RHEUMATOID REARFOOT Flashcards
articular pathology
soft tissue pathology
relieve pain, improve
function
synovectomy
arthrodesis
joint replacement
-goal: plantigrade, nonpainful foot and ankle
these are indication for what type of pathology?
rheumatoid rearfoot
rearfoot fusion indications?
rheumatoid flatfoot
function loss due to deformity/instability
poor prognosis of joint
RA>non RA ankle OA
Glissans principles of arthrodesis?
removal of all cartilage, soft tissue
-subchondral bone
good apposition of fusion sites
optimum position
maintenance of position until fusion
RA=high risk patients ankle valgus more common ankle joint affected up to 50% RA patients over 50% with RA over 13 years slows down adjacent joint
total ankle arthroplasty in RA patient
wound healing issues up to 40% cases
malleolar fractures
malalignment
stiffness
infection with/without implant loosening
TAA (TAR) complications
charcot arthropathy complications?
delayed union/nonunion vascular compromise neurologic complications tendon pathology soft tissue pathology
complications encountered with RA surgical foot and ankle?
10% nonunion rate
5% lesser digit revision
20% infection
RA surgery complications can lead to?
deep vein thrombosis
- long term steroid use
- virchows triad
- 2 aspirin
- warfarin
- enoxaparin
types of surgical intervention for the rheumatoid patient?
synovectomy soft tissue release arthrodesis TAR physical therapy tx plan is unique
important considerations?
preoperative evaluation imperative
consult with rheumatologist
early attempts at synovectomy
modified hoffman and hoffman clayton
rearfoot fusions
watch for infection/delayed incision healing
