Arthroplasty

Question 1

Soft tissue releases in a valgus knee

Answer 1

Flexion - popliteus
Extension - IT band
Both - LCL

Question 2

Soft tissue releases in varus knee

Answer 2

tibial osteophyte removal
deep MCL
posteromedial corner
attachment of the semimembranosus
partial superficial MCL

Question 3

Risks of HO following TKA

Answer 3

male
trauma
obesity
increased osteophyte formation

Question 4

Initial implant for a charcot knee

Answer 4

hinged

Question 5

polyethylene wear rates associated with loosening

Answer 5

0.1 mm per year

Question 6

common complication in patients with sickle cell undergoing THA

Answer 6

femoral canal perforation

Question 7

what effect does TKA have on your golf game

Answer 7

improves your handicap

Question 8

position for hip arthrodesis

Answer 8

5deg ER
0 deg Add
20 degrees flexion

Question 9

number one reason for failure of low friction charnley

Answer 9

acetabular failure

Question 10

what is the only advantage to a smaller incision for THA

Answer 10

cosmesis

Question 11

Risk factors for sciatic nerve palsy

Answer 11

DDH
female
revision
limb lengthening
post traumatic OA
surgeon self-rating the procedure

Question 12

cell involved in metal on metal debris

Answer 12

lymphocytes

Question 13

drains are associated with

Answer 13

increased risk of transfusion

Question 14

AAOS bone loss acetabulum

Answer 14

1 - segmental
2 - cavitary
3 - both
4 - seperation between superior and inferior acetab
5 - arthrodesis

Question 15

groin pain following THA

Answer 15

psoas tendonistis

cortisone injection
release if normal component
revise acetabular component

Question 16

risk factors for HO THA

Answer 16

prolonged surgery
soft tissue handling
male
heterotrophic OA

need to wait 6 months following procedure to do resection

Question 17

best predictor of transfusion post-op

Answer 17

low HgB

Question 18

indications for revision MOM

Answer 18

component loosing
progressive osteolysis
large effusion
pseudotumor
unremitting pain

Question 19

risk factors for dislocation following THA

Answer 19

female
AVN
fracture treated with tHA
inflammatory OA
> 70yo

Question 20

indications for PS

Answer 20

patellectomy
PCL gone
inflammatory OA

easier to balance
more ROM
easier exposure

Question 21

advantage of mobile bearing

Answer 21

in theory reduces strain on polyethelene

Question 22

difficulty with posterior referencing in a valgus knee

Answer 22

internal rotation of the femoral component

Question 23

what will lead to increased Q angle

Answer 23

internal rotation of the femur
internal rotation of the tibia
lateralizaiton of the patella
medialization of the femur
medialization of the tibia

Question 24

where should you center your tibial component

Answer 24

over the medial 2/3 of the tubercle

Question 25

normal angles of the knee

Answer 25

distal femur - 6 deg valgus tibia - 3 deg varus posterior condyles - 3 deg IR need to neutralize all these angles when you do your cuts 6 deg off femru 3 deg off tibia 3 deg ER from posterior condyles (be careful of hypoplastic lateral condyle in vaglus knee)

Question 26

benefits of UKA compared to osteotomy

Answer 26

``` faster rehabilitation and quicker recovery improved cosmesis higher initial success rate fewer short-term complications lasts longer easier to convert to a TKA ```

Question 27

complications of UKA

Answer 27

stress fracture - high level of activity | tibial compoenent loosening - will see on XR

Question 28

compare lateral UKA to medial UKA

Answer 28

the same

Question 29

factors associated with elevated metal ion levels in MOM

Answer 29

cup abduction > 55 | small femoral head

Question 30

Strong AAOS recommendations for arthritis of hip or knee

Answer 30

weight loss physical activity NSAIDS tramadol

Question 31

what form of wear is most important in osteolysis

Answer 31

adhesive wear

Question 32

main determinant in the number of particles created

Answer 32

volumetric wear | related to the size of the head - increased head is increased wear

Question 33

factors increasing POLY wear

Answer 33

un-cross linked | thickness

Question 34

compare wear properties

Answer 34

poly - > 0.1 is associated with osteolysis, macrophage ceramic - best wear, stripe wear Metal - smaller particles, lower than poly, lymphocytes

Question 35

risk factors for supracondylar periprosthetic fractures

Answer 35

``` Rheumatoid arthritis Parkinson's disease chronic steroid therapy osteopenia female gender ```

Question 36

risk of tibial periprosthetic fractures

Answer 36

prior tibial tubercle osteotomy component loosening component malposition insertion of long-stemmed tibial components