THA

Question 1

cane in what hand to decresae joint reactive force

Answer 1

contralateral hand, you are pushing the body weight up to decrese the force the abductors have to work.

Question 2

carrying loa din ipsilateral side decreases joint reactive force why

Answer 2

it is pulling gainst bodyweight, abductors dont have to work as hard

Question 3

risk factors for THA wear

Answer 3

thickness <6 mm
malalignment of components
patients <50 y/o
men
higher activity level

Question 4

femoral head size and wear

Answer 4

need a paper

Question 5

UHMWPE is cross linked

Answer 5

No, all poly is UHMWPE, cross linking is separate, gamma rays

Question 6

Factors increasing wear in THA

Answer 6

<6 mm thickness, malalignment of components, patients <50 yrs, men, higher activity levelC

Question 7

Ceramic on poly wear rate

Answer 7

0-.15 mm/year

Question 8

ceramic on ceramic wear rate

Answer 8

.5 to 2.5 micron/year

Question 9

titanium bearing surfaces

Answer 9

bad, poor resistance to wear and notch sensitivityD

Question 10

Does titanium ions lead to issues?

Answer 10

…..

Question 11

ALVAL

Answer 11

Aseptic lymphocyte dominant vasculitis associated lesion (pseudotumor)

Question 12

ALTR

Answer 12

Adverse Local Tissue Reaction

Question 13

Treatment for blow out abductors

Answer 13

Gluteus maximus transfer

Question 14

which cell type causes osteolysis

Answer 14

macrophage activated by polyethylene debris

Question 15

cytokines of osteolysis

Answer 15

TNF alpha is the key, TNA alpha increases RANK and RANK Ligamend mediated bone resorption

Question 16

volumetric wear and highly cross linked poly

Answer 16

Volumtric wear initially concerning however modern highly crosslinked has shown similar wear rates between different head sizes

Question 17

Head size and wear rates

Answer 17

22-46 mm head size does not influence wear rates of UHMWPE

Question 18

study for head size and wear rates

Answer 18

Journal of Arthroplasty 2001 by Muratoglu

Question 19

most important type of wear for osteolysis

Answer 19

adhesive wear

Question 20

how to measure osteolysis and wear pattersn

Answer 20

radiostereometric analysis, tantulum beans in the bone

Question 21

how to prevent HO formation

Answer 21

indomethacin x10 days to 6 weeks vs. 600-800 cGy within 24-48 hours after procedure

Question 22

Dislocation incidence in all THA

Answer 22

1-3%

Question 23

Dislocation after THA when does it happen

Answer 23

70% within the first month, most within 3 months

Question 24

Direction of most dislocations

Answer 24

75-90% posterior

Question 25

how to dislcoate anterio rand posterio

Answer 25

posterior is flex/add/IR, eanterior is ext/ER

Question 26

risk factors for dislcoation

Answer 26

prior hip surgery, more comorbidities, BMI <20 or >35, cemented, posterior hip approach, malpositioning of components!!!!, neuromuscular disease like Parkinson’s, drug or alcohol abuse, decreased head neck ratio, decreased femoral offset, spinal fusion or fixed spinopelvic alignment. POLY WEAR IS A COMMON CAUSE OF LATE INSTABILITY >5 YEARS POST procedure.

Question 27

when to revise for dislocation

Answer 27

2 or more dislocations with implant malaligment, failure, or poly wear

Question 28

indicaitons for a constrained liner

Answer 28

abductor deficiency

Question 29

which THA approaches has most risk for HO

Answer 29

Smith Petersen and Hardinge (Posteiror has lowest risk for HO)

Question 30

HO markers

Answer 30

elevated alkaline phosphatase

Question 31

Risks for Direct anterior approach

Answer 31

LFCN, superficial surgical site infection riskt

Question 32

trunnoinosis type of wear

Answer 32

crevice corrosion is most important

Question 33

treatment for trunnionosis

Answer 33

painful THA, synovectomy, inspect stem, if you can retain it ceramic with titanium sleeve and new poly liner

Question 34

trunnionosis with Ceramic on Ti

Answer 34

A study from Montreal showed that Ceramic on titanium stem showed no radiological or biological signs of trunnionososis and Ti ion levels were bleow the accepted range

Question 35

implanting on a trunnion

Answer 35

The trunnion should be rinsed, cleaned, and dried carefully, while avoiding any contamination of the bore—the female counterpart within the head—prior to assembly. Biological debris, and even residual water, might critically reduce the fixation of the taper connection between the head and the neck.

Question 36

Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture
Corentin Pangaud, Vanessa Pauly, Christophe Jacquet, Veronica Orleans, Laurent Boyer, Raghbir Khakha, Jean Noël Argenson & Matthieu Ollivier
Scientific Reports volume 1

Answer 36

After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: . Hazard Ratio (HR) = 1.119 (1.056–1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731–0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067–1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

Question 37

Anterior THA benefits

Answer 37

…..

Question 38

Should have arguemnt to support antibiotiocs for wound drainage for DAA wound…

Question 39

when to worry about metal on poly

Answer 39

when it is > 1 ppb

Question 40

Fracture rate cemented vs. unceemented hemis

Answer 40

10x higher fractur rate???