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15 Cards in this Set
- Front
- Back
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Types of Total Joint Replacement
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Hip, knee, shoulder, elbow
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Indications for total joint replacement (7)
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Joint derangement (deformity)
Age (<60) Significant and disabling pain Impaired daily function Capable of significant rehabilitation Reduced and painful ROM on physical exam Radiographic changes |
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Contraindications for total joint replacement (8)
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Ongoing infection (absolute)
Too young and active Poor skin coverage Paralyzed quads or abductor muscles Neuromuscular disease (relative) Severely limiting mental dysfuncion (relative) Serious physical disease - terminal illness, etc (relative Extreme obesity/cardiopulmonary disease |
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TJR indications for joint derangement (5)
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Arthritis (OA,RA, psoriatic, traumatic, post-traumatic)
Avascular necrosis Protusio acetabuli (hip) Bone tumours Paget's disease |
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TJR indications for significant and disabling pain (4)
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Not relieved by steroids, hyaluronic acid or analgesics
Affects QOL Affects sleep Pain at rest AND with activity |
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TJR indications for radiographic changes (4)
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Lost joint space
Osteophytes Subchondral sclerosis Subchondral cysts |
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Obesity and TJR
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Higher rate of replacement in obese population
Knee replacement > hip replacement |
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Steps in pre-operative planning for TJR
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Avoid old incisions
Avoid limb length discrepencies Know vascular and neurologic status Investigate signs of infection |
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TJR: pre-op radiographs (hip and knee)
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Hip: AP and lateral + AP pelvis
Knee: Standing AP, lateral skyline *use for templating |
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TJR: templating definition
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Determining size of prosthesis using radiographs
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Surgical Techniques: total hip arthroplasty
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Trochanteric slide
Extended trochanteric osteotomy |
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Total joint replacement: complications
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DVT (Warfarin or LMWH) prophylaxis
Nerve injuries (majority resolve) Vascular injuries Dislocation (THA, most posterior, prevalance is 3.1% in primaries, 20-30% in revisions, inversely correlated to physician experience) Infection (prophylactic antibiotics) Wound healing problems |
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Types of knee osteotomies
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High tibial osteotomy
Distal femoral varus osteotomy |
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Osteotomy: purpose (3)
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Realignment
Off-loading of weight Pain relief (will need TJR in 10-15 years) |
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Indications for osteotomy (5)
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Unicompartmental, medial or lateral arthritis with varus or valgus alignment
At least 90 degree arc of motion Male <65yo, female <60yo Physiologically youthful, active Capable of extensive rehabilitation |
