Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Orthopaedics PPT 14 Principles of Arthroplasty Lecture Notes
Principles of arthroplasty
Learning Objectives
? Understand basics of cuts
? Importance of alignment
? Introduce soft tissue balance
? Alignment and offsets
? Uncemented /Cemented implants
Normal knee alignment
Normal joint line
Knee alignment
Total Knee arthroplasty- Basics
Total Knee
arthroplasty-
basics
Total Knee arthroplasty-Bony cuts
Total Knee arthroplasty- Gaps
Patellar resurfacing
Case 1-53 y/F
? Pain over B/L knee since 2 years
? Difficulty in walking since 2 years
? Walking without aid
? H/o morning stiffness for more than a hour since 14 years
? Pain B/L shoulder and left elbow
? OKS 18 R, 19 L
On examination
? Medial and lateral joint line tenderness B/L knee.
? Medial patellar facetal tenderness
? Crepitus present over b/l knee.
? valgus RT. 22 degrees, LT. 19 degrees in standing, correctable partially
? No medial laxity
? Range of motion: flexion 8-110 degrees on rt side, 5-100 degrees on
left side
Clinical Diagnosis??
Next investigations?
Pre-Op X-Rays
Case 2
?C/O: Bilateral knee pain x 8-10yrs
?Walking with support *2 years
?OKS 21 R, 20 L
15? varus deformity right and 20? varus deformity left
10 ? FFD on right, 5 ? on the left
Pre-op X rays
Post-op
Xray
Post-op Xray
Principles of THA
Case 3
? Patient presented with C/o pain in right hip x 3 yrs
? Gradually progressive, dull aching in nature
? Pain increases on walking and strenuous activities
? Relieves on taking medication and rest
? H/o indigenous medication intake for 1 year till dec 2019
? No H/o trauma, fever, TB contact or ATT intake
? Tenderness at anterior hip point
?Deformity- Right limb
? 10* FFD (Thomas test)
? 10* external rotation
? 20* adduction deformity
? 2 cm supra-trochanteric shortening
Pre-op x ray
Pre-operative
Templating
Post-op x ray
39.3o
A
B
LLD = A-B, No Clinical y evident LLD
No
varus/valgus
Post-op xray
Medial offset 38mm Medial offset 33mm
Case 4 57 years old male
? C/o Low back ache x 10-12 yrs
Neck pain x 8-9 yrs
B/L hip pain x 3-4 yrs
? K/C/O Ankylosing spondylitis
Examination
? Gait : Stiff Hip Gait, walks with support
Right (degrees)
Left (degrees)
Flexion
20-80
40-60
Extension
-
-
Adduction
-
20 fixed
Abduction
15 fixed
-
IR
0-20
-
ER
0-10
20 fixed
2 cm apparent shortening left side with flexion deformity
Examination
? Measurements:
Right (cm)
Left (cm)
Apparent length
107
105
True length
91
89
Femur length
46
46
Tibia length
40
40
Examination
? Cervical spine- wall to occiput-33 cm
wall to tragus- 41 cm
ROM- 5? rotation
? Chest expansion- 0.5 cm
? Mod. Schober test- 0.5 cm increase in forward flexion
oGanslen test- +ve
oFABER test- could not be performed, because of the ankylosed hips
Pre op Xrays
Templating Cup Size ? 56
Stem size - 11
Pre-operative CT
? Right FA ? 18.9
? Left FA - 8
Post op Radiograph
48.1o
LLD
10mm
Conclusion
? Surgery of the century
? Extremely satisfying results
? Good long- term results
? The problem of arthritis will increase as our population ages
? Revisions are challenging ? Bone defects and soft tissue problems
Thank you
This post was last modified on 07 April 2022