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Recon > THA > Flashcards

THA Flashcards

1
Q

How does anterior approach compare to posterior approach?

What is the main con of each?

A

Anterior slightly better/faster at rehab -> NO DIFF after 3 months
Anterior - high rate of femoral failure
Posterior - higher rate of dislocation

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2
Q

What is the average failure rate %/year of THA?

A

1%/year

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3
Q

In what scenario should you consider cementing a cup?

A

Previously irradiated

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4
Q

What should the average size be for the following to have good bone ingrowth:

  1. ) Metal porosity %
  2. ) Depth of pores
  3. ) Gap
A

Rules of 50’s!

  1. ) 50%
  2. ) 50-150 microns
  3. ) < 50 microns
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5
Q

What is the consequence of wear rate of modern PE (UHMWPE) with use of larger femoral heads?

A

NO consequence of bigger femoral heads!
(typically with old poly the larger femoral heads led to higher volumetric wear and small heads led to high linear wear)

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6
Q

What is the main type of wear that occurs with ceramic on poly THA bearings - contributes MOST to osteolysis?

A

Adhesive wear

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7
Q

What is the osteolytic threshold (that is the wear rate under which osteolysis is not seen)?

A

< 0.1 mm/year

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8
Q

What are the main molecules/mediators involved in osteolysis?

A

TNF-alpha
IL1-beta
IL-6

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9
Q

What technical error is particularly bad for MoM/hip resurfacing?

A

Vertical cup placement -> edge loading!!

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10
Q

What is the main mediator cell for:

  1. ) Osteolysis due to PE
  2. ) ALVAL
A
  1. ) Macrophage
  2. ) Lymphocyte (delayed Type IV hypersensitivity)
    * *Realize that ALTR (which is the condition and ALVAL is the histologic dx) can result in XR with signs of osteolysis! PE is not the only thing that causes osteolysis!
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11
Q

What is the best study to look at pseudotumor in MoM hips?

A

MARS MRI

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12
Q

What is the cause of trunionosis?

What is the treatment?

A

Micromotion at modular head/neck jxn of metal head w/ trunion -> fretting corrosion = corrosion due to small cyclic motion disrupting the protective oxide layer. See Co:Ch levels 4-5:1
Treatment is revision w/ placement of Ceramic head w/ titanium sleeve

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13
Q

What bad consequence can happen due to destruction from metallosis (MoM or trunionosis)? And what is the revision surgery typically needed?

A

Loss of abductors

Constrained liner

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14
Q

If a patient has footdrop postop and you think it is due to hematoma what is the first thing that you do?

A

TAKE THEM BACK TO OR AND DECOMPRESS IT!

Don’t order any imaging studies if you know from presentation!

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15
Q

What are the two possible HO ppx treatments? And when should they be given?

A
  1. ) Indomethacin (variable dosing) given for 1-6 weeks postop (look out for people w/ kidney issues and AVOID this!)
  2. ) Radiation - 7 Gy to be given 24 hrs preop or 48 hrs postop (very small risk of cancer!)
    * *There is NO role for late use of these - if they form HO…just wait for it to mature and take out later
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16
Q

What is the cause of most LLD postop?

A

Perceived! -warn the patients that they may feel long b/c they have been living short!
Tx -> observe, stretch and let tissue accommodate

17
Q

What is a possible cause of anterior hip pain after THA? And what are the possible tx’s?

A

Iliopsoas impingement/tendonitis.
Can verify w/ injection
1.) Get crosstable lateral XR to eval for cup overhang -> if overhand > 8 mm revise!
2.) Tenotomy

18
Q

In the case of performing a revision for PE wear w/ osteolysis and lytic defects behind a well-fixed, well-positioned cup what should you do?

A

LEAVE THE CUP!!! EVEN IF BIG OSTEOLYTIC DEFECT BEHIND IT!! (High morbidity if you do this!)…..if the poly locking mechanism doesn’t exist b/c it’s an old cup -> CEMENT IN THE LINER

19
Q

What is the #1 cause for THA revision longterm?

A

Aseptic loosening

20
Q

What is the Paprosky definition of femoral bone loss? And what implant should be used for each?

A

Type 1: Intact metaphysis (any primary implant)
Type 2: Metaphyseal bone loss (cementless diaphyseal engaging stem)
Type 3A: > 4 cm diaphysis remaining
Type 3B: < 4 cm diaphysis remaining
(cementless diaphyseal engaging)
Type 4 -> Nonsupportive diaphysis (DFR or APC)

21
Q

In a revision THA on the acetabular side, how much acetabulum do you need to use a hemispherical cup w/ screws?

A

> 2/3 rim intact

> 50% acetabular bone stock

22
Q

What do you do if there is an intraop calcar fracture?

A

1.) Expose fracture!
If limited to calcar/metaphysis -> cable and keep same stem. WBAT!
If extends to diaphysis -> switch to a diaphyseal engaging stem!

23
Q

What is the most common cause of acute PJI?

What is the most common cause of chronic PJI?

A

Acute -> Staph aureus

Chronic -> Staph epi (aka coagulase negative Staph)

24
Q

What is MoA of TXA?

Who is it contraindicated in?

A

Competitively inhibits plasminogen (antifibrolytic) by binding to the lysine binding site
Contraindicated in renal failure and pt w/ active VTE
**NO evidence that it increases the risk of VTE…but decrease intraop blood loss and need for transfusion!

25
Q

What is the largest predictor of progression of femoral head osteonecrosis?

A

SIZE and LOCATION of the lesion!

26
Q

What are the normal ranges for the LCEA and Tonnis angle?

A

LCEA: 25-30

Tonnis < 10

27
Q

Who should you consider acetabular osteotomy for? Which acetabular osteotomy should we choose for the test and what are some of its pros?

A

DDH in young pt, no arthritis/intact cartilage (okay if have labral tear), shallow socket
PAO = Bernese Periacetabular Osteotomy
Pros:
High degree of correction, posterior column stays intact/ NV structures somewhat protected

28
Q

What 2 hips should you never scope?

A

Dysplastic or arthritic hip!

29
Q

In a Crowe IV hip that you are doing THA on, what additional surgery do you need to think about doing?

A

Subtrochanteric osteotomy if you are going to lengthen > 2-4 cm OR ~10% of length of the femur

30
Q 
Hip Biomechanics (look a diagram and see my notes on this!). 
What does medializing the hip COR do to abductors and JRF?
What does lateralizing the hip COR do to  abductors and JRF?
A

Decreases the work of abductors
Decreases JRF

Increases work of abductors
Increases JRF

31
Q

If your abductors are weak what happens to pelvis tilt and body tilt w/ single leg stance? Choose example of left hip w/ weak abductors
What can help this?

A

During single leg stance on left hip the right hemipelvis will drop - and to compensate the upper body/trunk will lean toward the left side to balance and decrease the BW moment.
Can help by putting cane in CONTRALATERAL (right for above example) hand - will help level pelvis and REDUCE JRF through hip by 50%!

32
Q

What common problems do these groups get postop?

  1. ) Sickle cell
  2. ) Psoriatic arthritis
  3. ) Ankylosing Spondylitis
  4. ) Parkinsons
  5. ) Dialysis
A
  1. ) Early loosening, infection
  2. ) Infection
  3. ) HO
  4. ) Dislocation, mortality
  5. ) Infection, loosening
33
Q

What do you do with a draining wound at 10-14 days?

A

URGENT I&D!… don’t need to wait for cultures, etc! Want to clean it out before has chance to form biofilm so can retain componenets.

34
Q

What are the MoA for the following VTE ppx meds?

  1. ) Aspirin
  2. ) LMWH
  3. ) Dabigatran
  4. ) Fondaparinux
  5. ) Rivaroxaban/Apixaban
  6. ) Warfarin
A
  1. ) COX inhibitor
  2. ) Activates anti-thrombin III and inhibits Xa
  3. ) Thrombin inhibitor
  4. ) Indirect Xa inhibitor
  5. ) Direct Xa inhibitors
  6. ) Vit K antagonist (Factors II, VII, IX, X)
35
Q

What is the typical presentation of transient hip osteoporosis/who does it present in? What does imaging look like? What is tx?

A

MC in middle-aged men or women (esp in 3rd trimester of preg).
XRs are typically negative but MRI shows diffuse edema in the femoral head
Tx: TTWB to protect from stress fx - resolves in 6-8 months

36
Q

Other than abductor dysfunction/damage, what is they other main indication on the test for constrained liner?

A

Pt s/p bariatric surgery and large weight loss who has hip instability/dislocations w/ well-fixed, well positioned implants! We know these patient’s are prone to this!

Recon (2 decks)

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