TSA Technique
Goal
- head that translates 50% in all directions
- allows 30o ER with arm at side
- stable posteriorly
Pre-Op
- antibiotics
- consider specific Propionobacterium cover
- head that translates 50% in all directions
- allows 30o ER with arm at side
- stable posteriorly
- antibiotics
- consider specific Propionobacterium cover
Always use the most lateral scar
- blood supply comes from medial aspect
- want to avoid a large lateral flap of dubious quality
- cross transverse scars at 90o
- minimum 7 cm skin bridge
Options
- can do trial / sham incision down to capsule
CT / quantify bone loss
X match 4 units
Cell saver
Anaesthetic review
Bone graft (cortical, cancellous)
Component removal gear
- extraction gear for femur / liners
- cement removers for cemented femur
- curved osteotomes for cemented cup
- X-plant for uncemented cup
Revision long stem femoral implants
Revision acetabular implants including cages
RA
- very good results
- 97% 10 year survival Coonrad-Morrey prosthesis
Other Dx
- OA / post-traumatic arthritis / nonunion
- tend to have worse survival than RA
Haemophilia
- elbow joint commonly involved
- 90% of haemophiliacs
Acute unreconstructable fracture > 60
A valgus knee has a tibiofemoral angle of > 10o
Inflammatory
- RA