Salvage - arthroplasty and arthrodeses Flashcards
(42 cards)
Define arthroplasty
= joint moulding
- replacement or excision both allow movement
- elective orthopaedic procedure where the joint is either commonly excised or replaced
- replacement aims to remove pain and restore/maintain normal movement (ROM)
- Excision removes pain and has altered movement (ROM)
- load transfer mechanics differ
Define arthrodesis
= joint binding
- irreversible sx fusion of 2 or more joints. Creation of osseous bridging that prevents joint motion and allows the joint to withstand weight bearing forces
Define amputation
normally considered as a fallback after other tx has proved ineffective but may be used if finance is a problem
Species indications - arthroplasties
- dogs
- cats
- (small ponies)
- other small animals
- alpacas
Species indications - arthrodesis
- all spp depending on joint
- e.g. pancarpal/ partial carpal and pantarsal/ partial tarsal
Species indications - amputation
- dogs
- cats (limb, digit, tail)
- limbs in small caged pets
- occasionally larger animals
Indications - arthroplasty
- dysplasia (juvenile pain)
- intractable arthritis/ joint pain
- articular fx (un-reconstructable)
- persistent luxation
- avascular necrosis
What is the most common joint for excision arthroplasty?
- HIP
- Also described in: TMJ, radial head (humans), shoulder, MT/MC phalangeal joint, phalangeal joints
Define FHNE
Femoral Head and Neck Excision
Indications - FHNE
- hip dysplasia (juvenile pain)
- intractable OA / DJD
- femoral head and neck fractures/ acetabular fractures
- persistent luxation
- Legg-Calve-Perthes disease (avascular necrosis of the femoral head)
- all dog sizes, good results up to 30kg
- some restriction in ROM will affect full athletic performance
- sx technique critical
Aftercare - FHNE
- vital to outcome
- early return to controlled exercise
- pain-relief
- physio/hydro
What is FHNE outcome influenced by? 3
- obesity
- preop mm wastage
- other orthopaedic problems
Where is the femur cut in FHNE?
- cut medial to greater trochanter of femur
- cut exits above lesser trochanter
What is another name for replacement arthroplasty?
joint replacement
Which joints can undergo replacement arthroplasty?
- canine and feline hip
- canine stifle (limited case reports for feline)
- canine elbow
- canine hock? (anecdotal)
Define THA
Total Hip Arthroplasty (= hip replacement, THR)
Describe THA
- any dog
- typically large, active or working dogs >30kg
- any time after skeletal maturity
- outcome influenced by: obesity, other orthopaedic problems
- expensive but excellent results thus gold standard.
Ideal patient for a THA
- painful hip (non-responsive to meds)
- large breed dog
- previously active lifestyle
- sensible, well-trained dog
- compliant owners
- (insured)/ committed owners
How do THA and FHNE compare?
- THA more expensive
- 10% risk of severe complications in THA but low risk of minor cx for FHNE
- THA aftercare is cage rest for 6 weeks whilst for FHNE activity encouraged asap
- THA function is excellent/ normal but for FHNE is reduced but often acceptable in smaller animals
Ideal patient joint arthroplasty in joints other than hips
- similar indications/ ideal patient
- currently elbow (and knee)
- long term outcome for elbow and knee replacement are not as established as the hip
Outline total arthroplasty
- sx technique complex and critical
- variable risk of serious complications in sx and postop
- infxn control critical
- variety of techniques and equipment based on cemented or un-cemented bone-implant interface/ prosthesis
What is arthrodesis also known as?
= ‘artificial ankylosis’
= ‘syndesis’
- the artificial induction of joint ossification b/w two bones via sx
Define ankylosis
the gradual development of joint siffness d/t pathologic processes. Joint stiffness develops d/t fibrosis of the joint capsule and the periarticular tissues, and the formation of intra-articular adhesions and OPs
Arthrodesis - indications - 5
- intractable arthritis/ joint pain
- articular fx (un-reconstructable)
- persistent luxation or instability
- low grade pain interfering with performance
- revision of failed joint sx
