Adult Reconstruction

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Chapter 5

Adult Reconstruction

Contents

SECTION 1 HIP DYSPLASIA—ADULT PRESENTATION

SECTION 2 HIP ARTHRITIS ASSESSMENT

SECTION 3 HIP ARTHRITIS TREATMENT

SECTION 4 OSTEONECROSIS OF THE HIP

SECTION 5 TOTAL HIP ARTHROPLASTY

SECTION 6 REVISION THA

SECTION 7 OSTEOLYSIS IN THA

SECTION 8 PERIPROSTHETIC THA FRACTURE

SECTION 9 TOTAL ARTICULAR RESURFACING

SECTION 10 THA—MISCELLANEOUS

SECTION 11 THA—JOINT STABILITY

SECTION 12 THA—ARTICULAR BEARING TECHNOLOGY

SECTION 13 KNEE ARTHRITIS ASSESSMENT

SECTION 14 KNEE ARTHRITIS TREATMENT

SECTION 15 TOTAL KNEE ARTHROPLASTY

SECTION 16 TKA DESIGN

SECTION 17 REVISION TKA

SECTION 18 PATELLAR TRACKING IN TKA

SECTION 19 CATASTROPHIC WEAR IN TKA

SECTION 20 SHOULDER ARTHROPLASTY

SECTION 21 PERIPROSTHETIC JOINT INFECTION

TESTABLE CONCEPTS

section 1 Hip Dysplasia—Adult Presentation

NATURAL HISTORY

II SPECTRUM OF PRESENTATION

III CLASSIFICATION OF ADULT HIP DYSPLASIA

IV ACETABULAR DYSPLASIA (Box 5-1 and Figure 5-1)

Classical (too little coverage)

Acetabular retroversion

1. Acetabular socket faces backward. (Normal socket faces forward, i.e., anteversion.)

2. Radiographic findings (Figure 5-2)

Acetabular overcoverage

PROXIMAL FEMORAL DYSPLASIA

Head-neck dysplasia (Figure 5-3)

Altered neck version

VI CLINICAL SYNDROME ASSOCIATED WITH DYSPLASIA

Femoral acetabular impingement

Clinical progression

Clinical presentation

Causes of femoral acetabular impingement

Femoral acetabular impingement—two types

1. Pincer impingement (Figure 5-5)

2. Cam impingement (Figure 5-6)

VII DYSPLASIA TREATMENT

Treatment depends upon the extent of deformity and location.

Surgical correction goals are to relieve pain and to correct anatomic deformity. Long-term goal is to reduce the occurrence of degenerative joint disease.

Surgical correction addresses the main anatomic deformity: shallow socket, retroverted socket, reduced femoral neck offset (i.e., fat neck), abnormal femoral neck version.

Main surgical options

Periacetabular osteotomy (Figure 5-7)

Anterior hip decompression (Figure 5-8)

Proximal hip osteotomy

section 2 Hip Arthritis Assessment

Patient assessment of hip pain includes a physical examination and diagnostic radiographic modalities.

PHYSICAL EXAMINATION TESTS FOR HIP IRRITABILITY

Impingement test

Roll test

Stinchfield test

Patrick test

II STUDIES

section 3 Hip Arthritis Treatment

NONOPERATIVE

II OPERATIVE

Arthroscopy

1. Best indication

2. Beware of labral resection in dysplasia.

3. Other indications

4. Arthroscopy technique

5. Arthroscopy complications

Osteotomy (adult)

THA

Hip fusion

1. Less frequently used as THA technology advances

2. Classical indication

3. Energy expenditure

4. Collateral arthritis

5. Hip fusion technique

6. Fusion position

7. Fusion conversion to THA

8. Function after conversion to THA

Resection arthroplasty

1. Usually last step before hip disarticulation in a frustrating downward clinical course

2. Indications

Hemiarthroplasty

1. Relegated to specific limited role

2. Hemiarthroplasty advantage

3. Hemiarthroplasty disadvantage

section 4 Osteonecrosis of the Hip

OCCURRENCE

II ETIOLOGY (see Chapter 1, Basic Science)

III CLINICAL PRESENTATION

IV IMAGING

STAGING (Table 5-1)

VI TREATMENT

Nonsurgical

Surgical treatment

1. Surgical treatment depends on these major variables.

2. Younger age and crescent (or worse)

3. Younger age and no crescent

image Common treatments

image Core decompression

image Vascularized fibular strut (Figure 5-10)