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ORTHOBULLETS > JOINTS > Flashcards

JOINTS Flashcards

1
Q

tx tight in extension (unable to achieve full extension), balanced flexion

A

cut more distal femur

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2
Q

cut off for aspirate TKA

A

WBC more than 1100

PMN more than 64%

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3
Q

cut off for aspirate THA

A

WBC more than 3000

PMN more than

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4
Q

cam mech

A

in PS knee

post built into poly that articulates w fem component in flexion

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5
Q

loose flexion gap in PS knee causes

A

posterior knee dislocation when cam jumps the post in flexion

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6
Q

osteolysis cellular mech

A

macrophage activation and bone resorption (lytic lesion on XR)

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7
Q

ideal size of cement mantle

A

at least 2 mm

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8
Q

contraindication for constrained acetab liner

A

malpositioned implant

young pt w large inherent ROM

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9
Q

if pt had prior patellectomy what type of TKA

A

posterior stabilized TKA

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10
Q

if fem component has a box then it is

A

Posterior stabilied

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11
Q

indications for constrained acetab components

A

1) abd insufficiency/capsular attenuation
2) neuro dz
3) well positioned comp

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12
Q

WAYS to incr hip dislocation

head neck ratio

A

decr head neck ratio

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13
Q

WAYS to decr hip dislocation

skirted femoral head

A

incr dislocation bc decr head neck ratio

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14
Q

osteolysis is due to macrophage response to wear particles of what size

A

less than 1 micron in size

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15
Q

indications for constrained nonhinged TKA

A

varus/valgus deformity w MCL/LCL incompetency

post polio

neuorpathic arthropathy

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16
Q

how to measure femoral offset

A

distance from center fem head to line down fem shaft

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17
Q

how to decr osteolysis around distal fem stem

A

use proximally circumferentially coated ingrowth stem

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18
Q

indications for constrained acetab component

A

recurrent dx due to

  1. capsular attenuation
  2. abductor dysfunction
  3. cog dz
  4. late dx w well positioned components
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19
Q

if tight in both flexion/extension do what

A

resect more prox tibia

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20
Q

high or low osteolysis with alumnia ceramic

A

low

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21
Q

mc reason for reoperation in 1st 6 months after hip resurfacing

A

fem neck fx

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22
Q

release of popliteus does what in valgus knee

A

increase lateral flexion space

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23
Q

how to decr Q angle and patellar subluxation

A

ER fem/tibial component

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24
Q

moving fem head medially will incr or decr offset

A

incr

25
Q

changes to tibia incl poly affect flexion vs extension

changes to femur

A

tibia = affects both flex/ext

femur = affects one of the two

26
Q

what inhibits ossteolysis

A

IFN gamma
OPG
IL4
IL10

27
Q

median parapatellar approach vs quad sparing for TKA

A

median = better alignment

28
Q

offset liner

incr or decr joint reactive forces

A

incr

29
Q

incr or decr joint reactive forces

extended offset femoral component

A

incr

30
Q

incr or decr joint reactive forces

varus neck angle (more than 120)

A

decr

31
Q

type of wear

pitting/delamination

A

fatigue wear

32
Q

type of wear

deformation w/o wear

A

creep

33
Q

type of wear

removal of material on the backside of modular tibial components

A

adhesive/abrasive wear

34
Q

valgus malalignment TKA usu due to

A

deformity in distal femur (varus = proximal tibia)

35
Q

for valgus knee avoid femoral malrotation by referencing

A

AP axis (not hypoplastic LFC)

36
Q

complication unique to computer nav in TKA

A

fem shaft fx

37
Q

painful catching in PS TKA due to?

tx?

A

patellar clunk syndrome due to extensor mechanism over trochlear notch from flex to extension

tx = arthro synovectomy

38
Q

mechanism of alendronate

A

inhib farnesyl pyrophosphate synthase (nitrogen containing)

39
Q

mechanism of denosumab

A

RANKL inhibition

40
Q

mech of steroids

A

phospholipase A2 inhib

41
Q

incr risk of peroneal nerve injury

A

preop valgus alignment, hx of HTO

42
Q

adhesive vs abrasive wear

A

adhesive = rubbing 2 hard surfaces so transfer from less to more wear resistant material

abrasive wear = surface imperfects with less-wear-resistant material

43
Q

medial gastroc flap relies on which artery

A

medial sural artery

44
Q

what is best tka implant that decr poly wear and bone-implant interface stresses

A

mobile bearing TKA

45
Q

incr risk of what after acetab liner revision

A

dislocation

46
Q

revision surgery for acetab fx with medial cup migration

A

acetab revision with cup-cage construct (not triflange = only for bone loss)

47
Q

highest risk of PJI

A

revision TKA

48
Q

best tka for neuromuscular disease with valgus knee

A

rotating-hinge TKA

49
Q

osteolysis after tha correlated with

A

linear wear rate

50
Q

wbc and pmn % for PJI in TKA

A

wbc more than 1100

pmn % more than 64%

51
Q

disadvantage of highly cross linked poly

A

decr toughness
decr ductility
decr fatigue strength

improved wear properties

52
Q

how does femur change from flexion to extension

A

MEDIAL PIVOT femur INTERNALLY ROTATES relative to tibia

femur translates ANTERIORLY

53
Q

moving acetab component more medial = incr or decr stability of hip

A

decr

54
Q

mc complication of custom triflange component

A

dislocation

55
Q

mechanism of osteolysis

A

1) macrophage make TNFa, IL-1
2) promotes RANK-RANKL
3) activate osteoclasts

56
Q

RANKL produced by

A

osteoblasts

57
Q

function of OPG

A

OPG binds RANKL (so RANKL can’t bind RANK on osteoclast precursor cells)

58
Q

wear rate above what is considered significant

A

0.1 mm per year

ORTHOBULLETS (9 decks)

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