Major Joint Arthroplasty, Bone Cement Implantation Syndrome, and Perioperative Thromboprophylaxis — WACS Viva & Clinical Scenarios (Orthopaedics & Trauma)

Exam-style major joint arthroplasty, bone cement implantation syndrome, and perioperative thromboprophylaxis viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: An 82-year-old female (ASA 3) with severe hypertension and mild aortic stenosis presents for a cemented bipolar hemiarthroplasty for a displaced femoral neck fracture. Two minutes after manual pressurisation of PMMA bone cement into the femoral canal, end-tidal CO2 drops abruptly from 36 mmHg to 14 mmHg, HR slows to 42 bpm, and BP plummets to 50/30 mmHg. Diagnose the crisis and provide your step-by-step management.
• SCENARIO 2: A 68-year-old male (ASA 2) with bilateral severe tricompartmental knee osteoarthritis is scheduled for primary Total Knee Arthroplasty. He has a history of a previous DVT 5 years ago. Formulate a comprehensive perioperative plan covering regional anaesthetic choice, blood conservation (TXA dosing and contraindications), and postoperative thromboprophylaxis guidelines.
• SCENARIO 3: A 75-year-old male (ASA 3) with controlled Type 2 diabetes and chronic kidney disease (baseline eGFR 38 mL/min/1.73m2) is scheduled for elective uncemented Total Hip Arthroplasty. Defend your choice between general anaesthesia versus central neuraxial block in this patient, detailing your hemodynamic goals and postoperative pain strategy.
• SCENARIO 4: A 70-year-old female (ASA 3) undergoing revision total hip arthroplasty under general anaesthesia experiences unexpected surgical blood loss of 2200 mL during acetabular cup extraction and femoral stem revision. How do you monitor, resuscitate, and correct coagulopathy when cell salvage and point-of-care coagulation analysers are unavailable?