Salvage Procedures Flashcards
(48 cards)
Define arthroplasty
‘Excision’ or ‘replacement’ of joint
Define arthrodesis
Surgical fusion of a joint
(Ankylosis = non-surgical slow natural fusion)
What are the 2 types of arthroplasty and what species can we do this in?
- Excision arthroplasty:
- Dogs, cats (removal of a surface)
- Joint replacement arthroplasty:
- -hip (dogs & cats), elbow & stifle (dogs)
Which species can we do a arthrodesis in?
All species - jont dependant
Which species ccan we do amputation in?
Dogs and cats: limbs, digits, tail
Small caged pets: limbs, tails
Name 3 indication in the hip for an arthroplasty (4)
- Dysplasia = unmanageable juvenile pain
- Persistent luxation
- Non-reconstructable articular fracture
- Intractable degenerative joint disease = pain
Name 5 effects of excision arthroplasty (7)
- Should be pain free
- Instability of the joint = abnormal movement
- May have reduced range of motion and regional muscle
atrophy (cannot extend the hip as much) - Mechanical lameness
- Morbidity highest in first 1-2 months
- Outcome can be variable / unpredictable
What is a lifelong effect of a replacement arthroplasty?
Lifelong ppoteential morbidity
Excision arthroplasty, where is it:
A) Common?
B) Very rare?
C) Occasional?
A) Hip
B) Shoulder
C) Temporomandibular joint
What are the benefits of a femoral head and neck excision?
- Technically simple, cheap, few complications
What are the 2 affects of “body size” on a fermoral head and neck excision?
What factors inflience the outcome of a femoral head and neck excision?
•Patient temperament
- obese, sedentary dogs (muscles less strong) do less well than fit active individuals
•Age
- younger animals adapt better than older patients
- Chronicity, disuse muscle atrophy = poorer outcome
- Bilateral condition or concurrent problems?
- Two hips that are poor - harder to manage
- Do not do in a large dog
What are the crucial “important factors” in a femoral head and neck excision?
•Accurate and complete excision of the femoral neck
- Remember that there is a degree of anteversion and
hence more of the neck must be removed caudally - When you make a cut from a cranial aspect need to take off more caudally due to the anteversion
- Maintain the lesser trochanter with the insertion of the ilio psoas muscle, an important hip flexor
- Early and intense physiotherapy with appropriate analgesia
What is the procedure for a femoral head and neck excision?
- Standard craniolateral approach to hip
- Disarticulate hip
- Take out the hip
- Rotate femur 90 degrees to table – see femoral head and neck
- Cut perpendicularly down onto base of femoral neck
- Best to use an oscillating saw.
- Preserve greater and lesser trochanters.
- Visualise & digital palpation of cut neck for quality of cut.
- Entire femoral neck and head must be removed
What does this show?
The end results of a femoral head and neck excision
Where can we do a replacement arthroplasty in a cat?
Hip
Where can we do a replacment arthoroplasty in a dog?
- Hip
- Elbow
- Stifle
What is the “ideal patient” for a total hip replacement?
- Painful hip (non-responsive to medication)
- 10-40kg dog
- Has had no previous hip surgery – scarring or if recent there is a chance of infection
- Previously active lifestyle
- Sensible, well-trained dog
- Compliant owners - rest
- Can afford cost
- Can afford / cope complications
If a client can’t afford a total hip replacement, what can we consider?
FHNE
What are the different ways/systems of doing a total hip replacement? (3)
Cemented systems: polmethylmetha-crylate (PMMA)
Cementless systems: bone ingrowth
Hybrid systems
What type of hip replacement?
Biomedtrix
BFX
Biological fixation
What type of hip replacement?
CFX
What type of hip replacement?
Hybrid
What can be seen about how this hip replacement was done?
Cement around the stem
