These are currently one of the most widely used not only for scoliosis as it allows better control of the vertebral body alignement and correction of its rotation.
Hardware positioning in the spine particularly pedicular screws is a delicate procedure and post-op imaging should assess their positioning. Regarding pedicular screws' positioning, medially there's the spinal cord; laterally the screw would not provide sufficient purchase and noble structure might be injured.
Caudally and cephalically are the nerve roots, which might cause severe pain and fuctional compromise. Other types of material such as titanium boxes, bone grafts or even prosthesis have also been developed. Hip and knee replacements are one of the most common procedures today.
The Radiology Assistant : Hip - Arthroplasty
In , in the US, there was an average of 1 surgery per thousand of inhabitants, and the double of knee replacement surgeries. In Europe there has been a steady increase in the number of this procedures, and probably the demographics are rather similar to the US. Total hip replacement is an invasive procedure. Other alternatives have been attempted in order to minimize trauma. Total hip prothesis is used when the femoral head and the acetabulum have both pathological changes.
Hip endoprothesis without acetabular component is used when the femoral head alone is diseased. There has been a slight collapse of the neck with leg shortening, protrusion and sclerosis of the small trochanter indicating impaction. Girdlestone procedure was discusssed above. It is a last resource surgery being used in most cases for neuropathic or infectious disease.
ECR 2014 / C-0601
May occur due to metal wear in metal-metal prothesis. Besides the expected prothesis wear damage, dissemination of metal debris to regional lymph nodes has been documented. The potential development of hypersensitivity reactions, infections, and tumors are a concern. Within the involved joint, metal debris in the synovial membrane leads to a diagnostic radiographic appearance, with radiodense material observed at the periphery of the joint. Arthrocentesis documents the presence of thick, dark gray or black fluid.
Fully constrained prosthesis were the first type of prosthesis available.
Findings and procedure details
Fully constrained with rotations are still used in older patients, with massive tumour resection or in revision arthroplasties. These have no ligament stability, meaning the joint stability is provided by sparing the patients own ligaments. As little bone is actually ressected, they are composed by "resurfacing" components - both a tibial and a femoral one. Some may also possess a patelar resurfacing component. Usually the radiographic assessment should be done with an anteroposterior and lateral knee incidence, a axial patelar radiograph, a whole leg length radiograph.
Angulation with the femoral mechanical axis is important as this is the best intraopertory reference aviable. The development of such scoring systems stresses the need for methodical follow up - quantification of radiolucent areas in milimeters , the number of lucent areas, the angular relationships and, very importantly, their evolution are important aspects to pay attention. Component alignement is an important factor to considerate as mal-alignement is a cause for instability, loosening and failure.
On lateral view, the femoral component should be nearly perpendicular with the femoral mechanical axis and no lucent spot should be seen. The tibial component should be placed perpendicular to the tibial shaft AP , centered or slightly posterior to the axis on lateral view. Overhanging of the tibial component may be symptomatic. The joint line height is determined by measuring the distance from a line passing through the tibial tubercule perpendicular to the tibial shaft to a paralell line passing through the the tibial plateau.
Loosening is believed to be caused by a combination of mechanical stress, malalignement, osteolysis and poor bone stock. Criteria for diagnosis are. Infection is always a consideration with radiolucent lesions, especially in the first two years. More commonly they are indolent with mild to moderate disconfort. Fluoroscopic dynamic examination may be helpful in patients with unexplained pain after TKA and normal radiographs. Contrast medium should not be present in fluid aspiration. In case of dry tap, sterile saline lavage has been described.
Radiographs are instrumental in their diagnosis. Artiles 1 , S. Fernandez, V. Artiles, M. Kwiatkowska 1 , J. Czubak 1 , M. Tyrakowski 1 , M. Measurements of tunnel placements after anterior cruciate ligament reconstruction; a comparison between x-ray, CT and MRI.
Parkar 1 , M. Adriaensen 2 , C. Fischer-Bredenbeck 1 , T. Strand 1 , E. Inderhaug 1 , E. Donato , F. Pereira da Silva, P. Oliveira, J. Ilharco, F. Nunes Correia 1 , J. Costa 2 , P. Donato 2 , A. Agostinho 2 , V.
Findings and procedure details
Carvalheiro 2 , F. Mota, F. Pereira da Silva , M. Gil-Pereira, H. Donato, P. Donato, F. Pereira da Silva, I. Candelaria, P. Oliveira, F. Browse posters. Brought to you by. This poster is published under an open license. Please read the disclaimer for further details. Pereira da Silva , H. Findings and procedure details Fig. A fully Digital topogram Two parallel rods are seen We believe that the X-BOLT device has the potential to transform fixation in patients suffering from osteoporosis and hip fractures, providing a significant improvement in mobility and quality of life.
Loss of mobility and independence among hip fracture survivors is profound; less than 50 percent regaining their previous function and 33 percent being totally dependent or in a nursing home a year later. Reducing the re-operation rate provides a significant opportunity for hospitals and governments to greatly reduce day readmissions and overall healthcare costs, notwithstanding the benefits to patients by improving their quality of life.
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