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Surgery > Joints > Flashcards

Joints Flashcards

1
Q

define OCD

A

Disease that affects the normal endochondral ossification of growth plates.
Necrotic cartilage develops a fissure undermining cartilage and forming a cartilage flap –> seepage of synovial fluid under flaps causes subchondral bone pain and inflam –> secondary OA

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2
Q

define OC

A

endochondral ossification disturbed –> cartilage continues to grow w/out being transformed into bone causing it to become abnormally thick

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3
Q

pathogenesis of OC in articular cartilage

A
  • nutrition to articular cartilage is by diffusion of nutrients from the synovial fluid –> OC causes cartilage to become too thick –> no nutrients and necrosis of basal layers –> edochondral ossification fails in that area –> subchondral defects in epiphysis
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4
Q

rad findings of OCD

A
  • radiolucent defect in the subchondral bone
  • subchondral bone sclerosis
  • a cartilage flap is only visible if mineralised
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5
Q

sequelae of OC of growth plate cartilage

A
  • does not lead to necrosis of cartilage because nutrition from blood vessels not synovial fluid
  • may cause some disturbance in growth often not clinically significant
  • important if occurs in radius/ulna –> asynchronous growth results in incongruity of elbow + antebrachial growth deformities
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6
Q

aetiology of OC

A
  • hereditary
  • males > females (2:1)
  • overnutrition/rapid growth
  • mature size >25kg
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7
Q

hx/sig of OC

A

large breed dogs, 4-8mo w/ progressive intermittent lameness worsened by exercise

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8
Q

if suspect OC always radiograph…

A

both limbs!

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9
Q

tx of OCD

A
  • debride necrotic cartilage down to healthy bleeding subchondral bone –> forage underlying subchondral bone to encourage revasc and healing
  • healing bone replaces necrotic cartilage
  • articular cartilage replaced by fibrocartilage
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10
Q

which OCD type/location has the best prognosis?

A

the shoulder

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11
Q

where does OCD occur in the shoulder?

A

caudal aspect of humeral head

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12
Q

breeds predisposed to shoulder OCD?

A

Great Dane, GSD, Newfie, Bernese Mt Dog

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13
Q

radiographic findings of shoulder OCD?

A
  • radiolucent defect cd aspect of humeral head
  • loss of convex shape/flattening + assoc. subchondral bone sclerosis
  • +/- jt mouse
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14
Q

what rad view to diagnose shoulder OCD?

A
  • laterals (bilateral)
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15
Q

shoulder OCD ddx

A
  • elbow dz
  • panosteitis
  • sesamoid dz
  • metaphyseal osteopathy
  • Soft tissue injury
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16
Q

when is surgical treatment of shoulder OCD indicated?

A

if lameness/pain apparent

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17
Q

sx approaches to OCD lesions?

A
  • open arthrotomy

- arthroscopically (preferred)

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18
Q

which part of the stifle is commonly affected by OCD

A

lateral condyle of femur

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19
Q

stifle OCD breed assoc.

A

young, large breed dogs esp. retrievers

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20
Q

rad findings of stifle OCD

A
  • radiolucent concavity in either femoral condyles
  • subchondral sclerosis + flattening of condyle
  • stifle DJD
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21
Q

prognosis of hock OCD

A

-poor as high motion, low tolerance joint and reformation of trochlear ridge is unrealistic thus progression of OA inevitable

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22
Q

3 types of elbow disease

A
  1. FCP
  2. OCD
  3. UAP
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23
Q

how useful are rads to investigate elbow disease

A
  • all types of elbow disease show evidence of OA
  • can diagnose OCD (Cr.Cd view) and UAP from x-rays
  • cannot diagnose FCP
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24
Q

what is FCP

A

disease of the medial part of coronoid process of ulna resulting in progressive OA and ‘kissing’ lesion on adjacent medial humeral condyle

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25
Q

where do you palpate to feel elbow effusion?

A

lateral elbow btwn lateral epicondyle + olecranon

normal should be convex

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26
Q

tx of FCP

A

subtotal coronoidectomy + tx of kissing lesion (like OCD)

+ ongoing NSAIDs/OA management

27
Q

typical stance of dog w/ bilateral elbow disease

A
  1. base narrow
  2. Supination
  3. Elbow abduction
28
Q

where does elbow OCD occur?

A

medial humeral condyle

29
Q

what rads do you take if you suspect elbow OCD?

A

Bilateral

  • lateral
  • flexed lateral
  • Cr. Cd views
30
Q

how do you definitively diagnose elbow OCD?

A

rads – radiolucent concavity on trochlear ridge of medial humeral condyle + secondary OA

31
Q

earliest rad. signs of elbow OA secondary to OCD?

A

osteophytes on anconeal process

32
Q

later rad. signs of elbow OA secondary to OCD?

A

articular and periarticular osteophytes, subchondral bone sclerosis, jt space narrowing, jt effusion

33
Q

tx of UAP

A

if early in dx before major degenerative change an ulna osteotomy + lag screw repair
– recheck 10wks = complete union of AP w/ good congruity + callus healing of ulna osteotomy

34
Q

what rad view to diagnose UAP?

A

laterals

35
Q

what imaging to diagnose FCP?

A

CT

36
Q

Hip dysplasia aetiology

A
  1. Genetic: most common heritable ortho problem in dogs - schemes exist to prevent breeding
  2. Environment: XS exercise/weight gain/ growth while immature, obese, large breeds
37
Q

define hip dysplasia

A

abnormal development of coxofemoral joint characterised by subluxation in young animals - leads to DJD in older animals

38
Q

2 presentations of hip dysplasia

A
  • younger growing dogs w/ pain of instability + sublux

- older dogs w/ chronic OA, reduced ROM, crepitus

39
Q

what stance/gait characteristics are indicative of hip dysplasia?

A
  • waddling
  • weight shifted forwarded
  • poorly developed HL muscles
40
Q

hip joint laxity tests are only reliable in dogs as what age?

A

> 16wks

41
Q

why may older dogs w/ hip dysplasia not display hip laxity?

A

due to chronic OA changes and stabilisation of hip joint

42
Q

a positive ortolani test indicates

A

the dog has hip dysplasia

43
Q

why are PennHip rads taken?

A

To assess degree of sublux of femoral head (50% of fem head in acetabulum)
- stimulate position of hips when standing

44
Q

what are the 4 surgical approaches to hip dysplasia

A
  1. Juvenile pelvic symphysiodesis
  2. Triple/Double pelvis osteotomy
  3. Total hip replacement
  4. Femoral head excision arthroplasty
45
Q

when are preventation sx approaches indicated in a dog with hip dysplasia?

A
  • young (6-8monts) w/ no DJD
46
Q

age requirement for juvenile pubic symphysiodesis?

A

<20wks old

47
Q

age req. for triple/double pelvis osteotomy?

A

5-12mo

48
Q

triple/double pelvic osteotomy goal

A

axially rotates and lateralises the acetabulum resulting in increased dorsal coverage of the femoral head

49
Q

when are salvage sx indicated to tx hip dysplasia?

A

only if dog does not response to WET therapy

50
Q

complications of THR

A
  • infection
  • aseptic loosening of implants
  • dislocation
51
Q

success rate of THR

A

80-90%

52
Q

femoral head excision arthroplasty ideal candidates are…

A

<15kg

53
Q

what causes Legg-Calve-Perthes disease?

A

interuppted blood supply to femoral epiphysis –> avascular necrosis of epiphysis (femoral head) –> femoral head collapses and remodels –> incongruity and DJD results

54
Q

signalment/presentation for Legg-Calve-Perthes-Disease

A
  • 6-10mo, small (<10kg)
  • WHWT, cairns
  • slowly progressive HL lameness, usu. unilateral
55
Q

rad signs of chronic Legg-calve-perthes disease

A

collapse and remodelling of femoral neck w/ femoral head deformity + DJD

56
Q

tx and px of legg-calve-perthes disease

A

quite good as femoral head excision arthroplasty to tx –> small dogs respond well

57
Q

use of cartrophen and NSAIDs is…

A

contraindicated

58
Q

ddx of Hip dysplasia in young animals

A
  • OCD of stifle/hock
  • panosteitis
  • Cruciate disease
  • patella lux
  • hypertrophic osteodystrophy
  • neurologic disease
59
Q

ddx of hip dysplasia in mature animals

A
  • cruciate disease
  • polyarthropathy
  • neoplasia
  • neuro: degen myelopathy, IVDD
60
Q

how does obesity affect OA?

A
  • inflammatory mediators released from adipose tissue –> higher serum and synovial fluid leptins (pro-inflam) + lower adiponectin (anti-inflam)
  • increased mechanical stress does not significantly contribute to OA
61
Q

what weight loss % is associated with improvement of lameness in dogs?

A

8.5-11% weight loss

62
Q

what analgesics are indicated to tx OA?

A
  • NSAIDs
  • Amantadine
  • Grapiprant
  • Paracetamol
  • Gabapentin
63
Q

what salvage surgery options exist for advanced/severe OA not responsive to WET tx?

A
  • joint replacement
  • arthrodesis
  • femoral head osteotomy

Surgery (22 decks)

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