SAQ Flash Cards
- 6 causes for groin pain and decreased function in a THA (2012)
- Infection
- Aseptic loosening of acetabular component/Pelvic osteolysis
- Psoas tendonitis
- Dislocation/instability
- Synovitis secondary to wear debris
- Periprosthetic fracture
- Pseudotumor
- Heterotopic ossification
- Hernia
- Stress fracture of pelvis
- Lumbar spine disease
- GY/Gyne/Abdo
List 4 advantages of using a high offset femoral stem. (2013, 2015)
- Improved ROM
- Increased stability
- Decreased impingement of GT on pelvis
- Improved joint reactive forces - decreased wear/loosening
- Increased abductor strength/decreased limping
What are 5 potential complications from a mal-positioned acetabular component?
- Instability/Dislocation
- Impingement
- Aseptic Loosening
- Bearing surface wear/pelvic osteolysis
- Revision Surgery
- Psoas Irritation
- Leg Length Discrepancy
X-ray of a hip with cystic changes and sclerosis (AVN). Give 3 common causes for this disease process?
- Trauma
- Steroids
- Alcohol
- SLE
- Renal Failure
- Organ Transplant
- Irradiation
- Hematologic Disorder (hemophilia, sickle cell, hypofibrinolysis, thrombophilia)
- Cytotoxins
- Dysbarism
- Storage Diseases (Gaucher’s)
X-ray with a Crowe 4 hip - The patient is ready to undergo a THA. List 4 things that you have to consider from a technical aspect with regards to the procedure.
Femoral Side:
- Increased anteversion
- Small diameter canal
- Increased anterior bow of femur
- Valgus neck shaft angle
- May need to shorten femur to reduce hip/avoid sciatic nerve palsy (from Jess’ head)
Acetabulum:
- Increased anteversion
- Deficient anterosuperiorly
- Difficulty identifying true acetabulum
- Deficient bone stock
Soft Tissues:
- Tensioning of sciatic nerve by leg lengthening
- Contracted, deficient abductors
List 4 relative contraindications to total joint arthroplasty
- Active or remote infection
- Presence of well-functioning, painless arthrodesis
- Neuromuscular disease causing potential instability
- Medically unfit
- Non-ambulatory patients/lack of active muscle power
- Active Charcot Neuroarthropathy
- Asymptomatic Arthritis
- Insufficient soft tissues
Patient with a 15 year old THA. Suffers peri-prosthetic fracture. List 3 factors that are important when deciding on treatment.
Vancouver Classification
- Location of fractures
- Implant Stability
- Bone Stock
70 yr old with cemented 15 yr THA, 1 yr history of thigh pain and periprosthetic fracture. List 3 factors important in the surgical management
Vancouver Classification:
- Location of fracture
- Stability of implant
- Bone stock available
Other:
- Pre-operative medical optimization/function
- Abductor deficiency (constraint)
- Acetabular component stability (dual revision)
- Previous components
List 4 radiographic findings in considering adult FAI?
Cam: (no good cut off evidence)
- Increased head-neck offset (>11)
- Alpha angle > 70o (group 55-60)
- Pistol Grip Deformity
Pincer:
- Acetabular Retroversion:
- Cross-over sign
- Ischial spine sign
- Posterior Wall Sign
- Global Overcoverage:
- Lateral CEA > 40o
- Down-sloping sourcil
- Acetabular Index < 0o
What are 3 cause of impingement in the hip other than FAI?
Ischiofemoral Impingement Syndrome
- Narrowing between ischial tuberosity and LT –> QF gets pinched
Anterior Inferior Iliac Spine/Sub-spine Impingement Syndrome
- Abnormal contact between AIIS and proximal femur
Iliopsoas Impingement Syndrome
- Thickened or taut psoas at acetabular rim/anterior hip capsule
Picture of a BHR with a femoral neck fracture. Name 4 risk factors for this complication.
Patient Factors:
Obesity
Decreased BMD
Inflammatory arthritis
Female gender (2x)
Intra-operative (85% of fractures)
Femoral neck cysts
Excessive prosthesis varus (<130O)
Improper implant seating (center of the neck and head size at least 50)
Notching of femoral neck
What are 5 factors to consider preop that suggest poor prognosis when considering a pelvic osteotomy in adult developmental dysplasia of the hip?
2013, 2014, 2015, 2016 (slight variations)
- “considerations, poor prognosticators or contra-indications” for PAO in adult patients
Radiographic poor prognosticators (Troelsen JBJS 2009)
- Tonnis grade 2/3 OA
- Pre-op CEA < 0o
- Pre-op os acetabuli (calcified labrum)
- Incongruent abduction IR view
- Post-op medial clear space > 2cm
- Post-op acetabular sclerotic zone width < 2.5cm
JAAOS 2002 - Surgical Treatment of DDH in Adults
- Moderate to advanced degenerative disease
- Loss of ROM
- Asymptomatic dysplasia
- Proximal migration of center of rotation of femoral head
- Non-ambulatory patient
- Incongruent joint
- Advanced physiologic age (better candidate for THA)
- Morbid obesity (relative)
6 anatomical releases for balancing a varus knee?
- Removal of osteophytes
- Medial capsule
- Deep MCL
- Posterior oblique ligament
- PCL
- Semimembranosus fibres
- Pes anserine
- Medial Gastrocnemius
- Superficial MCL
List 4 soft tissue releases for a valgus knee in TKA?
- Removal of osteophytes
- Posterolateral Capsule
- IT Band
- Popliteus Tendon
- PCL
- Lateral Head of Gastrocnemius
- LCL
6 types of failure of a TKA requiring a revision?
- Infection
- Patello-femoral instability
- Aseptic Loosening/Osteolysis
- Extensor Mechanism Disruption
- Peri-prosthetic Fracture
- Instability (varus/valgus)
- Arthrofribrosis/Stiffness
- Metal Allergy
