This document discusses the management of infected total hip replacements. It begins by noting that postoperative infection is a difficult complication that can be painful, disabling, and costly. Advances in patient selection, operating room environment, surgical technique, and antibiotic prophylaxis have reduced risk of infection. Those at higher risk include those with diabetes, rheumatologic diseases, obesity, and prolonged operative time. The causative organisms are often gram-positive cocci like staphylococci. Diagnosis involves aspiration and lab tests. Treatment depends on chronicity and may involve antibiotics, debridement with or without component retention/removal, and reconstruction procedures like one-stage or two-stage reimplantation. Management of loosening also involves identification
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
This presentation gives a brief idea of Acute osteomyelitis, its cause, predisposing factors, pathogenesis, signs and symptoms, investigation and its management. It also explain Nades principle.
Similar to Management of infected total hip replacement (20)
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Introduction
• Postoperative infection is a difficult
complication
• It is painful, disabling, costly, often requiring
removal of both components, and is
associated with a reported mortality rate of
2.5%
3. In modern days
1. Advances in understanding of patient
selection
2. The operating room environment
3. Surgical technique
4. The use of prophylactic antibiotics have
dramatically reduced the risk
4. Higher incidence
1. Diabetes
2. Rheumatologic disease
3. Obesity
4. Coagulopathy
5. Corticosteriods
6. Preoperative anemia/sickle cell disease.
7. Prolonged operative time and previous hip
surgery.
6. MECHANISM INVOLVED IN INFECITION
1. Direct contamination of the wound at the
time of surgery
2. Local spread of superficial wound infection
3. Hematogenous spread of distant bacterial
colonization / infection from a separate site
4. Reactivation of latent hip infection in a
previously septic joint.
7. ANTI-BIOTIC PROPHYLAXIS
• Infections are caused by gram-positive
organisms, particularly coagulase-negative
staphylococci and Staphylococcus aureus
• MR SA & Pseudomonas aeruginosa is mainly
because of presence of glycocalyx extension in
the cell wall.
9. Classification of Infection post
operatively
TSUKAYAMA CLASSIFICATION ::
1. Early postoperative infection: onset within 1 M
2. Late chronic infection: onset more than 1 M ,insidious onset.
3. Acute hematogenous infection—onset more than 1 month
after surgery, acute onset of symptoms, distant source of infection
4. Positive intraoperative cultures: positive cultures obtained
at the time of revision for supposedly aseptic condition
10. • Extended classification by Trampuz & Zimmerli
1. Early Infection : upto 3 M Post Op.
2. Delayed Infection : 3 M – 24 M
3. Late Infection : > 24 M
• Senneville Classification : timing of infection
Acute < 1 M :::: Late > 1 M.
11. DIAGNOSIS
• Diagnosis of early postoperative infection or
acute hematogenous infection is often not
difficult.
• Late chronic infection is difficult for diagnosis
– clue – well functioning arthroplasty with
pain not subsiding.
12. • History of excessive wound drainage after the
initial arthroplasty
• multiple episodes of wound erythema
• prolonged antibiotic treatment by the
operating surgeon also are worrisome.
• Lab reports : ESR – 30mm/hr , CRP – 10mg/l
are sensitive & specific
13. • Normal pt- ESR may take upto 1 yr for
normalisation.
• But CRP should normalize with in 3 weeks
after replacement.
• Aspiration not undertaken until after 2 weeks
of stopping antibiotics.
15. • Ideal scenario for diagnosis =
• when abnormal ESR and CRP are found in
combination with an aspirate WBC count
greater than 3000 leukocytes/ml.
16. • Radionucleotide study for infected THR
1. Nuclear medicine studies may be obtained if the
diagnosis : not confirmed by hip aspiration but
still high index of suspicion remains.
2. The combination of indium labeled leukocyte
and technetium sulfur colloid-labeled marrow
imaging seems to be more reliable.
17. International Consensus on
Periprosthetic Infection Guidelines
1) Two positive periprosthetic cultures with
phenotypically identical organisms, or
2) sinus track communicating with the joint, or
3) Having three of the following minor criteria:
■ Elevated serum (CRP) and (ESR)
■ Elevated synovial fluid (WBC) count
or change on leukocyte esterase test strip
■ Elevated synovial fluid neutrophil% (PMN%)
■ Positive histologic analysis of periprosthetic tissue
■ A single positive culture
18. MANAGEMENT PRINICIPLES
1. Antibiotic therapy
2. Debridement and irrigation of the hip with
component retention
3. Debridement and irrigation of the hip with
component removal
4. One-stage or two-stage reimplantation of total
hip arthroplasty
5. Arthrodesis
6. Amputation
19. MANAGEMENT DEPENDS ON ::
• Chronicity
• Virulence
• Status of wound
• Surrounding soft tissues
20. DECISION FOR COMPONENT
RETENTION OR REMOVAL
• < 2 WEEKS OF
PRESENTATION since
onset of symptoms
• Debridement +
retention
• > 2 WEEKS OF
PRESENTATION since
onset symptoms
• Debridement +
component removal
21. EARLY POSTOPERATIVE INFECTION
• Early infections may range in severity from
superficial cellulitis (antibiotics) to deep
infections (surgical management).
• Decision making for medical / surgical line of
management = EXTENSION OF INFECTION
BELOW THE DEEP FASCIA.
22. • Surgery required if – wound dehiscence/ skin
necrosis/ infected hematoma + .
• If joint is infected superficially then take the
joint is to be opened in OT. The wound is
opened down to the deep fascia, and the
structures are examined carefully to see
whether the infection extends beneath it.
23. • If the infection is superficial
the wound is thoroughly
irrigated with large quantities
of a physiologic solution
containing antibiotics, and all
necrotic subcutaneous tissue
and skin are excised.
• If the infection extends to the
hip joint, the wound debrided
and irrigated with an antibiotic
solution.
• The hip must be dislocated to
perform this procedure
thoroughly,
• if modular components have
been implanted,liner and
femoral head are exchanged to
limit the previously
contaminated foreign bodies
• Wounds are closed over the
drains.
24. • Cultures of joint fluid or other fluid collections
encountered along with tissue cultures from
the superficial, deep and periprosthetic layers
are sent for analysis of the offending organism
and antibiotic sensitivities.
25. LATE CHRONIC INFECTION
• Surgical debridement and component
removal are required if eradication of the
infection is to be done.
• Sinus tracks are debrided
• Nonabsorbable sutures and trochanteric
hardware are removed.
• The hip is dislocated, and all infected and
necrotic material is excised.
26. • The femoral and acetabular components and any
other foreign material, including cement, cement
restrictors, cables or wires are removed.
• One recommendation for non removal of well
fixed femoral component because removal causes
more bone loss.
• c/s of synovium, necrotic tissue is sent
• If antibiotic-containing beads or spacers have
been placed, some authors have recommended
that drains not be used to maintain a high
concentration of antibiotic in the wound
27. ACUTE HEMATOGENOUS INFECTION
• The hip becomes acutely painful long after the
index operation.
• The infection may have been caused by
hematogenous spread from a remote site of
infection or from transient bacteremia caused
by an invasive procedure.
28. • C/F :: Pain on weight bearing, on motion of
the hip, and at rest is the chief symptom of
acute hematogenous infection.
• Lab : ESR & CRP = +
• Diagnosis established by joint aspiration.
• Joint aspirate fluid shows raised WBC counts,
positive cultures & relevant sensitivity.
29. • While reports on cultures are being done,
broad-spectrum antibiotics = against gram-
positive and gram-negative organisms are
administered.
• More aggressive approach includes complete
removal of components and immediate
reimplantation with primary cementless
components.
30. RECONSTRUCTION AFTER INFECTION
• Decision making in reimplanting a new
prosthesis –
1. Functional impairment of pt
2. Infecting organism
3. Adequacy of debridement
4. Control local & distant infection
32. • Delayed re-implantation is advantageous :
1. The adequacy of debridement is ensured
because repeat debridement of soft tissues
is done.
2. Infecting organism identified & treatment
started
3. Foci of infection can be identified
4. Distant infection can be eradicated
5. Decision regarding resection plasty can be
done (depending on degree of disability).
33. • One-stage exchange is done =
• when effective antibiotics are available and
systemic symptoms of sepsis are absent.
• Contra indicn : sinus tract + , soft tissue
compromise
34. • Two stage is indicated : septic pts, sinus tracts,
unidentified organism , compromised soft tissues.
• Re- implantation with cement or cementless is
guided by –
available bone stock
physiologic age
expected longevity of pt
35. Duncan and Beauchamp 2 stage Techn
• Tech in which a prosthesis of antibiotic
loaded acrylic cement (PROSTALAC) is
implanted at the time of the initial
debridement.
• The prosthesis is constructed intraoperatively
by molding antibiotic-laden cement around a
femoral component and an all-polyethylene
acetabular component.
37. • Current guidelines for re- implantation :
1. 6 weeks of antibiotics
2. ESR & CRP negative
3. Repeat hip aspiration negative reports
4. Reconstruction done at 3 months interval.
38. • Restoration of limb length & full motion shouldn’t
be expected
• If trochanteric osteotomy is done then limb
lengthened & abductor weakness is present.
• Iliopsoas & gluteus maximus tendon release may
be needed for hip reduction.
39. • If acetabular anterior or post wall is thin, it
may be fractured by over sized implants
• Femoral canal prepared avoiding fractures ,
by placing prophylactically cerclage wires.
• Frozen sections of tissues can be examined for
residual inflammation.
40. GIRDLE STONE ARTHROPLASTY
• Using standard approach head of femur ,
neck, greater trochanter is exposed
completely.
• Here head, neck , GT , infected synovium are
removed , thorough debridement done skin
closed.
• Followingly patient is put on skeletal traction
of = 3-10 kg for 6 weeks.
• Followed by mobilization.
41. LOOSENING OF IMPLANTS
• Femoral and acetabular loosening are some of
the most serious long-term complications of
total hip arthroplasty and commonly lead to
revision.
• Some studies define failure as radiographic
evidence of loosening despite continued
satisfactory clinical performance.
43. FEMORAL LOOSENING
CEMENTED FEMORAL COMPONENT LOOSENING
1. Radiolucency b/w gruen zone 1 =
debonding of stem from cement & early
stem deformation.
2. Radiolucency between the cement mantle
and surrounding bone
44. 3. Subsidence of stem or with cement mantle
4. Femoral stem becoming varus position
5. Fragmentation in gruen zone 7
6. Fragmentation of cement in gruen 4
7. Deformation of stem
8. Fracture of stem.
45. Harris, McCarthy, and O’Neill defined femoral
component loosening radiographically :
definite loosening
• when there is migration of the component or cement;
probable loosening
• when a complete radiolucency is noted around the
cement mantle
possible loosening
• when an incomplete radiolucency surrounding more
than 50% of the cement
46. • Mechanism of loosening in cemented
component
Debris produced because of
mechanical factors
Biological response by formation
of FIBROUS MEMBRANE B/W
cement & bone interface
Results in loosening
47. • Not all gaps are loosening ….
1. Incomplete removal of cancellous bone
2. Age related expansion of canal
3. Femoral cortex thinning
Less than 2mm lucency in gruen zone 1 is not
indicative of loosening.
48. • Stem in canal may subside due to the fracture
at the tip of the stem & the with entire
cement mantle it may subside.
49. TECHNICAL PROBLEMS THAT
CONTRIBUTE TO
STEM LOOSENING:
1. Failure to remove the soft cancellous bone
from the medial surface of the femoral neck
2. Failure to provide a cement mantle of
adequate thickness around the entire stem
3. Removal of all trabecular bone from the
canal, leaving a smooth surface with no
capacity for cement intrusion
50. 4. Inadequate quantity of cement
5. Failure to pressurize the cement, resulting in
inadequate flow of cement
6. Failure to prevent stem motion while the
cement is hardening
7. Failure to position the component in a
neutral alignment (centralized)
8. The presence of voids in the cement as a
result of poor mixing or injecting technique
51. Barrack, Mulroy, and Harris grading for
femoral cement mantle
1. Grade 1 :Complete filling of
the medullary canal
without radiolucencies
(“white-out”)
2. Grade 2 : Slight
radiolucency at the bone-
cement interface (<50%)
3. Grade 3 : Lucency
surrounding 50% to 99% of the
interface
4. Grade 4 :Complete lucency
& a defect of the mantle at the
tip of the stem
52. CEMENTLESS FEMORAL COMPONENTS
• Bobyn, and Glassman classification of fixation of
femoral stem :
• Bone ingrowth - is defined as an implant with no
subsidence and minimal or no radiopaque line
formation around the stem.
• Cortical hypertrophy near porous surface + ,
• “spot welds” between the stem and endosteum
53. • stable fibrous fixation : no progressive
migration ,
• Extensive radiopaque line forms around the
stem, femoral cortex shows no local
hypertrophy, suggesting bone has a uniform
load-carrying function
54. • unstable implant : definite evidence of
progressive subsidence or migration within
the canal. Divergent radio-opaque lines
around stem.
• Increased cortical density around collar & tip
of the stem.
• Bony pedestal at the tip indicates
pistoning/telescoping
55. • Subsidence of a cementless femoral
component early in the postoperative course
may allow the stem to attain a more stable
position within the femoral canal.
• Bone ingrowth is still possible with durable
implant fixation.
56. ACETABULAR LOOSENING
• CEMENTED ACETABULAR COMPONENTS
Changes in the pelvis and acetabular
component
1. Absorption of bone from around part or all
of the cement mantle.
2. Cephalad translation combined with sagittal
plane rotation.
57. 3. Wear of the cup, as indicated by a decrease in
the distance between the surface of the head
and the periphery of the cup.
4. Fracture of the cup and cement
• Femoral loosening occurs at stem – cement
interface , but acetabular loosening occurs at
cement – bone interface
58. • Ace loosening starts at the periphery progress
towards dome.
• Radiolucencies + horizontal
cup
59. • Technical difficulties leading to loosening :
1. Inadequate cup support –Ace not reamed
deeply/ sup & post wall deficiencies/ medial
wall deficiencies during preparation .
2. Failure to remove all of the cartilage, loose
bone fragments, fibrous tissue, and blood.
3. Failure to pressurize the cement adequately
60. 4. Failure to distribute the cement
5. Movement of the cup or cement mantle
while the cement is hardening
6. A small diameter cup would not pressurize
the cement adequately
7. Malpositioning of the cup.
61. • radiolucency of 2 mm or more in width is
present in all three zones is accepted for
loosening.
62. CEMENTLESS ACETABULAR
COMPONENTS
• Loosening of cementless, porous-coated
acetabular components is an uncommon
finding
• Engh, Griffin, and Marx classification : stable,
probably unstable & definitely unstable
63. • Diagnosis ::
1. Septic loosening produces pain on
movement, pain at rest.
2. In acetabular loosening there is a startup
pain which is worst in the first few steps .
3. Early post op pain suggest infection.
64. • Loosening diagnosis is done only on follow up
x rays which shows progressive
radiolucencies.
• Adjunctive investigations : arthrography,
nuclear medicine studies.
• Arthrography shows : layer around the ace cup
shows loosening.