By Daniel J. Berry MD, Scott P. Steinmann MD, Paul Tornetta III MD, Thomas A. Einhorn MD
Written via top specialists from the Mayo health center, this quantity of our Orthopaedic surgical procedure necessities Series offers the entire info citizens want on hip, knee, shoulder, and elbow reconstruction in adults. it may well simply be learn disguise to hide in the course of a rotation or used for fast reference sooner than a sufferer workup or operation. The elementary, visually stimulating layout positive aspects abundant illustrations, algorithms, bulleted lists, charts, and tables.
Coverage of every area contains actual evaluate and imaging, overview and remedy of issues, and operative therapy tools. The huge assurance of operative remedy contains fundamental and revision arthroplasty and choices to arthroplasty.
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S PA N G E H L Osteoarthritis and inflammatory arthritis are the most frequently encountered diseases in orthopaedics. They are the leading causes of joint disease in the hip, resulting in joint destruction, and often in the need for hip replacement. Symptomatic osteoarthritis of the hip is prevalent in 3% to 5% of the adult white population. Radiographic evidence of osteoarthritis is more common (9% to 10%), indicating that roughly half of the patients with some radiographic evidence of osteoarthritis are asymptomatic.
Recently, new imaging protocols have allowed for less artifact and more accurate depiction of soft tissue and bone around the prosthesis. One area where this technology may prove particularly useful is in the early detection and assessment of periprosthetic osteolysis. Preliminary data suggests that metal suppression MRI techniques may be more sensitive and specific than plain radiographs in determining the presence and volume of periprosthetic osteolysis. NUCLEAR IMAGING Nuclear imaging studies (bone scintigraphy) remain useful tools for detecting areas for abnormal metabolic activity in Figure 2-20 MRI arthrography of the hip demonstrating anterior labral tear.
Additionally, in most circumstances, lower extremity surgery should be planned prior to upper extremity surgery and hip replacement prior to knee replacement when both are needed. It is more difficult for the patient to regain knee motion if there is significant hip disease. , methotrexate, TNF-α antagonists). The use of these before surgery should be reduced if possible or temporarily discontinued. This is particularly true for TNF-α antagonists, which are potent immune suppressors; continued use during the perioperative period may increase the risk of infection.