Download MBBS Orthopaedics PPT 14 Principles of Arthroplasty Lecture Notes

Principles of arthroplasty

Learning Objectives
? Understand basics of cuts

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? Importance of alignment
? Introduce soft tissue balance
? Alignment and offsets
? Uncemented /Cemented implants

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Normal knee alignment

Normal joint line
Knee alignment

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Total Knee arthroplasty- Basics
Total Knee

arthroplasty-

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basics

Total Knee arthroplasty-Bony cuts

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Total Knee arthroplasty- Gaps

Patellar resurfacing
Case 1-53 y/F

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? 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

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? Pain B/L shoulder and left elbow
? OKS 18 R, 19 L

On examination

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? 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

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? Range of motion: flexion 8-110 degrees on rt side, 5-100 degrees on

left side

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Clinical Diagnosis?

Next investigations?

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Pre-Op X-Rays
Case 2
?C/O: Bilateral knee pain x 8-10yrs

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?Walking with support *2 years

?OKS 21 R, 20 L

15? varus deformity right and 20? varus deformity left

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10 ? FFD on right, 5 ? on the left

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Pre-op X rays

Post-op

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Xray


Post-op Xray

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Principles of THA


Case 3

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? 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

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? No H/o trauma, fever, TB contact or ATT intake


? Tenderness at anterior hip point

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?Deformity- Right limb

? 10* FFD (Thomas test)

? 10* external rotation

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? 20* adduction deformity

? 2 cm supra-trochanteric shortening

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Pre-op x ray


Pre-operative

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Templating

Post-op x ray

39.3o

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A

B

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LLD = A-B, No Clinical y evident LLD

No

varus/valgus

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Post-op xray

Medial offset 38mm Medial offset 33mm

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Case 4 57 years old male

? C/o Low back ache x 10-12 yrs

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Neck pain x 8-9 yrs
B/L hip pain x 3-4 yrs

? K/C/O Ankylosing spondylitis
Examination

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? Gait : Stiff Hip Gait, walks with support

Right (degrees)

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Left (degrees)

Flexion

20-80

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40-60

Extension

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-

-

Adduction

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-

20 fixed

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Abduction

15 fixed

-

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IR

0-20

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-

ER

0-10

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20 fixed

2 cm apparent shortening left side with flexion deformity

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Examination

? Measurements:

Right (cm)

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Left (cm)

Apparent length

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107

105

True length

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91

89

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Femur length

46

46

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Tibia length

40

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40
Examination

? Cervical spine- wall to occiput-33 cm

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wall to tragus- 41 cm
ROM- 5? rotation

? Chest expansion- 0.5 cm
? Mod. Schober test- 0.5 cm increase in forward flexion

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oGanslen test- +ve

oFABER test- could not be performed, because of the ankylosed hips

Pre op Xrays

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Templating Cup Size ? 56

Stem size - 11

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Pre-operative CT

? Right FA ? 18.9
? Left FA - 8

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Post op Radiograph

48.1o

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LLD

10mm
Conclusion

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? 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

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Thank you