infection

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

 

Painful THA

Aetiology

 

Intrinsic

 

Infection

 

Loosening

 

Thigh pain in uncemented

- micro motion at distal end of stem

- modulus mismatch

 

Stress fracture / insufficiency fracture

- pubic rami, sacral

 

Intra-operative fracture

 

Prosthesis failure

 

Subtle instability

 

Extrinsic

Infection

Risk factors

 

Patient 

 

Advanced age

Immunosuppression - steroids / Rheumatoid / DM

Malnutrition - Lymphocyte count / Transferrin / Albumin

Vascular disease

Obesity

Poor skin i.e. psoriasis

Previous infection in joint

Infection elsewhere - i.e. UTi

Prolonged hospital admission

Revision surgery

 

Operative Factors

 

Preoperative

Sesamoids

Anatomy

 

3 Sesamoids may be present in great toe

- 2 almost always present on plantar aspect of MTPJ

- 1 may be present on plantar aspect of IPJ

 

MTPJ sesamoids most important

- embedded in FHB tendons

- held together by intersesamoid ligament & plantar plate

- each side of crista / inter-sesamoid ridge

- articulate with plantar facets of 1st MT

 

Tibial usually larger than fibula