infection

Tsukayama Classification

Incidence

Dale et al Acta Orthop 2012

- Nordic Arthroplasty Registry of 430,000 THA

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

General

- haemarthrosis

- DVT

- infection

Septic Arthritis

Incidence

1.  Infection

Peters et al J Arthroplasty 2009

Incidence

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

Ideal < 1%

Risk Factors

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Preoperative

Identify high risk groups

- immunocompromised

- diabetes

- RA

- malnutrition

Urine screen

- check for and treat UTi

Groin, nose, axilla swabs

- for MRSA

- if positive, treat

- need 3 consecutive free swabs

3 x chlorhexidine preoperative showers in 8 hours

Admit day of surgery

- check skin for lesions

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex