Term
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Definition
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Term
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Definition
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Term
|
Definition
| knobs/bulbs on the end of the bone. ex) femoral condyles |
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Term
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Definition
| surface of tibia femoral condyles articulate with |
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Term
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Definition
| spongy bone, near ends of bone, allows redirection of forces into bone shaft |
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Term
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Definition
| hard, sturdy, dense bone, in bone shaft, allows for support |
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Term
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Definition
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Term
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Definition
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Term
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Definition
end of the bone -
ends transfer load from different directions, then towards the middle.
more yield at the ends, can compress more before failure |
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Term
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Definition
middle of the bone -
made of cortical/compact bone |
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Term
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Definition
bone grows outward in from here - fuses after puberty
growth plate offers least resistance, common to fracture here |
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Term
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Definition
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Term
| three compartments of knee joint |
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Definition
| medial femoral, lateral femoral, patellar |
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Term
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Definition
| tibio femoral joint, patello femoral joint |
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Term
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Definition
| load bearing bone interaction |
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Term
| meniscus, articular cartilage |
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Definition
lines the joints, limits friction and creates deeper sockets, cushions and stabilizes
lowers coefficient of friction to 0.001
energy expended creates motion instead of overcome friction |
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Term
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Definition
| embedded in patellar tendon |
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Term
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Definition
| muscles, tendons, structures that move and stabilize joint |
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Term
| static stabilizers - knee |
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Definition
ligaments. ACL, PCL, LCL, MCL
(anterior, posterior, lateral, and medial cruciate ligaments) |
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Term
| fibrocartilagenous joint sac |
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Definition
| sac of fluid around knee joint filled with fluidand seals to lubricant joint |
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Term
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Definition
| fluid that fills sacs around joints |
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Term
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Definition
| plant and turn injury, rupture of synovial sac |
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Term
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Definition
| shave rough cartilage off to create a smooth surface once more |
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Term
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Definition
| 6 total - three axes, translation and rotation about each |
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Term
| how many degrees of freedom does the knee have? |
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Definition
| 6 degrees of freedom. 3 active, 3 passive, and one mostly |
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Term
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Definition
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Term
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Definition
| wear out of cartilage, rubbing of bone (non inflammatory) |
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Term
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Definition
| autoimmune, inflammatory response against body's own cartilage |
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Term
| two cause of osteoarthritis |
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Definition
idiopathic - onset by age
post traumatic - caused by injury
mechanical load misalignment |
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Term
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Definition
bones start to rub
bony spur creation
ligaments weaken from lesser load (mechanical misalignment)
muscle atrophy from no use |
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Term
| which is more common? hip or knee arthitis? |
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Definition
| knee - 80% over 75 years old |
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Term
| why is knee arthitis more common in women after 55? |
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Definition
| menopause and hormonal changes |
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Term
| risk factors of osteoarthritis |
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Definition
increasing age
obesity
gender - female
trauma
infection
repetitive occupational trauma |
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Term
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Definition
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Term
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Definition
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Term
| non pharmacological therapy (5) |
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Definition
patient education
use of assistive devices
weight loss
physical therapy
occupational therapy |
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|
Term
| pharmacological therapy (4) |
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Definition
NSAIDS (non steroidal anti inflammatory drugs)
glucosamine sulfate
intra articular corticosteroids
intra articular hyaluronic acid |
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|
Term
| disadvantages of steroid shots |
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Definition
affect how condocytes are produced (main building block of cartilage)
disrupts the capsule |
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Term
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Definition
| remove wedge from tibia to realign the mechanical loading of the joint (altered due to arthitis) |
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Term
| conditions needed for osteotomy |
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Definition
| 60yo or younger, 90 degrees of motion before surgery |
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Term
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Definition
unicompartental replacement (one condyle and part of the tibial plateau)
done with critical trauma - younger patient |
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Term
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Definition
| replace both condyles and entire tibial plateau |
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Term
| unconstrained knee implants (3) |
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Definition
cruciate retaining/sparing
cruciate subsituting (posterior stabilized - PS knee)
Mobile bearing prosthesis (rotating platform implant) |
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Term
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Definition
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Term
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Definition
| device pulling away/separating from the bone |
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Term
| most popular knee implant |
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Definition
| PS - posterior stabilized |
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Term
| mobile bearing prosthesis - success or failure? |
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Definition
| failure - allowed unnecessary movement - failure rate actually INCREASED |
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Term
| constrained knee implant - when is it recommended? |
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Definition
| when muscle strength is not there, compensates for lack of dynamic constraint |
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Term
| lifespan of knee replacement |
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Definition
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Term
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Definition
stainless steel
cobalt-chromium alloys
titanium alloys
tantalum (trabecular metal)
zirconium alloy
UHMWPE |
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Term
|
Definition
| ultra high molecular weight polyethylene |
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Term
| metal on metal disadvantage |
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Definition
wear debris into bloodstream, not healthy
loosening, breakage, fracture, pain, stiffness, instability |
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Term
| cemented vs uncemented TKR |
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Definition
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Term
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Definition
| PMMA - polymethylmethacrylate |
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Term
| cementless encourages what? |
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Definition
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Term
| downsides to cementless fixation |
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Definition
low bone density
longer healing time
not popular in practice |
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Term
| differences between cement and cementless devices |
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Definition
cement smooth
cementless: textured, holes through femoral component |
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Term
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Definition
femoral component fixated without cement
tibial and patellar components are inserted with cement |
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Term
| downsides to cement fixation |
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Definition
| if replacement surgery is needed, cement must be chiseled out |
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Term
| most successful material combination? |
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Definition
metal on plastic
femoral component metal
tibial component plastic |
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Term
| change in knee axis orientation is due to what? |
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Definition
| difference in size of lateral and medial femoral condyles |
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Term
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Definition
| axis changes as the joint rotates |
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Term
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Definition
| radius of circle created by rotation path at any specific moment (will vary due to polycentricity) |
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Term
| screw-home mechanism of the knee |
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Definition
last 20 degrees of extension, knee goes into external rotation and locks
geometric congruity in flexion, after first 15-20 degrees, knee unlocks |
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Term
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Definition
cobalt-chrome alloy femoral component
cobalt-chrome alloy/titanium tibial tray
UHMWPE tibial bearing component
UHMWPE patella component |
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Term
| robotic knee surgery benefits |
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Definition
| accuracy, personalized replacement designs, reduce risk of future complications |
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Term
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Definition
| angle between line of action of force (mechanical alignment of knee) and line from origin of quadriceps to tibial line |
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Term
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Definition
| hips widen at puberty, larger Q-angle, more prone to injury |
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Term
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Definition
| separates anterior from posterior |
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Term
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Definition
| separates left from right |
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Term
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Definition
| separates top from bottom (proximal from distal?) |
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Term
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Definition
| cartilagenous extension from hip socket that stabilizes joint |
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Term
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Definition
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Term
| stabilizing ligament in hip |
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Definition
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Term
| reasons for hip replacement (5) |
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Definition
osteoarthritis
rheumatoid arthritis
traumatic arthritis (injury that damages cartilage)
hip fractures (results in degeneration)
avascular necrosis (head of femur loses blood supply and dies)
BONUS: idiopathic osteonecrosis - without known cause |
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Term
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Definition
| multiple separable parts that allow for easier replacement |
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Term
| cementless hip replacement |
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Definition
| femoral component with hole in stem, beads on surface to mimic pores in bones, |
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Term
| increased angle of torsion |
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Definition
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|
Term
| decreased angle of torsion |
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Definition
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Term
| normal angle of inclination for hip |
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Definition
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|
Term
| range of hip flexion/extension |
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Definition
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|
Term
| larger hip angle of inclination consequences |
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Definition
| more force on head, longer limb |
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Term
| smaller hip angle of inclination |
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Definition
| more force on neck, shorter limb |
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Term
| two lines that make up angle of inclination |
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Definition
| femoral neck and femoral shaft - obtuse angle |
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Term
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Definition
| distal end of bone shifted laterally |
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Term
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Definition
| distal end of bone shifted medially |
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Term
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Definition
| bow legged (in reference to hip joint) |
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Term
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Definition
| knocked knees (in reference to hip joint) |
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Term
|
Definition
| knocked knee (in reference to knee joint) |
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Term
|
Definition
| bow legged (in reference to knee joint) |
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Term
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Definition
angle between femoral neck line and axis of femoral condyles
(in reference to hip, distal end of femur is torqued) |
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Term
| normal angle of torsion (#) |
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Definition
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|
Term
| hip replacement components |
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Definition
| femoral stem (metal), separate head piece, acetabular cup/shell (metallic), inner liner (metal, ceramic, polyethylene) |
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Term
|
Definition
| inner liner of hip replacement |
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Term
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Definition
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Term
| large femoral head pros/cons |
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Definition
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Term
| small femoral head pros/cons |
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Definition
| higher chance of dislocation/lower wear |
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Term
| polyethylene on metal hip replacement |
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Definition
most common
greatest wear on all material combos
wear results in osteolysis |
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Term
| ceramic on ceramic hip replacement |
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Definition
high density, high purity, small grain
little debris
excellent wear resistance
no toxic side effects
no evidence of osteolysis
expensive
squeaky hip
low fracture toughness |
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Term
| ceramic on polyethylene hip replacement |
|
Definition
.05 mm per year
new ceramics have low fracture rates
more expensive than metal on poly, less than ceramic on ceramic |
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Term
| metal on metal hip replacement |
|
Definition
allow for larger ball heads
0.01 mm year
not good for women or people with reduced kidney function - particles from wear can adversely affect kidney function |
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Term
| hip replacement posterior approach |
|
Definition
access joint from back
preserves hip abductors
more extensive approach
higher dislocation risk |
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Term
| hip replacement lateral approach |
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Definition
from the side
common
elevation of hip abductors
lower dislocation risk than posterior
occasional improper healing of abductor muscles |
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Term
| hip replacement anterio-laterial approach |
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Definition
minimally invasive procedure
small incision on the side of the hip
no cutting of muscles or tendons
implant more likely to remain in place
quicker recovery |
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Term
| hip replacement anterior approach |
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Definition
from the front
reduces dislocation rates in smaller diameter heads
10% rate of numbness due to injury of the Femoral Cutaneous Nerve |
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Term
| hip replacement minimally invasive approach |
|
Definition
double incision
reduces soft tissue damage
visualization and accuracy impaired
comp assisted surgical techniques |
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Term
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Definition
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Term
|
Definition
| decrease in torsion angle |
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Term
|
Definition
| increase in torsion angle |
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
| curves into back, cervical and lumbar spines |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| tail bone, five fused vertabrae |
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Term
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Definition
| deviation in the front/cordonal plane |
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Term
| total number of vertebrae |
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Definition
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Term
| how many vertebrae in cervical spine |
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Definition
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|
Term
| how many vertebrae in thoracic spine |
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Definition
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|
Term
| how many vertebrae in the lumbar spine |
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Definition
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Term
|
Definition
| soft tissue element of spine |
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Term
|
Definition
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Term
| spinous process (projection) |
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Definition
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Term
|
Definition
| two projections on either side of vertebra |
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Term
|
Definition
| processes that connect on either side of the spinous process |
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Term
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Definition
| removing one or both lamina to relieve spinal cord pressure - often followed by fusion |
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Term
|
Definition
| pain that isn't present at the spine though the nerve cell damage might be at the spine. pinch off nerves between vertebrae and cause pain elsewhere |
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Term
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Definition
| connect the body of the vertebra with the spinous processes |
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Term
| functional spinal unit (FSU) |
|
Definition
| sandwich of vertebra intervertebral disc and vertebra |
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Term
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Definition
| planar surfaces that come into contact between vertebrae |
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Term
|
Definition
| plane on lower vertebra (upper plane) |
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Term
|
Definition
| plane on upper vertebra (lower plane) |
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Term
| angle of facet joints near top of spine |
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Definition
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|
Term
| angle of facet joints near bottom of spine |
|
Definition
| more vertical/less horizontal |
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Term
|
Definition
| tendency for something to return to its original shape after deformation - proportional to displacement |
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Term
|
Definition
| resistance to flow - proportonal to rate of change of displacement |
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Term
| causes of degeneration of intervertebral discs |
|
Definition
rupture in annulus fibers
nucleus pulposus shrinks
herniation of nucleus pulposus |
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Term
| two components of intervertebral disc |
|
Definition
| nucleus pulposis and annulus fibrosis |
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Term
|
Definition
| inner viscous core of intervertebral disc |
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Term
|
Definition
| anisotropic - layers of fibers that surrounds the nucleus pulposis in the intervertebral disc |
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Term
| process of disc degeneration |
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Definition
| loss of fluid content in disc, loss of viscoelasticity, loss of disc height, vertebral bodies start closing together, close down on nerve roots leaving gaps, bulging disc, partial herniation |
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Term
|
Definition
| slipping of any two levels |
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Term
|
Definition
| connect two or more vertebrae together to increase stability and alleviate pain, commonly lumbar |
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Term
|
Definition
| possible non fusion, loss of range of motion and flexibility, stress transfer to adjacent vertebrae,highly invasive |
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Term
|
Definition
| tissue from the same person you are implanting it in |
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Term
|
Definition
| response of bone to applied stress - less load - less bone formation |
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Term
|
Definition
| allows some range of motion, higher load on fused joints to allow for bone growth, NOT FDA approved!!!! Failed in too many patients |
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Term
|
Definition
| remove small quantities to relieve stress on structures bone might be pushing against, minimally invasive, bandaid procedure |
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|
Term
| four surgical approaches for spinal fusion |
|
Definition
Lumbar Interbody Fusion (LIF)
anterior, posterior, lateral, transforaminal |
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Term
|
Definition
| drug or device not FDA approved for the use of the product for a specific use, up to the surgeon and the surgeon ONLY if the device could be successful in patient. Companies CANNOT promote or even suggest off label use. Any consequences that come from off label use are on the surgeon |
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Term
| true/false - all vertebrae are the same size |
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Definition
| FALSE - they become larger as you move downward. Think stress = F/A To keep stress the same with increasing force (due to increasing weight bearing, you must increase the cross sectional area |
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Term
|
Definition
anterior cervical discectomy fusion
treatment for disc herniation
posterior screws are off label use, anterior is very common (possible paralysis) |
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Term
|
Definition
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Term
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
| common polymer used for disc spacers |
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Term
|
Definition
| replacement intervertebral disc |
|
|
Term
|
Definition
soft fusion
promotes fusion by small movements
less stress on adjacent levels (adacent disc degeneration is very common with solid fixation) |
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Term
|
Definition
congenital
neuromuscular
idiopathic scoliosis |
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|
Term
|
Definition
| forward bend test to check for scoliosis |
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Term
|
Definition
measurement of degree of side to side spinal curvature
draw line from top and bottom most tilted vertebrae
perpendicular lines from both lines - at intersection, measure angle |
|
|
Term
| cobb angle 15-20 degrees - treatment |
|
Definition
| physical therapy and regular check ups |
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|
Term
| cobb angle 20 -45 degrees - treatment |
|
Definition
|
|
Term
| cobb angle over 45 degrees - treatment |
|
Definition
| surgical measures necessary - often fuse most of spine -- remove facet joints, vertebrae roughened up to promote new bone growth, eventually fuse together, realigned with metal pins and rods |
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
using a composite implant to mimic and intervertebral disc
polymer center with metal endplates |
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|
Term
| true/false - it is more common to use mechanical IV replacement constructs than injectables |
|
Definition
|
|
Term
|
Definition
| artificial disc, available angled endplates, increases range of motion |
|
|
Term
|
Definition
constrained artificial disc design
15 degrees in flexion extension
10 in lateral bending
unlimited axial |
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|
Term
| IVD replacement repeat surgery rate |
|
Definition
|
|
Term
|
Definition
material rejection
nerve damage
generally not covered by insurance |
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Term
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
| young patient, trauma causes damage, replace femoral head ONLY |
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