complications

Issues

Femur

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

Acetabulum

Dysplasia often present

- not as severe as in DDH

LLD

Can be significant

Abductors

Have been short for long time

- difficult to restore length

Definition

Device that encircles a limb to occlude the vascular supply

Aim is to provide bloodless field

Contra-Indications

Local

- poor skin

- PVD

- DVT

- vascular bypass surgery

General

- sickle cell anaemia

Goal

Ultimate goal of blood management is to AVOID allogenic blood transfusion

Problems

Increased infection rate

- demonstrated in THR

- decreased killer T cells

Increased risk disease transmission

Increased risk transfusion reaction

Increased post-op fever and antibiotic requirements

Increased cost

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

- may need to release  check rein ligaments / accessory collateral ligaments

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

1.  Infection

Peters et al J Arthroplasty 2009

Options

1. Always resurface

2. Never resurface

3. Selectively resurface

Decision Making

Controversial

- literature divided on issue

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

Aim

UKA is intended to be load sharing

- correct to neutral or slight varus

HTO is a load-shifting / load-sparing procedure

- over correct into valgus

UKA v TKR

Advantages UKA

1.  Rapid rehabilation

Undercorrection /  loss of correction 

Most important factor in good results and duration of results

- must correct to 8^o of valgus

- mechanical axis must pass through lateral joint line

Causes

- inadequate initial correction

Epidemiology

Usually young patients

- 15 - 40

15% compound

Aetiology

High velocity injury

- MBA

- MVA

- pedestrian v car

- fall from height

Emergency Managment

EMST principles

- need for transfusion not uncommon