mkdir -p /home/daytona/workspace/ortho-prosthesis && ls /home/daytona/workspace/

~/ortho-prosthesis/build_pptx.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orthopedics Education";
pres.title = "Orthopedic Prosthesis: Indications, Design & Recent Advances";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  darkBlue:  "0D1F3C",   // dominant dark bg
  midBlue:   "1A3A6B",   // section headers
  accent:    "2ABFBF",   // teal accent
  accentOr:  "E87722",   // orange highlight
  white:     "FFFFFF",
  lightGray: "E8EEF4",
  textDark:  "1C2B3A",
  textLight: "D4E5F7",
  gold:      "F5C842",
  green:     "2ECC71",
  red:       "E74C3C",
};

// ─── HELPERS ─────────────────────────────────────────────────────
function sectionDivider(pres, num, title, subtitle) {
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.08, fill: { color: C.accent } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.545, w: "100%", h: 0.08, fill: { color: C.accent } });
  // large section number
  s.addText(num, { x: 0.3, y: 1.0, w: 1.5, h: 1.5, fontSize: 72, bold: true, color: C.accent, align: "center" });
  s.addText(title, { x: 2.0, y: 1.4, w: 7.5, h: 1.2, fontSize: 36, bold: true, color: C.white, align: "left" });
  if (subtitle) {
    s.addText(subtitle, { x: 2.0, y: 2.7, w: 7.5, h: 0.8, fontSize: 18, color: C.textLight, align: "left", italic: true });
  }
  return s;
}

function contentSlide(pres, title, bullets, ref) {
  let s = pres.addSlide();
  // Background gradient-like
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.lightGray } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: "100%", fill: { color: C.midBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.midBlue } });
  // Title bar
  s.addText(title, { x: 0.25, y: 0.1, w: 9.5, h: 0.72, fontSize: 22, bold: true, color: C.white, valign: "middle" });
  // Bullet content
  const bulletItems = bullets.map((b, i) => {
    const isSubBullet = b.startsWith("  ");
    return {
      text: b.trim(),
      options: {
        bullet: isSubBullet ? { indent: 30 } : true,
        fontSize: isSubBullet ? 14 : 16,
        color: isSubBullet ? C.textDark : C.darkBlue,
        bold: !isSubBullet,
        breakLine: true,
        paraSpaceAfter: isSubBullet ? 2 : 4,
      },
    };
  });
  s.addText(bulletItems, {
    x: 0.35, y: 1.05, w: 9.3, h: 4.15,
    valign: "top",
  });
  if (ref) {
    s.addText(ref, { x: 0.2, y: 5.2, w: 9.6, h: 0.35, fontSize: 9, color: "5A7A9A", italic: true });
  }
  return s;
}

function twoColSlide(pres, title, leftItems, rightItems, ref) {
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.lightGray } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.midBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.1, h: "100%", fill: { color: C.midBlue } });
  s.addText(title, { x: 0.25, y: 0.1, w: 9.5, h: 0.72, fontSize: 22, bold: true, color: C.white, valign: "middle" });
  // Left column header
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.0, w: 4.5, h: 0.4, fill: { color: C.accent }, line: { type: "none" } });
  s.addText(leftItems.header, { x: 0.2, y: 1.0, w: 4.5, h: 0.4, fontSize: 14, bold: true, color: C.darkBlue, align: "center", valign: "middle" });
  const leftBullets = leftItems.bullets.map(b => ({ text: b, options: { bullet: true, fontSize: 14, color: C.textDark, bold: false, breakLine: true, paraSpaceAfter: 3 } }));
  s.addText(leftBullets, { x: 0.2, y: 1.45, w: 4.5, h: 3.7, valign: "top" });
  // Right column header
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.0, w: 4.8, h: 0.4, fill: { color: C.accentOr }, line: { type: "none" } });
  s.addText(rightItems.header, { x: 5.0, y: 1.0, w: 4.8, h: 0.4, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle" });
  const rightBullets = rightItems.bullets.map(b => ({ text: b, options: { bullet: true, fontSize: 14, color: C.textDark, bold: false, breakLine: true, paraSpaceAfter: 3 } }));
  s.addText(rightBullets, { x: 5.0, y: 1.45, w: 4.8, h: 3.7, valign: "top" });
  if (ref) {
    s.addText(ref, { x: 0.2, y: 5.2, w: 9.6, h: 0.35, fontSize: 9, color: "5A7A9A", italic: true });
  }
  return s;
}

function tableSlide(pres, title, headers, rows, ref) {
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.lightGray } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.darkBlue } });
  s.addText(title, { x: 0.25, y: 0.1, w: 9.5, h: 0.72, fontSize: 22, bold: true, color: C.white, valign: "middle" });
  const tableRows = [
    headers.map(h => ({ text: h, options: { bold: true, color: C.white, fill: C.midBlue, align: "center", fontSize: 13 } })),
    ...rows.map((row, i) => row.map(cell => ({ text: cell, options: { fontSize: 12, color: C.textDark, fill: i % 2 === 0 ? "FFFFFF" : "EAF2FA", align: "left" } }))),
  ];
  s.addTable(tableRows, { x: 0.2, y: 1.0, w: 9.6, colW: headers.map(() => 9.6 / headers.length), border: { type: "solid", color: "B0C8E0", pt: 1 } });
  if (ref) {
    s.addText(ref, { x: 0.2, y: 5.2, w: 9.6, h: 0.35, fontSize: 9, color: "5A7A9A", italic: true });
  }
  return s;
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.12, fill: { color: C.accent } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.505, w: "100%", h: 0.12, fill: { color: C.accent } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.3, w: "100%", h: 0.06, fill: { color: C.accentOr } });
  s.addText("ORTHOPEDIC PROSTHESIS", {
    x: 0.4, y: 0.5, w: 9.2, h: 1.0, fontSize: 40, bold: true, color: C.white,
    align: "center", charSpacing: 3,
  });
  s.addText("Indications • Design • Recent Advances", {
    x: 0.4, y: 1.55, w: 9.2, h: 0.65, fontSize: 22, color: C.accent, align: "center", italic: true,
  });
  s.addText("A Comprehensive Review", {
    x: 0.4, y: 2.55, w: 9.2, h: 0.55, fontSize: 18, color: C.textLight, align: "center",
  });
  s.addText([
    { text: "References: ", options: { bold: true, color: C.gold } },
    { text: "Campbell's Operative Orthopaedics 15th Ed 2026  •  Miller's Review of Orthopaedics 9th Ed\nRockwood & Green's Fractures in Adults 10th Ed 2025  •  General Anatomy & MSK System (THIEME)", options: { color: C.textLight } },
  ], { x: 0.4, y: 3.4, w: 9.2, h: 0.9, fontSize: 12, align: "center", lineSpacingMultiple: 1.4 });
  s.addText("July 2026", { x: 0.4, y: 4.9, w: 9.2, h: 0.4, fontSize: 13, color: C.accent, align: "center" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.midBlue } });
  s.addText("TABLE OF CONTENTS", { x: 0.3, y: 0.15, w: 9.4, h: 0.6, fontSize: 24, bold: true, color: C.white, charSpacing: 2 });

  const sections = [
    ["01", "Introduction & Historical Perspective"],
    ["02", "Classification of Orthopedic Prostheses"],
    ["03", "Biomaterials & Biomechanics"],
    ["04", "Total Hip Arthroplasty (THA) – Indications & Design"],
    ["05", "Total Knee Arthroplasty (TKA) – Indications & Design"],
    ["06", "Shoulder Arthroplasty – Indications & Design"],
    ["07", "Unicompartmental & Partial Arthroplasty"],
    ["08", "Implant Fixation Methods"],
    ["09", "Bearing Surfaces"],
    ["10", "Recent Advances & Future Directions"],
    ["11", "Complications & Outcomes"],
    ["12", "References"],
  ];
  sections.forEach(([num, title], i) => {
    const col = i < 6 ? 0 : 1;
    const row = i % 6;
    s.addShape(pres.ShapeType.rect, {
      x: col === 0 ? 0.3 : 5.1,
      y: 1.1 + row * 0.71,
      w: 0.5, h: 0.5,
      fill: { color: C.accent }, line: { type: "none" },
    });
    s.addText(num, {
      x: col === 0 ? 0.3 : 5.1,
      y: 1.1 + row * 0.71,
      w: 0.5, h: 0.5,
      fontSize: 14, bold: true, color: C.darkBlue, align: "center", valign: "middle",
    });
    s.addText(title, {
      x: col === 0 ? 0.9 : 5.7,
      y: 1.1 + row * 0.71,
      w: 4.0, h: 0.5,
      fontSize: 14, color: C.white, valign: "middle",
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 1 – INTRODUCTION & HISTORY (Slides 3-5)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "01", "Introduction &\nHistorical Perspective", "From ivory femoral heads to modern bionic implants");

contentSlide(pres,
  "What is an Orthopedic Prosthesis?",
  [
    "Definition: An artificial device that replaces a missing or damaged musculoskeletal structure",
    "  Restores function, relieves pain, and improves quality of life",
    "  Encompasses joint replacements, limb prostheses, and spinal implants",
    "Scope of modern orthopedic prosthetics:",
    "  Total joint arthroplasty (hip, knee, shoulder, elbow, ankle)",
    "  Hemiarthroplasty (partial joint replacement)",
    "  Unicompartmental arthroplasty",
    "  Spinal disc replacements",
    "  Limb amputee prostheses",
    "Global burden: >1 million THAs and >700,000 TKAs performed annually in the USA alone",
    "Fastest growing orthopedic procedure category worldwide",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026 | Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Historical Milestones in Joint Replacement",
  [
    "1890 – Themistocles Gluck: First ivory ball-and-socket hip replacement",
    "1938 – Philip Wiles: First total hip replacement using stainless steel",
    "1940s – Austin Moore & Harold Bohlman: First metal femoral head hemiarthroplasty",
    "1962 – Sir John Charnley: Low-friction arthroplasty – modern THA era begins",
    "  Introduced PMMA cement, polyethylene acetabular cup, small femoral head",
    "Early 1970s – Gunston: First total condylar knee prosthesis (modern TKA ancestor)",
    "1970s – Neer: Shoulder hemiarthroplasty for proximal humeral fractures",
    "1980s-90s – Cementless porous-coated implants introduced",
    "2000s – Highly cross-linked polyethylene, ceramic-on-ceramic bearings",
    "2010s – Computer-assisted navigation and robotic surgery",
    "2020s – AI-driven planning, smart implants, patient-specific designs",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026, Historical Introduction"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 2 – CLASSIFICATION (Slides 6-8)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "02", "Classification of\nOrthopedic Prostheses", "By design, fixation, bearing surface, and application");

twoColSlide(pres,
  "Classification by Joint & Procedure Type",
  {
    header: "Lower Extremity",
    bullets: [
      "Total Hip Arthroplasty (THA)",
      "Hemiarthroplasty (Austin Moore, Thompson, Bipolar)",
      "Total Knee Arthroplasty (TKA)",
      "Unicompartmental Knee Arthroplasty (UKA)",
      "Patellofemoral Arthroplasty",
      "Total Ankle Arthroplasty (TAA)",
    ],
  },
  {
    header: "Upper Extremity & Spine",
    bullets: [
      "Total Shoulder Arthroplasty (TSA)",
      "Reverse Shoulder Arthroplasty (RSA)",
      "Total Elbow Arthroplasty",
      "Wrist Arthroplasty",
      "Finger/Thumb Joint Replacements",
      "Cervical/Lumbar Disc Arthroplasty",
    ],
  },
  "Campbell's Operative Orthopaedics 15th Ed 2026"
);

tableSlide(pres,
  "Classification by Fixation Method",
  ["Fixation Type", "Method", "Mechanism", "Ideal Patient"],
  [
    ["Cemented", "PMMA bone cement", "Mechanical interlock – immediate fixation", "Elderly, osteoporotic, low-demand"],
    ["Cementless (Press-fit)", "Porous/HA-coated surface", "Biologic – bone ingrowth/ongrowth", "Young, active, good bone stock"],
    ["Hybrid", "Cemented stem + cementless cup", "Combined advantages", "Moderate age/activity level"],
    ["Reverse Hybrid", "Cementless stem + cemented cup", "Preferred in some European registries", "Selected cases"],
  ],
  "Miller's Review of Orthopaedics 9th Ed; Campbell's Operative Orthopaedics 15th Ed 2026"
);

contentSlide(pres,
  "Classification by Constraint Level (Knee)",
  [
    "Constraint = degree of mechanical stability provided by implant geometry",
    "Unconstrained (CR – Cruciate Retaining):",
    "  Retains PCL; relies on soft tissues for stability; most physiological kinematics",
    "  Requires intact, functional PCL",
    "Partially Constrained (PS – Posterior Stabilized):",
    "  Tibial post engages femoral cam; substitutes for PCL",
    "  Most commonly used design; excellent long-term results",
    "Semi-constrained (VVC – Varus-Valgus Constrained):",
    "  For moderate coronal plane instability; uses thicker tibial polyethylene post",
    "Fully Constrained (Hinged/Rotating Hinge):",
    "  For severe bone loss, ligament instability, revision; highest risk of aseptic loosening",
    "Unicompartmental (UKA):",
    "  Medial or lateral compartment only; preserves cruciate ligaments and opposite compartment",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 3 – BIOMATERIALS (Slides 9-12)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "03", "Biomaterials &\nBiomechanics", "The science behind implant longevity and performance");

tableSlide(pres,
  "Biomaterials Used in Orthopedic Implants",
  ["Material", "Applications", "Advantages", "Limitations"],
  [
    ["Cobalt-Chrome (CoCr) Alloy", "Femoral stems, femoral condyles", "High strength, wear resistance, corrosion resistance", "Potential metal ion release, heavy"],
    ["Titanium Alloy (Ti-6Al-4V)", "Cementless femoral stems, cups", "Biocompatible, osseointegration, low modulus", "Lower wear resistance than CoCr"],
    ["UHMWPE (Polyethylene)", "Acetabular liners, tibial inserts", "Low friction, biocompatible, shock absorber", "Creep, oxidative degradation, wear debris"],
    ["Highly X-linked PE (HXLPE)", "Modern liners and inserts", "90% reduction in volumetric wear vs conventional PE", "Reduced fracture toughness at ultra-high crosslink"],
    ["Alumina / Zirconia Ceramics", "Femoral heads, acetabular liners", "Excellent hardness, very low wear, wettability", "Brittle – risk of fracture"],
    ["PMMA Bone Cement", "Cemented fixation", "Immediate fixation, antibiotic delivery", "Stress shielding, third-body wear"],
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Biomechanics of Hip Prosthesis",
  [
    "Normal hip: Center of rotation (COR), offset, and leg length critical for function",
    "Femoral Offset: Horizontal distance from femoral shaft axis to COR",
    "  Reduced offset → reduced abductor moment arm → Trendelenburg gait",
    "  Increased offset → increased bending stress on femoral stem",
    "Neck-Shaft Angle: 127–135° for standard stems; varus/valgus variants available",
    "Acetabular cup positioning:",
    "  40° ± 10° abduction (inclination)",
    "  15° ± 10° anteversion (Lewinnek safe zone)",
    "  Malposition → increased dislocation risk",
    "Stress Shielding: occurs when implant stiffness bypasses normal bone loading",
    "  Leads to proximal femoral bone resorption (Gruen zones 1 & 7)",
    "  Titanium alloy (lower modulus) reduces stress shielding vs CoCr",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed – Section 5 THA"
);

contentSlide(pres,
  "Biomechanics of Knee Prosthesis",
  [
    "TKA aligns mechanical axis: tibiofemoral angle restored to neutral (0–3° valgus)",
    "Flexion-Extension Gap Balancing:",
    "  Equal and rectangular extension and flexion gaps mandatory",
    "  Femoral component rotation: 3° external rotation relative to posterior condylar axis",
    "Tibial Component:",
    "  Posterior slope: 3–7° replicates native tibial slope",
    "  Tibial tray should cover maximum bone surface to distribute loads",
    "Patellar Tracking:",
    "  'No thumbs test' – patella should track centrally without manual correction",
    "  Lateral release if patellar tilt > 10°",
    "Kinematics:",
    "  CR designs – femoral rollback depends on intact PCL",
    "  PS designs – controlled rollback via cam-post mechanism; greater flexion achieved",
    "  Mobile-bearing designs – allow rotation to reduce polyethylene stress",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Tribology – Bearing Surfaces",
  [
    "Tribology: Science of friction, lubrication, and wear between articulating surfaces",
    "Metal-on-Polyethylene (MoP) – 'Gold standard':",
    "  Conventional PE: wear rate ~100 mm³/year; osteolysis from debris",
    "  HXLPE (Highly Cross-Linked PE): wear rate ~10 mm³/year – 90% reduction",
    "Ceramic-on-Polyethylene (CoP):",
    "  Lower wear than MoP; reduced metal ion release; preferred in young patients",
    "Ceramic-on-Ceramic (CoC):",
    "  Lowest wear rate; concerns: audible squeaking (0.5–2%), stripe wear, rare catastrophic fracture",
    "Metal-on-Metal (MoM) – LARGELY ABANDONED:",
    "  High wear in large heads → adverse local tissue reactions (ALTR), pseudotumors",
    "  MHRA recall 2010; ASR implant recall 2010 (DePuy/J&J)",
    "Oxidized Zirconium (OxZr / Oxinium):",
    "  Ceramic surface on metal substrate – wear resistance + fracture toughness",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 4 – TOTAL HIP ARTHROPLASTY (Slides 13-19)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "04", "Total Hip Arthroplasty\n(THA)", "Indications, Design, Approaches & Outcomes");

contentSlide(pres,
  "THA – Indications",
  [
    "Primary Indications:",
    "  Osteoarthritis (OA) – most common; KL Grade 3–4",
    "  Rheumatoid Arthritis (RA) and other inflammatory arthropathies",
    "  Avascular Necrosis (AVN) of the femoral head – Ficat Grade III–IV",
    "  Post-traumatic arthritis – after acetabular fractures, femoral neck fractures",
    "  Developmental Dysplasia of the Hip (DDH) – Crowe Type I–IV",
    "  Ankylosing Spondylitis",
    "  Protrusio Acetabuli",
    "Criteria for Surgery (Miller's, Campbell's):",
    "  Debilitating pain affecting ADLs (activities of daily living)",
    "  Failed conservative management (NSAIDs, physiotherapy, injections, walking aids)",
    "  Kellgren-Lawrence Grade 3–4 OA on plain radiograph",
    "  Patient medically fit for surgery; no active infection",
  ],
  "Miller's Review of Orthopaedics 9th Ed p.430; Campbell's Operative Orthopaedics 15th Ed 2026"
);

contentSlide(pres,
  "THA – Contraindications & Patient Selection",
  [
    "Absolute Contraindications:",
    "  Active infection – local or systemic",
    "  Neuropathic arthropathy (Charcot joint) – relative",
    "  Insufficient abductor musculature (relative)",
    "Relative Contraindications:",
    "  Morbid obesity (BMI > 40) – increased risk of infection, dislocation, revision",
    "  Young age < 50 years – counsel carefully; higher lifetime revision rate",
    "  Neuromuscular disease affecting hip stability",
    "Patient Optimization Before Surgery:",
    "  HbA1c < 8% in diabetics (reduces infection risk)",
    "  Weight loss – BMI < 35–40 recommended",
    "  Nutritional optimization (albumin > 3.5 g/dL)",
    "  Smoking cessation ≥ 4 weeks preoperatively",
    "  Dental clearance if indicated",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

twoColSlide(pres,
  "THA – Surgical Approaches",
  {
    header: "Anterior / Anterolateral",
    bullets: [
      "Anterior (Smith-Petersen / DAA): intermuscular, true tissue-sparing",
      "  Pros: Early stability, rapid recovery, lower dislocation",
      "  Cons: Difficult femoral exposure, LFCN risk",
      "Anterolateral (Watson-Jones): between TFL and Glut. Med",
      "  No internervous plane; abductor risk",
      "  Good stability; limited posterior capsule",
    ],
  },
  {
    header: "Posterior / Others",
    bullets: [
      "Posterior (Moore/Southern): Most widely used worldwide",
      "  Pros: Extensile, excellent femoral exposure",
      "  Cons: Higher dislocation rate (~3%) if capsule not repaired",
      "  Posterior capsular repair restores stability",
      "Lateral (Hardinge): Splits gluteus medius",
      "  Risk of abductor damage/Trendelenburg gait",
      "Mini-invasive approaches: < 10 cm incision",
    ],
  },
  "Miller's Review of Orthopaedics 9th Ed Table 5.2; Campbell's Operative Orthopaedics 15th Ed 2026"
);

contentSlide(pres,
  "THA – Femoral Stem Design",
  [
    "Cemented Stems:",
    "  Polished tapered stem (e.g., Exeter): subsidence creates taper-lock in cement mantle",
    "  Matt/roughened stem (e.g., Charnley): macro-interlock with cement",
    "  Cement generation: 1st–4th generation technique improvements",
    "Cementless Stems:",
    "  Fit-and-Fill: diaphyseal fixation (e.g., AML); cylindrical canal",
    "  Proximal-fill: metaphyseal loading (e.g., Taperloc, Corail); more physiological",
    "  Full porous-coated: extensive ingrowth along entire stem length",
    "Stem Materials: Titanium alloy preferred – lower modulus, reduced stress shielding",
    "Modular stems: Allows independent head/neck/body sizing; modular junction corrosion concern",
    "Short/Neck-preserving stems: Preserve proximal bone; used in younger patients",
    "Revision stems:",
    "  Fluted/tapered titanium for diaphyseal fixation in bone deficient cases",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "THA – Acetabular Cup Design",
  [
    "Cemented Cup: All-poly (Charnley original); largely replaced; still used in elderly/osteoporotic",
    "Cementless Hemispherical Press-Fit Cup:",
    "  Porous coated (sintered beads, fiber metal, plasma spray)",
    "  Hydroxyapatite (HA) coating – biologically active; promotes bone apposition",
    "  Porous-coated cementless cup is preferred choice with superior long-term results",
    "Screw Fixation: Supplementary screws provide initial stability",
    "  Safe zone for screw placement: posterior-superior quadrant (Wasielewski zones)",
    "Liner Options:",
    "  HXLPE – gold standard for low wear",
    "  Ceramic – for CoC or CoP bearing",
    "  Lipped liner – for at-risk dislocation patients (adds 10° effective head coverage)",
    "Cup Sizing: Underream by 1–2 mm for press-fit; 40±10° inclination, 15±10° anteversion",
  ],
  "Miller's Review of Orthopaedics 9th Ed p.431; Campbell's Operative Orthopaedics 15th Ed 2026"
);

contentSlide(pres,
  "THA – Outcomes & Survivorship",
  [
    "Survivorship at 15 years: 95–97% for modern cementless THA",
    "Survivorship at 20+ years: 90–93% for cemented Charnley-type THA",
    "Oxford Hip Score (OHS): Most commonly used PROMs",
    "Harris Hip Score (HHS): Surgeon-based; ≥80 = satisfactory",
    "Common Causes of Failure:",
    "  Aseptic loosening – 39.9% of all revisions (most common long-term)",
    "  Infection (PJI) – 27.4% (most common early revision cause)",
    "  Dislocation – 7.5%",
    "  Periprosthetic fracture – 4.7%",
    "  Wear / osteolysis – HXLPE dramatically reduced this cause",
    "Hemiarthroplasty (Austin Moore/Thompson/Bipolar):",
    "  Indication: Displaced femoral neck fractures in elderly; AVN Ficat I-II",
    "  Bipolar: Reduces acetabular erosion vs unipolar; equivalent outcomes in RCTs",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026, Prosthesis Survival section; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 5 – TOTAL KNEE ARTHROPLASTY (Slides 20-26)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "05", "Total Knee Arthroplasty\n(TKA)", "Indications, Implant Design, Alignment & Outcomes");

contentSlide(pres,
  "TKA – Indications & Contraindications",
  [
    "Primary Indications:",
    "  End-stage knee OA (most common); Kellgren-Lawrence Grade 3–4",
    "  Rheumatoid Arthritis / inflammatory arthropathy",
    "  Post-traumatic arthritis (after distal femur/tibial plateau fractures)",
    "  Failed prior procedures (osteotomy, UKA conversion)",
    "Clinical Criteria:",
    "  Significant pain not controlled by conservative measures",
    "  Functional limitation (difficulty climbing stairs, walking < 400 m)",
    "  Radiographic joint space narrowing with bone-on-bone contact",
    "Contraindications:",
    "  Active septic arthritis / PJI",
    "  Recent knee infection within 6–12 months",
    "  Neuropathic (Charcot) arthropathy",
    "  Absent or non-functional extensor mechanism",
    "  Severe peripheral vascular disease",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "TKA – Implant Designs: CR vs PS",
  [
    "Cruciate Retaining (CR) TKA:",
    "  PCL retained; more physiological rollback; theoretically better proprioception",
    "  Requires intact, functional PCL",
    "  Posterior slope of tibial insert facilitates rollback",
    "  Risk: If PCL too tight → flexion instability; too loose → posterior tibial sag",
    "Posterior Stabilized (PS) TKA:",
    "  Tibial post-femoral cam mechanism substitutes PCL function",
    "  Allows controlled femoral rollback; greater ROM achieved",
    "  Allows more aggressive flexion gap balancing",
    "  Most widely used design globally",
    "Outcomes comparison: Multiple studies show equivalent 10-year survivorship > 95%",
    "  (Bhandari et al.; Jacobs et al. – no significant clinical difference in most RCTs)",
    "Long-term CR results: 95% at 15 yrs; 91% at 21–23 yrs (original Total Condylar design)",
    "Modern cementless CR TKA: 98.6% at 15–18 years, 79% pain-free",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026 – Prosthesis Survival section"
);

twoColSlide(pres,
  "TKA – Alignment: Mechanical vs Kinematic",
  {
    header: "Mechanical Alignment (MA) – Traditional",
    bullets: [
      "Femoral cut: perpendicular to mechanical axis",
      "Tibial cut: perpendicular to tibial mechanical axis",
      "Goal: Restore neutral mechanical axis (0° HKA)",
      "Valgus correction: 5–7° distal femoral cut",
      "Potential drawback: Alters natural joint obliquity",
      "Most widely validated method; extensive long-term data",
    ],
  },
  {
    header: "Kinematic Alignment (KA) – Modern",
    bullets: [
      "Aligns implant to patient's native joint obliquity",
      "Restores pre-arthritic limb alignment",
      "Goal: Preserve constitutional varus/valgus anatomy",
      "Potentially better kinematics and proprioception",
      "Concerns: Long-term data limited; out-of-range alignment",
      "Patient-specific instruments (PSI) / robotic-assisted often used",
    ],
  },
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "TKA – Component Design Details",
  [
    "Femoral Component:",
    "  Asymmetric design matches native femoral anatomy (medial-lateral asymmetry)",
    "  Gender-specific implants: narrower A-P dimension for women",
    "  J-curve / multi-radius vs single-radius: single-radius allows quad activation throughout ROM",
    "Tibial Component:",
    "  Metal-backed tibial tray (modular) – preferred; allows insert exchange",
    "  All-poly tray: lower cost; good for lower demand/elderly patients",
    "  Cementless tibial fixation: Porous baseplate ± screws",
    "Patellar Component:",
    "  All-poly dome – most common",
    "  Patellar resurfacing: controversial; most surgeons routinely resurface",
    "  Selective non-resurfacing: acceptable if articular surface well-preserved",
    "Polyethylene Insert:",
    "  HXLPE dramatically reduces osteolysis in TKA",
    "  Highly conforming inserts reduce contact stress; mobile-bearing reduces PE stress",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "TKA – Causes of Failure & Revision",
  [
    "Registry data (781 revisions over 10 years – Campbell's):",
    "  Aseptic loosening – 39.9% (most common long-term failure mode)",
    "  Periprosthetic Joint Infection (PJI) – 27.4% (most common early failure)",
    "  Instability – 7.5%",
    "  Periprosthetic fracture – 4.7%",
    "  Arthrofibrosis / Stiffness – 4.5%",
    "  Extensor mechanism failure, component fracture (less common)",
    "Principles of Revision TKA:",
    "  Staged revision for PJI (2-stage gold standard); 1-stage gaining evidence",
    "  Augments and stems to address bone loss (Anderson Orthopaedic Research Institute classification)",
    "  Constrained implants (VVC/RHK) for ligament insufficiency",
    "  Tibial/femoral cones/sleeves for metaphyseal bone defects",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026 – Revision TKA section"
);

contentSlide(pres,
  "Unicompartmental Knee Arthroplasty (UKA)",
  [
    "Indications (Oxford criteria):",
    "  Single compartment OA (medial most common; lateral rare)",
    "  Intact ACL and PCL",
    "  Correctable varus/valgus deformity (≤ 15°)",
    "  Flexion contracture < 15°; ROM > 90°",
    "  No significant patellofemoral arthritis (relative contraindication)",
    "  Weight: No absolute BMI limit; higher revision in obese patients",
    "Advantages over TKA:",
    "  Bone-preserving; faster recovery; better proprioception",
    "  Lower perioperative morbidity; shorter hospital stay",
    "  Meta-analysis (Arirachakaran 2015): comparable functional outcomes, higher revision rate",
    "Medial vs Lateral UKA:",
    "  Medial: Fixed or mobile bearing; Oxford mobile-bearing widely used",
    "  Lateral: More technically demanding; mobile-bearing preferred",
    "Survivorship: 90–95% at 10 years in registry data",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Baker et al. JBJS 2013"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 6 – SHOULDER ARTHROPLASTY (Slides 27-30)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "06", "Shoulder Arthroplasty", "Anatomic TSA, Reverse RSA & Hemiarthroplasty");

contentSlide(pres,
  "Total Shoulder Arthroplasty (TSA) – Indications",
  [
    "Primary Indication: End-stage glenohumeral OA with intact rotator cuff",
    "Other conditions treated with TSA:",
    "  Rheumatoid Arthritis",
    "  Osteonecrosis of humeral head",
    "  Post-traumatic arthritis",
    "  Capsulorrhaphy arthropathy",
    "Contraindications to TSA:",
    "  Active or recent infection",
    "  Irreparable rotator cuff tear (→ consider RSA instead)",
    "  Deltoid paralysis / complete deltoid dysfunction",
    "  Debilitating medical status",
    "  Uncorrectable glenohumeral instability",
    "Outcomes: 89% pain relief in OA; 91% satisfactory in RA (Wilde meta-analysis)",
    "  Long-term results equivalent to THA and TKA",
    "Risk factors for worse outcomes: Diabetes (higher complications); Hepatitis C (infection risk)",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026, p.735 – Total Shoulder Arthroplasty"
);

contentSlide(pres,
  "Reverse Shoulder Arthroplasty (RSA)",
  [
    "Concept: Reverses the ball-and-socket – glenoid becomes convex (ball), humerus becomes concave (socket)",
    "  Medialization and distalization of center of rotation (COR)",
    "  Converts deltoid from pure abductor → activates all three deltoid heads",
    "  Compensates for non-functional rotator cuff",
    "Indications (Campbell's):",
    "  Rotator cuff tear arthropathy (primary indication – Hamada Grade 3–5)",
    "  Failed shoulder arthroplasty (as revision procedure)",
    "  Irreparable rotator cuff tears with pseudoparalysis",
    "  Comminuted proximal humerus fractures in elderly (> 70 years)",
    "  Complex glenohumeral instability",
    "Design (Grammont principles):",
    "  Glenosphere 36–42 mm; 155° neck-shaft angle → medialization effect",
    "  Modern modifications: lateralization of COR reduces notching, improves rotation",
    "  Lateralized glenosphere designs (BIO-RSA, Lateralized RSA)",
    "Outcomes: Excellent pain relief; forward flexion 120–140°; external rotation often limited",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026 – Reverse Shoulder Arthroplasty section"
);

contentSlide(pres,
  "Shoulder Hemiarthroplasty & Stemless Designs",
  [
    "Shoulder Hemiarthroplasty:",
    "  Humeral head replacement only; glenoid preserved",
    "  Indications: Comminuted proximal humeral fractures (4-part, 3-part in elderly)",
    "  Head-splitting fractures; AVN with preserved glenoid",
    "  Outcomes in fractures: Variable; functional results less predictable than RSA",
    "  RSA increasingly preferred over HA for complex fractures in patients > 65–70 yrs",
    "Prosthesis Design (Campbell's):",
    "  Modular humeral head – varying diameters and neck lengths",
    "  Independent sizing of head thickness and diameter for soft-tissue balancing",
    "  Stems: CoCr or titanium alloy with proximal porous ingrowth coating",
    "  Anatomic positioning via eccentric Morse taper locking",
    "Stemless Shoulder Arthroplasty:",
    "  Bone-conserving metaphyseal fixation only",
    "  Advantage: Easier revision; preserves bone stock",
    "  Suitable: Good bone quality, primary OA or AVN (not fractures)",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026, Prosthesis Design section, p.724"
);

contentSlide(pres,
  "Shoulder Implant Parameters & Positioning",
  [
    "Humeral Head Anatomy (Campbell's):",
    "  Radius of curvature: 20–30 mm (smaller in women)",
    "  Neck-shaft angle: 30–55° (depending on measurement method)",
    "  Medial offset: 4–14 mm; A-P offset: −2 to 10 mm",
    "  Retroversion: 0–55° (highly variable)",
    "  Boileau & Walch: COR 2.6 mm posterior, 6.9 mm medial to humeral shaft center",
    "Humeral Component Positioning Goals:",
    "  Restore COR, neck-shaft angle, and version",
    "  Avoid superior positioning – impingement with supraspinatus",
    "  Eccentric Morse taper allows adjustments for medial/posterior offset",
    "Glenoid Component (TSA):",
    "  All-poly keeled or pegged (cemented) – most common",
    "  Cementless metal-backed glenoid: higher failure rate historically",
    "  Avoid glenoid 'rocking horse' phenomenon – ensure symmetric seating",
    "RSA glenosphere: 4–8 mm inferior tilt reduces scapular notching",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026, Prosthesis Design p.724–725"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 7 – IMPLANT FIXATION & BEARING SURFACES (Slides 31-34)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "07", "Implant Fixation\n& Bearing Surfaces", "Cement, cementless, hybrid, and tribology in depth");

contentSlide(pres,
  "Cemented Fixation – Technique & Generations",
  [
    "PMMA (Polymethylmethacrylate) – mechanism: mechanical interlock, not true bonding",
    "Cement Generations (technique improvements):",
    "  1st Generation: Finger-packing into dry canal",
    "  2nd Generation: Canal brush, pulse lavage, distal cement restrictor, pressurized injection",
    "  3rd Generation: Vacuum mixing (reduces porosity), retrograde gun injection, pressurized",
    "  4th Generation: Pre-cooled cement, centralization devices, optimized stem geometry",
    "Antibiotic-Loaded Bone Cement (ALBC):",
    "  Gentamicin, tobramycin, vancomycin",
    "  Used for infection prophylaxis, especially high-risk patients",
    "  Standard in many European countries for all primary THA/TKA",
    "Cemented TKA: Both femur and tibia cemented; most validated method",
    "  Excellent long-term data (total condylar: 91% at 21–23 years)",
    "Ideal for: Elderly, osteoporotic bone, poor bone quality, metabolic bone disease",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Cementless Fixation – Surface Technologies",
  [
    "Principle: Initial press-fit stability → biologic bone ingrowth/ongrowth over 6–12 weeks",
    "Bone Ingrowth Surfaces:",
    "  Sintered beads (CoCr): Classic porous coating; pore size 150–400 μm",
    "  Fiber-metal mesh: Higher porosity; good for revision stems",
    "  Trabecular Metal (Tantalum): 75–80% porosity; closest to cancellous bone",
    "    → Superior ingrowth; used for cups, cones, sleeves in revision surgery",
    "Bone Ongrowth Surfaces:",
    "  Grit-blasted (plasma-sprayed): Surface roughness promotes ongrowth",
    "Hydroxyapatite (HA) Coating:",
    "  Biologically active; calcium phosphate chemistry",
    "  Promotes rapid bone apposition; reduces early migration",
    "  Corail stem: HA-coated – excellent 20-year survivorship data",
    "Press-Fit Principles:",
    "  Under-ream acetabulum by 1–2 mm for initial friction fit",
    "  Line-to-line or slight under-reaming for femoral stems",
    "Modern cementless TKA: 98.6% survivorship at 15–18 years (Campbell's)",
  ],
  "Miller's Review of Orthopaedics 9th Ed p.431; Campbell's Operative Orthopaedics 15th Ed 2026"
);

tableSlide(pres,
  "Bearing Surface Comparison – Summary",
  ["Pairing", "Wear Rate", "Key Advantages", "Key Concerns", "Current Status"],
  [
    ["Metal-on-PE (MoP)", "High (~100 mm³/yr)", "Long track record, low cost", "Osteolysis from PE debris", "Superseded by HXLPE"],
    ["HXLPE-on-Metal/Ceramic", "Very low (~10 mm³/yr)", "90% wear reduction vs conv PE", "Reduced fracture toughness at highest XL doses", "Current gold standard"],
    ["Ceramic-on-Ceramic (CoC)", "Lowest of all", "Inert debris, biocompatible, hard", "Squeaking (0.5-2%), fracture risk, cost", "Growing use in young active patients"],
    ["Ceramic-on-HXLPE (CoP)", "Very low", "Low wear, no metal ions", "Ceramic fracture risk (rare)", "Excellent choice for young patients"],
    ["Metal-on-Metal (MoM)", "Variable – high in large heads", "Large heads → low dislocation", "Metal ions, ALTR, pseudotumour, MHRA recall", "ABANDONED for hip; historical only"],
    ["Oxidized Zirconium (OxZr)", "Low", "Ceramic hardness, metal toughness", "Limited long-term data", "Used in TKA; some THA applications"],
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 8 – RECENT ADVANCES (Slides 35-43)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "08", "Recent Advances &\nFuture Directions", "Robotics, navigation, 3D printing, smart implants & more");

contentSlide(pres,
  "Computer-Assisted Surgery (CAS) & Navigation",
  [
    "Principle: Real-time intraoperative tracking of bone and instrument position",
    "Types of Navigation:",
    "  CT-based: Preoperative planning; high accuracy; radiation/cost",
    "  Imageless: Intraoperative registration; no preop CT; practical",
    "  Fluoroscopy-based: Real-time X-ray guidance",
    "Benefits in TKA:",
    "  Reduces mechanical alignment outliers (> 3° deviation) significantly",
    "  MRCT study: Navigation reduces outliers from 32% to 9%",
    "Benefits in THA:",
    "  Acetabular cup placement within Lewinnek safe zone",
    "  Reduces component malposition and dislocation risk",
    "Limitations:",
    "  Increased OR time (15–20 min extra)",
    "  Learning curve; cost of equipment",
    "  Does not improve functional outcomes in all studies",
    "Current status: Widely used; transitioning to robotic-assisted platforms",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Robotic-Assisted Arthroplasty",
  [
    "Platforms: MAKO (Stryker), ROSA (Zimmer-Biomet), NAVIO (Smith & Nephew)",
    "Types:",
    "  Active (fully autonomous): Surgeon supervises, robot executes",
    "  Semi-active (haptic feedback): Robot constrains instrument within planned boundaries – most common",
    "  Passive: Navigation only; no mechanical constraint",
    "MAKO System:",
    "  CT-based preoperative 3D planning",
    "  Haptic boundary prevents bone resection outside planned boundaries",
    "  Used for THA, TKA, and UKA",
    "Advantages:",
    "  Improved component positioning accuracy vs conventional",
    "  Reduced outliers in limb alignment and component position",
    "  Reproducible gap balancing in TKA",
    "Evidence Base:",
    "  RCTs show improved short-term accuracy; no definitive long-term survival benefit yet",
    "  Dunbar et al. (2011): Dynamic tactile-guided UKA improved accuracy",
    "  High cost remains barrier; learning curve for preoperative planning",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Dunbar et al. J Arthroplasty 2011"
);

contentSlide(pres,
  "3D Printing & Patient-Specific Implants",
  [
    "Additive Manufacturing Technologies:",
    "  Selective Laser Sintering (SLS) – titanium, CoCr powder sintering",
    "  Electron Beam Melting (EBM) – titanium; creates highly porous structures",
    "  Fused Deposition Modeling (FDM) – polymers for guides/models",
    "Patient-Specific Cutting Guides (PSI):",
    "  Made from preoperative MRI/CT scans",
    "  Snap onto patient's anatomy; guide saw cuts without navigation",
    "  Accuracy comparable to navigation in some studies",
    "Patient-Specific Implants (PSI):",
    "  Custom-designed for unique anatomy (tumor resections, complex deformity)",
    "  Reduces need for intraoperative adjustments",
    "Trabecular Metal 3D-Printed Acetabular Cups:",
    "  Titanium lattice structure mimics trabecular bone (75–80% porosity)",
    "  Used in primary and revision THA; excellent bone ingrowth",
    "Spinal Applications:",
    "  3D-printed titanium interbody fusion devices; patient-specific rods/screws",
    "Future: On-demand manufacturing; point-of-care 3D printing",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Smart Implants & IoT in Orthopedics",
  [
    "Instrumented / Smart Implants:",
    "  Embedded micro-sensors measure in-vivo forces and moments",
    "  Orthoload database: Real-time hip and knee joint contact forces during activities",
    "Intraoperative Sensing (Verasense, OrthoSensor):",
    "  Tibial insert sensor in TKA measures medial-lateral load balance",
    "  Guides surgeon to optimize soft-tissue balancing in real-time",
    "Wearable Sensors:",
    "  Continuous monitoring of gait, step count, ROM post-arthroplasty",
    "  Detect early implant loosening via vibration signatures",
    "Connected Implants (Future):",
    "  Bluetooth/RFID-enabled implants for remote monitoring",
    "  Detect early infection via temperature/pH changes",
    "AI and Machine Learning:",
    "  Predictive models for surgical outcomes, PJI risk, revision timing",
    "  Automated pre-operative templating from radiographs (AI-assisted)",
    "  Computer vision for intraoperative landmark identification",
  ],
  "Miller's Review of Orthopaedics 9th Ed; Campbell's Operative Orthopaedics 15th Ed 2026"
);

contentSlide(pres,
  "Advanced Bearing Surfaces & Materials",
  [
    "Vitamin E-Stabilized Polyethylene (VE-PE):",
    "  Alpha-tocopherol (Vit E) added to HXLPE to prevent oxidative degradation",
    "  Addresses the concern of reduced fatigue strength in highly crosslinked PE",
    "  Comparable or better wear than conventional HXLPE in wear simulator studies",
    "Highly Crosslinked Polyethylene (HXLPE) – 2nd generation:",
    "  Sequentially irradiated and annealed; optimized crosslink density",
    "  Better balance between wear resistance and mechanical properties",
    "Porous Titanium Foam Implants:",
    "  Lattice structures with tunable stiffness; reduces stress shielding",
    "Diamond-Like Carbon (DLC) Coatings:",
    "  Ultra-hard, bio-inert coating; potential low-friction bearing surface",
    "PEEK (Poly-ether-ether-ketone):",
    "  Elastic modulus close to bone; reduces stress shielding",
    "  Used in spinal implants; research stage for joint replacement",
    "Biodegradable / Bioabsorbable Fixation:",
    "  For temporary fixation; research ongoing in pediatric orthopedics",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

contentSlide(pres,
  "Outpatient & Enhanced Recovery Arthroplasty",
  [
    "Outpatient (Same-Day) Arthroplasty – Major Trend:",
    "  UKA first performed as outpatient (Cross & Berger 2014)",
    "  THA and TKA increasingly performed in outpatient settings in selected patients",
    "  Requirements: ASA I–II, BMI < 35–40, good social support, motivated patient",
    "Enhanced Recovery After Surgery (ERAS) Protocols:",
    "  Preoperative: Carbohydrate loading, cessation of anticoagulants",
    "  Intraoperative: Spinal anesthesia ± sedation preferred, tranexamic acid, periarticular infiltration analgesia (PIA)",
    "  Postoperative: Early mobilization (walking day 0), multimodal analgesia, no routine drains",
    "Benefits of ERAS:",
    "  Shorter hospital stay (1–2 days vs 3–5 days)",
    "  Lower complication rates; earlier return to function",
    "  Drager et al. (2016): Shorter stay and lower 30-day readmission after UKA vs TKA",
    "Periarticular Injection Cocktail:",
    "  Ropivacaine + epinephrine + ketorolac + morphine",
    "  Superior to epidural in some protocols; no neurological risk",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Cross & Berger 2014; Drager et al. 2016"
);

contentSlide(pres,
  "Periprosthetic Joint Infection (PJI) – Management",
  [
    "Definition (ICM 2018 Criteria): ≥1 of: elevated serum CRP/D-dimer, elevated synovial WBC, positive culture, positive histology, single positive culture, purulence",
    "Classification:",
    "  Early (< 3 months): Acute post-operative PJI",
    "  Delayed (3–12 months): Low-virulence organisms (Propionibacterium)",
    "  Late (> 12 months): Hematogenous",
    "Diagnostic Workup: ESR, CRP, joint aspiration (WBC, differential, culture × 3), alpha-defensin",
    "Treatment Principles:",
    "  DAIR (Debridement, Antibiotics, Implant Retention): For acute (< 3–4 weeks) PJI with well-fixed implant",
    "  2-Stage Revision (Gold Standard for chronic PJI):",
    "    Stage 1: Implant removal, thorough debridement, antibiotic cement spacer",
    "    Interval: 6–12 weeks IV antibiotics",
    "    Stage 2: Reimplantation with new components",
    "  1-Stage Revision: Growing evidence; requires organism identification, no severe bone loss",
    "New Prevention: Locally applied vancomycin powder; bacteriophage therapy (research)",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026 – Revision TKA section; ICM 2018"
);

contentSlide(pres,
  "Ankle, Elbow & Finger Arthroplasty",
  [
    "Total Ankle Arthroplasty (TAA):",
    "  Indications: End-stage ankle OA, RA, post-traumatic OA",
    "  Modern designs: 3-component (HINTEGRA, STAR, Salto Talaris) – mobile bearing",
    "  Two-component (fixed bearing, e.g., INFINITY, INBONE)",
    "  Survivorship improving: 80–90% at 10 years with newer designs",
    "  Advantage over ankle fusion: Better gait; preserves adjacent joint motion",
    "Total Elbow Arthroplasty (TEA):",
    "  Primary indication: Rheumatoid elbow (most common), comminuted distal humeral fracture in elderly",
    "  Linked (constrained) design most common (e.g., Coonrad-Morrey)",
    "  Weight restriction post-TEA: < 1 kg repetitive, < 5 kg one-time lift",
    "Finger/MCP/PIP Joint Arthroplasty:",
    "  Silastic (Swanson) implant: For RA MCP deformities; acts as spacer, not true joint",
    "  Pyrocarbon prostheses: For PIP joint OA; better motion and durability",
    "Wrist Arthroplasty: Limited role; reserved for low-demand RA patients",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 9 – COMPLICATIONS (Slides 44-47)
// ══════════════════════════════════════════════════════════════════
sectionDivider(pres, "09", "Complications &\nClinical Outcomes", "Prevention, recognition and management");

tableSlide(pres,
  "Common Complications of Total Joint Arthroplasty",
  ["Complication", "Incidence", "Prevention", "Management"],
  [
    ["Periprosthetic Joint Infection (PJI)", "1–2% primary; 3–5% revision", "ALBC, skin antisepsis, MRSA screening, Vit D optimization", "DAIR / 2-stage revision + antibiotics"],
    ["Dislocation (THA)", "0.5–3%", "Posterior capsular repair, large heads (≥ 36 mm), correct cup position", "Closed reduction; revision if recurrent"],
    ["Aseptic Loosening", "2–5% at 15 yrs", "HXLPE, cementless fixation in young, good cementing technique", "Revision THA/TKA"],
    ["Periprosthetic Fracture", "0.1–3%", "Avoid stress risers, notching; correct sizing", "ORIF ± stem revision (Vancouver/AAOS classification)"],
    ["DVT / PE", "Uncommon with prophylaxis", "LMWH/aspirin, TED stockings, early mobilization", "Therapeutic anticoagulation; IVC filter if indicated"],
    ["Instability / Stiffness (TKA)", "2–7%", "Correct gap balancing, component sizing", "Manipulation under anesthesia; revision if refractory"],
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Rockwood & Green's Fractures in Adults 10th Ed 2025"
);

contentSlide(pres,
  "Periprosthetic Fractures – Classification & Management",
  [
    "Hip – Vancouver Classification (B Fractures most common):",
    "  Type A: Around greater/lesser trochanter – non-operative or fixation",
    "  Type B1: Around/below well-fixed stem – ORIF (plate ± cables)",
    "  Type B2: Around loose stem, adequate bone – stem revision",
    "  Type B3: Around loose stem, poor bone – stem revision + allograft",
    "  Type C: Well below stem – treat as standard fracture",
    "Knee – Felix Classification:",
    "  Type I: Patella fractures",
    "  Type II: Femoral periprosthetic (most common) – ORIF vs distal femoral replacement",
    "  Type III: Tibial periprosthetic – ORIF vs revision",
    "Risk Factors: Osteoporosis, notching anterior cortex, osteolysis, stress risers",
    "Incidence: 4.7% of TKA revision causes (Campbell's registry data)",
    "Modern implants: Prophylactic stems and augments for high-risk patients",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Rockwood & Green's Fractures in Adults 10th Ed 2025"
);

contentSlide(pres,
  "Outcomes Measurement & Quality of Life",
  [
    "Patient-Reported Outcome Measures (PROMs) – Essential in Modern Practice:",
    "Hip Arthroplasty:",
    "  Oxford Hip Score (OHS): 12 questions; 0–48; ≥ 41 = excellent outcome",
    "  Harris Hip Score (HHS): 100-point scale; ≥ 80 = good/excellent",
    "  WOMAC (Western Ontario & McMaster Universities Osteoarthritis Index)",
    "Knee Arthroplasty:",
    "  Oxford Knee Score (OKS): 12 questions; 0–48",
    "  Knee Society Score (KSS): Functional + radiographic components",
    "  KOOS (Knee Injury and Osteoarthritis Outcome Score)",
    "Shoulder Arthroplasty:",
    "  ASES (American Shoulder & Elbow Surgeons) Score",
    "  Constant-Murley Score",
    "National Joint Registries:",
    "  NJR (UK), AOANJRR (Australia), SHAR (Sweden), Kaiser Permanente (USA)",
    "  Provide population-level survivorship and revision data",
    "  Median survivorship THA: 25+ years for young patients (AOANJRR data)",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SECTION 10 – FUTURE DIRECTIONS (Slides 48)
// ══════════════════════════════════════════════════════════════════
contentSlide(pres,
  "Future Directions in Orthopedic Prosthetics",
  [
    "Biological Integration:",
    "  Osseointegrated (bone-anchored) prostheses for amputees – direct skeletal attachment",
    "  BioMedical-grade titanium implants with bio-functionalized surfaces (growth factors, peptides)",
    "  Cartilage tissue engineering to delay or prevent need for arthroplasty",
    "Smart & Connected Implants:",
    "  In-vivo load sensors with wireless telemetry for continuous monitoring",
    "  Implant-embedded antibacterial coatings (silver nanoparticles, bacteriophages)",
    "  Early PJI detection via bioelectrical impedance or pH monitoring",
    "Artificial Intelligence & Big Data:",
    "  AI-driven preoperative planning; automated component sizing from radiographs",
    "  Machine learning models to predict implant failure and optimize patient selection",
    "Regenerative Medicine:",
    "  Stem cell-coated implants to enhance osseointegration",
    "  Gene therapy approaches to reduce peri-implant osteolysis",
    "Personalized/Precision Orthopedics:",
    "  Multi-omics profiling to predict implant material compatibility",
    "  'Digital twin' patient models for simulation before surgery",
  ],
  "Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed"
);

// ══════════════════════════════════════════════════════════════════
// SLIDE 49 – KEY SUMMARY
// ══════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.midBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.1, h: "100%", fill: { color: C.accent } });
  s.addText("KEY TAKE-HOME MESSAGES", { x: 0.25, y: 0.15, w: 9.5, h: 0.65, fontSize: 22, bold: true, color: C.white, charSpacing: 1 });

  const msgs = [
    ["01", "THA indication: KL Grade 3–4 OA, failed conservative care, medically fit patient (Campbell's / Miller's)"],
    ["02", "TKA indication: End-stage tricompartmental OA; CR vs PS have equivalent long-term survivorship > 95% at 15 yrs"],
    ["03", "UKA: Bone-preserving; strict patient selection (intact cruciate ligaments, single-compartment OA) essential"],
    ["04", "Bearing surfaces: HXLPE is gold standard – 90% wear reduction; CoC for young, active patients"],
    ["05", "Cementless fixation preferred in young/active patients; cemented in elderly/osteoporotic"],
    ["06", "RSA: Revolutionized treatment of rotator cuff tear arthropathy and irreparable cuff tears"],
    ["07", "Robotic surgery and navigation improve component positioning accuracy but long-term survival benefit still being established"],
    ["08", "3D printing, smart implants, and AI are the major future directions for orthopedic prosthetics"],
  ];
  msgs.forEach(([num, msg], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.05 + i * 0.56, w: 0.45, h: 0.42, fill: { color: C.accent } });
    s.addText(num, { x: 0.2, y: 1.05 + i * 0.56, w: 0.45, h: 0.42, fontSize: 12, bold: true, color: C.darkBlue, align: "center", valign: "middle" });
    s.addText(msg, { x: 0.78, y: 1.05 + i * 0.56, w: 9.0, h: 0.42, fontSize: 12, color: C.white, valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 50 – REFERENCES
// ══════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: C.midBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.1, h: "100%", fill: { color: C.accentOr } });
  s.addText("REFERENCES & FURTHER READING", { x: 0.25, y: 0.15, w: 9.5, h: 0.65, fontSize: 20, bold: true, color: C.white });

  const refs = [
    "1. Azar FM, Beaty JH, Canale ST (eds). Campbell's Operative Orthopaedics, 15th Edition. Elsevier, 2026.",
    "   Sections: Total Hip Arthroplasty, Total Knee Arthroplasty, Shoulder Arthroplasty, Prosthesis Design, Bearing Surfaces, Revision Arthroplasty.",
    "2. Miller MD, Thompson SR (eds). Miller's Review of Orthopaedics, 9th Edition. Elsevier, 2024.",
    "   Sections: THA Indications & Fixation (p.430-431), Kellgren-Lawrence Grading, Implant Fixation, Section 5 & 14.",
    "3. Tornetta P III, Ricci WM, Ostrum RF et al. Rockwood & Green's Fractures in Adults, 10th Edition. Wolters Kluwer, 2025.",
    "   Sections: Periprosthetic Fractures, Prosthesis Dislocation, Total Hip Arthroplasty.",
    "4. Schunke M, Schulte E, Schumacher U. General Anatomy and Musculoskeletal System. THIEME Atlas of Anatomy. 2nd Ed.",
    "5. Arirachakaran A et al. Is UKA superior to TKA? Systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2015;25:799.",
    "6. Baker P et al. Centre and surgeon volume influence revision rate after unicondylar knee replacement. JBJS Am. 2013;95:702.",
    "7. Cross MB, Berger R. Feasibility and safety of outpatient unicompartmental knee arthroplasty. Int Orthop. 2014;38:443.",
    "8. Drager J et al. Shorter hospital stay and lower 30-day readmission after UKA vs TKA. J Arthroplasty. 2016;31:356.",
    "9. Dunbar NJ et al. Accuracy of dynamic tactile-guided UKA. J Arthroplasty. 2011;27:803.",
    "10. ICM 2018 Consensus on Periprosthetic Joint Infection (Philadelphia Consensus).",
  ];

  s.addText(refs.map(r => ({
    text: r,
    options: { bullet: r.startsWith("   ") ? false : false, breakLine: true, fontSize: r.startsWith("   ") ? 11 : 12, color: r.startsWith("   ") ? C.textLight : C.gold, italic: r.startsWith("   "), bold: !r.startsWith("   ") && !r.startsWith("5.") && !r.startsWith("6.") && !r.startsWith("7.") && !r.startsWith("8.") && !r.startsWith("9.") && !r.startsWith("10."), paraSpaceAfter: r.startsWith("   ") ? 1 : 4 }
  })), { x: 0.25, y: 0.95, w: 9.5, h: 4.5, valign: "top" });
}

// ──────────────────────────────────────────────────────────────────
// WRITE FILE
// ──────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/ortho-prosthesis/Orthopedic_Prosthesis_Presentation.pptx" })
  .then(() => { console.log("SUCCESS: Presentation written."); })
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/ortho-prosthesis && node build_pptx.js 2>&1

ls -lh /home/daytona/workspace/ortho-prosthesis/ && python3 -c " from pptx impor…

cd /home/daytona/workspace/ortho-prosthesis && python3 -m markitdown Orthopedic_…

cd /home/daytona/workspace/ortho-prosthesis && node -e " const pptxgen = require…

cd /home/daytona/workspace/ortho-prosthesis && unzip -l Orthopedic_Prosthesis_Pr…