Notas / Notes - Active Congress.......
Notas / Notes - Active Congress.......
Notas / Notes - Active Congress.......
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VIERNES / FRIDAY<br />
198<br />
15.30 - 16.15 h<br />
RODILLA / KNEE<br />
Complicaciones / Complications<br />
Moderador: Carlos Resines<br />
EVALUATION OF THE PAINFUL<br />
TOTAL KNEE<br />
Thomas S. Thornhill M.D.<br />
John B. and Buckminster Brown<br />
Professor of Orthopedic Surgery, Harvard Medical School<br />
Orthopaedist-in-Chief Brigham and Women’s Hospital<br />
Boston, Massachusetts (USA)<br />
1) DIAGNOSTIC TESTS FOR THE EVALUATION OF THE<br />
PAINFUL TKR<br />
-history/ physical exam<br />
-plain radiographs<br />
-scintigraphy<br />
technetium/gallium/indium<br />
-aspiration with synovial fluid analysis<br />
-arthrography<br />
-sinograms<br />
-selective local anesthetic injections<br />
-articular<br />
-periarticular<br />
-phentolamine injection<br />
-sympathetic block<br />
-pain unit consultation<br />
2) CAUSES OF A PAINFUL TKR<br />
A. Intra-Articular Problems<br />
- loose bodies<br />
- overhanging component<br />
- patellar clunk<br />
- recurrent hemarthrosis<br />
- gout/CPPD/RA<br />
- persistent synovitis<br />
B. Periarticular Problems<br />
- pes anserine bursitis<br />
- patellar tendinitis<br />
- stress fracture<br />
- heterotopic ossification<br />
C. Malalignment<br />
- MCL strain in valgus knee<br />
- tibial overload in varus knee<br />
- rotational impingement<br />
- patellar subluxation<br />
D. Instability<br />
- flexion<br />
- PCL sag<br />
- anterior knee pain<br />
- increased poly wear<br />
- “start up pain”<br />
- medial/lateral<br />
- global<br />
E. Systemic Problems<br />
- ipsilateral hip<br />
- vascular claudication<br />
F. Neurologic Complications<br />
- peroneal entrapment<br />
- reflex sympathetic dystrophy<br />
- L3/4 HNP<br />
- neurogenic claudication (spinal stenosis)<br />
G. Patellar Problems<br />
- avascular necrosis<br />
- stress fracture<br />
- subluxation<br />
- impingement<br />
- patellar clunk<br />
H. Stiff Knee<br />
- limited pre-op motion<br />
- tight PCL<br />
- residual flexion contracture<br />
- aggressive fibrous tissue response<br />
I. Patient Issues<br />
- unrealistic expectations<br />
- limited pre-operative changes<br />
- depression<br />
- family dynamics
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