By Thomas P. Sculco MD, Moe R. Lim MD, Andrew D. Pearle MD, Anil S. Ranawat MD
With counsel from one of many world’s prime hospitals!
Hospital for specified surgical procedure Orthopaedic Manual
Created through citizens and attending physicians at New York's health center for distinctive surgical procedure, this guide is a pragmatic, concise, reference for orthopaedic residents. The book’s content material is drawn from clinic for specific surgical procedure residency lectures, attendings' educating issues, and top textbooks and magazine articles.
This dynamic surgical handbook includes…
- Rotation-based organization—including general/basic technology, arthroplasty, fractures, pediatrics, tumors, activities, backbone, foot and ankle, and hand—delivers need-to-know info in a structure that’s effortless to navigate.
- Authoritative views from clinicians at one of many major orthopaedic courses within the usa allow you to enjoy the adventure of across the world acclaimed practitioners.
- Abundant images and illustrations make clear either particular pathologic beneficial properties and surgical techniques.
- User-friendly layout lets you entry crucial info quickly.
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Additional info for Hospital for Special Surgery Orthopaedics Manual
C) 2015 Wolters Kluwer. All Rights Reserved. , 2006) – Failure by poly wear and progressive DJD in other compartments – Conversion to TKA is difficult and results are worse due to bone deficiencies in medial compartment, also will need PS for conversion, results are better – Advantages—in middle-aged patients: better success rate than HTO, fewer complications, better cosmetic limb alignment than valgus; in elderly patients: faster recovery, less medical morbidity, shorter hospitalization, and cheaper implants – Role of mini-Uni (Romanowski & Repicci, 2002); Romanowski and Repicci also champion for pure poly tibial component for medial side versus modular components for lateral tibial plateau.
Medial meniscus is “C” shaped and fixed; lateral is “O” shaped and mobile. Tibial tubercle—oblong anterior elevation for patella ligament; Gerdy tubercle is iliotibial band (ITB) insertion laterally – Femur: MFC is larger, prominent medial epicondyle supports adductor tubercle, lateral femoral condyle (LFC) is raised and longer. Note: Anatomical TKA designs take LFC in consideration but more expensive versus universal components (c) 2015 Wolters Kluwer. All Rights Reserved. CHAPTER 1 Normal alignment Genu varum ARTHROPLASTY 33 Genu valgum Knee deformities: normal alignment, genu varum, genu valgum.
C) 2015 Wolters Kluwer. All Rights Reserved. CHAPTER 1 ARTHROPLASTY 29 An example of a polished collarless cemented stem (A: Exeter stem, Stryker, Mahwah, NJ From Callaghan JJ, et al. The Adult Hip. Philadelphia: Lippincott Williams & Wilkins, 1998) and a cemented stem with collar (B: Accolade C stem, Stryker, Mahwah, NJ) Operative Technique – Cobalt-chrome (CoCr) is metal of choice for cemented stem – Mantle should be >2 mm – Avoid mantle defects – Center stem within mantle (may use centralizer) – Distal plugging 2–3 cm distal to component tip; this maintains adequate cement pressurization and equalizes distance – No reaming – Pressurized lavage to decrease embolism and prevent intrusion – Varus orientation can lead to aseptic loosening – Sterilization via irradiation favors cross-linking, which improves resistance to wear, but in presence of oxygen promotes oxidation, which is detrimental – Cross-linking also reduces Young’s modulus, yield strength, and fracture toughness – Oxidation causes molecular chain scission, leading to accelerated wear and failure – Sterilization via gas plasma and ethylene oxide has no effect on cross-linking – Use of HCLPE is now the standard of care – New Antioxidant HIGHLY CROSSLINKED polyethylene, Vitamin E enhanced Alternate Bearing Surfaces BEARING SURFACES Combinations Traditional – “Hard on soft” cobalt or titanium on polyethylene cup – Titanium should be avoided due to increased thirdbody debris – Wear related to roughness of surface Polyethylene Biomechanics – Ultra-high-molecular-weight polyethylene (UHMWPE) – Avoid calcium stearate; it decreases strength of UHMWPE Ceramic on Highly Crosslinked Polyethylene (HCLPE) – Aluminum oxide first used—brittle – Zirconium oxide introduced later – Tribologic properties: more lubrication, less friction, less wear – Inert due to highly oxidized states and does not release ions – Several studies have shown better survivorship and lower wear of ceramic, especially with modern highly cross linked poly – Newer ceramic composites are more scratch resistance and lower fracture – Ceramic head fracture associated with: – Vertical cup—high stress at rim – Small ceramic head—high focal contact stress (c) 2015 Wolters Kluwer.