The Hip

Revision Femoral Component Arthroplasty

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

THR: Positioning and Prepping

        – Discussion:     – anesthesia considerations:           – note that with spinal anesthesia, the table will be tilted reverse trendelenburg inorder to prevent high spinal (this will have the effect                    of predisposing for vertical cup position if note remedied;           – note that leg lengthening is more common with spinal vs general; … Read more

THR: Posterolateral Approach

(see: Total Hip Replacement Menu) – PreOp: – Theory and Background: – Checklist for THR and Radiographs: – Initial Exposure: – positioning, prepping and antibiotics: – posterolateral skin incision:  – incise thru iliotibial band: – split gluteus maximus: – The course of the superior gluteal nerve in the lateral approach to the hip; – identify the … Read more

THR: Osteolysis

– See: Total Hip Replacement Menu – Discussion:     – most common complication in total hip arthroplasty and most common cause of component failure;     – osteolysis is a time dependent process which arises from inflammatory reaction against polyethylene particulate debris;     – patho-biology:            – osteolysis is … Read more

THR: Cemented Acetabular Component

  – See: Total Hip Replacement Menu:            – cementless components            – cement technique            – acetabular component revision            – operative considerations for hip dyplasia            – protrusio – Discussion:     – technical considerations:     – in the report by Crites BM, et al (2000), the effect of porosity reduction            cementing techniques with respect to radiolucent lines … Read more

STSG Donor Site

– Discussion:     – determine required thickness for the STSG:           – since a thick STSG graft harvested from donor site w/ a thin dermal thickness, may lead to a full thickness wound, as well as causing hyperpigmentation of the transplanted STSG;           – thick donor sites: posterolateral … Read more

Osteochondral Lesions of the Talus – Allograft Repair

Co-Authors:  Milford H. Marchant Jr., M.D.; Mark E. Easley, M.D.; James A. Nunley II., M.D. Osteochondral Lesions of the Talus Review Etiology – Primary Causes – Trauma – Ischemic Necrosis – Embolic phenomenon – Ossification Defects – Predisposing Factors – Endocrine Disorders – Peripheral vascular disease – Genetic Predisposition? – 10-25% Bilateral Lesions Evaluation – … Read more

Staph epidermidis

  – Discussion:     – is a coagulase negative, gram positive organism;     – has emerged as one of the most common organisms in total joint infections (and in other implanted devices);     – it is often minimally toxic (as compared to other bacterial infections), and many patients will have minimal symptoms of infection; … Read more