconia head in tha means

A

monoclinc phase transformation - look for osteolysis

64
Q

all poly tibia rate of loosening

A

same as regular tibia

65
Q

absolute indication for patellar resurfacing

A

RhA

66
Q

metal on metal revision

A

must revise acetab component, cannot just put a new poly liner in

67
Q

does head size affect THA wear rate

A

NO 22-46mm has no diff in wear rate

68
Q

best predictor of pain from fem head AVN

A

bone marrow edema

69
Q

what is benzoyl peroxide

A

initiator in polymer powder (polymethylmethacrylate)

70
Q

approach with highes HO

A

extended illioFEMORAL

71
Q

what is Q ankle

A

ASIS to patella to TT

72
Q

center of knee rotation in flexion

A

shifts posterior on the LATERAL side with flexion

73
Q

bone scan to identify aseptic loosening

A

good after 2-3 years look for WHERE the activitiy is - even with long stem can be metaphyseal problem

74
Q

most common causes of charnley reviion

A

acetab, both component, deep infection, femoral

75
Q

reasons to do tib tubercle osteotomy in revision tka

A

patella baja

76
Q

what causes debris to spread into increased joint space

A

inflamation leads to increased hydrostatic pressure which pushses debris

77
Q

what are the ways to get pincer FAI

A

overcoerage OR retroversion

78
Q

what is PJI risk and RHA

A

higher risk; and RhA has higher risk of LATE pji

79
Q

before total joint in RhA what else is needed

A

c=spine flex/ex views

80
Q

what is double density on MRI for femoral head osteoN

A

revasc and new bone formation

81
Q

what position is THA cup in anky spondy patietns

A

more horizontal and less anteverted to avoid ANTERIOR hip dislocation

82
Q

moA of TXA

A

TXA binds to lysine binding site on plasminogen and renders it inactive

83
Q

what TKA design to be used in Rheumatoids

A

any design is acceptable

84
Q

key demogrpahic difference between Acetab dysplasia vs DDH

A

DDH is more common in Females; left Hip; Breech; bilateral, more likely to have first order family members with DDH

85
Q

do you need bone scan for stem loosening

A

NO if clinical and XR lines up - go ahead and revise

86
Q

what is insertion of glut med and glut minimus

A

G. medius is superoposterior and lateral facet with bald spot between medius and minimus

87
Q

how much subsidenc is allowed in femur

A

up to 1cm before you must revise

88
Q

medial opening vs lateral closing HTO

A

less pain, more ROM, more satisfaction, better union with LATERAL CLOSING

89
Q

does cup position affect offset

A

NO - hip center medial/lateral DOES NOT affect of femur

90
Q

moving cup medial does what

A

decreases joint reactive forces and abductor forces

91
Q

LMWH vs warfarin

A

LMWH is a/w more bleeding at surgery site with equal rates of PE prevention and LOWER rate of asymptomatic DVT

92
Q

evidence on steroid injection for knee OA

A

INCONCLUSIVE

93
Q

ceramic head hitting metal is what type of wear

A

adhesive

94
Q

adhesive wear is when

A

two diff metals where one adheres on to the other

95
Q

Vit k dependent clotting factor

A

2,7,9 10

96
Q

when to use constrained liner

A

ONLY if components are in solid position; if not then those MUST be revised first

97
Q

avg ROM gained with MUA

A

37deg; no diff at 6 vs 12 weeks

98
Q

PAO for middle age

A

good option for early OA in patients with preserved joint space

99
Q

what lab values are higher risk for wound complications

A

Zinc< 95; Albumin< 3.5; WBC < 1500

100
Q

TKA after Tib Plateau outcomes

A

similar satisfaction and PR-outcomes but higher complication

101
Q

order of complication frequency after TKA

A

infection, aseptic loosening, instablity, poly wear; arthrofibrosis and malalignment

102
Q

one complication after THA conversion from IMN

A

higher dislocation

103
Q

nv injury with knee dislocaiton

A

ultra low and high velocity have same rate (40%) but low velocity is lower around 5-10%

104
Q

what are risk factors for peroneal nn injury in TKA

A

flexionand valgus; OR if previous HTO - choose this one

105
Q

what timeframe for surgical site infection if implants

A

365days

106
Q

decreased abduction of acetabular cup leads to

A

NO difference in wear rate or dislocation rate, may reduce ROM

107
Q

mrsa nasal colonization risk factors

A

black, male, — females and older age are reduce risk

108
Q

when does VTE happen post-op total joint

A

1week to 6 weeks post-op

109
Q

PCL retaining TKA principles

A

choose same size femur to match AP size; take least amount of tibia to keep joint line; tension and balance via soft tissue not bone; avoid distal femur cuts

110
Q

highest risk factor for dislocation after surgery

A

previous hip surgery

111
Q

before selecting hip scope look for

A

dysplasia on Xray including cross over sign

112
Q

osteyltic defect management

A

other than liner exchange - need to debride and possible bone graft defects IF components are stable

113
Q

m/c complication after revision for MoM hip

A

instablity due to abductor damage - in which case may need to consider constrianed liner

114
Q

rate of intra-op tibia fracture with long stem revision TKA

A

3-5%; most are treated non-op

115
Q

tissue finding in MoM tissue reaction

A

lymphocytes AND plasma cells

116
Q

high cell count, normal ESR/CRP, no eccentric wear

A

think trunionsis causing metal reaction and pseudotumor - needs head/liner exchange

117
Q

risk factors for failure of MoM

A

female; young age ; small components and DDH as diagnosis for OA

118
Q

cuting post obique ligament helps balance knee how

A

extension tightness

119
Q

obese tja vs non-obese

A

similar change in clinical function and satisfaction; but obese is overall lower clinical scores compared to controls

120
Q

before confirming dysplasia check for

A

proper AP; up to 9 deg of inclination can result in cross over sign, post wall signs, or ischial spine signs

121
Q

patellar clunk syndrome prevention and tx

A

prevention involves taking synovial fold above patella; using a CR knee. Tx is arthroscopic resection; does not recur

122
Q

after THA foot turns out

A

stem is RETROverted

123
Q

CPG for normal risk pts after TJA dvt prophylaxis

A

MODERAT strenght recommendation

124
Q

standard THA neck angle

A

131 degrees

125
Q

bisphos fractures

A

treat right away - no other work up needed

126
Q

tx of fixed varus deformity during tka

A

start with medial soft tissue release - including MCL

127
Q

half life of apixaban

A

12 hours

128
Q

what other artery supplies femoral head

A

inf gluteal artery supply retinacular vessles

129
Q

what is main nerve at risk at level of anterior Ankle

A

medial branch SPN - NOT the DPN

130
Q

CPM and Drain for TKA what are CPG

A

STRONGLY AGAINST

131
Q

CPG for periarticular injection

A

strong evidence FOR

132
Q

gait mechanics direct anteior vs posterior

A

same at 3 months

133
Q

why does screw home mechanism occur in tibia

A

external rotation bc medial tib plateuea is LONGER

134
Q

what is wear rate of NON cross link UHMWPE

A

0.1-0.2; >0.1 is a/w loosening

135
Q

factors that reduce mechanical properties of X-link HMWPE

A

thickness < 6mm; malalignment, patients< 50; men; higher activity

136
Q

MoM vs Poly wear - what cells invovled

A

MoM -lymphocytes, poly - macrophage

137
Q

when to stop DMARDS before REVISION for PJI

A

4-6 weeks

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