SLIDE 1 Early Arthroplasty Failures: How I Recognize Them and Make the Correction – My Tricks
Keith R. Berend, MD
Joint Implant Surgeons, Inc., White Fence Surgical Suites, Midwest Training & Development Services New Albany, Ohio
SLIDE 2 Keith R. Berend, MD Disclosure
Consultant:
♦ Zimmer Biomet
Royalties:
♦ Zimmer Biomet; Innomed
Research Support:
♦ Zimmer Biomet; Pacira Pharmaceuticals;
Orthosensor; SPR Therapeutics Development Partner: SurgCenter Development
SLIDE 3
Alignment of Expectations
Pre-operative education Clear and accurate explanation of risks Need to know your own complication rates and profiles
♦ There is a 1%
risk of something bad happening such as…
♦ You have a 1/20 chance of
developing stiffness requiring another procedure
SLIDE 4 Intra-Operative
Always speak to the family after every surgery Answer any questions Give detailed and accurate explanations
♦ “We had some trouble with the ligaments
so we used a special device that should work great and have no issues with recovery or outcome”
SLIDE 5
Immediate Post-op
Nerve Palsy
♦ Take action!
Malaligned implant
♦ Discuss with family and fix it
Leg-Length Inequality
♦ Is it significant enough? ♦ Can you make it stable ♦ Acknowledge and fix?
SLIDE 6
Immediate Post-op
Nerve Palsy
♦ Take action!
Malaligned implant
♦ Discuss with family and fix it
Leg-Length Inequality
♦ Is it significant enough? ♦ Can you make it stable ♦ Acknowledge and fix?
SLIDE 7
Early and Obvious
Acknowledge the complication Address the complication Remedy the situation if you are qualified and comfortable
♦ If not, get help fast ♦ Direct surgeon to surgeon
communication
SLIDE 8
- 88 y.o. male
- OA
- 13.5 x 112.5 Lateralized
- 36mm CoCr on XLPE
- 10 wks postop
Sometimes it is Obvious
SLIDE 9
Wound Grief
SLIDE 10
Early But Not As Obvious
Continued pain/Excessive Pain
♦ Establish a narcotic agreement
preoperatively (expectations)
♦ Consider steroids (oral/injection)
Honeymoon phase of pain relief, pain returns
♦ Suspect aseptic loosening ♦ Serial radiographs
Early “guided” second opinion
SLIDE 11
Subsidence and Aseptic Loose
SLIDE 12
Stiffness
6 Weeks exam
♦ Supine, goniometer-assisted ROM
exam Is the patient happy with their motion? Is the ROM improved from pre-op? How’s the pain, swelling, effusion?
♦ If there is continued concern MUA is
recommended and results discussed
SLIDE 13
MUA
Document passive ROM under anesthesia Manipulate flexion using short lever-arm Manipulate extension using a heel bump +/- Inject with Steroid Repeat Manipulation Document with iPhone Goniometer App and Photographs
SLIDE 14
MUA
Document passive ROM under anesthesia Manipulate flexion using short lever-arm Manipulate extension using a heel bump +/- Inject with Steroid Repeat Manipulation Document with iPhone Goniometer App and Photographs
SLIDE 15 You Are Responsible Stay In Charge
Pre-Operative education to align expectations Be honest and address intra-operative and acute post-op complications Early referral to an expert or pointed second opinion Human nature says, ignore… do the
SLIDE 16
