Download MBBS Orthopaedics PPT 14 Principles of Arthroplasty Lecture Notes

--- Content provided by FirstRanker.com ---

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

--- Content provided by FirstRanker.com ---

Normal knee alignment

Normal joint line
Knee alignment

--- Content provided by‍ FirstRanker.com ---

Total Knee arthroplasty- Basics
Total Knee

arthroplasty-

--- Content provided by⁠ FirstRanker.com ---

basics

Total Knee arthroplasty-Bony cuts

--- Content provided by​ FirstRanker.com ---

Total Knee arthroplasty- Gaps

Patellar resurfacing
Case 1-53 y/F

--- Content provided by​ FirstRanker.com ---

? 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

--- Content provided by​ FirstRanker.com ---

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

On examination

--- Content provided by‍ FirstRanker.com ---

? 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

--- Content provided by FirstRanker.com ---

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

left side

--- Content provided by‌ FirstRanker.com ---

Clinical Diagnosis?

Next investigations?

--- Content provided by‌ FirstRanker.com ---

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

--- Content provided by⁠ FirstRanker.com ---

?Walking with support *2 years

?OKS 21 R, 20 L

15? varus deformity right and 20? varus deformity left

--- Content provided by‌ FirstRanker.com ---

10 ? FFD on right, 5 ? on the left

--- Content provided by‍ FirstRanker.com ---

Pre-op X rays

Post-op

--- Content provided by‍ FirstRanker.com ---

Xray


Post-op Xray

--- Content provided by‌ FirstRanker.com ---

Principles of THA


Case 3

--- Content provided by‍ FirstRanker.com ---

? 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

--- Content provided by⁠ FirstRanker.com ---

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


? Tenderness at anterior hip point

--- Content provided by‌ FirstRanker.com ---

?Deformity- Right limb

? 10* FFD (Thomas test)

? 10* external rotation

--- Content provided by​ FirstRanker.com ---

? 20* adduction deformity

? 2 cm supra-trochanteric shortening

--- Content provided by⁠ FirstRanker.com ---

Pre-op x ray


Pre-operative

--- Content provided by‍ FirstRanker.com ---

Templating

Post-op x ray

39.3o

--- Content provided by FirstRanker.com ---

A

B

--- Content provided by FirstRanker.com ---

LLD = A-B, No Clinical y evident LLD

No

varus/valgus

--- Content provided by‍ FirstRanker.com ---

Post-op xray

Medial offset 38mm Medial offset 33mm

--- Content provided by‌ FirstRanker.com ---

Case 4 57 years old male

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

--- Content provided by⁠ FirstRanker.com ---

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

? K/C/O Ankylosing spondylitis
Examination

--- Content provided by‍ FirstRanker.com ---

? Gait : Stiff Hip Gait, walks with support

Right (degrees)

--- Content provided by‌ FirstRanker.com ---

Left (degrees)

Flexion

20-80

--- Content provided by‌ FirstRanker.com ---

40-60

Extension

--- Content provided by‍ FirstRanker.com ---

-

-

Adduction

--- Content provided by‍ FirstRanker.com ---

-

20 fixed

--- Content provided by​ FirstRanker.com ---

Abduction

15 fixed

-

--- Content provided by‌ FirstRanker.com ---

IR

0-20

--- Content provided by FirstRanker.com ---

-

ER

0-10

--- Content provided by‍ FirstRanker.com ---

20 fixed

2 cm apparent shortening left side with flexion deformity

--- Content provided by⁠ FirstRanker.com ---

Examination

? Measurements:

Right (cm)

--- Content provided by⁠ FirstRanker.com ---

Left (cm)

Apparent length

--- Content provided by FirstRanker.com ---

107

105

True length

--- Content provided by⁠ FirstRanker.com ---

91

89

--- Content provided by⁠ FirstRanker.com ---

Femur length

46

46

--- Content provided by FirstRanker.com ---

Tibia length

40

--- Content provided by⁠ FirstRanker.com ---

40
Examination

? Cervical spine- wall to occiput-33 cm

--- Content provided by‍ FirstRanker.com ---

wall to tragus- 41 cm
ROM- 5? rotation

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

--- Content provided by‌ FirstRanker.com ---

oGanslen test- +ve

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

Pre op Xrays

--- Content provided by FirstRanker.com ---

Templating Cup Size ? 56

Stem size - 11

--- Content provided by FirstRanker.com ---

Pre-operative CT

? Right FA ? 18.9
? Left FA - 8

--- Content provided by‌ FirstRanker.com ---

Post op Radiograph

48.1o

--- Content provided by​ FirstRanker.com ---

LLD

10mm
Conclusion

--- Content provided by​ FirstRanker.com ---

? 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

--- Content provided by FirstRanker.com ---

Thank you