Complex Total Hip Replacement - Asian Joint Reconstruction Institute - AJRI experience
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This document discusses a case report of a failed subtrochanteric shortening osteotomy in a 36-year-old female patient. It provides details of her surgical history including multiple prior hip surgeries. The reasons for failure of her current implant are discussed, including that sleeves do not work well in tubular bone and mismatches in proximal and distal femur. Pre-operative workup to rule out infection is outlined. Options for revision surgery including acetabular component retention or revision and choices for distal fitting femoral stems are presented.
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Carpometacarpal ( C)
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Excision of the trapezium presentation
Excision of the trapezium bone is a surgical treatment for carpometacarpal arthritis of the thumb. The document summarizes the results of excising the trapezium bone in 26 wrists. It found that excision provided good relief from pain and hand function, though some patients had reduced grip strength. Arthrography showed the metacarpophalangeal joint space was distinct initially but became irregular and smaller within 6 months of surgery in most patients. One patient experienced late deterioration from pseudoarthrosis. Overall, trapezium excision effectively treated carpometacarpal arthritis symptoms in most patients.
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This document discusses the treatment of nonunion and fixation failure of pertrochanteric fractures through calcar replacement arthroplasty. It begins by outlining the objectives and providing background on pertrochanteric fractures. It then discusses causes of fixation failure, classification systems, and various treatment options including revision fixation and hip arthroplasty. The study aims to evaluate the clinical and radiological outcomes of using calcar replacement arthroplasty to treat nonunion or previously failed fixation of these fractures. It provides details on patients, surgical technique, post-operative outcomes including Harris Hip Scores, complications, and conclusions. In general, it finds the procedure provides acceptable clinical outcomes with improved pain and function though it is technically challenging.
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Lumps, bumps, tingles in the night gp education
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Basal joint arthritis, or arthritis of the thumb carpometacarpal joint, is a common condition affecting women in particular. It has multiple treatment options depending on the stage of arthritis. For early stage arthritis with instability, volar ligament reconstruction is recommended. For more advanced arthritis, options include ligament reconstruction with tendon interposition, trapezium excision with tendon interposition, or arthrodesis (fusion) of the joint, with the choice depending on patient age, demands, and severity of arthritis. Surgical treatment aims to relieve pain while maintaining function and stability.
Rotationplasty
Rotationplasty is a surgical procedure that removes the limb below the knee and surgically rotates the remaining lower leg and foot 180 degrees. This is done for patients with bone cancers in the lower femur or congenital limb deformities. After rotation, the ankle acts as the new knee joint and allows movement through the use of a prosthetic leg. The procedure takes 6-10 hours to complete and involves pre-fitting of the prosthetic and casting of the rotated limb for attachment. The patient then stays in the hospital to practice with the new prosthetic and allow bone healing.
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This document discusses knee arthritis and surgical treatment options. It begins with introductions of two orthopaedic surgeons, Jarrad Stevens and Dave Slattery. It then discusses where orthopaedic surgeons fit in the treatment of knee arthritis, noting they are involved when non-surgical options are exhausted and the patient will benefit from joint replacement. Surgical approaches for knee replacement are described, including use of a medial parapatellar incision. Robotic replacement is discussed as providing accurate placement of components. Options for partial versus total knee replacement are presented, and the future of knee replacement surgery is addressed.
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Pilon fractures are severe fractures of the distal tibia that require careful management of both the bone and soft tissues. Initial treatment involves restoring length and alignment with temporary external fixation to avoid further soft tissue injury. Definitive surgery is typically delayed 10-21 days to allow the soft tissues to heal before open reduction and internal fixation is performed. Surgical approaches must provide access to the articular surface while avoiding vulnerable structures, and fixation aims to reconstruct the joint, fill defects, and buttress medial fragments. Proper wound management and staged procedures may improve outcomes for these complex injuries.
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The document discusses potential complications from ACL reconstruction surgery, noting that surgical technical errors during graft harvest, tunnel preparation, or fixation are most common causes of failure. Five possible causes of reconstruction failure are identified as graft discontinuity, inappropriate tunnel positioning, hardware failure, infection, or arthrofibrosis. Proper surgical technique and avoidance of tunnel malpositioning are emphasized to prevent complications.
Carpometacarpal ( C)
Carpometacarpal (CMC) arthritis most commonly affects the thumb joint, causing pain and loss of motion. It involves wear and tearing of cartilage at the saddle joint between the thumb metacarpal and trapezium bones. Non-surgical treatments include splinting and injections, while surgical options range from joint preserving procedures like osteotomy to joint replacement or fusion depending on severity. Outcomes of different procedures include reduced pain and improved function.
Periprosthetic fractures around the knee
Periprosthetic fractures around total knee replacements can occur in the femur, tibia, or patella. Femur fractures have various classification systems and treatment depends on the specific fracture type, bone quality, and implant stability. Options include open reduction internal fixation with plates or nails, or revision arthroplasty. Tibia fractures also have a classification system and are typically treated with osteosynthesis or revision if the tibial component is loose. Patella fractures also have a classification and treatment involves tension band wiring, osteosynthesis, or revision as needed. Complications can include nonunion, mechanical failures, and infection.
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This document discusses current concepts in unicondylar knee arthroplasty and high tibial osteotomy for the management of unicompartmental osteoarthritis of the knee. It provides an overview of the procedures, including types of osteotomies for high tibial osteotomy, indications and contraindications for each procedure, long-term results, and risks of converting between the two procedures. The document also reviews principles and considerations for each technique as well as selected implant designs for unicondylar knee arthroplasty.
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This document summarizes forefoot fractures, including anatomy, biomechanics, classification, and treatment principles. It describes fractures of the metatarsals, sesamoids, and phalanges. Treatment often involves closed or open reduction with pinning or plating to restore alignment and allow weight bearing. More comminuted fractures sometimes require bone grafting. Proximal fifth metatarsal fractures are classified into zones with implications for healing and management approaches.
Valgus total knee arthroplasty
This document discusses total knee arthroplasty (TKA) for valgus knees. It defines valgus knee deformity and classifications. The lateral parapatellar surgical approach is described as advantageous over the medial parapatellar approach for valgus knees, avoiding additional soft tissue releases. Key challenges include lateral femoral hypoplasia, externally rotated tibia, and lateral tibial defects. Surgical techniques involve lateral releases and pie crusting to balance the knee in extension and flexion. Complications can include common peroneal nerve palsy and hindfoot deformities requiring correction.
2017-008
The document discusses different means to prevent dislocation after total hip arthroplasty (THA), including surgical techniques, implant designs, and clinical studies. It describes approaches like anterior or Hardinge to avoid medialization and offset loss. Implant options mentioned are long posterior wall cups, retentive cups, tripolar cups, and double mobility cups. Clinical studies show dislocation rates ranging from 0-2.85% with various dual mobility cup designs at up to 12 years follow-up. The conclusion of one study presented found that dual mobility cups reduce dislocation rates compared to conventional implants for femoral neck fractures.
Proximal fibular osteotomy - What is the evidence?
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
practical tips in planning TKR
This document provides guidance on preoperative planning and evaluation for total knee arthroplasty (TKA). It discusses assessing patient expectations and psychological factors, identifying radiographic views needed, evaluating alignment and deformities, differentiating knee pain sources, selecting the appropriate prosthesis based on factors like disease severity and deformity, and the surgeon's goals of recreating alignment, balancing soft tissues, and normal knee movement. Key considerations include patient factors like age, activity level, and comorbidities that may influence outcomes, and surgical factors like constraint level needed based on ligament integrity and deformity.
Excision of the trapezium presentation
Excision of the trapezium bone is a surgical treatment for carpometacarpal arthritis of the thumb. The document summarizes the results of excising the trapezium bone in 26 wrists. It found that excision provided good relief from pain and hand function, though some patients had reduced grip strength. Arthrography showed the metacarpophalangeal joint space was distinct initially but became irregular and smaller within 6 months of surgery in most patients. One patient experienced late deterioration from pseudoarthrosis. Overall, trapezium excision effectively treated carpometacarpal arthritis symptoms in most patients.
Was ist angesagt? (20)
TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospita...
TKR For Failed Uniknee Replacement Surgery Dr Sandeep Agrawal Agrasen Hospita...
Current Concepts in High Tibial osteotomy and Unicondylar knee replacement
Current Concepts in High Tibial osteotomy and Unicondylar knee replacement
Proximal fibular osteotomy - What is the evidence?
Proximal fibular osteotomy - What is the evidence?
Ähnlich wie Complex Total Hip Replacement - Asian Joint Reconstruction Institute - AJRI experience
Basal joint arthritis presentation
This document discusses basal joint arthritis of the thumb, also known as trapeziometacarpal arthritis. It covers the ligamentous anatomy, epidemiology, etiology, clinical evaluation, radiographic evaluation, classification systems, treatment options including conservative and surgical management, postoperative care, complications, and cost analysis. The key points are that it is a common source of hand pain, especially in post-menopausal women, and treatment ranges from splinting and injections for mild cases to various surgical procedures like ligament reconstruction and tendon interposition or prosthetic arthroplasty for more advanced stages of arthritis.
Calcar replacement arthroplasty in treatment of failed trochanteric fractures
This document discusses the treatment of nonunion and fixation failure of pertrochanteric fractures through calcar replacement arthroplasty. It begins by outlining the objectives and providing background on pertrochanteric fractures. It then discusses causes of fixation failure, classification systems, and various treatment options including revision fixation and hip arthroplasty. The study aims to evaluate the clinical and radiological outcomes of using calcar replacement arthroplasty to treat nonunion or previously failed fixation of these fractures. It provides details on patients, surgical technique, post-operative outcomes including Harris Hip Scores, complications, and conclusions. In general, it finds the procedure provides acceptable clinical outcomes with improved pain and function though it is technically challenging.
Recurrent Patellar Instability
This document discusses the case of a 17-year-old female with recurrent bilateral patellar dislocation. Examination revealed features of bilateral patellar subluxation with trochlear dysplasia. Recurrent patellar dislocation has a high recurrence rate and requires a multifactorial treatment approach. Surgical options discussed include MPFL reconstruction, tibial tubercle transfer, trochleoplasty, and femoral derotational osteotomy, but there is no consensus on the best procedure. Treatment must be individualized based on the patient's anatomy and injury characteristics.
THORACOLUMBAR SPINE INJURIES
The document summarizes thoracolumbar spine injuries, including:
- Anatomy of the thoracic and lumbar spine regions which predispose the thoracolumbar junction to injury.
- Epidemiology showing these injuries most commonly affect segments T11-L2 and have bimodal age distribution.
- Classification systems including Denis, McCormack, and TLICS which evaluate morphology, neurology, and ligamentous integrity to determine treatment.
- Treatment principles aim to preserve neurology, minimize compression, stabilize the spine, and rehabilitate the patient either via non-operative or operative means.
TKA for severe valgus
This study reviewed the long-term outcomes of total knee arthroplasty (TKA) in patients with severe valgus knee deformity (variant-III). 32 patients (37 knees) underwent TKA with an average follow up of 10 years. The mean preoperative valgus alignment of 33 degrees was corrected to nearly neutral alignment postoperatively. Clinical and functional outcomes significantly improved based on HSS knee scores and range of motion. No revisions were required. Complications included 3 transient peroneal nerve palsies and 2 DVTs, but no infections or loosening. TKA can successfully treat severe valgus deformity with proper soft tissue balancing and implant selection.
patellofemoral instability
This document presents two case studies of patellofemoral instability. Case one involves a 40-year-old female with a history of patellar dislocation and recurrent instability. Physical exam reveals positive tests for instability. Radiographs show a crossing sign and Insall-Salvati index of 1.15. Case two is a 33-year-old female with a history of patellar instability and failed non-operative treatment. Radiographs show femoral anteversion of 24 degrees and increased TT-TG distances. The document discusses anatomy, biomechanics, symptoms, exam findings, imaging, and surgical and non-surgical treatment options for patellofemoral instability.
Total knee replacement (tkr) ppt
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
totalkneereplacementtkrppt-110208124132-phpapp01.pdf
The document discusses the anatomy of the knee joint and common conditions that can lead to total knee replacement (TKR) such as osteoarthritis and rheumatoid arthritis. It details the evolution of TKR from early resection techniques to modern prosthetics with three components. The procedure of performing a TKR is described along with postoperative rehabilitation and goals of restoring function. Data from the author's hospital on 8 TKR cases is presented.
Αρθροσκόπηση του Καρπού, απο την Κλινική Εξέταση στις Σύνθετες Επεμβάσεις- Wr...
Review of the clinical exam, radiologic findings and operative treatment of common wrist conditions treated with wrist arthroscopy
Ομιλία στο Σεμινάριο Χειρουργικής του Χεριού, Ιωάννινα 30 Οκτ- 1 Νοε, 2014. "Ανασκόπηση της Αρθροσκόπησης στο Χέρι".
Lecture 9 shah ankle fractures
This document discusses controversies in the treatment of ankle fractures based on recent literature. It addresses topics such as the timing of surgery, use of a tourniquet, stability of lateral malleolar fractures, fixation of the posterior malleolus, diagnosis and treatment of syndesmosis injuries, controversies regarding syndesmotic screws including screw type and number used, and challenges in treating ankle fractures in elderly and diabetic patients. The document provides an overview of current debates and evolving best practices in orthopedic management of ankle fractures.
Case discussion 5
This patient is a 22 year old man who presented with an anterior knee dislocation after tripping. On examination, he has an obvious knee deformity, shortened limb, inability to dorsiflex or move toes, and decreased sensation on the dorsum of the foot. X-rays show an anterior knee dislocation without fracture. Immediate management includes analgesia, traction to reduce deformity, splinting, and checking vascular status. Further assessment is needed to evaluate for additional injuries. Surgical management may be required for open dislocations, irreducible dislocations, or vascular injuries. The goals of treatment are restoration of stability and range of motion through either conservative immobilization or surgical repair/reconstruction of ligaments.
13. Lelli's Test
The study evaluated the accuracy of the Lelli test for detecting anterior cruciate ligament (ACL) tears and compared it to the anterior drawer test, Lachman test, and pivot shift test. 80 patients undergoing knee arthroscopy were evaluated clinically with the four tests. The sensitivity of the Lelli test was 85.71% and specificity was 91.11%, which was statistically similar to the anterior drawer and Lachman tests but higher than the pivot shift test. The Lelli test is a simple clinical test that can be used to reliably evaluate ACL function in both acute and chronic knee injuries.
Outcome of Mitchell's procedure in the treatment of hallux valgus
Mitchell's procedure involves a step-cut osteotomy of the distal metatarsal neck to correct mild to moderate hallux valgus. The study evaluated outcomes of Mitchell's procedure in 26 feet of 16 patients. Results found an 81.25% satisfaction rate with mean correction of the HVA and IMA angles. However, 19.2% experienced transferred metatarsalgia likely due to first metatarsal shortening. While Mitchell's procedure effectively corrected mild to moderate hallux valgus, shortening and recurrence remain potential drawbacks.
Patella Instability
Patella dislocation is a common problem in the young. Recurrence of dislocation can be significant problem causing pain and discomfort. The assessment and guidelines towards non-surgical and surgical treatment options are discussed here.
Foot ankle trauma 2013
Foot and ankle trauma, common pitfalls, imaging modalities and radiographic occult fractures. The concept of the PITFL or "pitiful injury" an easily overlooked ligamentous injury of the talocrural joint
Ankle fracture : Syndesmosis Injury
In this article, we present how to evaluate syndesmosis injury by a case discussion. We also review the current concepts of syndesmosis injury in ankle fracture especially intraoperative evaluation and how to set syndesmotic screw fixation.
Distal humerus revised
The document discusses fractures of the distal humerus, including the functional anatomy, surgical anatomy, mechanisms of injury, evaluation, classification systems, treatment principles focusing on anatomic reduction and stable fixation, surgical techniques including exposures and osteotomy fixation options, and considerations for treatment in elderly patients which may include total elbow arthroplasty. Classification systems aim to describe the injury, guide treatment, and allow for research and comparison of outcomes.
ΑΝΑΘΕΩΡΗΣΗ ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗΣ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΓΟΝΑΤΟΣ ΜΕ ΑΝΑΤΟΜΙΚΗ ...
ΑΝΑΘΕΩΡΗΣΗ ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗΣ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΓΟΝΑΤΟΣ ΜΕ ΑΝΑΤΟΜΙΚΗ ...STAVROS ALEVROGIANNIS
(Παρουσίαση στο 4ο Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, RZEZOW 2011).
REVISION ACL USING ANATOMICAL SINGLE BUNDLE TECHNIQUE.Thoraco lumbar fractures
Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.
L08 tibial plateau
1) Fractures of the tibial plateau can be complex injuries involving both bone and soft tissues. Accurate reduction of the articular surface is important but other factors like alignment, ligament stability, and meniscal integrity also influence outcomes.
2) Surgical treatment may involve open reduction and internal fixation with plates and screws or less invasive options like percutaneous plating and hybrid external fixation to minimize soft tissue disruption.
3) Patient factors like age, comorbidities, and the specific fracture pattern help determine the best treatment which can range from non-operative management to internal fixation, external fixation, or a combination approach.
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Calcar replacement arthroplasty in treatment of failed trochanteric fractures
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totalkneereplacementtkrppt-110208124132-phpapp01.pdf
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Outcome of Mitchell's procedure in the treatment of hallux valgus
ΑΝΑΘΕΩΡΗΣΗ ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗΣ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΓΟΝΑΤΟΣ ΜΕ ΑΝΑΤΟΜΙΚΗ ...
ΑΝΑΘΕΩΡΗΣΗ ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗΣ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΓΟΝΑΤΟΣ ΜΕ ΑΝΑΤΟΜΙΚΗ ...
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Regional anesthesia over general anesthesia is recommended when possible to limit people and movement in the operating theater and reduce risks. Proper protective equipment including masks, eye shields, gowns, shoe covers, and limited instrumentation with thorough cleaning is crucial for all staff in the operating theater to maintain safety. The goal is to follow basic guidelines and routines for positive cases while recognizing there is no single gold standard approach.
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Dr. Kalaivanan Kanniyan
for queries - drkkbriyan@gmail.com / drkkbriyan@outlook.com
Asian Joint Reconstruction Institute
AJRI
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India
Tamil nadu
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Complex Total Hip Replacement - Asian Joint Reconstruction Institute - AJRI experience
- 1. Choice of distal fitting femoral revision stem in a case of Failed Sub Trochanteric Shortening Osteotomy - A case report.
- 2. CLINICAL HISTORY 36 female - complex THR – 2011 (age28) ℅ Painful hip - 3 years - 2015 (age 32) Difficulty in walking - 2 years- 2016 Noisy Hip LLD +
- 3. (surgery 1) 2007 Hip Arthrodesis (age 24) ( surgery 2 ) 2008 Excision arthroplasty - ? Infection (age 25) (surgery 3 ) 09.6.2011 Right complex THR -STSO –S Rom (age 28) (surgery 4 ) 24.6.2011 Dislocation - Reduction + Plating Some xray – missing H/O ? Right Hip injury at 7 years of age managed conservatively
- 5. WHY it Failed ? • Sleeve doesn’t works in tubular bone • S-Rom doesn’t works in femur with Proximal distal mismatch • Rotational stability of cone sleeve always to be checked
- 7. Rule out Infection ESR 27 CRP 1.19 Investigate thoroughly
- 8. Implant Stability / Positioning ? ● Serial x- ray ● Bone scan – uptake ● Ischiolateral view ● CT scan
- 10. Stable acetabular socket Retain the cup if stability is good 10* Hooded poly is a constraint device Stable acetabular socket with poor abductors Dual mobility as backup If unstable acetabular socket – revision of cup
- 11. monoblock Vs modular distal fitting stem Wagner starts @ 14mm (min 9mm) – Peterbraun starts @ 13mm (min 8mm) – Redapt starts @ 12mm (min 7 mm) - solution starts@ @ SRom 9 stem 14 sleeve Curved vs Straight
- 14. Sratch fit
- 15. Take Home Message - AJRI - MOS Diagnosis – proper history Serial x ray , bone scan (Bone quality , Bone loss ) Rule out infection preoperative blood markers , Intraoperative culture Implant choice – patient specific – Age , Sex , ethnic Revision options - Constrained ++ options for backup Wagner Scratch fit– min 2.5cm
- 16. THANKS