Arthroplasty - Short Answers

  1. 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
  2. 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
  3. 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

  4. 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
  5. List 4 relative contraindications to total joint arthroplasty.
    • Active infection
    • Neuropathic joint
    • Previous OM
    • Morbid obesity
  6. List 6 complications of a mal-positioned acetabular component.
    • Asceptic loosening
    • Instability
    • Decreased ROM
    • Trendelenburg
    • Iliopsoas impingement
    • Squeaking
  7. 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
  8. 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
  9. List 3 contraindications for pelvic realignment in an adult.
    • Osteoarthritis
    • Active infection
    • Advanced age
  10. List 4 benefits of using a high offset THA.
    • Decreased Joint reactive forces
    • Better abductor tensioning
    • Improved stability
    • Improved wear rate
  11. 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
  12. List 6 anatomical releases for balancing a varus knee
    • Deep MCL
    • Osteophytes
    • Capsule
    • Posterior oblique ligament
    • Superficial MCL pie crust
    • Semimembranosus
    • Reduction osteoplasty
  13. 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
  14. List 6 causes for groin pain and decreased function in a total hip
    • Ilipsoas impingement
    • Acetabular loosening
    • Femoral Loosening
    • Instability
    • Pseudotumor
    • Infection
  15. List 4 contraindications to an HTO
    • Lateral compartment OA
    • Obesity
    • ACL incompetence
    • Fixed flexion contracture >10 degrees
    • Flexion <90 degrees
    • Inflammatory
    • Varus thriust
    • Obesity
  16. 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
  17. 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
  18. 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
  19. 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
  20. 4 Poor radiographic prognostic factors when doing a periacetabular osteotomy in an adult?
    • Osteoarthritis
    • Non congruent joint
    • Presence of os acetabuli
    • Magnitude of dysplasia
  21. 3 ways to prevent patellar maltracking in TKA?
    • ER femoral component
    • ER tibial component
    • Lateralization Femoral component
    • Medialization patellar component
  22. 4 reasons for loss of extensor mechanism in TKA?
    • Patella #
    • Tibial tubercle avulsion
    • Patellar tendon rupture
    • Quad tendon rupture
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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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