Surgical Tx of RA Flashcards Preview

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Flashcards in Surgical Tx of RA Deck (22)
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1
Q

what are some typical forefoot deformities seen in RA?

A
  • hyperpronation
  • metatarsalgia
  • MPJ dislocation
  • hallux valgus
  • claw toes
  • hammer toes
2
Q

what are some typical midfoot and rearfoot deformities seen with RA?

A
  • TN arthritis
  • STJ arthritis
  • rupture of PTT
3
Q

what are non-operative treatment options for RA?

A
  1. pharmacologic: NSAIDs, DMARDs, corticosteroids
  2. accommodative insoles
  3. AFO
  4. shoegear modifications: rocker bottom sole
4
Q

what are the goals for surger y in a RA patient?

A
  1. pain relief
  2. improvement of overall function
  3. correction of deformity by increasing stability and overall muscle force
5
Q

what is peri-op management of RA patients?

A

if 5mg, give regular dose + 25mg prior to srugery

6
Q

do you stop DMARDs prior to surgery?

A

yes, stop 1-2 wks prior to sx

7
Q

true or false: methotrexate DOES NOT need to be stopped prior to surgery

A

true

8
Q

what other peri-op mgmt do you worry about for RA patient?

A
  • prophylactic abx
  • prophylaxis for DVT
  • workup for atlantoaxial subluxation
  • overall bone stock
9
Q

what is a panmetatarsal head resection?

A

taking out met heads 2-5 followed with 1st MPJ arthroplasty or arthrodesis

10
Q

which incisional approach for pan-met head resection is a plantar transverse incision?

A

Hoffman

11
Q

which incisional approach for pan-met head resection is a three dorsal linear incision?

A

Larmon

12
Q

which incisional approach for pan-met head resection is a 5-dorsal linear incision?

A

Hodor and Dobbs

13
Q

which incisional approach for pan-met head resection is a dorsal longitudinal incision?

A

McKeever

14
Q

which incisional approach for pan-met head resection is a dorsal transverse incision?

A

Clayton

15
Q

which incisional approach for pan-met head resection is a one linear, two lazy S procedures?

A

Bilotti

16
Q

what are advantages of pan met head resection?

A
  • eliminates painful MPJs
  • ability to ambulate w/o pain
  • allows patient to wear regular shoes
  • allows reduction of dorsally contracted digits
  • elimination of plantar pressure points
17
Q

what is the Mayo arthroplasty technique?

A

resection of 1st met head

not used anymore

18
Q

what is the Keller arthroplasty?

A

resection of base of prox. phalanx

19
Q

which procedure is good for osteopenic bone?

A

arthroplasty

20
Q

if you have good bone stock, what procedure should you do?

A

arthrodesis

21
Q

if patient has hindfoot arthritis, what should you do?

A

triple arthrodesis- fusion of TN, STJ, CC

22
Q

if patient has ankle arthritis, what should you do?

A

total ankle arthroplasty

ankle arthodesis