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PATH3308 > 22. Bone, joint and Tendon Reconstruction > Flashcards

22. Bone, joint and Tendon Reconstruction Flashcards

1
Q

What is osteoarthritis caused by?

A

Degeneration of articular cartilage and underlying subchondral bone

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2
Q

What impacts does OA have?

A

Huge financial burden on society - bloody old people

  • 95% surgical volume
  • 1-2% GDP

OA is greatest mobility disability of all medical conditions

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3
Q

What is the main treatment for OA?

A

Joint reconstruction / replacement, (Athroplasty)

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4
Q

How long does it take an Athroplasty to restore a joint back to full strength?

A

Months or years!

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5
Q

What are some side effects of Knee Arthroplasty?

A 
Blood clots (15%)
Blood clots in lung
Urinary infections 
Leg length difference
Pain + stiffness
Loosening of prosthesis
Knee infection
Nerve injuries
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6
Q

What are some side effects of hip Arthroplasty?

A 
DVT + pulmonary embolism
Dislocation
Leg length inequality
Persistent chronic pain
Loosening of prosthesis
Fracture
Metal sensitivity 
Nerve injuries
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7
Q

What are the post operative effects of Knee athroplasty?

A

90% = increased ROM 0-110 degrees

25% loosening of prosthesis @ 10 yrs

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8
Q

How can dislocation be prevented after hip replacement?

A

Dont cross legs
Sleep with pillows between legs
Do not bend over 90 degrees

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9
Q

What is the average lifespan of a prosthesis?

A

12-15 yrs

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10
Q

What is a bone or bone substitue Graft/Implant?

A

Surgical procedure replacing missing bone with material from patients own body or an artificial substitute

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11
Q

What is a bone graft/implant used to treat?

A

Complex fractures

Large defects

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12
Q

What are the 4 types of bone substitutes?

A

1) Autologous + allogenic bone grafting
2) Calcium based chemical bone
3) Ceramic and polymer based
4) Steel based

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13
Q

What requirements should a bone graft satisfy in order to promote osteoregeneration?

A

1) Osteogenecity - MSCs, osteoprogenitors etc
2) Osteoinductivity - growth factors (BMP)
3) Osteoconductivity - Carrier scaffold for new bone

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14
Q

What is the current gold standard bone grafting treatment?

A

Autologous bone grafts

Stimulates regeneration at non-union site

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15
Q

What are some limitations associated with autologous bone grafts?

A 
Availability
Donor site morbidity
Donor site pain
Risk of infection
Variable fusion success rates
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16
Q

What is surgical fusion?

A

Surgical technique used to join two or more vertebrae
- Reduce pain due to movement of vertebrae

Uses bone graft to augment surgery

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17
Q

How long does it take surgical fusion to heal?

A

3 months

18
Q

What bone is commonly used in autologous graft of bone?

A

Iliac crest

Provides stem cells

19
Q

What two types of bone can be used in autologous bone Grafts?

A

Cortical

Cancellous

20
Q

What are the characteristics of cortical bone in relation to autologous bone grafts?

A

Low osteogenic potential
Barrier to vascular ingrowth and remodeling
Cortical bone loses strength during incorporation
Super strong

21
Q

What are the characteristics of cancellous bone in relation to autologous bone grafts?

A

Lacks compresive strength

Has greater conductivity, accelerates fusion mass

22
Q

What is the most common type of autologous bone graft used?

A

Cancellous bone

23
Q

Where is bone sourced in allograft bone grafts?

A

Cadaveric bone
Available in desired configuration
Avoids morbidity of donor site complications

24
Q

What are the disadvantages of allograft bone grafts?

A 
Delayed vascular penetration
Slow bone formation + fusion
Accelerated bone resorption
Delayed graft incorporation
Increased infection rate
Lack of histocompatibility
25
Q

What is distraction osteogenesis?

A

Surgery using healing property of bone for reconstruction of skeletal deformities and lengthening of long bones

26
Q

What is the process of distraction osteogenesis?

A

Fracture created
Ends of bone moved apart (distraction phase)
New bone forms in gap
Expands volume of surrounding tissues

27
Q

What are the applications of distraction osteogenesis?

A 
Congenital and developmental deformities
Post traumatic injuries
   - growth plate fractures
   - Bone defects
Infections + diseases
After tumours
Short stature and cosmetic lengthening
28
Q

What are two types of bone lengthening surgeries?

A

Ilzarov Surgery = brutal

Fitbone surgery = involves nail which extends

29
Q

What does the Anterior Crucial Ligament (ACL) do?

A

Prevents anterior translation and medial rotation of tibia in relation to femur

30
Q

What does ACL rupture result in?

A

Impaired stability of knee
Risk meniscal injury
Increased risk of early regenerative disorders
Increased risk of cartilage damage

31
Q

Can torn ACLs heal?

A

Not with conservative management

32
Q

What is the primary treatment for ACL rupture?

A

Autologous tendonous tissue is most popular method for reconstruction

33
Q

What are some common sources for ACL autograft?

A

Patellar tendon = za best
Hamstring tendons
Iliotibal band
Quadriceps tendon

34
Q

What is the current gold standard for ACL reconstruction autografts?

A

Patellar tendon

168% greater strength than native ACL

35
Q

What are the advantages of patellar tendon bone autograft?

A

High tensile strength
Permits bone-to-bone union at insertion sites
Does not sacrifice another significant stabilizer tendon of the knee

36
Q

What are some disadvantages of patellar - ACL reconstruction?

A 
Donor-site morbidity
Increased scar formation
Increased risk of patellar tendonitis/rupture
Risk of patellar fracture during harvest
Post-op patellar tendon shortening
37
Q

What are the two types of tendon in the hamistring tendon, and what is the strength of them in ACL reconstruction?

A

Gracilis tendon alone = 49% of native ACL

Semitendinous = 70% of native ACL

38
Q

What are the advantages of hamistring tendon ACL replacement?

A

Low incidence of donor-site complications such as pain

Faster, easier and significantly smaller wound

39
Q

What are the disadvantages associated with ACL reconstruction?

A

Longer period required for tendon-to-bone fixation

Initial tensile strength of graft may not be sufficient to achieve post-op stability

Inferior strength to original tendon

Weakening of quads

40
Q

What are some cadaveric sources of allograft ACL reconstruction?

A

Patellar tendon
Anterior tibialis tendon
Achilles tendon
Fascia lata

41
Q

What are the advantages of allograft tendon reconstruction?

A 
No-donor site morbidity
Cosmetically better outcome
No size limitation
Shorter operation time
Decreased incidence of post op morbidity e.g. stiffness due to scar formation
42
Q

What are the disadvantages of allograft tendon reconstruction?

A 
Disease transmission
Host immune rejection
Delayed incorporation
Alteration of mechanical properties secondary to sterilization
Cost

PATH3308 (21 decks)

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