Arthroplasty - Short Answers

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Patient with THA 15 years ago and sustains a periprosthetic fracture. List 3 things that may affect your treatment plan
- Location
- Implant stability
- Bone stock
45 y.o. male with left hip pain. Shown an AP pelvis. A - List 3 common causes of his left hip pain. B - You had to determine that he had AVN of the left hip. Give 3 common causes

A: Osteoarthritis, AVN, FAI

A: Alcohol, steroids, caisson's, gauchers, idiopathic, trauma, radiation, SLE, Virus, Sickle cell
X-ray of AP pelvis that showed DDH left hip in an adult. 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

Metaphyseal diaphyseal mismatch

Excessive femoral anteversion

Poor superolateral bone stock

LLD
Patient presents 8 months after TKA. His preoperative flexion was 120 degrees, but he now only has 75 degrees. In the absence of infection, mention 4 causes of decreased flexion. (4)
- Arthrofibrosis
- Patella baja
- Heterotrophic ossification
- Pre op ROM
List 4 relative contraindications to total joint arthroplasty.
- Active infection
- Neuropathic joint
- Previous OM
- Morbid obesity
List 6 complications of a mal-positioned acetabular component.
- Asceptic loosening
- Instability
- Decreased ROM
- Trendelenburg
- Iliopsoas impingement
- Squeaking
Given a picture of an AP pelvis with bilateral hip resurfacing. R has femoral neck # / osteolysis. List 4 risk factors why this would happen.
- Poor bone stock
- Malpositioned implant: varus <130
- Unrecognized intra op fracture: notching
- Femoral neck cysts
List 3 anatomic landmarks for placing the femoral component in a TKA.
- Whiteside line
- Transepicondylar axis
- Posterior condylar axis: usually in 3 degrees of IR
List 3 contraindications for pelvic realignment in an adult.
- Osteoarthritis
- Active infection
- Advanced age
List 4 benefits of using a high offset THA.
- Decreased Joint reactive forces
- Better abductor tensioning
- Improved stability
- Improved wear rate
List 4 anatomic features of a pincer type femoral acetabular impingement
- Anterior overcoverage: CEA >39
- Coxa profunda
- Acetabular protrusio
- Posterior overcoverage: post wall crosses lateral to center of femoral head
List 6 anatomical releases for balancing a varus knee
- Deep MCL
- Osteophytes
- Capsule
- Posterior oblique ligament
- Superficial MCL pie crust
- Semimembranosus
- Reduction osteoplasty
List 6 types of failure of a TKA requiring a revision
- Infection
- Patellar maltracking
- Periprosthetic fracture
- MCL/LCL rupture or incompetence
- Cam post dislocation
- Asceptic loosening
List 6 causes for groin pain and decreased function in a total hip
- Ilipsoas impingement
- Acetabular loosening
- Femoral Loosening
- Instability
- Pseudotumor
- Infection
List 4 contraindications to an HTO
- Lateral compartment OA
- Obesity
- ACL incompetence
- Fixed flexion contracture >10 degrees
- Flexion <90 degrees
- Inflammatory
- Varus thriust
- Obesity
List 3 advantages of a valgus-producing medial opening wedge high tibial osteotomy, compared to a lateral closing wedge
- Avoids proximal tibio fibular joint
- Easier exposure: avoids peroneal nerve
- Easier to dial in correction
What are 2 physical exam findings in a patient who has a Trendelenburg gait

Weak active abduction compared to contra-lateral side

Trendelenburg sign: Contralateral pelvic tilt with single leg stance
Describe the Vancouver classification

A: GT or LT #

B1: fracture around or just distal to stem with stable prosthesis

B2: fracture around or just distal to stem with unstable prosthesis and good bone stock

B3: fracture around or just distal to stem with unstable prosthesis and poor bone stock

C: distal to prosthesis
List 3 principles to avoid patellar maltracking when performing a TKA
- Avoid femoral component IR
- Avoid femoral component medialization
- Avoid tibial component IR
- Avoid placing patellar component lateral
4 Poor radiographic prognostic factors when doing a periacetabular osteotomy in an adult?
- Osteoarthritis
- Non congruent joint
- Presence of os acetabuli
- Magnitude of dysplasia
3 ways to prevent patellar maltracking in TKA?
- ER femoral component
- ER tibial component
- Lateralization Femoral component
- Medialization patellar component
4 reasons for loss of extensor mechanism in TKA?
- Patella #
- Tibial tubercle avulsion
- Patellar tendon rupture
- Quad tendon rupture
What is the order of releases for the correction of a valgus knee? Name 4 possible soft tissue releases to help balance during a total knee arthroplasty in a valgus knee.
- Capsule
- Osteophytes
- Popliteus: if tight in flexion
- IT band: if tight in extension
- LCL
Name 4 methods used to prevent the placement of the humeral stem too proud when performing a shoulder hemiarthroplasty for a humerus fracture.
- X ray contra lateral side
- 5.6 cm above pec insertion
- Intra op soft tissue tensioning
- GT 5-8 mm below top of humeral head
Describe 4 ways to deal with posterior glenoid bone loss when doing a shoulder arthroplasty for osteoarthritis.
- Eccentric reaming
- Posterior bone graft
- Posterior metal augments
- Doing RSA
List 4 types of wear

Type 1: bt 2 primary bearing surfaces >>adhesive and abrasive

Type 2:Btw bearing surface and non bearing surface >>head on cup

Type 3: Third body wear

Type 4: wear of non bearing surface>>backside wear
What anatomic structures can help guide the level of your joint line?
- 1 cm above fibular head
- 2.5 cm from lateral epicondyle
- 2 cm from origin of MCL

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Arthroplasty - Short Answers

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Arthroplasty sa

Updated

2019-03-07T17:32:27Z

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