Orthopaedic Salvage Procedures

Question 0

In which species can an arthroplasty be performed?

Answer 0

Dogs, cats, small ponies (Shetlands and smaller), other small animals, alpacas

Question 1

What is an arthoplasty?

Answer 1

Elective orthopaedic procedure where the joint is either commonly excised or replaced

Question 2

What are the indications for an arthroplasty?

Answer 2

Dysplasia causing juvenile pain
Intractable arthritis or joint pain
Articular fracture that is un-reconstructable
Persistent luxation
Avascular necrosis

Question 3

What are the similarities and differences between excision and replacement?

Answer 3

Both allow movement
Replacement aims to remove pain and restore/maintain normal movement and range of motion
Excision removes pain and has altered movement and range of motion
Load transfer mechanics differ

Question 4

What joints can an excision arthroplasty be performed on?

Answer 4

Hip, TMJ, radial head, shoulder, MT/MC phalangeal joint, phalangeal joint

Question 5

In what conditions is a Femoral Head and Neck Excision (FHNE) indicated?

Answer 5

Juvenile hip dysplasia, intractable OA/DJD, femoral head/acetabular fractures, persistent luxation and Legg-Calve-Perthes disease

Question 6

What is Legg-Calve-Perthes disease?

Answer 6

Avascular necrosis of the femoral head

Question 7

What sizes of dog is a FHNE suitable for?

Answer 7

Can be used on all sizes however as size increases there is a worse result when compared to a total hip replacement

Question 8

Is there any difference in ROM?

Answer 8

Yes and it will affect athletic performance

Question 9

How do you perform a FHNE?

Answer 9

Cut between greater trochanter and just proximal to lesser trochanter to ensure neck is removed to prevent impingement

Question 10

What aftercare is needed for a FHNE?

Answer 10

Early return to controlled exercise
Pain-relief
Physio/hydrotherapy

Question 11

What is the outcome of a FHNE determined by?

Answer 11

Obesity, pre-op muscle wastage and presence of other orthopaedic diseases

Question 12

What joints can a replacement arthroplasty be performed in?

Answer 12

Canine and feline hip

Canine stifle, elbow and hock

Question 13

Which animals is a total hip replacement (THR) performed in?

Answer 13

Any dog but typically large, active or working dogs over 20kgs any time after skeletal maturity

Question 14

What influences the outcome of a THR?

Answer 14

Obesity and other orthopaedic problems

Question 15

What are the disadvantages of THR?

Answer 15

Expensive but gold standard of care

Has to be referred due to surgical and post-op risks

Question 16

What is an ideal patient for THR?

Answer 16

Large breed, previously active, sensible, well-trained dog with compliant owners and insurance

Question 17

What is arthrodesis?

Answer 17

Artificial induction of joint ossification between two bones via surgery

Question 18

What are the indications for an arthrodesis?

Answer 18

Intractable arthritis/joint pain
Articular fracture that is unreconstructable
Persistent luxation or instability
Low grade pain interfering with performance
Revision of failed joint surgery

Question 19

What are the principles of arthrodesis surgery?

Answer 19

Absolute stability through compression, remove cartilage from contact areas, contour opposing joint surfaces, bone graft for source of cells for osteogenesis, source of cytokines for osteoinduction and scaffolding for osteoconduction, fuse at a functional angle with possible need for external support

Question 20

What needs to be considered long term with arthrodesis?

Answer 20

Long recovery may require transarticular support (ESF or cast)
Implants are mechanically vulnerable and may break or back out over time
Problems with high motion joints

Question 21

What is amputation?

Answer 21

Removal of a body extremity by trauma or surgery

Question 22

What are the indications for amputation?

Answer 22

Neoplasia either malignant or locally invasive
Trauma due to excessive tissue damage or ischaemia
Paralysis such as brachial plexus avulsion
Unmanageable conditions, intractable pain or congenital deformity
Client finances

Question 23

What considerations need to be made prior to amputation?

Answer 23

Animal temperament
Concurrent orthopaedic diseases
Owner
Mechanically better to lose pelvic rather than thoracic limb

Question 24

What are the sites for amputation?

Answer 24

Forelimb = forequarter (scapula as well) or mid humerus
Hindlimb = mid/high femur, transarticular or hemipelvectomy
Digit = proximal interphalangeal joint with cartilage removal in cattle, distal P1/P2 in small animals
Tail = leave enough to cover perineum

Question 25

What are the principles of amputation?

Answer 25

Choose suitable margin of excision, local block and fresh scalpel for neurectomies, make sure it isn’t possible for stump to get traumatised post-op by leaving enough skin and muscle to cover it, carefully reconstruct the tissue to eliminate dead space and place a drain if necessary

Question 26

How can you tell if a limb is salvageable?

Answer 26

Distal pulse, nails bleed when cut short, limb warm, neurologically fine

Question 27

What are the advantages of amputation?

Answer 27

Predictable, straight-forward, minor complications, cost-effective, instant palliation and short recovery period

Question 28

What are the disadvantages of amputation?

Answer 28

Get out of jail free card used up, worse balance, temperament change, knock on effects to other joints/spine, posturing problems, phantom limb or neuropathic pain