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Total Hip Arthroplasty (THA) — Approaches & Complications
Surgical approaches: posterior, anterolateral, direct anterior, transtrochanteric. Posterior: excellent exposure, preserves abductors, higher dislocation risk. Anterolateral: stable, lower dislocation, abductor weakness risk. Direct anterior: internervous, muscle-sparing, early rehab, risk of LFCN injury, intra-op fracture. Transtrochanteric: trochanteric osteotomy, good exposure, risk of nonunion. Complications: dislocation, infection, aseptic loosening, periprosthetic fractures, nerve injury,...
Open topicTotal Hip Arthroplasty (THA) — Indications & Outcomes
Indications: end-stage hip OA, AVN, RA, ankylosing spondylitis, fracture neck femur (elderly). Contraindications: active infection, severe medical comorbidity, poor bone stock without reconstruction option. Implants: cemented, uncemented, hybrid, resurfacing. Approaches: posterior, lateral, anterior; each with pros/cons. Outcomes: >90% pain relief, implant survival >90% at 15–20 years.
Open topicTotal Knee Arthroplasty (TKA) — Implant Designs
Implants classified by degree of constraint: CR (least) → PS → CCK → Hinged (most). CR retains PCL; PS substitutes with cam-post. Constrained implants indicated for instability or major deformity. Mobile-bearing vs fixed-bearing — theoretical wear reduction, but long-term benefit unclear. Principle: use minimum constraint required.
Open topicTotal Knee Arthroplasty (TKA) — Indications & Outcomes
Indications: end-stage OA, RA, post-traumatic arthritis with pain and disability. Contraindications: active infection, severe vascular disease, extensor mechanism dysfunction. Implants: cruciate-retaining, posterior-stabilized, constrained, hinged. Outcomes: >90% pain relief, implant survival ~90% at 15 years. Complications: infection, loosening, instability, stiffness, thromboembolism.
Open topicTrigger Finger & de Quervain
Trigger finger: stenosing tenosynovitis of flexor tendon sheath (A1 pulley). Symptoms: painful clicking/locking of finger; risk in diabetics, RA. De Quervain: stenosing tenosynovitis of APL & EPB tendons in 1st dorsal compartment. Finkelstein’s test positive; pain over radial styloid. Management: splints, steroid injection, surgical release if persistent.
Open topicTscherne–Oestern — Closed Fracture Soft-Tissue Injury
Grade 0: minimal; 1: superficial abrasions/contusions; 2: deep contaminated abrasions, muscle contusion; 3: extensive crush, compartment risk. Higher grades predict complications and influence timing/approach to fixation.
Open topicTuberculosis of Hip
Introduction Tuberculosis of the hip is one of the most common forms of osteoarticular tuberculosis after spinal involvement. It results from hematogenous spread of Mycobacterium tuberculosis to the synovium or bone around the hip joint. The disease leads to progressive destruction of articular cartilage, subchondral bone, and eventually the entire hip joint if untreated. Because the hip is a weight-bearing joint, tuberculous infection often results in severe functional disability. Early diagnos...
Open topicTumour Biology — Benign vs Malignant
Benign: slow, well circumscribed, no metastasis. Malignant: rapid, infiltrative, metastasis. Histology: benign differentiated; malignant atypia, mitoses, necrosis. Radiology: benign geographic margins; malignant permeative with periosteal reactions.
Open topicTypes of Callus in Fracture Healing
External (periosteal) vs internal (endosteal) callus; bridging and uniting fragments. Primary (contact) healing has minimal/no callus under rigid stability; secondary healing forms abundant callus under relative stability. Radiographic callus reflects mechanical environment and biology; hypertrophic callus suggests instability. Histology: woven bone → lamellar bone remodeling along stress lines.
Open topicUlnar Collateral Ligament Injury — Skier’s Thumb
Injury to ulnar collateral ligament (UCL) of thumb MCP joint. Mechanism: valgus stress from fall on abducted thumb (ski pole). Clinical: pain, swelling, instability at MCP; Stener lesion if adductor aponeurosis interposes. Diagnosis: valgus stress test (>30° opening suggests complete tear); MRI confirms. Treatment: partial tear—immobilization; complete tear/Stener lesion—surgical repair.
Open topicUnhappy Triad of O'Donoghue
The unhappy triad (O'Donoghue triad) is a combined knee injury involving the ACL, MCL, and medial meniscus, classically caused by a valgus contact force on a planted foot. Modern evidence has revised the original description — the lateral meniscus is now recognised as the more commonly injured meniscus in this injury pattern.
Open topicUnicompartmental Knee Arthroplasty (UKA)
Indicated in isolated medial/lateral compartment OA with intact ligaments. Advantages: smaller incision, bone preservation, faster rehab, more natural kinematics. Contraindications: inflammatory arthritis, tricompartmental OA, fixed deformity >10° varus/valgus, flexion contracture >15°, ligament deficiency. Survivorship improving with better implants and patient selection. Revision to TKA possible if progression occurs.
Open topicUnicompartmental Knee Arthroplasty (UKA) — Indications & Outcomes
Indications: isolated unicompartmental OA with intact ligaments and correctable deformity. Contraindications: inflammatory arthritis, fixed deformity, ACL deficiency. Advantages: smaller incision, faster recovery, more natural kinematics. Outcomes: pain relief and function good in selected patients; 10–15 year survival ~80–90%. Conversion to TKA may be needed if progression of arthritis occurs.
Open topicUnicompartmental Knee Arthroplasty vs High Tibial Osteotomy (HTO)
Both indicated for isolated medial compartment OA in younger active patients. HTO: joint-preserving, shifts weight-bearing axis, delays arthroplasty. UKA: joint-replacing, preserves kinematics, faster recovery. HTO better for younger, high-demand, ligament-intact; UKA better for older, lower-demand. Revision: UKA easier conversion to TKA than failed HTO.
Open topicUnicompartmental vs Total Knee Arthroplasty — Indications & Outcomes
UKA: isolated compartment OA, intact ACL/collaterals, correctible deformity; faster recovery, more natural kinematics. TKA: multicompartment disease, inflammatory arthritis, significant deformity/instability; durable outcomes. UKA risks: OA progression, bearing dislocation (mobile), higher revision if selection poor. TKA risks: PF complications, stiffness; less normal kinematics. Choice individualized by age, activity, alignment, expectations.
Open topicWinquist–Hansen — Femoral Shaft Comminution
0: none; I: small butterfly; II: larger butterfly with ≥50% cortical contact. III:
Open topicWrist Arthrodesis vs Arthroplasty
Wrist arthrodesis: gold standard for pain relief in advanced wrist arthritis; provides stability but sacrifices motion. Wrist arthroplasty: motion-preserving alternative for low-demand elderly RA patients. Indications differ: fusion for high-demand/younger, arthroplasty for low-demand/RA. Arthroplasty complications: loosening, implant failure, dislocation. Fusion complications: nonunion, hardware issues, loss of function in high-demand tasks.
Open topicYoung–Burgess — Pelvic Ring Mechanism
APC I–III: progressive symphysis/SI disruption (III complete). LC I–III: sacral compression → crescent fx → windswept (bilateral). VS: vertical shear; CM: combined mechanisms.
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