Salvage - arthroplasty and arthrodeses Flashcards Preview

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Flashcards in Salvage - arthroplasty and arthrodeses Deck (42)
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1

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

2

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

3

Define amputation

normally considered as a fallback after other tx has proved ineffective but may be used if finance is a problem

4

Species indications - arthroplasties

- dogs
- cats
- (small ponies)
- other small animals
- alpacas

5

Species indications - arthrodesis

- all spp depending on joint
- e.g. pancarpal/ partial carpal and pantarsal/ partial tarsal

6

Species indications - amputation

- dogs
- cats (limb, digit, tail)
- limbs in small caged pets
- occasionally larger animals

7

Indications - arthroplasty

- dysplasia (juvenile pain)
- intractable arthritis/ joint pain
- articular fx (un-reconstructable)
- persistent luxation
- avascular necrosis

8

What is the most common joint for excision arthroplasty?

* HIP
- Also described in: TMJ, radial head (humans), shoulder, MT/MC phalangeal joint, phalangeal joints

9

Define FHNE

Femoral Head and Neck Excision

10

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

11

Aftercare - FHNE

- vital to outcome
- early return to controlled exercise
- pain-relief
- physio/hydro

12

What is FHNE outcome influenced by? 3

- obesity
- preop mm wastage
- other orthopaedic problems

13

Where is the femur cut in FHNE?

- cut medial to greater trochanter of femur
- cut exits above lesser trochanter

14

What is another name for replacement arthroplasty?

joint replacement

15

Which joints can undergo replacement arthroplasty?

- canine and feline hip
- canine stifle (limited case reports for feline)
- canine elbow
- canine hock? (anecdotal)

16

Define THA

Total Hip Arthroplasty (= hip replacement, THR)

17

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.

18

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

19

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

20

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

21

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

22

What is arthrodesis also known as?

= 'artificial ankylosis'
= 'syndesis'
- the artificial induction of joint ossification b/w two bones via sx

23

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

24

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

25

Principles - arthrodesis (REALLY IMPORTANT TO REMEMBER)

- absolute stability, ideally though compression
- remove cartilage from contact areas
- contour opposing joint surfaces
- bone graft (osteogenesis, osteoinduction and osteoconduction)
- fuse at functional angle
- external support?

26

Define osteogenesis (bone graft)

source of osteoprogenitor cells

27

Define osteoinduction (bone graft)

scaffold for bone to grow across

28

Define osteoconduction (bone graft)

conduction of bone growth factors

29

Outline long term implications of arthrodesis

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

30

Generally what should you expect form stifle arthrodesis?

high motion joint so might expect poor function but there are exceptions