Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Orthopaedic Surgery > Conditions Of The Knee And Surgery > Flashcards

Conditions Of The Knee And Surgery Flashcards

(86 cards)

Start Studying
1
Q

What side of the knee does OA most commonly affect?
What abnormalities does this cause?

A

Medial compartment
Valgus deviation of the leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the process of a total knee replacement

A
  • vertical anterior incision made on the knee
  • patella is rotated out of the way
  • articular surfaces of the femur + tibia removed
  • replaced by metal surfaces (cemented or uncemented)
  • plastic spacer is added between the metal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chemical VTE prophylaxis after total knee replacement

A

LMWH or aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of septic arthritis

A
  • acute red swollen joint
  • warmth
  • pain on movement
  • temperature (not always)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What microorgnism organism can cause septic arthritis?

A
  • Staphylococcus aureus (most common)
  • neisseria gonorrhoea
  • streptococcus pyogenes
  • haemophilus influenza
  • E. coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of septic arthritis

A
  • surgery
  • prosthetic joints
  • knee effusion secondary to bacterial infection
  • articular cartilage damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk factors of septic arthritis

A
  • increasing age
  • pre-existing joint disease
  • diabetes mellitus
  • immunosuppresion
  • CKD
  • prosthetic joints
  • IV drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gold standard investigation of suspected septic arthritis

A

Joint aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should the joint aspiration fluid in suspected septic arthritis be sent off for?

A
  • gram stain
  • leucocyte count
  • polarising microscopy
  • fluid culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What will joint aspiration of septic arthritis show?

A

Bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of septic arthritis

A
  • empirical IV abx until sensitivities are known
  • flucloxacillin first line
  • clindamycin if penicillin allergic
  • ceftriaxone if N.gonorrhoea
    .
  • abx normally needed for 4-6 weeks (IV first for 2 weeks then oral)
    .
  • joint irrigation + debridement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of septic arthritis

A

OA + osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of knee swelling

A

VITAMIN C+D
- Vascular: - haemarthrosis
- Inflammatory: bursitis
- Trauma: meniscal tear > baker’s cyst | fracture
- Autoimmune: RA
- Metabolic: gout/pseudogout
- Iatrogenic: infected prosthetic joint
- Neoplasia: rare
- Cancer: rare
- Degenerative**: OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the 6 bursae of the knee

A
  • suprapatellar bursa
  • subcutaneous prepatellar bursa
  • subcutaneous infrapatellar bursa
  • deep infrapatellar bursa
  • subsartorial bursa
  • semimembranosus bursa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What bursa is inflamed in Housemaid’s knee?
How does this happen?

A

SC prepatellar bursa
Leaning forward on knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What bursa is inflamed in Clergyman’s knee?
How does his happen?

A

SC infrapatellar bursa
Prolonged kneeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is bursa is involved in Baker’s/popliteal cyst?

A

Semimembranosus bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cause of Baker’s cyst

A

Secondary to degenerative changes in the knee associated with:
- meniscal tears
- OA/RA
- knee injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathophysiology of a Baker’s cyst

A
  • secondary to degenerative changes in the knee joint
  • synovial fluid is squeezed out of the knee joint and collects in the popliteal fossa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presentaion of Baker’s cyst

A

Localised to the popliteal fossa
- pain
- fullness
- pressure
- palpable lump or swelling
- restricted ROM if large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Examination findings of Baker’s cyst

A
  • most apparent when pt standing with knee fully extended
  • Foucher’s sign lump will get smaller when the knee if flexed at 45°
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Foucher’ sign?
What is it seen in?

A

The lump of a Baker’s cyst will get smaller when the knee if flexed to 45°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigations of Baker’s cyst

A

USS
MRI to evaluate cyst before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of Baker’s cysts

A
  • no treatment if asymptomatic
  • non surgical: modified activity, analgesia, PT, USS guided aspiration, steroid injections
  • surgical: arthroscopic procedures to treat underlying knee pathology causing the cyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What do you call fluid inside a joint vs outside a joint?
Inside - effusion Outside - soft tissue haematoma
26
What are the two types of knee effusion? What is suspected until proven otherwise in each case?
- **haemarthrosis**: blood in joint | ACL injury until proven over wise - **lip-haemathrosis**: fat + blood in joint | fracture until proven otherwise
27
Name the four ligaments in the knee
Anteior cruciate ligament Posterior cruciate ligament Lateral collateral ligament Medical collateral ligament
28
Mechanism of meniscal injuries
Twisting injury
29
Presentation of meniscal tears
- occurs during twisting movement of the knee - pop sound or sensation - pain - swelling - stiffness - restricted ROM - knee giving way - locking of the knee
30
What are the two special tests of meniscal tears?
McMurray’s test Apley grind test
31
What is McMurray’s test? Whata is it used for?
- involves the pt lying supine - examiner takes leg + flexes knee - turn the foot inwards (**internal rotation of tibia**) + apply outwards pressure to the inside of the knee (**varus pressure**) extend the knee - pain or restriction indicates **lateral meniscal damage** . - **External rotation of tibia** + applying inwards pressure on the knee (**valgus pressure**) extend the knee - pain or restriction indicates **medial meniscal damage**
32
What is the Apley Grind test? What is it used for?
- patient lying prone + flexing knee to 90 with thigh flat on cough - downward pressure applied to the thigh - the tibia is internally + externally rotated at the same time - pain indicates a positive result - meniscal damage
33
What are the Ottawa knee rules used for?
To determine whether a patient requires an x-ray for the knee after an acute knee injury to look for a fracture
34
What are the Ottawa Knee rules?
A patient requires a knee x-ray if any of the following are present: - age 55 or above - patella tenderness (with no tenderness elsewhere) - fibula head tenderness - cannot flex knee to 90° - cannot weight bear/limping
35
Imaging for meniscal damage
**MRI scan** first line **Arthroscopy** is gold standard for diagnosing meniscal tear
36
Management of meniscal damage
- RICE - NSAIDs - Physiotherapy - arthroscopy for repair or resection
37
What is a risk of arthroscopy resection of meniscus?
Often results in OA
38
Function of the ACL
Prevents anterior displacement of tibia relative to the femur
39
Function of PCL
Presents posterior displacement of tibia to relative femur
40
What is origin + insertion of the ACL?
From anterio-medial tibia (intercondylar eminence) to lateral condyle of femur
41
What is the origin + insertion of the PCL?
From the posterior lateral tibia to the medial condyle of the femur
42
Function of the medial collateral ligament
Resists valgus angulation (lateral pressure)
43
Function of the lateral collateral ligament
Resists varus angulation (medial pressure)
44
Mechanism of collateral knee ligament injury
Contact/direct blow *e.g. sport* - if MCL: valgus strain - if LCL: varus strain
45
Treatment of collateral ligament injury
- RICE - Brace - gradual return to activity - analgesia
46
What special tests can be done to test ACL and PCL function?
Anterior + posterior drawer test Lachman’s test
47
Presentation of ACL injury
- a twisting injury - pain - swelling - pop sound or sensation - instability - tibia moves anteriorly to the femur > buckling
48
Investigations of cruciate ligament damage
**MRI** first line imaging **arthroscopy** is gold standard Ix
49
Management of ACL injury
- RICE - analgesia > NSAIDs - crutches + knee braces - Physiotherapy - arthroscopic surgery to reconstruct the ligament
50
Describe ACL arthroscopic surgery
A new ligament is formed using a graft or tendon from another location Such as hamstring tendon, quadriceps tendon, bone-patellar tendon-bone
51
Mechanism of PCL injury
Falls Hyperextension
52
What is the unhappy triad?
ACL Medial collateral ligament Medial meniscus
53
What is Osgood Schlatter disease?
Inflammation at the tibial tuberosity where the patella tenon inserts (apophysis) Common cause of anteior knee pain in adolescents
54
Pathophysiology of osgood schlatter disease
- Multiple minor avulsion fractures at the apophysis of the patella ligament into the tibial tuberosity - this causes growth of the tibial tuberosity > visible lump below the knee - initially the lump is tender but as it heal, the lump becomes hard and no tender
55
Presentation of osgood schlatter disease
- gradual onset of symptoms - visible or palpable hard + tender lump at tibial tuberosity - pain in anterior knee - pain worsened by activity, kneeling or extension of knee
56
Management of osgood schlatter disease
- reduction in physical activity - ice - NSAIDs - stretching + physio once symptoms settle
57
What structure helps prevent patella dislocation?
Vastus medialis obliquus
58
What is the function of Vastus medialis obliquus?
- stabilise patella in trochlea groove - control tracking in flexion + extension - prevents patella dislocation
59
Mechanism of patella dislocation
- twisting action in slight flexion - trauma - direct blow to knee
60
What factors predispose a patella dislocation?
- previous dislocation - long patella ligament - shallow trochanter groove - ligament laxity - weakness of Vastus medialis obliquus
61
Management of patella dislocation
- reduce + immobilise - knee brace - analgesia
62
How do you check for a patella fracture?
Ask patient to raise a straight leg Inability is indicative of patella fracture
63
Mechanism of action of tibial plateau fracture
- High energy trauma *e.g. RTC or fall from height* - due to impaction of femoral condyle onto tibial plateau - normally varus force > lateral tibial plateaus is more often fractured
64
What side is most commonly damaged in tibial plateau fractures and why?
Lateral tibial plateau due to varus strain
65
Presentation of tibial plateau fracture
- sudden onset pain in knee - inability to weight bear - swelling - tenderness
66
Investigations of tibial plateau fractures
X-ray AP + lateral CT scan
67
Management of tibial plateau fracture
- **non-operative management**: hinged knee brace, reduce weight bearing, PT, analgesia - **surgical management**: open reduction + internal fixation
68
Mechanism of action of patella fracture
- Direct trauma to the patella (most common) - as a result of rapid eccentric contraction of quads
69
Presentation of patella fracture
- anterior knee pain - worse with movement - inability to raise straight leg - swollen + bruised
70
What is bipartite patella?
A congenital condition where there is failure of patella fusion > two separate bones Asymptomatic + is picked up incidentally on imaging
71
What classification is used for patella fractures? What are they?
**AO foundation classification** - extra-articular or avulsion - partial articular - complete articular
72
Management of patella fractures
- open reduction + internal fixation with tension band wiring - brace - analgesia
73
Investigations of patella fracture
X-ray in AP, lateral + skyline views
74
What is a Hoffa fracture?
- A specific type of type B partial articular distal femoral fracture - a fracture of posterior aspect of femoral condyle in coronal plane - more often affects lateral condyle
75
Presentation of distal femoral fracture
- severe pain in distal thigh - inability to weight bear - swelling + bruising
76
Management distal femur fracture
- if there is significant malalignment > initial realignment in A&E then immobilisation - if more proximal extra-articular: **retrograde nailing** - if more distal intra-articular: **ORIF with distal femoral plate**
77
How does the location of a distal femoral fracture affect the surgical treatment given?
- if more proximal extra-articular: **retrograde nailing** - if more distal intra-articular: **ORIF with distal femoral plate**
78
Complications of distal femoral fracture
- Malunion - Non-union - Secondary OA - Compartment syndrome - Haemorrhage
79
What is the most common cause of lateral knee pain in athletes?
Iliotibial band syndrome
80
What is Iliotibial band syndrome?
- inflammation of the Iliotibial band/tract
81
What is the Iliotibial band/tract?
A branch of fibres that form the shared aponeurosis of tensor fasciae lactate and gluteus maximus
82
Risk factors of Iliotibial band syndrome
- Regular exercise involving repetitive flexion + extension *e.g. runners* - foot pronation - hip adbuctor weakness
83
Presentation of Iliotibial band syndrome
Lateral knee pain worsened by exercise
84
What special tests can be used for ilitiotibal band syndrome?
Nobles test Renne test
85
Management of Iliotibial band syndrome
- modified activity - analgesia - steroid injections - Physiotherapy - surgery only indicated is symptomatic for 6 months > release of Iliotibial band from attachments > allows greater ROM
86
Why are knee dislocations serious injuries?
Popliteal artery and common peroneal nerve are in close proximity

Orthopaedic Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions