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37 visible knowledge nodes in arthroplasty
Revision TKA — Indications & Techniques
Common indications: aseptic loosening, PJI, instability, stiffness, polyethylene wear, periprosthetic fracture, malalignment. Workup: exclude infection (ESR/CRP ± aspiration); quantify bone loss (AORI). Reconstruction: restore joint line, balance gaps; use stems, augments, cones; match constraint to ligament competence. Constraint ladder: PS → CCK → hinge; use minimum needed. Outcomes depend on accurate diagnosis and restoration of alignment/rotation/soft-tissue balance.
Open topicRobotic-Assisted Joint Replacement — Current Evidence
Robotics assists bone preparation and implant positioning (mostly semi-active systems). Potential: improved accuracy, reproducibility, individualized alignment strategies. Limitations: cost, time, learning curve; uncertain long-term functional advantage. Evidence: improved radiographic accuracy; PROMs and survivorship similar in short- to mid-term. Use case: complex deformity, kinematic alignment strategies, teaching environments.
Open topicShoulder Arthroplasty — Indications
Hemiarthroplasty: isolated humeral head disease (e.g., AVN, head-splitting fracture). Anatomic TSA: primary OA, RA, post-traumatic arthritis with intact rotator cuff. Reverse TSA: cuff tear arthropathy, pseudoparalysis, failed TSA. Contraindications: active infection, absent deltoid (RSA). Choice depends on cuff integrity, bone stock, patient age/activity.
Open topicTotal Elbow Arthroplasty — Indications & Outcomes
Indications: rheumatoid arthritis, post-traumatic arthritis, complex distal humerus fractures in elderly, tumor resection. Implant types: linked (semi-constrained), unlinked (requires intact ligaments), convertible designs. Linked implants provide stability but ↑ stress at bone-cement interface; unlinked mimic anatomy but require ligamentous integrity. Complications: loosening, infection, triceps insufficiency, periprosthetic fracture, ulnar nerve palsy. Survivorship: 85–90% at 10 yea...
Open topicTotal Hip Arthroplasty (THA) — Approaches & Complications
Surgical approaches: posterior, anterolateral, direct anterior, transtrochanteric. Posterior: excellent exposure, preserves abductors, higher dislocation risk. Anterolateral: stable, lower dislocation, abductor weakness risk. Direct anterior: internervous, muscle-sparing, early rehab, risk of LFCN injury, intra-op fracture. Transtrochanteric: trochanteric osteotomy, good exposure, risk of nonunion. Complications: dislocation, infection, aseptic loosening, periprosthetic fractures, nerve injury,...
Open topicTotal Hip Arthroplasty (THA) — Indications & Outcomes
Indications: end-stage hip OA, AVN, RA, ankylosing spondylitis, fracture neck femur (elderly). Contraindications: active infection, severe medical comorbidity, poor bone stock without reconstruction option. Implants: cemented, uncemented, hybrid, resurfacing. Approaches: posterior, lateral, anterior; each with pros/cons. Outcomes: >90% pain relief, implant survival >90% at 15–20 years.
Open topicTotal Knee Arthroplasty (TKA) — Implant Designs
Implants classified by degree of constraint: CR (least) → PS → CCK → Hinged (most). CR retains PCL; PS substitutes with cam-post. Constrained implants indicated for instability or major deformity. Mobile-bearing vs fixed-bearing — theoretical wear reduction, but long-term benefit unclear. Principle: use minimum constraint required.
Open topicTotal Knee Arthroplasty (TKA) — Indications & Outcomes
Indications: end-stage OA, RA, post-traumatic arthritis with pain and disability. Contraindications: active infection, severe vascular disease, extensor mechanism dysfunction. Implants: cruciate-retaining, posterior-stabilized, constrained, hinged. Outcomes: >90% pain relief, implant survival ~90% at 15 years. Complications: infection, loosening, instability, stiffness, thromboembolism.
Open topicUnicompartmental Knee Arthroplasty (UKA)
Indicated in isolated medial/lateral compartment OA with intact ligaments. Advantages: smaller incision, bone preservation, faster rehab, more natural kinematics. Contraindications: inflammatory arthritis, tricompartmental OA, fixed deformity >10° varus/valgus, flexion contracture >15°, ligament deficiency. Survivorship improving with better implants and patient selection. Revision to TKA possible if progression occurs.
Open topicUnicompartmental Knee Arthroplasty (UKA) — Indications & Outcomes
Indications: isolated unicompartmental OA with intact ligaments and correctable deformity. Contraindications: inflammatory arthritis, fixed deformity, ACL deficiency. Advantages: smaller incision, faster recovery, more natural kinematics. Outcomes: pain relief and function good in selected patients; 10–15 year survival ~80–90%. Conversion to TKA may be needed if progression of arthritis occurs.
Open topicUnicompartmental Knee Arthroplasty vs High Tibial Osteotomy (HTO)
Both indicated for isolated medial compartment OA in younger active patients. HTO: joint-preserving, shifts weight-bearing axis, delays arthroplasty. UKA: joint-replacing, preserves kinematics, faster recovery. HTO better for younger, high-demand, ligament-intact; UKA better for older, lower-demand. Revision: UKA easier conversion to TKA than failed HTO.
Open topicUnicompartmental vs Total Knee Arthroplasty — Indications & Outcomes
UKA: isolated compartment OA, intact ACL/collaterals, correctible deformity; faster recovery, more natural kinematics. TKA: multicompartment disease, inflammatory arthritis, significant deformity/instability; durable outcomes. UKA risks: OA progression, bearing dislocation (mobile), higher revision if selection poor. TKA risks: PF complications, stiffness; less normal kinematics. Choice individualized by age, activity, alignment, expectations.
Open topicWrist Arthrodesis vs Arthroplasty
Wrist arthrodesis: gold standard for pain relief in advanced wrist arthritis; provides stability but sacrifices motion. Wrist arthroplasty: motion-preserving alternative for low-demand elderly RA patients. Indications differ: fusion for high-demand/younger, arthroplasty for low-demand/RA. Arthroplasty complications: loosening, implant failure, dislocation. Fusion complications: nonunion, hardware issues, loss of function in high-demand tasks.
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