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Arthroplasty by Mind Map: Arthroplasty

1. Upper limb

2. Lower limb

2.1. Hip

2.1.1. Bipolar hip Fractures - elderly No acetabulum replacement shorter operation time less blood loss lower dislocation lower embolism risk lower cost Lower friction PE (polyethylene) - ball & acetabulum to prevent wear and pain f.e. tapered 'exeter hip' implants gets pushed into the bone during load which gives it a long survival time

2.1.2. Birmingham hip - resurfacing Bone sparing Original leg lengt revision reserve Large head 'natural' low dislocation risk (0,3%) large ROM more 'natural motion' Bearing surface metal on metal Co Cr no PE wear particles increased blood level metal ions

2.1.3. Surgical approach Anterior to place implant, hip is dislocated by exorotation NO leg crossing! Posterior isn't used as much Dislocated by rotating the leg: no natural movement, but don't let patients cross legs Lateral same as anterior, most of the time because you can't cross trough muscles Scar tissue Needs 6 weeks to heal After 6w: shoud have force back, chance of dislocation decrease

2.1.4. Consolidation osteotomy (PSOS) at least 6w non-weight bearing

2.1.5. Risks (1%) Infection (glycocalix) Loosening Persisting pain Mortality (embolism) Instability (luxation) Material failure Fracture

2.1.6. Survival rates 50-95% after 30y

2.1.7. Hip (des)artrodesis surgical immobilization of a joint by fusion of the bones Risks Dislocation Infection Loosening Pain Feasability?

2.1.8. Take home message artificial joint It'll never be the same joint as it was once before Patient can use it Do NOT manipulate Soft tissue envelope is weak Risk of dislocation Active functional rehabilitation NOT passive/manipulation Communication with the surgeon! Weight bearing policy Dislocation risk

2.2. Knee

2.2.1. Alignement Mechanic - anatomic axis Recurvatum Rotation Hip/ankle PF alignement - Q angle

2.2.2. Isolated lesions Trauma OCD = osteochondritis dissecans Young patient

2.2.3. Surgical repair Debridement Ice-picking Cartilage transplantation Chondrocyte culture

2.2.4. Degenerative Unicompartimental Varus - valgus

2.2.5. Gonarthritis Uni-bi-tricompartimental Knee arthroplasty

2.2.6. Knee arthroplasty Approach Tissue sparing Tendon/liganent lesions Osteotomy Fracture

2.2.7. Survival rate TKA 90% 10y 70% 20y Revision survival 85% 10y

2.2.8. Take home message TKA rehab = soft tissue Long period: 1y! Active rehab preferable Manipulations within pain limits Soft tissue envelop is key Fibrosis Redness Swelling Above is normal Active functional rehab Limited passive/manipulation! Regain flexion-extension postures Communication with the surgeon Weight bearing policy Instability risks

2.3. Ankle and foot

2.3.1. Ankle arthritis Tibiotalar Arthroscopy Artrodesis: handicap Arthroplasty implant Subtalar: triple artrodesis Calcaneum - talus - naviculare - cuboideum Arthritis/deformity (correction) Loss eversion/inversion Compromised before surgery Intact flexion/extension

2.3.2. Postoperative ankle arthroplasty Weight bearing within POP Risk instability/loosening After 6w, active extenion/flexion rehab

2.3.3. Small joints More frequent athrodesis/resection arthroplasty Swanson implant used as implant in the big toe These approaches are impractical and the long term survival isn’t known.

2.4. Conclusion

2.4.1. Arthroplasty design - option and indications Available anatomy Desirable biomechanics and kinematics Motion - stability - survival... and NO pain

2.4.2. Technique variety - impact on rehab Resurfacing Constraint - linkage Cementing Surgical approach Ligamentous/bony reconstruction

2.4.3. Remember: it's an artificial joint!

2.4.4. Key to succes: knowledge and communication

2.4.5. talk to patient! What are the risks, what is the impact on rehab! Communicate with surgeon!