Courtesy: Dr T Vail, Ashok Shyam TV, Ortho 1?? Evaluation of Labral Pathology and Femoroacetabular Impingement Patient Counseling and Expectations When evaluating patients with: Labral tears Femoroacetabular impingement Key counseling points include: Recovery Timeline Simple labral debridement: Recovery approximately 6 weeks. Extensive impingement correction (cam/pincer correction, labral repair): Recovery 4 to 6 months. Recovery after […]
Hip Imaging Radiograph and MRI
Courtesy: Dr T Vail, Ashok Shyam TV, Ortho Why Hip Imaging Matters Imaging plays a critical role in: Understanding hip biomechanics Planning hip reconstruction procedures Identifying intra-articular pathology Direct visualization (e.g., arthroscopy) highlights how challenging it can be to detect subtle pathology using imaging alone. Each modality (plain radiographs, MRI) has specific strengths and limitations. […]
Cementless THR
Courtesy: Dr D Padgett, Ashok Shyam TV, Ortho Limitations of Cemented Fixation Cement fatigue fractures may: Lead to implant loosening Contribute to particle-induced osteolysis Certain patient groups historically performed poorly with cemented fixation: Heavy, highly active males Ideal goal: Direct bone–implant fixation Avoidance of an intermediary cement layer Elimination of a second mechanical interface Biologic […]
Current Trends in Hemi Arthroplasty
Courtesy: Dr Suryanaraya, Ashok Shyam TV, Ortho Hemiarthroplasty vs Total Hip Arthroplasty in the Elderly Ongoing debate in displaced femoral neck fractures: Internal fixation vs hemiarthroplasty vs THA. Considerations: Functional outcome Morbidity and mortality Revision risk Historical Failures of Early Hemiarthroplasty Primary Causes of Early Failure Metallurgical failure Fixation failure Cartilage degeneration over time Design-Related […]
Hip-Alternate Bearing Ceramic
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho
Osteolysis in TKR
Courtesy: Dr Ranawat, Ashok Shyam TV, Ortho Background Osteolysis remains a significant long-term complication in total knee arthroplasty (TKA). Strongly associated with: Polyethylene wear debris Modular implant designs Historically uncommon in: Fixed-bearing, monoblock all-polyethylene tibial components. Historical Perspective All-Polyethylene Fixed-Bearing Knees Single-unit tibial component. Long-term data (up to 20+ years): Minimal to no osteolysis reported. […]
Painful and Stiff Knee
Courtesy: Dr T Vail, Ashok Shyam TV, Ortho Overview TKA is successful in ~95% of patients. The remaining 2–5%: Experience pain, stiffness, or dissatisfaction. Often consume a disproportionate amount of clinical time. Typical scenario: Radiographs appear normal. Patient reports the knee “just doesn’t feel right.” Clinical Presentation Patients may report: Stiffness Swelling Limited flexion […]
Mobile Bearing TKR
Courtesy: Dr Maniar, Ashok Shyam TV, Ortho Why Consider a Mobile-Bearing Knee? Primary concern: Polyethylene wear: At the articular surface At the undersurface (backside wear) Fixed-bearing knees have demonstrated: Significant articular wear. Undersurface micromotion leading to wear debris. Associated osteolysis and revision in mid-term follow-up. Problem 1: Articular Surface Wear Contact Stress Principle Contact stress […]
Cruciate Retaining TKR
Courtesy: Dr A Reddy, Ashok Shyam TV, Ortho Introduction Focus: Cruciate-retaining (CR) total knee arthroplasty. Personal practice preference: ~99% of primary TKAs performed as CR knees. Used even in severe deformities. Transition from posterior-stabilized (PS) to CR: Smaller knee sizes. Thinner femoral condyles. Concerns regarding box cuts in smaller bone stock. Why Choose Cruciate Retaining? […]
Early TKR Failure-Common Mistake
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Foundational Premise We can always improve surgical outcomes. Most complications occur because of preventable errors. Understanding common technical mistakes helps reduce failures. Common Causes of Surgical Errors 1. Poor Exposure Limited visualization leads to “guesswork.” Small-incision approaches may: Compromise rotational alignment. Leave retained cement (especially posterolateral corner). […]
Arthrofibrosis
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Introduction Arthrofibrosis is an uncommon but frustrating complication after total knee arthroplasty (TKA). Incidence: < 2% following primary TKA. Defined as: Functional impairment with restricted knee motion. Important distinction: Not all stiff knees are arthrofibrotic. Definition of a Stiff Knee Knee flexion < 75° generally considered stiff. […]
Advances & Techniques in Joint Replacement Surgery
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Case 1: Young, Active Patient with Varus & Flexion Deformity Patient Profile Age: 56 years Weight: 250 lbs Long-standing post-traumatic deformity 15° varus + 15° flexion contracture Previously active tennis player Key Considerations Young, high-demand patient. Long life expectancy ? risk of polyethylene wear. Need durable fixation. […]
Radiographic Criteria for Optimum TKR
Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Don’t Forget Pre-Operative Evaluation Before analyzing a painful postoperative knee, always revisit: Was TKA truly indicated? Was there clear bone-on-bone osteoarthritis? Could pain have originated elsewhere (e.g., hip)? Key Clinical Lesson Mild radiographic knee arthritis + severe hip arthritis ? knee replacement will not solve the pain. […]
Prevention of Infection in TKR
Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Why This Matters Incidence of infection after TKA: ~1% to 2.5%. Devastating complication: Severe patient morbidity. Surgeon burden. High healthcare cost. Prevention requires a multifactorial strategy: Patient factors Intraoperative factors Postoperative factors 1 Patient-Related Risk Factors Some modifiable, some not. Gender Large registry data (e.g., Finnish arthroplasty […]
Correction of Flexion Contracture in TKR
Courtesy: Dr S Macdonald, Ashok Shyam, Ortho TV Flexion contracture is frequently encountered in advanced osteoarthritis—particularly in populations presenting late. It significantly affects gait mechanics and functional recovery. Why It Matters Flexion contracture increases quadriceps workload. Bilateral 30° contractures ? ~50% increase in quadriceps effort. Leads to: Energy-inefficient gait Reduced walking endurance Poor postoperative satisfaction […]