Recon Flashcards
(137 cards)
1
Q
what complication Is increased with quad sparing TKA
A
quad tendon laceration
2
Q
tx of open wound over TKA patella tendon
A
rotational gastroc flap
3
Q
which pcl fibers are usually tight for balancing
A
anterolateral bundle of PCL
4
Q
anteromedial vs posteromedial OA
A
PM OA is seen with ACL incompetent knees
5
Q
AAOS CPG grade for pharm/scd for vte propjhylaxis
A
MODERATE
6
Q
fatigue wear shows as what on tibia poly
A
pitting and delamination
7
Q
adhesive and abrasive wear on tibia poly is seen on
A
tibia BACKside
8
Q
what image is needed before UKA
A
valgus stress to evaluate for correction AND lateral joint space
9
Q
UKA vs TKA survivorship
A
lower for UKA at 10 years
10
Q
what is consequence of patella baja in TKA
A
anterior knee pain
11
Q
what does high Co ion ratio to Cr mean
A
trunionsis (vs MoM has EQUAL rise in ions)
12
Q
what is head liner swap for ATLR
A
ceramic head with Ti sleeve
13
Q
after femoral nerve block for TKA make sure to use
A
Knee immobilizer
14
Q
osteotomy for early OA
A
if valus -distal femur; if varus - prox tibia
15
Q
requirements for distal femoral osteotomy for valgus
A
12-15valgus and at least 15-90 motion
16
Q
tibia periprosthetic frx classification
A
type 1 - plateau; type 2 next to stem, type 3 is distal to stem - A is well fixed, B -loose. Type 4 is tubercle, C is intra-op
17
Q
complication of navigation TKA
A
femoral shaft fracture from array pins
18
Q
what is protocol for tib tubercle osteotomy for TKA
A
WBAT and ROM as tolerated
19
Q
risk factor for failure of cementless femoral stem
A
osteoporosis
20
Q
main risk of radiation to cementless surgery
A
poor ingrowth
21
Q
tx of nondisplaced GT fracture
A
PWB 4-6 weeks
22
Q
osteonecrosis of femoral head -ok to resurface?
A
only if < 40% involved; avoid for large femoral head lesions
23
Q
tx of charcot knee in poor candidate
A
amputation; even knee fusion is not best option
24
Q
what size micron for histiocytic response in osteolysis
A
SUBMICRON .1-1micron
25
when was tranistion to high cross link Poly
2001-2002
26
which conditions do you avoid pharamcologic dvt ppx
Acute liver disease and hemophiia
27
excess femoral flexion in PS knee leads too
cam-post impingment and wear of the post
28
most important factor for stress sheilding
poor bone quality
29
major and minor criteria for PJI
major - draining sinus, 2 positive cultures same org; minor - high SYNOVIAL WBC, high PMN percentage; high ESR/CRP; high WBC on HPF frozen, SINGLE positive culture
30
MSIS infection if how many criteria are met
1 major or 3/5 minor
31
what is considered acute time frame for TKA, THA
6 weeks for PJI; use CRP cut off of 100 or Synovial WBC > 10k; ESR does not have a number
32
what is at risk with antermedial hip approach
obturator artery
33
nitrogen containing bisphos
alendranate - farnesyl transferase
34
early failure of cementeless TKA look for
aspetic loosening
35
patellar fracture with TKA and extensor lag
do NOT ORIF patella - revise it all
36
early acetab loosening seen with which liner
OFFSET liner; NOT constrained
37
tx of uncontained prox tibia defects
tantalum cones
38
innervation of sup and inf gluteal nerves
inf gluteal coveres Glut MAX; sup glut covers medius and minimus
39
cell count in setting of metallosis
needs a manual count - automated can be high bc particles seen as cells
40
which paprosky is most common in revision THA
IIIA - exntesnive proximal and diaphyseal bone loss BUT with > 4cm diaphysis left
41
acute tka pji cuttoff
30000 for acute (6 weeks)
42
timing of etanercept
stop 1 week before and resume 2 weeks after
43
best recommendatio for knee OA
tramadol
44
does popliteus affect static knee balance
NO
45
alpha defensin is test from what fluid
SYNOVIAL -not a serum test
46
paprosky acetab classification
I - minimal bone loss; II is 2cm or less, III is more than 3cm bone loss/hip migration
47
patients in 80s have lower femoral fracture risk with
cemented stem
48
how much acetab can be uncovered in THA
30-40% before worrying about aseptic loosening
49
how much deformity can you correct in TKA via bone cuts
10-20 coronal, up to 20 sagittal
50
tha revision with discontinuitiy tx with
CAGE or triflange - no allograft
51
risk factors for patella clunk
valgus; PS knees; smaller patellar component; large increased posterior condyle offset (Smaller femurs; fixed flexion femurs or thick Poly can also contribute)
52
line for acetab quadrants
ASIS to ischial tuberosit is first line then 90 deg perpendicular
53
what is modified Kerboul method
combined coronal and mid sag angle < 190 no collapse; moderate risk in 190-240; and > 240 collapse
54
acetab frx with THA cup. - what next
orif and revise cup
55
what is tx of intraop MCL injury
repair and BRACE - do NOT switch to PS
56
post capsule repair for dislocations
failure of repair leads to increased disocation rate up to 6.4%
57
what positivity rate of bone scan after TKA
20% at 1 y; 12% at 2y - thus lots of false positives
58
what is benefit of spinal anesthesia for EBL
lower EBL with hypotensive spinal anesthesia
59
tx of local injection induced asystole
20% fat emulsion
60
when to use jumbo cup in revision hip
if > 50% bone left and no major bone loss; other wise use augments; if discontinuity then go to cup cage or triflange
61
tx of late instability from abductor damage
revision to constrained liner
62
tx of scarred patella in revision setting
lateral release; can also consider Tib tubercle osteotomy?
63
zirconia head in tha means
monoclinc phase transformation - look for osteolysis
64
all poly tibia rate of loosening
same as regular tibia
65
absolute indication for patellar resurfacing
RhA
66
metal on metal revision
must revise acetab component, cannot just put a new poly liner in
67
does head size affect THA wear rate
NO 22-46mm has no diff in wear rate
68
best predictor of pain from fem head AVN
bone marrow edema
69
what is benzoyl peroxide
initiator in polymer powder (polymethylmethacrylate)
70
approach with highes HO
extended illioFEMORAL
71
what is Q ankle
ASIS to patella to TT
72
center of knee rotation in flexion
shifts posterior on the LATERAL side with flexion
73
bone scan to identify aseptic loosening
good after 2-3 years look for WHERE the activitiy is - even with long stem can be metaphyseal problem
74
most common causes of charnley reviion
acetab, both component, deep infection, femoral
75
reasons to do tib tubercle osteotomy in revision tka
patella baja
76
what causes debris to spread into increased joint space
inflamation leads to increased hydrostatic pressure which pushses debris
77
what are the ways to get pincer FAI
overcoerage OR retroversion
78
what is PJI risk and RHA
higher risk; and RhA has higher risk of LATE pji
79
before total joint in RhA what else is needed
c=spine flex/ex views
80
what is double density on MRI for femoral head osteoN
revasc and new bone formation
81
what position is THA cup in anky spondy patietns
more horizontal and less anteverted to avoid ANTERIOR hip dislocation
82
moA of TXA
TXA binds to lysine binding site on plasminogen and renders it inactive
83
what TKA design to be used in Rheumatoids
any design is acceptable
84
key demogrpahic difference between Acetab dysplasia vs DDH
DDH is more common in Females; left Hip; Breech; bilateral, more likely to have first order family members with DDH
85
do you need bone scan for stem loosening
NO if clinical and XR lines up - go ahead and revise
86
what is insertion of glut med and glut minimus
G. medius is superoposterior and lateral facet with bald spot between medius and minimus
87
how much subsidenc is allowed in femur
up to 1cm before you must revise
88
medial opening vs lateral closing HTO
less pain, more ROM, more satisfaction, better union with LATERAL CLOSING
89
does cup position affect offset
NO - hip center medial/lateral DOES NOT affect of femur
90
moving cup medial does what
decreases joint reactive forces and abductor forces
91
LMWH vs warfarin
LMWH is a/w more bleeding at surgery site with equal rates of PE prevention and LOWER rate of asymptomatic DVT
92
evidence on steroid injection for knee OA
INCONCLUSIVE
93
ceramic head hitting metal is what type of wear
adhesive
94
adhesive wear is when
two diff metals where one adheres on to the other
95
Vit k dependent clotting factor
2,7,9 10
96
when to use constrained liner
ONLY if components are in solid position; if not then those MUST be revised first
97
avg ROM gained with MUA
37deg; no diff at 6 vs 12 weeks
98
PAO for middle age
good option for early OA in patients with preserved joint space
99
what lab values are higher risk for wound complications
Zinc< 95; Albumin< 3.5; WBC < 1500
100
TKA after Tib Plateau outcomes
similar satisfaction and PR-outcomes but higher complication
101
order of complication frequency after TKA
infection, aseptic loosening, instablity, poly wear; arthrofibrosis and malalignment
102
one complication after THA conversion from IMN
higher dislocation
103
nv injury with knee dislocaiton
ultra low and high velocity have same rate (40%) but low velocity is lower around 5-10%
104
what are risk factors for peroneal nn injury in TKA
flexionand valgus; OR if previous HTO - choose this one
105
what timeframe for surgical site infection if implants
365days
106
decreased abduction of acetabular cup leads to
NO difference in wear rate or dislocation rate, may reduce ROM
107
mrsa nasal colonization risk factors
black, male, --- females and older age are reduce risk
108
when does VTE happen post-op total joint
1week to 6 weeks post-op
109
PCL retaining TKA principles
choose same size femur to match AP size; take least amount of tibia to keep joint line; tension and balance via soft tissue not bone; avoid distal femur cuts
110
highest risk factor for dislocation after surgery
previous hip surgery
111
before selecting hip scope look for
dysplasia on Xray including cross over sign
112
osteyltic defect management
other than liner exchange - need to debride and possible bone graft defects IF components are stable
113
m/c complication after revision for MoM hip
instablity due to abductor damage - in which case may need to consider constrianed liner
114
rate of intra-op tibia fracture with long stem revision TKA
3-5%; most are treated non-op
115
tissue finding in MoM tissue reaction
lymphocytes AND plasma cells
116
high cell count, normal ESR/CRP, no eccentric wear
think trunionsis causing metal reaction and pseudotumor - needs head/liner exchange
117
risk factors for failure of MoM
female; young age ; small components and DDH as diagnosis for OA
118
cuting post obique ligament helps balance knee how
extension tightness
119
obese tja vs non-obese
similar change in clinical function and satisfaction; but obese is overall lower clinical scores compared to controls
120
before confirming dysplasia check for
proper AP; up to 9 deg of inclination can result in cross over sign, post wall signs, or ischial spine signs
121
patellar clunk syndrome prevention and tx
prevention involves taking synovial fold above patella; using a CR knee. Tx is arthroscopic resection; does not recur
122
after THA foot turns out
stem is RETROverted
123
CPG for normal risk pts after TJA dvt prophylaxis
MODERAT strenght recommendation
124
standard THA neck angle
131 degrees
125
bisphos fractures
treat right away - no other work up needed
126
tx of fixed varus deformity during tka
start with medial soft tissue release - including MCL
127
half life of apixaban
12 hours
128
what other artery supplies femoral head
inf gluteal artery supply retinacular vessles
129
what is main nerve at risk at level of anterior Ankle
medial branch SPN - NOT the DPN
130
CPM and Drain for TKA what are CPG
STRONGLY AGAINST
131
CPG for periarticular injection
strong evidence FOR
132
gait mechanics direct anteior vs posterior
same at 3 months
133
why does screw home mechanism occur in tibia
external rotation bc medial tib plateuea is LONGER
134
what is wear rate of NON cross link UHMWPE
0.1-0.2; >0.1 is a/w loosening
135
factors that reduce mechanical properties of X-link HMWPE
thickness < 6mm; malalignment, patients< 50; men; higher activity
136
MoM vs Poly wear - what cells invovled
MoM -lymphocytes, poly - macrophage
137
when to stop DMARDS before REVISION for PJI
4-6 weeks
