– See: – Bone Scans following THR: – Post Op Evaluation of THR: – Discussion: – post op AP & lateral x-rays should include entire length of stem & cement mass; – femur and cement column are inspected carefully and compared w/ previous films for changes indicating component loosening, stem failure, trochanteric problems, or infection; – Radiographic … Read more
(See also: Total Hip Replacement Menu) Discussion evaluation of the painful THR indications for revision evaluation for loosening outcomes: references: Why revision total hip arthroplasty fails. Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure Examination examination for loosening: previoius incisions; contracture of the flexors and adductors (adds to complexity of the case); … Read more
Discussion removal of broken femoral stems: removal of cementless stems: removal of cemented femoral stems: as noted by Peters, et al. (1997), at the time of acetabular component revision, evidence supports leaving a well fixed cemented component in place; in femoral components inserted w/ first generation cementing techniques, the rate of mechanical failure was 22% … Read more
Rule Out Infection » probably every revision joint procedure should have frozen sections sent prior to insertion of the components in order to determine whether acute inflammation is present (indicating infection); references: Failed total hip replacement: assessment by plain radiographs, arthrograms, and aspiration of the hip joint. The value of aspiration of the hip joint before … Read more
See: Total Hip Replacement Menu: revision arthroplasty menu Femoral Revision exposure of femur it is essential that prior to attempted femoral component removal, that there is a clear retrograde path for stem removal; this means that any trochanteric overhang is removed, either with a high speed bur or with an trochanteric osteotomy: some recommend routine … Read more
– TKR Menu: AP cutting guide – Determine Appropriate AP Component Size: – most instrument systems incorporate cutting block that is placed on end of femur & rotated to appropriate orientation; – prior to inserting the AP sizing guide, remove any prominent meniscal remnants so that the posterior “fins” of the … Read more
– See: – Joint Line Position – Patella Infera: – Discussion: – elevation of the joint line occurrs when only very small amount of tibial plateua surface is removed and “space” for the components created by removing portion of the distal … Read more
– Discussion: – femoral cutting guide is set for the appropriate right or left valgus angulation of +5 to 7 deg (in the tall thin patient try +5 deg, & in short obese patient try 7 or even +9 deg); – in lateral plane, this cut is perpendicular to anatomic axis … Read more
– Component Insertion: – tibial insertion: – cement is applied to the proximal tibial surface, and the surgeon uses gloved fingers to manually press cement into proximal tibial surface; – subsequently additional cement is applied to the proximal tibial surface; … Read more
– Discussion: – flex the knee to 90 deg and release the anterior attachment of medial joint capsule from the tibia; – this should provide wide exposure of the interior of the knee; – at this point it should be possible to sublux tibia forward for complete visualization of the plateau surfaces; – trim osteophytes … Read more