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Exposure

Exposure. Femoral head. Posterior approach. Advantage Easy exposure Quicker surgery No limp Disadvantage Higher dislocation rate Have to limit patient’s motion postop A. Direct Anterior approach. Advantage Quicker rehabilitation Smaller incision No limp or dislocation

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Exposure

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  1. Exposure

  2. Femoral head

  3. Posterior approach Advantage • Easy exposure • Quicker surgery • No limp Disadvantage • Higher dislocation rate • Have to limit patient’s motion postop • A

  4. Direct Anterior approach • Advantage • Quicker rehabilitation • Smaller incision • No limp or dislocation • Disadvantage • More technically challenging • Not designed for complications during surgery

  5. Anterior Lateral Approach Advantage • Lower rate of dislocation • Disadvantage • Must repair and protect abductors • Increased limp

  6. Bipolar hip replacementHemiarthroplasty • Femoral neck fracture • Acetabulum is not arthritic

  7. Resurfacing • Disadvantages Risk of femoral neck Fracture Not all are candidates Risk of Pseudotumor – semi-solid or cystic periprosthetic mass of 2 cm in diameter or larger

  8. Resurfacing • Risk of neck fracture

  9. Hip Resurfacing

  10. Risks of Hip Replacement • Infection • Antibiotic given within one hour prior to incision and 3 doses within 24 hours • Antibiotic prior to dental / invasive procedure -

  11. Risks of Joint Replacement • Infection

  12. Infection Combordities • Diabetes • Immunosuppression • Steroids • Rheumatoid Arthritis • HIV

  13. DVT / PE • TEDs • SCDs • Active care devices • Anticoagulant – ongoing debate Chest Guidelines AAOS Guidelines Not for todays discussion

  14. Risk of Hip Replacement • Nerve Injury - Sciatic nerve / foot drop • Fracture – intraop or postop • Vessel Injury

  15. Fracture

  16. Knee Replacement • Keeping people active longer

  17. Knee Anatomy

  18. Knee Replacement Indications • Osteoarthritis

  19. Osteoarthritis

  20. Genu Varum

  21. Genu Varum

  22. Genu Valgum

  23. Genu Valgum

  24. Indications • Osteonecrosis

  25. Knee Implants

  26. Unicondylar Knee Replacement

  27. Implants • Patella Femoral Plasty

  28. Hemophilia Joint

  29. Knee Replacement Infection

  30. Risks • DVT • Anticoagulant • SCD • Active Care • TED stockings • Ambulation

  31. Stiffness

  32. Nerve Injury • Sciatic Neve • Peroneal Nerve

  33. New Trends • Navigation • Makoplasty • Selection of patient population

  34. Navigation

  35. Navigation

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