Total Knee & Hip

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explanation about limp salvage

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Total Knee & Hip

  1. 1. LIMP SALVAGE<br />ANAS AL DERBASHI<br />
  2. 2. *DEFINE BONE SARCOMA<br />*INDICATION FOR SURGERY.<br />*PHYSICAL EXAMINATION *<br />*TYPE & COMPONENT OF PROSTHESIS<br />*NURSING COMSIDERATION<br />*SURGERY KNEE &HIP PROCEDUREOPARATIVE<br />*TO KNOW SURGIAL INSTURMENT USED IN<br />OBEJECIVE:<br />
  3. 3. Its divided into two group:<br />1.Benign tumors:<br />*Bone cysts, are expanding lesion within bone this present with painful, palpable mass of the long bone (vertebra or flat bone) in children may cause pathological fracture.<br />*Osteochondroma.<br />2.Malignant tumors:<br />*Sarcoma, its from connective and supportive tissue.<br />*myelomas bone marrow tumor .<br />*(OSTEOSARCOMA)is the most common malignant bone tumors<br />BONE TUMORE<br />
  4. 4. BONE TUMORS<br />Ewing’s sarcoma of the distal two-thirds of the femur,<br />Sagittal section of a high-grade osteosarcoma<br />of the distal femur.<br />Biologic behavior of bone and soft-tissue<br />sarcomas<br />
  5. 5. Extension of an osteosarcoma of the distal<br />femur to the knee joint along the cruciate ligaments<br />
  6. 6. *Rheumatoid arthritis <br />*Osteosarcoma<br />*Trauma<br />*Maintain stability<br />*Relieve pain<br />INDICATION OF SURGERY<br />
  7. 7. *Physical examination of orthopedic injuries in the ED is based on a simple four step process<br />*Palpation of the injury for deformity and tenderness<br />*Assess range of motion (both active and passive) of the affected bone, as well as consideration of the joints above and below the injured bone<br />*Inspection (deformity, swelling, discoloration)<br />Neurovascular exam <br />PHYSICAL EXAMINATION<br />
  8. 8. Preoperative planning might include physical examination,<br />patient education, radiographic examination,<br />((((Patients should be educated about what to expect before, during, and after surgery)))),<br />PHYSICAL EXAMINATION<br />
  9. 9. Most joint replacement consist metal and high density polyethylene component ,the joint implant may cemented in the prepared bone with polymethy methacrylate (PMMA: a bone bonding agent) which has properties similar to bone which may lead to failure of prosthesis, cementing method of securing prosthetic implant.<br />*Cementless,artificial joint component ,porouse-coated.that allow pt bone to grow accurate fitting and the presence of healthy bone with adequate blood supply are important in using cementless component <br />TYPE &COMPONENT OF PROSTHESIS<br />
  10. 10. Distal femoral modular<br />replacement. The most current prosthetic design for replacement<br />
  11. 11. Modular prostheses. (A) Proximal femur, and (B) total femur<br />
  12. 12. 1.Pain management(medication).<br />2.Wound care(keep wound clean and dry sign of infection).<br />3.Mobility(using assistive device, don’t moving in acute flexion put pillow between knee)<br />4.Potential problems. dislocation of prosthesis,, pain,,encourge pt to accept help with ADLs.<br />NURSING CONSEDRATION<br />
  13. 13. T K R<br />
  14. 14. KNEE SURGERYLIMP SALVAGE<br />(A) Anatomic location of malignancy. Adequate resection includes 15–20 cm of the distal femur and<br />proximal tibia and portions of the quadriceps. <br />(B) An intra-articular resection is usually performed.<br />
  15. 15. SURGICAL PROCEDURE FOR DISTAL FEMUR <br />Surgical approach and incision. The patient is placed supine on the operating table. The entire extremity, including the groin and pelvis, is prepared and Draped<br /> The groin should always be included to allow for the rare instance in which exposure of the common femoral vessels is<br />required.<br />
  16. 16. (A) Popliteal exploration. Resectability is determined by exploration of the popliteal space and vessels. <br /> (B) Superficial femoral artery exploration. The superficial femoral artery is <br />(C) Posterior exploration. The interval between the<br />popliteal vessels and the posterior femur is developed and explored. The popliteal artery is mobilized,<br />
  17. 17. Distal femoral resection.<br />Proximal femoral osteotomy<br />
  18. 18. Tibial osteotomy and preparation of the femur<br />Preparation of the proximal tibial canal<br />Preparation of distal femur by facing reamer.<br />
  19. 19. Trial reduction with templates. The purpose of the trial reduction is to determine the easy of insertion of the<br />femoral and tibial components prior to cementing<br />
  20. 20.
  21. 21. CLOSURE<br />
  22. 22.
  23. 23. spacer blocks<br />Resect the distal femur using the chosen resection level. The distal thickness of the Sigma femoral implant<br />is 9 mm (10 mm on size 6).<br />The holes on the block are designated -2, 0 and +2, indicating in millimeters the amount of bone resection<br />each will yield supplemental to that indicated on the calibrated outrigger.<br />Position the oscillating saw blade through the slot or, where applicable, position the blade flush to the top<br />cutting surface of the block. Resect the condyles and check the surface for accuracy.<br />
  24. 24. Assemble the upper cutting platform<br />Assemble the upper cutting platform<br />Translate the lower assembly anteroposteriorly to align it parallel to the tibial axis.<br />
  25. 25. Lateral alignment is similarly confirmed.<br />
  26. 26. Cut an entry slot with a narrow oscillating saw into the intercondyle the attachment of<br />the PCL. Position an osteotome to shield the ligament<br />Fixation of plate cutting in the tibia anterior with alignment <br />reevaluation at trial reduction.<br />
  27. 27. FEMORAL SIZER<br />
  28. 28. The Femoral Sizing Guide: Anterior Down/Posterior Up<br />The Anterior Reference Femoral Sizing Guide<br />
  29. 29. Cutting Block<br />
  30. 30. TABIAL PREPRATION<br />STEM PUNCH <br />drill bushing<br />
  31. 31.
  32. 32. Femoral and proximal tibial cuts are now completed.<br />
  33. 33. FINISH CUTTING THE FEMURE AND TIBIA THIN PREPARED FOR TRIAL <br />
  34. 34. Trial Reduction<br />
  35. 35. permanent tibial insert at any time during the cementing procedure.<br />
  36. 36. LIMP SALVAGE <br />TOTAL FEMUR SAVAGE<br />
  37. 37. Titanium are strong, have<br />excellent biocompatibility, and are<br />more flexible than Cocr<br />
  38. 38. PROXIMAL FEMUR<br />
  39. 39. NORMALHIP<br />
  40. 40. COMPONANT OF T H R <br />Acetabular<br />Component ,,shell & liner<br />Femoral<br />Component ,stem and head<br />
  41. 41.
  42. 42. Proximal humeralprostheses<br />
  43. 43. PROXIMAL HUMERUS<br />
  44. 44. proximal tibial<br />
  45. 45.
  46. 46. Various proximal tibial prostheses<br />
  47. 47. surgery requires a<br />number of instruments to be available to the surgeon. Surgical instruments<br />are needed to expose the joint, retract and protect soft tissue,<br />and cut and shape the bone. Additionally, trays of instruments are<br />provided with implant systems. These instruments allow for appropriate<br />sizing, shaping, and cutting of the bone<br />SURGICAL INSTRUMENT<br />
  48. 48. These general instrument trays should include:<br />• standard surgical instruments: a basic tray that varies from<br />hospital to hospital but should include scissors, hemostats,<br />clamps, retractors, forceps, scalpel handles, needle holders,<br />and other standard instruments<br />• retractors: general retractors that are used on many different<br />orthopedic surgical procedures (e.g., Hofmann, Hibbs, and<br />Richardson retractors); and specific retractors that are used for<br />particular TJA applications (e.g., a Charley retractor for THA<br />or a notch retractor for TKA)<br />• osteotomes: surgical chisels that come in various sizes (usually<br />0.25 to 1 inch) and are either straight or curved<br />SURGICAL INSTRUMENT<br />
  49. 49. • curettes: spoon-shaped cutting tools that come in various<br />sizes (2–5 mm)<br />• rongeurs: plier-like tissue resectors that have slightly sharpened<br />jaws used to grab and/or rip tissue<br />• large oscillating and/or reciprocating saw (depending on<br />surgeon preference) for cutting/shaping bone<br />• reamer: a drill-like device with a high torque-to-speed ratio<br />used to prepare the canal of the femur or humerus<br />
  50. 50. acetabular reamer: reamer that has a hemispherical head to<br />prepare the acetabulum for cup replacement<br />• pulsatile lavage system: battery-operated irrigating system that delivers pressurized irrigation<br />• medullary canal preparation kit: brush used to scrub the<br />intramedullary canal after reaming/broaching, suction apparatus,<br />cement restrictor, etc; used to mechanically remove any<br />debris from the canal prior to cementing<br />• post-op drain system (if the surgeon prefers a drain;)<br />• cement gun<br />• vacuum cement mixer: cement mixing bowl used under<br />suction; limits formation of air pockets in the cement and<br />limits staff exposure to methylmethacrylate fumes<br />• electrocautery: instrument whose electrified tip is used to cauterize bleeding tissue<br />
  51. 51.
  52. 52. THANK YOU<br />

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