Download MBBS Orthopaedics PPT 14 Principles of Arthroplasty Lecture Notes

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