Complications
General
- haemarthrosis
- DVT
- infection
Septic Arthritis
Incidence
- haemarthrosis
- DVT
- infection
Incidence
Femur
Multiplanar deformity
- worsend by previous surgery
- may require osteotomy
Acetabulum
Dysplasia often present
- not as severe as in DDH
LLD
Can be significant
Abductors
Have been short for long time
- difficult to restore length
Device that encircles a limb to occlude the vascular supply
Aim is to provide bloodless field
Local
- poor skin
- PVD
- DVT
- vascular bypass surgery
General
- sickle cell anaemia
Ultimate goal of blood management is to AVOID allogenic blood transfusion
Increased infection rate
- demonstrated in THR
- decreased killer T cells
Increased risk disease transmission
Increased risk transfusion reaction
Increased post-op fever and antibiotic requirements
Increased cost
1. Significant functional impairment
2. PIPJ contracture
- originally thought to intervene early
- Macfarlane showed residual FFD always about 30o
- may need to release check rein ligaments / accessory collateral ligaments
3. MCPJ contracture >30o
4. Trigger fingers
- must do limited fasciectomy
Education regarding shoe wear
- extra wide / large toe box
Insoles
- longitudinal arch support
- pre MT dome for metatarsalgia
- podiatry to attend to callosities
Toe spacers
Analgesia
1. Continued pain and discomfort
2. Difficulties with shoe wear
Peters et al J Arthroplasty 2009
1. Always resurface
2. Never resurface
3. Selectively resurface
Controversial
- literature divided on issue
Historically
- poor outcomes due to poor implant design
- now improved designs
- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation
UKA is intended to be load sharing
- correct to neutral or slight varus
HTO is a load-shifting / load-sparing procedure
- over correct into valgus
Advantages UKA
1. Rapid rehabilation
Most important factor in good results and duration of results
- must correct to 8o of valgus
- mechanical axis must pass through lateral joint line
Causes
- inadequate initial correction