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ABOS Part 1 > Arthroplasty > Flashcards

Arthroplasty Flashcards

1
Q

Releasing the PCL during TKA does what to the flexion and extension gaps?

A

Significant increase in extension gap
Average increase in flexion gap

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2
Q

Recurvatum or hyper extension deformity of the knee is best addressed with this TKA design when performing total knee arthroplasty?

A

Rotating hinged construct

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3
Q

Inflammatory cell type for metal on metal hips/metalosis?

A

Lymphocytes

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4
Q

Inflammatory cells for polyethylene wear?

A

Macrophage

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5
Q

What is modern Morse taper design?

A

-12/14 taper
-Similar metal types between head and trunnion (limit corrosion)
-Apply head to a dry taper

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6
Q

C. Acnes is susceptible to which antibiotics?

A

Penicillin
Zosyn
Vancomycin

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7
Q

Factors that contribute to total hip arthroplasty joint reaction force?

A

Medializing the acetabulum decreases joint reactive force so,

-lateralized acetabular liner
-incompletely medialized cup
-extended offset femoral components

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8
Q

For TKA soft tissue balancing laterally, what structures are tight in flexion and extension?

A

Tight in…

Extension: IT band
Flexion: popliteus

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9
Q

Hetertopic ossification matures after ____? And can be monitored by this test?

A

18 months
Serum alk phos levels

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10
Q

Inferior gluteal artery is located where during posterior approach?

A

Inferior to piriformis

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11
Q

Press fit stems should be made of this material?
Cemented stems?

A

Titanium

Cobalt chrome/stainless steal

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12
Q

Ductile definition

A

Large amount of plastic deformation

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13
Q

Creep definition

A

Progressive deformation over time

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14
Q

Order of decreasing Young’s modulus for arthroplasty material?

A

Young’s modulus is stiffness (stress/strain).

Ceramic
Cobalt chrome
Stainless steal
Titanium

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15
Q

Cement is good in _______ but fails with ____

A

Compression
Shear

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16
Q

Process for cross linking polyethylene?

A

Irradiation
- leads to cross-linking via production of free radicals (must be done in inert environment)

Free radical elimination
-done via reheating/melting and vitamin E (need to remove residual free radicals so the poly does not oxidize in the patient)

Sterilization
-ethylene oxide
-gas plasma

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17
Q

Three processes to remove polyethylene free radicals after cross linking irradiation?

A

Melting (changes shape)
-highly effective
-reduces polyethylene mechanical properties

Annealing (heating, does not change shape)
-less effective
-maintains mechanical properties

Vitamin E
-biological antioxidant

18
Q

Trade off of polyethylene irradiation

A

19
Q

Effect oxidation has on polyethylene?

A

Increases elastic modulus (stiffness) and decrease strength

20
Q

THA goal combined anteversion?

A

35-45 deg

21
Q

Benefits of using a larger femoral head for THA?

A

Greater arc of ROM and less risk of impingement.
Larger head jump distance for dislocation.

22
Q

Abrasive wear

A

Caused by 3rd body trapped between two surfaces

23
Q

Adhesive wear

A

Most important process in osteolysis caused by chemical bonds between the poly and implant surface which then trigger the osteolysis cascade

24
Q

Osteolysis cascade

A

Adhesive wear
Macrophages ingest particles and release inflammatory molecules TNF alpha, IL-6
The osteoclasts are then activated and remove bone.

25
Q

Cell type involved with metal on metal hips?

A

Lymphocyte

26
Q

Serum ion levels above what value is a problem?

A

>7 ppb

27
Q

After explanting a metal on metal THA, what are the best next implants to re-implant.

A

Ceramic head
Polyethylene liner

28
Q

Diagnostic criteria for trunionosis?

A

Cobalt > chromium elevations 2:1 or greater

29
Q

Mecahanism of trunionosis?

A

-Fretting corrosion: Mechanically assisted micromotion between two surfaces that disrupt the protective oxide layer
-Crevice corrosion: crevices create local conditions that increase oxidation

30
Q

How to revise trunionosis

A

Convert to ceramic head with titanium sleeve

Must have titanium sleeve because if resting the stem the corroded reunion can fracture an otherwise standard ceramic head

31
Q

Long term risk of hemiarthroplasty?

A

Protrusio

32
Q

Praprofsky femur classification and treatment?

A

Classification for loose femoral stem
1. Loose stem, no ingrowth, no bone loss
2. Metaphyseal bone loss
3. Metaphyseal + cortical bone loss
4. Extreme near complete bone loss

1. Standard metaphyseal fit stem
2. Diaphyseal fit stem
3. Diaphyseal fit stem
4. Mega prosthesis

33
Q

Criteria during a revision of the acetabulum to use cementless hemispherical cup (with screws)?

A

2/3rd rim fit
50% acetabular bone stock necessary

34
Q

During cartilage revision if there is pelvic discontinuity you want to use these implants?

A

Cup-cage or triflange implant

35
Q

VTE prophylaxis pearls

A

36
Q

Mechanism of action of TXA

A

Binds plasminogen and prevents the breakdown of fibrin

37
Q

Things to know about DDH when doing THA?

A

Lack of anterior and lateral acetabular coverage.
The acetabulum is naturally more anteverted.
The femur is more anteverted.

38
Q

MCL differential functions of the anterior portion of the MCL and the posterior oblique portion?

A

Anterior MCL: tight in flexion
Posterior oblique portion: tight in extension

39
Q

When do you do a coronal correcting osteotomy during TKA?

A

- when deformity on distal 1/4 of femur or proximal 1/4 of tibia and > 20 deg

*must be closing wedge
*use diaphyseal fit stem with splines to provide rotational stability

40
Q

Postop wound drainage after ___ days requires a washout.

A

5 days

*every subsequent day increases infection risk 42% in hips and 29% in knees

41
Q

Largest arterial contribution to the patella?

A

Inferomedial geniculate artery

ABOS Part 1 (11 decks)

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