indications

Background

 total shoulder arthroplast allPoly Glenoid

 

Indications

 

RA 

OA 

AVN 

 

Contra-indications

 

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

 

Platelet Rich Plasma

Definition

 

Platelet rich plasma

 

Concept

 

2 main components

 

1.  Platelets

- contain PDGF, TGF, VEGF

 

2.  Growth factors

- ILGF

- FGF

 

Formed from the separation of whole blood into plasma and RBC

- separation usually achieved with centrifugation

 

Platelet concentration

Background

Indications

 

OA

Prevention OA i.e SUFE / Perthes / DDH

Deformity

Non union

Coxa Vara

 

OA

 

Rationale

 

Most OA is secondary to pre-existing disease 

- predisposes to articular cartilage failure

- failure of cartilage can be halted by decrease in load

- osteotomy corrects the underlying deformity

 

Pain relief achieved by

Displaced Arthroplasty

Indications

 

Patient > 70

 

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

 

Options

 

Hemiarthroplasty

- unipolar monoblock

- unipolar modular

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 

Stems

Advantage

 

1.  Reduce implant loosening

- offset load sharing to diaphysis

- 30% if > 70 mm

 

2. Restore optimal alignment

 

Indications

 

1.  Using augments or bone grafting

 

2.  Increased constraint 

- VVS / hinge

 

Planning

IndicationsRevision TKR

 

Aseptic loosening

Infection

Instability

Wear & breakage components

Fracture

Stiffness 

Pain

 

Aims

 

Restoration of anatomical alignment

Restoration of joint line

Restoration of bone stock

Navigation

Aim

 

Attempt to reduce outliers in all 3 planes of the knee

- improve alignment

- theoretically improve survival and outcomes

 

TKR Valgus Femoral Implant Non Navigated

 

Types

 

Image based

 

Pre-op CT

- uncommon

- resource heavy