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Orthopedic Surgery and Joint Reconstruction Overview
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Orthopedic Surgery and Joint Reconstruction Overview

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Questions and Answers

What is the main purpose of injections in the treatment of joint conditions?

  • To cause joint infection
  • To increase inflammation
  • To perform viscosupplementation (correct)
  • To worsen cartilage injury
  • Which surgical procedure involves cutting the bone to change its position for improving alignment or length?

  • Pelvic osteotomy (correct)
  • Arthroplasty
  • Hip arthroplasty
  • Arthrodesis
  • What is the primary goal of surgical arthroplasty or joint replacement?

  • Maximize patient function (correct)
  • Cause joint infection
  • Increase pain
  • Preserve motion
  • In what cases might arthrodesis be considered as a surgical option?

    <p>For elderly low-demand patients</p> Signup and view all the answers

    What is a potential risk associated with common injections like corticosteroids?

    <p>Joint infection</p> Signup and view all the answers

    For what reason might an isolated medial compartment knee osteotomy be performed?

    <p>To correct varus deformity</p> Signup and view all the answers

    Which surgical approach to the hip is also known as Smith Peterson?

    <p>Anterior</p> Signup and view all the answers

    What is the main consideration for conservative management and prevention of arthritis?

    <p>Weight loss</p> Signup and view all the answers

    What is the most common bearing surface combination in hip arthroplasty?

    <p>Metal femoral head on polyethylene liner</p> Signup and view all the answers

    Which symptom is associated with arthritis according to the text?

    <p>Decreased ability to perform</p> Signup and view all the answers

    Which type of prosthetic component relationship can lead to metallic staining on the ceramic femoral head in hip arthroplasty?

    <p>Metal on ceramic</p> Signup and view all the answers

    In hip arthroplasty, what is the Austin Moore Prosthesis primarily used for?

    <p>End-stage hip arthritis failed non-operative management</p> Signup and view all the answers

    What type of gait is observed in the physical examination of a patient with hip problems?

    <p>Antalgic gait</p> Signup and view all the answers

    When considering total joint arthroplasty, what is the final option for patients suffering from pain associated with arthritis in the joint?

    <p>Hip arthrodesis</p> Signup and view all the answers

    Which is NOT a method mentioned for the conservative management and prevention of arthritis?

    <p>Medication</p> Signup and view all the answers

    In what type of patients can a decrease of 11lbs reduce the risk of developing knee osteoarthritis?

    <p>Only women</p> Signup and view all the answers

    Which condition might present with peritrochanteric pain according to the text?

    <p>Hip arthritis</p> Signup and view all the answers

    What is the major concern associated with metal on metal bearing surfaces in hip arthroplasty?

    <p>Production of metal ions</p> Signup and view all the answers

    In hip arthroplasty, which type of fixation offers biologic fixation without the use of cement?

    <p>Cementless</p> Signup and view all the answers

    What is the main cause of osteolysis and aseptic loosening in joint arthroplasty?

    <p>Abnormal resorption of bone</p> Signup and view all the answers

    Which complication is unique to hip replacement among the listed options?

    <p>Dislocation</p> Signup and view all the answers

    Among the complications shared by hip and knee replacement, which one poses the risk of venous thromboembolic disease?

    <p>Infection</p> Signup and view all the answers

    What is the primary concern with ceramic on ceramic bearing surfaces in hip arthroplasty?

    <p>Brittleness</p> Signup and view all the answers

    What is the primary purpose of weight loss in the conservative management and prevention of arthritis?

    <p>To reduce the incidence of arthritis</p> Signup and view all the answers

    Which of the following is NOT a factor considered in the examination of a patient with arthritis according to the text?

    <p>Color of the skin surrounding the joint</p> Signup and view all the answers

    What is the term used to describe lateral hip pain often linked to peritrochanteric conditions as mentioned in the text?

    <p>Trochanteric bursitis</p> Signup and view all the answers

    Which of the following activities would be LEAST recommended for a patient with hip arthritis based on the text?

    <p>Running on hard surfaces</p> Signup and view all the answers

    In hip arthroplasty, what type of fixation offers biologic bonding without the use of cement as mentioned in the text?

    <p>Hydroxyapatite-coated fixation</p> Signup and view all the answers

    Which type of pain management technique is NOT typically recommended in the conservative management of arthritis according to the text?

    <p>Opioid medications</p> Signup and view all the answers

    What is the primary indication for hip arthrodesis as mentioned in the text?

    <p>Failed non-operative management of hip arthritis</p> Signup and view all the answers

    Which of the following surgical approaches to the hip is NOT correctly matched with its alternative name?

    <p>Anterior (Smith Peterson)</p> Signup and view all the answers

    Which bearing surface combination is considered an alternative to the common metal femoral head on polyethylene liner in hip arthroplasty?

    <p>Metal on ceramic</p> Signup and view all the answers

    What is a potential complication specifically associated with failed ceramic on metal hip arthroplasty components?

    <p>Metallic staining on the ceramic femoral head</p> Signup and view all the answers

    What distinguishes hip arthroplasty from hip arthrodesis in terms of surgical management, as highlighted in the text?

    <p>Hip arthroplasty involves replacing the joint, while arthrodesis involves fusing it.</p> Signup and view all the answers

    What is the primary concern associated with ceramic on ceramic bearing surfaces in hip arthroplasty?

    <p>Brittle nature making them prone to fractures</p> Signup and view all the answers

    What is the major risk associated with cemented fixation in joint arthroplasty?

    <p>Abnormal resorption of bone</p> Signup and view all the answers

    Which complication is unique to hip replacement among the listed options?

    <p>Leg length discrepancy</p> Signup and view all the answers

    What is the primary purpose of joint replacement surgery?

    <p>To maximize patient function and quality of life</p> Signup and view all the answers

    What is one of the complications shared by hip and knee replacement surgeries?

    <p>Intra/post-operative fracture</p> Signup and view all the answers

    What is the major concern associated with metal on metal bearing surfaces in hip arthroplasty?

    <p>Development of pseudotumors</p> Signup and view all the answers

    Which type of surgical management involves cutting the bone to improve alignment or length?

    <p>Femur Osteotomy</p> Signup and view all the answers

    What is a potential risk when administering corticosteroid injections for joint conditions?

    <p>Increased risk of joint infection</p> Signup and view all the answers

    What is the primary reason for the lowest wear rate in ceramic on ceramic bearing surfaces?

    <p>Brittle nature of ceramics</p> Signup and view all the answers

    In surgical management, when might arthroplasty/joint replacement be the preferred option?

    <p>As a last resort for elderly low-demand patients</p> Signup and view all the answers

    What is a common risk associated with surgical arthrodesis?

    <p>Limited mobility post-surgery</p> Signup and view all the answers

    What is a potential complication unique to osteotomy procedures compared to other surgical options?

    <p>Failure to achieve the desired alignment</p> Signup and view all the answers

    Study Notes

    Joint Arthroplasty/Replacement

    • Hip arthroplasty is used for end-stage hip arthritis that has failed non-operative management
    • Austin Moore Prosthesis is a type of hip arthroplasty
    • Surgical approaches to the hip include:
    • Anterior (Smith Peterson)
    • Anterolateral (Watson-Jones)
    • Lateral (Hardinge)
    • Posterior (Kocher Langenbach)

    Bearing Surfaces

    • Metal on metal bearing surfaces are associated with production of metal ions, pseudotumors, hypersensitivity reactions, and early failure
    • Ceramic on ceramic bearing surfaces have the lowest wear rate and friction, but are brittle
    • Metal femoral head on polyethylene liner is the most common bearing surface
    • Ceramic and metal are alternative bearing surfaces

    Fixation Options

    • Cementless fixation uses biologic fixation
    • Cemented fixation uses PMMA, which serves as grout

    Complications

    • 5-10% of joint arthroplasty patients experience complications
    • Shared complications of hip and knee replacement include:
      • Infection
      • Intra/post-operative fracture
      • Vascular injury
      • Nerve injury or palsy
      • Periprosthetic fracture
      • Stress shielding
      • Component fracture or wear
      • Medical complications (DVT, PE, MI, CVA)
    • Unique complications of hip replacement include:
      • Dislocation
      • Leg length discrepancy
      • Iliopsoas impingement or tendonitis

    Osteolysis and Aseptic Loosening

    • Caused by infection, metastatic disease, or production of wear debris
    • Results in abnormal resorption of bone

    Examination of the Patient

    • Physical examination includes:
      • Leg length discrepancy
      • Joint contractures
      • Skin changes
      • Prior surgical incisions
      • Neurovascular exam
      • Strength
      • Range of motion
    • Goals of treatment include:
      • Improving pain
      • Preserving motion
      • Maximizing patient function, independence, and quality of life

    Injections

    • Common injections include:
      • Corticosteroids to decrease inflammation
      • Hyaluronic acid for viscosupplementation
    • Risks include:
      • Joint infection
      • Cartilage injury from the needle
      • Hemarthrosis
      • Failure to receive benefit

    Surgical Management

    • Arthroplasty/joint replacement is the most commonly performed procedure for arthritis of a major joint
    • Hip and knee arthroplasty are the most successful procedures
    • Other non-arthroplasty options exist

    Osteotomy

    • Cutting the bone to change position of the fragments to improve length, rotation, alignment, or angulation
    • Performed for both congenital and acquired deformities
    • Types of osteotomy include:
      • Pelvic osteotomy
      • Femur osteotomy
      • Proximal tibia osteotomy for isolated medial compartment knee osteoarthritis with varus deformity
      • Knee osteotomy

    Arthrodesis

    • Surgical option for infection, elderly low-demand patients, or young and active patients too young for a joint replacement
    • Can also serve as a last resort

    Conservative Management and Prevention

    • Weight loss of 11lbs can decrease the risk of developing knee osteoarthritis by 50% in women
    • Regular activities can lower the incidence of arthritis
    • Conservative management includes:
      • Weight loss
      • Activity modification
      • Rest
      • Bracing
      • Physical therapy
      • Pain management
      • Assistive devices (cane, walker)

    Arthritis

    • Types of arthritis include:
      • Osteoarthritis
      • Rheumatoid arthritis
      • Septic arthritis
      • Post-traumatic arthritis
    • Symptoms include:
      • Pain
      • Loss of range of motion
      • Decreased ability to perform daily activities
      • Decreased quality of life

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    Description

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