Surgical Management of an Arthritic Joint

Question 1

How can we conservatively treat an arthritic joint

Answer 1

Analegsics 
weight loss 
lifestyle change 
splints, braces, orthoses 
Physio
Mobility aids 
Steroids 
DMARDs

Question 2

What changes can be seen on an X Ray of an arthritic joint

Answer 2

Reduced joint space
Sclerosis
Osteophyte formation

Question 3

When is appropriate to surgically manage an arthritic joint

Answer 3

When conservative measures are exhausted

The patient is really struggling - do not base on the xray

Question 4

What are the 3 aspects of gaining consent for surgery of an arthritic joint

Answer 4

Risks vs Benefits
Patient journey
Realistic outcomes and success rates

Question 5

What are the different surgical optoins for an arthritic joint

Answer 5

Athroscopic debridement 
Cartilage regeneration
Synovectomy for RA 
Open debridement/ cheilectomy 
Joint Excision (excision athroplasty)
Arthrodesis surgical fusion
Osteotomy surgical realignment 
Joint replacement arthroplasty

Question 6

What joint was Arthroscopic Debridement/ washout usually performed on.
Was the success good or bad

Answer 6

Knee

Usually poor results

Question 7

What is open debridement good for

Answer 7

Removing impinging osteophyte = cheilectomy

Question 8

What joints are operated on in an open debridement

Answer 8

Ankle
1st MTP joint
Elbow

Question 9

What joints are cartilage regeneration performed on

Answer 9

Knee and Ankle

Question 10

What joint are cartilage regeneration poor on

Answer 10

Patellofemoral joint

Question 11

What type of cartilage is produced in a cartilage regeneration

Answer 11

fibrocartilage instead of hyaline

Question 12

What is a excision arthroplasty

Answer 12

Surgical removal of the joint

Question 13

Excision arthroplasty are good for what joints

Answer 13

1st CMC joint OA in hand (trapeziectomy)

Question 14

What can be done for end stage rheumatoid foot in terms of excision arthroplasty

Answer 14

Can excise all metatarsal heads

Question 15

What is arthrodesis

Answer 15

Surgical fusion in position of function

Question 16

What does arthrodesis involve

Answer 16

All cartilage removed down to bleeding bone

Heals like fracture, bone graft may help union

Question 17

Arthrodesis is the gold standard for what joints

Answer 17

1st MTPJ OA
Ankle 
Wrist 
PIP and DIPJ hand 
Spine

Question 18

Arthrodesis was formerly used for what ?

Answer 18

TB hip and young hip OA

Question 19

What does Arthrodesis cause

Answer 19

Abnormal stress on surrounding joints

Question 20

What is ostetomy

Answer 20

Surgical realignment of a joint

Question 21

What does osteotomy result in

Answer 21

Offloads damaged areas and transfers load onto undamaged areas

Question 22

In what cases would an osteotomy be performed

Answer 22

Knee - isolated medial (or lateral) compartment OA

1st MTPJ - Hallux Valgus

Question 23

Describe the success rate etc of an osteotomy

Answer 23

70% success
Lasts around 7 years
Gold standard for hallux valgus
May delay arthritis in young hips

Question 24

What is another term for a joint replacement

Answer 24

Arthroplasty

Question 25

What is the main indication for a joint replacement

Answer 25

Pain relief

Question 26

What does a joint replacement NOT improve

Answer 26

Function or ROM

Question 27

What joints can be replaced

Answer 27

``` Hip knee shoulder elbow ankle wrist 1s MTPJ ```

Question 28

What are some of the risks of a joint replacement

Answer 28

Loosening Infection Instability/ dislocation Fracture

Question 29

What are some of the immediate risks of a joint replacement

Answer 29

Blood loss DVT / PE Medical complications

Question 30

What can cause vascular necrosis

Answer 30

Steroid use

Question 31

What is required for a cartilage injury to properly heal

Answer 31

A deep tear to the Tidemark to allow the blood supply to go up and lay down fibrocartilage

Question 32

Patients undergoing a THR usually complain of what

Answer 32

``` Reduced walking distance Pain not controlled by analgesics Night pain Impairment of activities of daily life Impairment of hobbies ```

Question 33

How long would you expect a total hip replacment to last

Answer 33

10-15 years

Question 34

How can Trochanteric bursitis be treated

Answer 34

Usually conservatively +/- injections

Question 35

How do patients with Trochanteric bursitis present

Answer 35

Lying on their hip and complaining of intense pain over the greater trochanter.r Exercise does not affect them

Question 36

What is the name of the operation performed for Perthes disease called

Answer 36

Head reshaping - shaving off of part of the bone.