The Hip book

C-Reactive Protein

(see also orthopaedic infections) Discussion an acute phase protein that can be used to follow the course of acute infections; produced in the liver by cytokines – IL-6 it rises and falls faster than the ESR; 10 mg per liter is used as the threshold for total hip infection infection; using this threshold, the sensitivity … Read more

When to use Beta Blockers in the MI patient

– Discussion:  – for patients with Q wave infarcts B. blockers are helpful when the following conditions apply: (assuming no contraindications)  – all patients > 60 yrs;  – all patients who exhibit ischemia on excercise;  – patients with abnormal left ventricular function; (? < 45%)  – patients who require B. blockers for rest Angina or … Read more

Local Anesthesia following TKR

– intraoperative injection:              – 300 mg ropivacaine (0.2%) (150 mL) + 30 mg ketorolac (1 mL) + 500 µg of epinephrine (1:1000) (0.5 mL) (prepared on the sterile field)              – 18 gauge needle is used to inject in 3 equal 50 mL doses into each of 3 locations:                     (a) posterior capsule                     (b) medial, lateral … Read more

Complications of Blood Transfusion

– Blood Product Menu:       – pRBCs – Fresh Frozen Plasma – Platlets – Cryoprecipitate – Transfusion Therapy – Coag Pathway – Acidemia and Hyperkalemia: from massive transfusions;     – massive transfusion: transfusion of pRBC >6-8 units, must also provide platlets;             – 8 units platlets for ea 10-12 units pRBC’s … Read more

Function and Activity after TKR:

See: Physical Therapy after TKR and Work Up of Painful TKR – Rising from Chair:      – Persistence of altered movement patterns during a sit-to-stand task 1 year following unilateral total knee arthroplasty. – Golf:      – Golf after total knee arthroplasty: do patients return to walking the course? – Workers Compensation:      – Total knee … Read more

Post Renal Azotemia

div class=”mh-row clearfix”> h1>/h1> div class=”bodycopy”>br/> hr size=”3″/>br/>   – r/o lower UT obstructionbr/>   – If bladder obstruction presentbr/>       * expect Uo > 400 mlbr/>       * pt to be relievedbr/>       * Regularly flush Foley w/ 20-30ml NS; ensure free urine flow;br/>   – If patient … Read more

Pertinent Blood Supply for Hallux Valgus Surgery

– Discussion:     – blood supply to 1st metatarsal head is both extraosseous & intraosseous;     – extra-osseous supply:           – enters metatarsal on its lateral and dorsolateral surface 2 cm proximal to the joint;           – extra-osseous branches also enter lateral capsule;     … Read more

Role of PeriOperative Oxygen in Reduction of Surgical Infection:

– Studies that Do Support the Use of O2 for Prevention of Infection:      – Supplemental Perioperative Oxygen to Reduce the Incidence of Surgical-Wound Infection       – Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. – Studies that Do Not Support the Use of O2 for Prevention of Infection: … Read more

Peri-Operative Dosing (for patient on Steroids)

  – pts who have had adrenalectomy, adrenal insufficiency, pituitary surgery, renal cell ca, or seminoma therapy should be given supplemental steroids;  – previously, it has been recommended that patients who are on steroids or who have taken steroids in the past year be provided with supplemental IV steroids inorder to prevent an adrenal crisis;  … Read more


  – mitotic rate of regenerating epidermal cells increased 5-10 fold in moist, O2 rich environment as compared to desiccated wound environment; – in experimental wounds the local pO2 is 0-20 as compared to 30-60 mm in the normal tissues;  – pCO2 in the wound is 60 mm with a pH of 7.1;  – Methods … Read more