contraindications

Surgery

Indications 

 

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 

Background

AimUKA Oxford AP

 

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

 

UKA v TKR

 

Advantages UKA

 

1.  Rapid rehabilation

 

Background

Aetiology Unicompartmental OAKnee Medial Compartment OA

 

Trauma

Meniscectomy

Osteonecrosis

Varus or valgus malalignment

 

Goals of Osteotomy

 

Relief of pain

Improve function

No loss of ROM

No or slight restriction of activity

Allow heavy functional demands 

 

MRI

Creation of images

 

Placing patient into a strong magnetic field

- 30 000 x stronger than the earth's magnetic field

 

Stronger magnets, better images, shorter times

- 1.5 Tesla 

- 3 Telsa

 

The nuclei of elements with odd numbers of protons line up

- i.e. hydrogen atoms

- hydrogen is plentiful in fat and water

 

A radiofrequency is then applied, exciting the protons

Replants

Replant 4 FingersReplant 4 fingers post

 

Definition

 

Replant

- reattachment of body part that has been completely severed

 

Revascularisation of incomplete Amputation

Arthroplasty

Indications

 

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

 

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

 

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

 

Acute unreconstructable fracture > 60

 

Arthrodesis

Indications

 

Very few

- young labourer with severe disabling elbow pain

- trial in POP at 90o for 6 weeks

 

Poor function

- adjacent joints cannot compensate for loss of function

 

Contraindications

 

RA

- high failure rate especially flail elbow with poor bone stock

 

Arthrodesis Conversion

Indications

 

Severe LBP 

- most common indication

 

Ipsilateral knee pain

- less beneficial

 

Malposition

- especially abduction

 

Contraindications

 

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

 

Examination

 

LLD

 

Arthrodesis

IndicationsHip Fusion

 

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

 

Aims of arthrodesis

 

Maximise bony contact

Minimise shortening

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