mcjrc017p
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1.
Please indicate intraoperative findings for the failure mode: Dislocation/Instability (Choose ALL that apply)
(Required.)
None
Previous capsular repair
Soft tissue insufficiency
Abductor insufficiency
Liner Failure
Other (please specify)
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2.
Was there a Liner Failure?
(Required.)
Yes
No
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3.
What is the direction of dislocation?
(Required.)
Anterior
Posterior
Multi-directional
Unknown
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4.
Is there damage from impingement to the components?
(Required.)
Liner
Cup
Stem (e.g. femoral neck notching)
None
Liner/Cup
Liner/Stem
Cup/Stem
Liner/Cup/Stem
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5.
What type of impingement did you notice? (Check all that apply)
(Required.)
Bone-bone
Bone-Prosthesis
Prosthesis-prosthesis
None
Bone-bone/Bone-Prothesis
Bone-bone/Prosthesis-prosthesis
Bone-Prosthesis/Prosthesis-prosthesis
Bone-bone/Bone-Prosthesis/Prosthesis-prosthesis
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6.
Prior to your revision, was the hip you are revising stable to your routine intra-operative exam, i.e. would you have left the OR feeling comfortable with the intra-op stability testing (do not judge based on component position, only stability testing)?
(Required.)
Yes, stable
No, dislocation with 90 flexion and internal rotation
No, dislocation with extension and external rotation
No, dislocation in position of sleep
No, dislocation with direct flexion (no rotation)
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7.
What is the quality of the abductor muscles
(Required.)
Intact
Small tear
Large tear
Complete disruption
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8.
What is the quality of the posterior soft tissue sleeve?
(Required.)
Intact
Deficient
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9.
What did you do to address the instability? (Check all that apply)
(Required.)
Change head size
Change bearing to constraint liner
Change bearing to dual mobility
Change version of cup
Change version of stem
Increased leg length
Increased offset
No Change
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10.
If you increased offset and/or leg length, did you exceed normal to achieve stability?
(Required.)
Yes
No
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11.
Please indicate the PREVIOUSLY IMPLANTED Device Fixation for ACETABULUM
(Required.)
Acetabular Device - solid
Acetabular Device - loose
Acetabular Device - cemented
Acetabular Device - cementless
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12.
Please indicate the PREVIOUSLY IMPLANTED Device Fixation for FEMUR
(Required.)
Femoral Device - solid
Femoral Device - loose
Femoral Device - cemented
Femoral Device - cementless
13.
Please indicate Special Techniques performed on the femur (choose all that apply)
None
Femoral Impaction Grafting
Extended Trochanteric Osteotomy
Wagner Spherical Osteotomy
Other (please specify)
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14.
Please indicate the Femoral Implant Types (Choose ALL that apply)
(Required.)
Conventional proximally coated stem
Modular metaphyseal engaging stem
Modular diaphyseal engaging stem
Nonmodular diaphyseal engaging stem
Proximal femoral replacement
Allograft prosthetic composite
Total femur replacement
Bipolar stem
Cemented modular stem
Cemented standard stem
Cemented long stem
Cement within cement
Other (please specify)
Femoral Bone Loss Classification (Paproksy Class)
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15.
What was the FEMORAL BONE LOSS CLASSIFICATION (Paprosky Class)?
(Required.)
N/A
Type I
Type II
Type IIIA
Type IIIB
Type IV
Acetabular Bone Loss Classification (Paprosky Class)
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16.
What was the ACETABULAR BONE LOSS CLASSIFICATION (Paprosky Class)?
(Required.)
N/A
Type I
Type IIA
Type IIB
Type IIC
Type IIIA
Type IIIB
17.
Indicate any Intra-Op Complications
None
Femoral Calcar Crack
Femoral Shaft Fracture
Femoral Shaft Perforation
Acetabular Wall Fracture
Acetabular Column Fracture
Femoral Fracture
Other (please specify)
18.
Was a deep drain used?
Yes
No
Current Progress,
0 of 18 answered