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Flashcards in Orthopaedic Salvage Deck (35):

Define arthroplasty

- replacement or excsision (joint molding)
- elective orthopaedic procedure where joint is either commonly excised or replaced


Define arthrodesis

- joint binding
- irreversible surgical ion of 2 or more joints
- creation of osseus bridging that prevents joint motion and allows the joint to withstand weight bearing forces


Define amputation

- all-around cuting off
- normally considereed as a fallback after other tx has proved ineffective
- can be used first line if finance is a problem


Indications for arthroplasty? Which species?

(joint replacement or excision)
- dogs, cats, small ponies, alpacas
- hip most common
- also TMJ, radial head, shoulder, MT/MCP joint, phlangeal
> dysplasia (juvenile pain)
> intractiable arthritis / joint pain
> unreconstructable articular fx
> persistnet luxation
> avascular necrosis (Carth Perthes Dz)


Indications for Arthrodesis? Which species?

> all species depending on jointi (eg. pancarpal/partial carpal and pantarsal/partial tarsal)


INdications for amputation? Which species?

- dogs , cats (limbs, digits, tails)
- limbs small caged aets
- occasionally larger animals


Aims and goals of arthroplasty?

- excision and replacemen both allow movement
- replacement aims to remove pain and resotre/maintain normal ROM
- excision removes pain and has altered ROM
- load transfr mechanics differ


INdications of femoral head and neck excision?

- hip dysplasia (juvenile pain)
- intractable OA/DJD
- femoral head and neck fx/acetbular fx
- persistent luxation
- Legg-Calve-Perthes disease (avascular necrosis of the femoral head)
> suitable all sizes of dogs, good results easier to achieve up to 30kg
- some restriction in ROM will affect full athletic performance
- surgical technique critical


Aftercare with FHNE? Outcome affected by?

> vital to outcome
- return to controlled exercise needed to encourage fibrosis
- analgese!!!
- physiotherapy/hydrotherapy
> outcome affected by obesity, pre-operative muscle wastage, ther orthopaedic problems


Outline surgial procedure of FHNE

- remove head and neck
- neck will cause impingement if left
- leave greter trochanter, cut to lesser trochanter
- fibrosis of the joint will occour


What replacement arthroplastys are available/

-canine and feline hip
- canine stifle
- canine elbow
- canine hock?


Which dogs are best indicated for total hip arthroplasty (THA) )Hiip replacement) Price and results?

- can be done in any dog
- trypically large, active, working dogs
- any time AFTER skeletal maturity
- outcome influenced by obesity and other orthopaedic problems
- expensive but good results - Gold standard


Ideal patient for hp replacmeent?

- painful hip non-responsive to medication
- large breed dog
- previously active lifestyle
- sensible, well-trained dog
- compliant owners that are committed!!


Is hip dysplasia an indication for hip replacement?

Not necessarily!
- 75% managed medically


Pros and cons comparing Total Hip Replacmeent and FHNE? LOOK UP

> Cost
- THR $4000
- FHNE $400-1500
> Complications
- THR post-op luxation
- FHNE low risk
> Aftercare
- THR cage rest 6 weeks
- FHNE activity encourae
> Function
- THR excellent
- FHNE reduced but often acceptabel in smaller animals


Which joints can be replaced?



Whats is involved in a total arthroplasty



What is arthrodesis? What is the natural form of this?

- artificial ankylosis
> ankylosis bodys pathological thing


Indications for arthrodesis

- intractible arthritis /joint pain
- articular fx (unreconstructable)


LEARN THIS - principles of arthrodesis

- absolute stability (ideally through compression)
- remove cartilage from contact areas
- contour opposing joint surfaces
- bone graft
> osteogenesis - source of progenitor cells to grown bone
> osteoconduction - scaffold
> osteoinduction - mediators
- fuse at a functional angle
- external support? many dont


Long term impliccations of arthrodesis?

- long recovery may require transarticular support (ESF/cast)
- implants mechanically vulnerable (may break or back out)
- problems with high motion joints)


Why may stifle arthrodesis cause problems?

- long lever arm
- high motion joint
> catastrophic fx can occour
> lots of risk of Cx!


Indications for amputation?

> neoplasia
- malignant/locally invasive
> trauma
- excessive tissue dmage/ischameia
> paralysis
- brachial plexus avulsion (not plegia, check deep pain)
> unmanageable joint conditions, intractable pain, congenital deformity
> client finances


Considerations for amputations?

- temprement
- concurrent orthopeadic dz
- owner
- mechanically better to lose pelvic rather than thoracic limb


Gait adaptation forces with amputation

- If forelimb removed, higher forces act on the remaining forelimb
- If hindlimb removed, same force acts on remaining hindlimb, forelimbs take most of the weight


Potential amputation sites of the limbs SA?

> FL
- forequarter (good cosmetic and margins)
- mid. humerus (easier but withered stump)
> HL
- mid/high femur
- transarticlar coxo-femoral [aware prepuce exposure]
- hemipelvectomy


Which digits can be amputated?

- PIP joint with cartilage removal in cattle
- Distal P1 and P2 in smallies
- careful dressing post surgery


Risks of amputating digits?

Insertion of collaterals on 1st or 5th digit
- dont cut too high


How much tail should be left for tail amputation?

- cover perineum


General principles of amputation

- choose suitable margins of excision (NB. neoplasia)
- local block + fresh scalpel for neurectomy
- make sure its not possible for stump to get traumatised post-op
- leave sufficient tissue to cover the stump
- careful reconstruction of tissue to eliminate dead space
- drain


Signs that a limb is salvagable

- distal pulse
- cut nails short and look for quick bleeding
- limb cold?
- neurological status (deep pain)
- time is your friend!! see if wound gets worse or better


Pros and cons of amputation

> pros
- predictable, straightfoward
- minor Cx
- cost effective
- instant palliation of signs
- short recovery
> cons
- worse balance?
- temperament change?
= knock-on effects of other joints/spine
- phantom limb/neuropathic pain?


2 main typeso f prosthesis?

> endo
- encorpoated into bone eg. ITAP
> exoprosthesis
- stick on end of stump


Define salvage

- no going back procedure


What should tx choice be based on?

- cost (financial and morbidity to animal)
- risk (success rate, complicatinos of op)
- benefit ( predictablilty of return to function)
> NB: animal, limb and joint outcome are not the same thing!!