arthroplasty marielle
TRANSCRIPT
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ArthroplastyMarielle Marasigan
Julie Ann Peano
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Avascular Necrosis of Femoral Head
A disease in which the living elements of bone inthe femoral head die
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Pathogenesis of AVN
Sinusoidal occlusion and venous stasis
marrow necrosis and partial osteocyte death Frank bone necrosis and early osteoblast
response
Early bone repair and inc bone density ate repair and distortion of the femoral head
Subchondral fragmentation and articular
breakdown
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Fracture
!isruption in the integrity of the living bone"involving in#ury to the bone marrow" periosteumand ad#acent soft tissue$
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Etiology
%ccurs when force applied to the bone e&ceedsthe strength of the involved bone
Intrinsic Factors:
' (one)s energy absorbing capacity
' *odulus elasticity' Strength
' !ensity
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Extrinsic Factors:
' +ate of load' !uration" !irection and *agnitude of force
Direct Trauma:
' ,rushing" Penetrating -n#uries
Indirect Trauma:
' .raction" ,ompression" +otational Forces
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General Principle of Fracture Healing
Ade/uate (lood Supply
*inimal 0ecrosisAnatomic +eduction
-mmobili1ation
Physiologic Stress
Absence of -nfection
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Fracture Complication
(one 2ealing Abnormalities3
' !elayed 4nion 5 678 months after in#ury' 0on74nion 7 9 : months after in#ury
' *alunion 5 4nacceptable Position
' Avascular 0ecrosis
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Hip Fractures
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2ip fracture is an emergency situation$
-ntertrochanteric fracture and femoral neckfracture accounts ;below lessertrochanter? accounts @= 7
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Categories
-ntracapsular
'ocated distal to the femoral head but pro&imal to thegreater and lesser trochanter s$
' Fre/uently disrupts the blood supply to the femoralhead" therefore associated with nonunion and
osteonecrosis of the femoral head$>eg$ Femoral neck fracture?
E&tracapsular
>eg$ .rochanteric Fracture?
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Femoral Neck Fracture
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Epidemiology
*ore than B@96< years?
Dounger p& 3 high7energy trauma elderly >Byrs?3 low7energy falls
-ncidence of femoral neck f& in 4S is :6$6 andB$ per
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Ris Factors Female se&
Ghite race
-ncreasing age
Poor health
.obacco and alcohol use Previous fracture
Fall history
ow estrogen level
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AnatomyHip Joint
ball and socket #t$
,omposed of femoral head Hthe acetabulum
2as 6 deg$ of freedom
Geight bearing #t$
Femoral epiphysis closes byage of : yrs
Neck-shaft angle3 6
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!igaments
-liofemoral
' D7ligament of (igelow >ant$? Pubofemoral
' anterior
-schiofemoral
' posterior
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"lood #upplyTrochanteric nastamosis
Provides the main blood supply to the head of the femur
0utrient arteries pass along the femoral neck beneath thecapsule
!arts:
Superior gluteal artery -nferior gluteal artery
*edial femoral circumfle& artery
ateral femoral circumfle& artery
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Mechanism of $n%ury
"o#-energ$ trauma >most common inelderly?
' Direct
' A fall onto the greater trochanter >valgus impaction? orforced e&ternal rotation of the E
' Indirect
' *uscle forces overwhelm the strength of the femoralneck
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High-energ$ Trauma
' both younger and older patients
Eg$ *KA or fall from a significant ht$ >osteoporoticp&?
%$clical "oading-stress Fractures
' .hese are seen in athletes" military recruits" ballet
dancers
' P& with osteoporosis and osteopenia are at particularrisk
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Clinical Evaluation P& with displaced femoral neck fractures typically are
non7ambulatory on presentation" with shortening
and e&ternal rotation$
P& with impacted or stress f& may demonstrate subtlefindings$
Pain on attempted +%* of the hip Pain on a&ial compression and tenderness to
palpation of the groin
ook for additional problems
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Classification
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JOINT REPLACEMENT
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Purpose
+elieve of severe disabling pain
,orrect deformities +e7establish function
Prevent meliorate painful secondary effects on
ad#acent #oints
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!imitations
!islocation >post Approach?
-nfection >most fatal? !K.
Periprothetic fracture
oosening
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Common causes of &oint 'estruction
%A
+AAK0
.raumatic Arthritis
egg7,alve7Perthes !se
Slipped capital femoral epiphysis
And failed Previous operation
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Contraindications&solute 'elative
Active sepsis >local or
systemic?
Paralysis about the #oint to bereplaced
0euro pathic Jt disease
Dounger age and obesity
Severe muscle weakness
Severe osteoporosis
Severe uncorrected defectsabout the #oint
Physiological or psychological
deficiencies and proportion
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(ypes
.otal
' (oth sides of the #oint are replaced Partial
' %nly one side is replaced
-nterpositional
+esectional
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Methods of Fi)ation
Polymethylmethacrylate >bone cement?
Porous coated7bony ingrowth 2ydro&yapatite coating
Press7fit stabili1ation
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"earing #urface *etal7on7metal
,eramic7on7ceramic Polyethylene
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Complications .hromboembolic !isease
Prophyla&is' *echanical3 elevation of the limb early
mobili1ation" compression stockings
Aseptic oosening' P& usually complains of pain in the groin or
buttocks or thigh
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Pre*operative Education *uscle Strengthening
Strengthening muscles around the #oint operatedeither by isometrics" isotonic or isokinetic
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Post*op Reha+ilitation Program
(oal:to ma&imi1e the p&)s f&n)l statuswithrespect to mobility" A! and also to minimi1e
post7operative complications
,emented
' -mmediate G(
0on7cemented
' .oe touch for si& wks
' PG( ne&t : wks
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First day
' P& can stand at bedsite if possible
' (egin ambulating with assistive device
Second day
' ambulation should begin transfers to bed" chairand toilet alone safely
Second week
' Perform mobility task at supervision level Si&th week
' *uscle strengthening e&ercise
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Precautions 0o fle&ion the hip past ;