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Adult Hip Dysplasia for Orthopaedic Exams
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Adult Hip Dysplasia for Orthopaedic Exams
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https://cadmoreoriginalmedia.blob.core.windows.net/6069ab70-4431-4e75-b22b-9b5763365156/Adult Hip Dysplasia for Orthopaedic Exams.mp4?sv=2019-02-02&sr=c&sig=k6RdXhJ5dUjVoPRhQp0sEDcaIirT7cq8LnzwphCOGkA%3D&st=2024-11-21T17%3A11%3A00Z&se=2024-11-21T19%3A16%3A00Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
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Language: EN.
Segment:0 .
OK, guys, thank you very much for joining us again on the FRCS with OR mentor groups. We are lucky today to have Osman Muhammad Usman khattak, who's just recently passed exams.
He's going to be giving us a talk on dysplasia before we. And we've got Abdullah, who knew one of our new mentors. You've all heard him talk before, so he'll be helping us as well. We're going to be doing voiceover sessions at the end of the presentation. There may be some of them related to the topics we're doing, and others will not be related if you do want to be private.
Please do put your hand up and you do know we don't record those, so it's all for your benefit. We'll do it. We'll have some of our mattress sutures soon, I hope. OK how about if you want to go ahead? The adult dysplastic hip, and this is a very common scenario. And here I'm going to give you an idea. Briefly, if you get an X-ray like shown above on the screen and this is all about how you're going to tackle this question, you need to have a system as to how the X-ray.
What would be the questions that might be asked from you guys? And basically, this is not a trick question. And yet they are not going to ask you how you are going to do this hip replacement. But basically, they want to know your thinking, your rationale or planning by tackling such a challenging case. So you start by simple things. So the mental dysplasia of the pit is one of the leading causes of adult young adult hip osteoarthritis in this country.
And whenever you get a patient, whether it's your clinical or it is, your wife who is a young has got osteoarthritis with the onset osteoarthritis. Just make sure that you think about either discuss typekit congenital problems with Curtis or Sophie, or they've had a trauma or maybe an infection as well. So just keep those scenarios in mind, because that's how you drive all your clinical cases and find out.
Don't miss these things. So it is one of the leading causes of arthritis, and the basic reason is that the inactivity smoking is normal context in the joint. And these people do develop arthritis. Certainly don't talk about it would be the solution to them as they have become more stress, more painful. And it is a challenging procedure and we need to plan it properly and have a game played in a game plan in mind.
And these patients, like you have to tailor make the treatment for these patients depending upon what the anatomy is like, what their ages, and you have to think about the whole of that spectrum as well. It is challenging because it's a young patient. They are going to have revision surgery. You need to think about the implant that you are using. There are bony challenges associated with this problem.
They are soft tissue challenges, and these patients do have a high failure rate in remission rates as well. We keep all of this in your mind when you are structuring your answer for this problem. Now, the first thing that we're going to do is they're going to show you an x-ray, so always have a system for X for describing where X-ray and the main. The basic thing that I found easier was to start with the acetabulum and then make your way down.
So with such a hit, the X rays, you need to comment on the acetabulum. The acetabulum is going to be shallow. There is going to be lack of coverage, either posterior, sapele anterior. Laterally, there is going to be proximal migration. The head might be distorted. There are going to be osteoarthritis changes. The version is going to be it's mostly integrated.
The neck is going to be either in various or religous. Then you need to comment on the canal as well. And also in this table, do mention, if you could see or localize the teardrop, which is the true flow of your acetabulum. And when you are talking about these things, the examiner would know that what you are talking about what's going through your mind, and that's where you can show that you have got this ability of the higher order thinking going on with you.
Because this is a surgical exam, they're going to take you towards the surgical management of this patient and what you are describing the extreme you need to score all of these points. So be very systematic when you describe an X-ray any X-ray. But with this, have a system like this in your mind? There are a few and some of the examiners might ask you to draw them and might ask you, and this is not just for this plastic hip, you can use that for any kind of dysplasia in the pediatric patient as well.
And there are the three most common ones. And one of the examiners did ask me about two of these angles and he asked me to draw them. And he was more interested in knowing the normal values. So the center edge angle, it is the most commonest one, and that's how we draw it. As you see it in the picture, you can do a practice, a simple diagram of drawing this. And basically, if the angle is becoming narrow, if it's going less than 25 degrees, then there is adequate coverage, inadequate coverage of the femoral head and this table is becoming shallow.
Normally when it increases, when it increases quite a lot, then you get over coverage with it and you get your pencil kind of impingement with that, this plastic. So that's one angle. The other angle is the angle. This is not very commonly asked, but some people might get asked about this. One of my friends did get asked about this.
So basically, it's the angle that you line is drawn from the weight bearing area of the femoral head, which is called the nostril, and the other line is drawn towards the lateral edge of the acetabulum, and it needs to be less than 10 degrees if it's going more than 10 degrees. Again, there is inadequate coverage as well. The other one is the egawa test index, so you draw a line from the teardrop, where if it's a pediatric patients, it's going to be the engineers line basically.
And the other line is drawn towards the edge of the lateral edge of the acetabulum. And that is 33 to 38 degrees is within normal limits. So that's what would be called a normal stable in Israel. Now there are lots. There are two main classification systems for ease. I memorize the high kaldas classification and it's very easy.
So in a way, the FDA establishes this plastic, but the head is within the true acetabulum. It's not displaced. It's not dislocated. Then in b, the thing the difference between B and C is that with the B is called the loudest location and the female goes up and it makes a false acetabulum. But the lower lip of the false acetabulum is overlying the true acetabulum.
There is overlap between the two. And then in high distribution, there is no overlap between the false and the true acetabulum. As you can see in this image, it is quite high, so that's called the high dislocation. This was easier for me to remember than to confuse myself with the next two, and that is the crew classification. You're talking about ratios.
You're talking about lines. So in the UI, you would get confused. Stressful situation. So I found the hydrofracking this easy. Some of you people might be using the croes classification in your day to day routine and you would be more familiar with it. So stick to whatever, whichever one you like. But usually it's this the difficulties I found easier.
And now they are going to take you towards the surgical management, and they are going to tell you that this is the x-ray, you will describe the x-rays and they will tell you this is a patient 49 years of age, 48 years of age, and they have exhausted all non operative management. And now how are you going to do this? So there are certain things that you need to talk about. So firstly, you need to say this is a challenging case, so you need to.
And that's where your safety factor comes into play, that you've identified something that is challenging and that is difficult. You are going to discuss it with your colleague who is doing these dealing with these conditions. A young adult arthroplasty colleague. So all you need to have, you need to say this then starts your planning. So for the planning, you need to know the anatomy very well.
You need to know where is the defect in the acetabulum? What is the version in? All of this could be quantified by the CT scanning. So you need to mention a CT scan in your pre-op management and that would help you plan. You need to know how thin the meeting wall is. What is? What is the version of your femur? Where is the deficiency lying in your acetabulum?
And that will help you in planning. Then you talk about templating as well. So templating is very important with these patients, then the things that you might require with this surgery. So it's common sense all that you would require a complex arthroplasty kit. You might need bone grafts. You are going to need tantalum augments if there is natural coverage deficiency.
If there is soft tissue problems, you might need to capture a cup. You might need osteotomy kits if you are doing a femoral osteotomy. Some patients may even require custom made implants. So all of these things, so basically when you are answering this question, just think that you are going to plan and do a hip replacement on this patient.
And basically, what you are doing is you are thinking aloud, so you practice it and your thinking will be automatic and then you just be uttering the words that you are thinking about and that's what they want to see. So approach is very important. So are going to do an intermediate approach to the posterior approach. If you look at various literature about these hips.
Now for the lower dislocations or the Crow type 1 type two, you can either use a posterior approach or you can use video go with your normal hardening approach. But with most.
Segment:0 .
OK, guys, thank you very much for joining us again on the FRCS with OR mentor groups. We are lucky today to have Osman Muhammad Usman khattak, who's just recently passed exams.
He's going to be giving us a talk on dysplasia before we. And we've got Abdullah, who knew one of our new mentors. You've all heard him talk before, so he'll be helping us as well. We're going to be doing voiceover sessions at the end of the presentation. There may be some of them related to the topics we're doing, and others will not be related if you do want to be private.
Please do put your hand up and you do know we don't record those, so it's all for your benefit. We'll do it. We'll have some of our mattress sutures soon, I hope. OK how about if you want to go ahead? The adult dysplastic hip, and this is a very common scenario. And here I'm going to give you an idea. Briefly, if you get an X-ray like shown above on the screen and this is all about how you're going to tackle this question, you need to have a system as to how the X-ray.
What would be the questions that might be asked from you guys? And basically, this is not a trick question. And yet they are not going to ask you how you are going to do this hip replacement. But basically, they want to know your thinking, your rationale or planning by tackling such a challenging case. So you start by simple things. So the mental dysplasia of the pit is one of the leading causes of adult young adult hip osteoarthritis in this country.
And whenever you get a patient, whether it's your clinical or it is, your wife who is a young has got osteoarthritis with the onset osteoarthritis. Just make sure that you think about either discuss typekit congenital problems with Curtis or Sophie, or they've had a trauma or maybe an infection as well. So just keep those scenarios in mind, because that's how you drive all your clinical cases and find out.
Don't miss these things. So it is one of the leading causes of arthritis, and the basic reason is that the inactivity smoking is normal context in the joint. And these people do develop arthritis. Certainly don't talk about it would be the solution to them as they have become more stress, more painful. And it is a challenging procedure and we need to plan it properly and have a game played in a game plan in mind.
And these patients, like you have to tailor make the treatment for these patients depending upon what the anatomy is like, what their ages, and you have to think about the whole of that spectrum as well. It is challenging because it's a young patient. They are going to have revision surgery. You need to think about the implant that you are using. There are bony challenges associated with this problem.
They are soft tissue challenges, and these patients do have a high failure rate in remission rates as well. We keep all of this in your mind when you are structuring your answer for this problem. Now, the first thing that we're going to do is they're going to show you an x-ray, so always have a system for X for describing where X-ray and the main. The basic thing that I found easier was to start with the acetabulum and then make your way down.
So with such a hit, the X rays, you need to comment on the acetabulum. The acetabulum is going to be shallow. There is going to be lack of coverage, either posterior, sapele anterior. Laterally, there is going to be proximal migration. The head might be distorted. There are going to be osteoarthritis changes. The version is going to be it's mostly integrated.
The neck is going to be either in various or religous. Then you need to comment on the canal as well. And also in this table, do mention, if you could see or localize the teardrop, which is the true flow of your acetabulum. And when you are talking about these things, the examiner would know that what you are talking about what's going through your mind, and that's where you can show that you have got this ability of the higher order thinking going on with you.
Because this is a surgical exam, they're going to take you towards the surgical management of this patient and what you are describing the extreme you need to score all of these points. So be very systematic when you describe an X-ray any X-ray. But with this, have a system like this in your mind? There are a few and some of the examiners might ask you to draw them and might ask you, and this is not just for this plastic hip, you can use that for any kind of dysplasia in the pediatric patient as well.
And there are the three most common ones. And one of the examiners did ask me about two of these angles and he asked me to draw them. And he was more interested in knowing the normal values. So the center edge angle, it is the most commonest one, and that's how we draw it. As you see it in the picture, you can do a practice, a simple diagram of drawing this. And basically, if the angle is becoming narrow, if it's going less than 25 degrees, then there is adequate coverage, inadequate coverage of the femoral head and this table is becoming shallow.
Normally when it increases, when it increases quite a lot, then you get over coverage with it and you get your pencil kind of impingement with that, this plastic. So that's one angle. The other angle is the angle. This is not very commonly asked, but some people might get asked about this. One of my friends did get asked about this.
So basically, it's the angle that you line is drawn from the weight bearing area of the femoral head, which is called the nostril, and the other line is drawn towards the lateral edge of the acetabulum, and it needs to be less than 10 degrees if it's going more than 10 degrees. Again, there is inadequate coverage as well. The other one is the egawa test index, so you draw a line from the teardrop, where if it's a pediatric patients, it's going to be the engineers line basically.
And the other line is drawn towards the edge of the lateral edge of the acetabulum. And that is 33 to 38 degrees is within normal limits. So that's what would be called a normal stable in Israel. Now there are lots. There are two main classification systems for ease. I memorize the high kaldas classification and it's very easy.
So in a way, the FDA establishes this plastic, but the head is within the true acetabulum. It's not displaced. It's not dislocated. Then in b, the thing the difference between B and C is that with the B is called the loudest location and the female goes up and it makes a false acetabulum. But the lower lip of the false acetabulum is overlying the true acetabulum.
There is overlap between the two. And then in high distribution, there is no overlap between the false and the true acetabulum. As you can see in this image, it is quite high, so that's called the high dislocation. This was easier for me to remember than to confuse myself with the next two, and that is the crew classification. You're talking about ratios.
You're talking about lines. So in the UI, you would get confused. Stressful situation. So I found the hydrofracking this easy. Some of you people might be using the croes classification in your day to day routine and you would be more familiar with it. So stick to whatever, whichever one you like. But usually it's this the difficulties I found easier.
And now they are going to take you towards the surgical management, and they are going to tell you that this is the x-ray, you will describe the x-rays and they will tell you this is a patient 49 years of age, 48 years of age, and they have exhausted all non operative management. And now how are you going to do this? So there are certain things that you need to talk about. So firstly, you need to say this is a challenging case, so you need to.
And that's where your safety factor comes into play, that you've identified something that is challenging and that is difficult. You are going to discuss it with your colleague who is doing these dealing with these conditions. A young adult arthroplasty colleague. So all you need to have, you need to say this then starts your planning. So for the planning, you need to know the anatomy very well.
You need to know where is the defect in the acetabulum? What is the version in? All of this could be quantified by the CT scanning. So you need to mention a CT scan in your pre-op management and that would help you plan. You need to know how thin the meeting wall is. What is? What is the version of your femur? Where is the deficiency lying in your acetabulum?
And that will help you in planning. Then you talk about templating as well. So templating is very important with these patients, then the things that you might require with this surgery. So it's common sense all that you would require a complex arthroplasty kit. You might need bone grafts. You are going to need tantalum augments if there is natural coverage deficiency.
If there is soft tissue problems, you might need to capture a cup. You might need osteotomy kits if you are doing a femoral osteotomy. Some patients may even require custom made implants. So all of these things, so basically when you are answering this question, just think that you are going to plan and do a hip replacement on this patient.
And basically, what you are doing is you are thinking aloud, so you practice it and your thinking will be automatic and then you just be uttering the words that you are thinking about and that's what they want to see. So approach is very important. So are going to do an intermediate approach to the posterior approach. If you look at various literature about these hips.
Now for the lower dislocations or the Crow type 1 type two, you can either use a posterior approach or you can use video go with your normal hardening approach. But with most.
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