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Ebook Basic musculoskeletal imaging: Part 2

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Nội dung chi tiết: Ebook Basic musculoskeletal imaging: Part 2

Ebook Basic musculoskeletal imaging: Part 2

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2ionHip ProsthesesSpinal InstrumentationKnee ProsthesesSurgical ApproachesAnkle ProsthesesPostoperative Evaluation and ComplicationsShoulder Prostheses

Fracture FixationElbow ProsthesesTechniques in Fracture FixationWrist and Hand prosthesesConclusionINTRODUCTIONInterpretation of postoperative orthope Ebook Basic musculoskeletal imaging: Part 2

dic radiographs comprises a significant portion of the practice of not only subspecialized musculoskeletal radiologists but also general radiologists.

Ebook Basic musculoskeletal imaging: Part 2

A good foundation and understanding of the most common performed orthopedic procedures is essential for accurate interpretation of postoperative radi

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2res performed by orthopedic surgeons. In addition, the postoperative evaluation of various orthopedic hardware including the imaging findings for comm

on complications will be discussed.JOINT REPLACEMENTJoint replacement is one of the most common orthopedic procedures performed. Generalized indicatio Ebook Basic musculoskeletal imaging: Part 2

ns for joint replacement include severe osteoarthritis, avascular necrosis, trauma, and inflammatory arthropathies such as rheumatoid arthritis. Absol

Ebook Basic musculoskeletal imaging: Part 2

ute contraindications for joint replacementinclude active local or systemic infection. Relative contraindications include obesity, remote infection, u

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2 joint included joint arthrodesis (e.g., joint fusion), osteotomy, nerve division, and joint debridement. Patients were afforded significant improveme

nt in quality of life with the development of joint replacement techniques; however, older joint replacement components often suffered from premature Ebook Basic musculoskeletal imaging: Part 2

wear. Recent advances in biomaterials and joint replacement technology have led to marked improvements in the longevity of joint prostheses. Orthopedi

Ebook Basic musculoskeletal imaging: Part 2

c surgeons can now choose between a vast array of prosthetic devices, many based on preference and familiarity. Though it is impossible for the radiol

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2rent prostheses.The main components of any modern joint arthroplasty include a metal alloy and a plastic polyethylene liner. The low coefficient of fr

iction between the metal alloy component and the polyethylene component simulates movements of212CHAPTER 10normal joints. Alloys represent the metalli Ebook Basic musculoskeletal imaging: Part 2

c component of the prostheses. They are combinations of different metals such as chromium-cobalt, chromium-cobalt-titanium, or chromium-cobalt-molybde

Ebook Basic musculoskeletal imaging: Part 2

num.' These different alloys have individual biomechanical properties based on their metal composition, and differ in terms of their resistance to str

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2e the prosthesis, the prosthesis may either be press fit into the bone or cemented to the bone. Polymethylmethacrylate is the most commonly used cemen

t to secure the prosthesis into the medullary cavity of the bone. Cement is seen as a radiopaque lining surrounding the prosthesis. Alternatively, por Ebook Basic musculoskeletal imaging: Part 2

ous-coated press-fit cementless prosthesis demonstrate an irregular surface coated with lucent bone growth-stimulating material to ensure adherence to

Ebook Basic musculoskeletal imaging: Part 2

the surface? Another concept to be familiar with is the resistance of a prosthetic implant to motion, whether in the anteroposterior (AP) direction o

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2ly one direction. In a nonconstrained prosthesis, it is the muscles, ligaments, and tendons that provide stability with no connection between the two

prosthetic parts. This not only provides the greatest possible range of motion but is also most prone to joint subluxation or dislocation. Semiconstra Ebook Basic musculoskeletal imaging: Part 2

ined prosthesis allow intermediate motion in a given direction.’The postoperative radiograph evaluation includes at least two radiographic views of th

Ebook Basic musculoskeletal imaging: Part 2

e prosthesis at right angles to one another (e.g., orthogonal views) in addition to any specific views particular for the joint imaged. For example, a

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2 the patella. The entire prosthesis and surrounding bone need to be imaged on the examination. The technical factors of the radiograph must allow the

examiner to distinguish between metal-bone, metal-cement, and cement-bone interfaces. Other radiologic examinations such as arthrography, ultrasonogra Ebook Basic musculoskeletal imaging: Part 2

phy, computed tomography (CT), magnetic resonance imaging, and nuclear scintigraphy also have specific roles in evaluating joint replacement.HIP PROST

Ebook Basic musculoskeletal imaging: Part 2

HESESThree types of hip prosthesis exist: unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (Figures 10-1 and 10-2). A u

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2 either a noncemented or cemented femoral stem with a femoral head that articulates directly with the native acetabulum. This is the least common hip

prosthesis and is typically performed in patients with femoral head or femoral neck fractures and decreased life expectancy. A bipolar hip arthroplast Ebook Basic musculoskeletal imaging: Part 2

y▲ Figure 10-1. Bipolar prosthesis. AP view of the bipolar right hemiarthroplasty, with separate acetabular cup. Note the radiolucent native articular

Ebook Basic musculoskeletal imaging: Part 2

cartilage surface.includes a femoral stem with a small diameter femoral head and a separate acetabular cup (Figure 10-1). The outer portion of the ac

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2ar surface is unaltered. This design is most prone to dislocation as motion can occur between both the femoral head and acetabular component and exter

nal surface of the acetabular component and the native acetabulum. The total hip arthroplasty is the most common type of performed hip arthroplasty (F Ebook Basic musculoskeletal imaging: Part 2

igure 10-2). In a total hip arthroplasty, the articular surface of both the femur and the acetabulum is replaced. These components may either be cemen

Ebook Basic musculoskeletal imaging: Part 2

ted or noncemented. The metallic acetabular cup includes a radiolucent polyethylene liner that articulates directly with the metallic femoral head.The

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2easure the angle of inclination that is optimal at 30-55° (Figure 10-2), and the lateral film is used to measure the angle of anteversion that is opti

mal around 15°.u The femoral component should beORTHOPEDIC HARDWARE AND COMPLICATIONSI ▲ Figure 10-2. Total hip replacement. AP view of the total hip Ebook Basic musculoskeletal imaging: Part 2

arthroplasty, consisting of both the femoral and acetabular components. The polyethylene liner separating the acetabular cup from the femoral head is

Ebook Basic musculoskeletal imaging: Part 2

radiolucent. The AP view best Illustrates the angle of inclination (normal between 30 and 55s).either parallel to the femoral shaft or in slight valgu

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2 femoral cortex is most often injured. Regardless of the location of the periprosthetic fracture, revision to a longer-stemmed revision prosthesis is

often needed. The femoral component should also be symmetric in the center of the acetabular component. Smooth 2 mm or less radiolucent lines at the b Ebook Basic musculoskeletal imaging: Part 2

one-cement interface can be normal if not progressive. Subsidence (sinking in of the prosthesis) of less than 2 mm is also within normal limits.’KNEE

Ebook Basic musculoskeletal imaging: Part 2

PROSĨHESESMost knee replacements are total knee replacements involving resurfacing of the femoral condyle and the tibial plateau (Figure 10-4). Tire p

Orthopedic Hardware and ComplicationsReza Dehdari, MDMinal Tapadia, MD, JD, MA10IntroductionJoint Prosthetic ComplicationsJoint ReplacementSpinal Fusi

Ebook Basic musculoskeletal imaging: Part 2ip prosthesis. (A) AP radiograph shows significant femoral stem loosening (arrows) and varus alignment of the femoral stem tip. (B) Arthrogram of the

hip reveals contrast accumulation in between the bone and cement interface indicating loosening of the prosthesis stem (arrows).214 J Ebook Basic musculoskeletal imaging: Part 2

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