4- Elective Surgery Flashcards
When would you consider surgical management
When there is a surgical solution to the problem
When conservative methods have not controlled the patients symptoms
Must consider pain severity and disability caused
What are the types of joint replacement
Hemiarthroplasty - replace one half of the joint
Total joint replacement
What are the most successful arthroplasties
Hip and knee
Good function and pain relief
Low complication rates
List the materials that can be used in arthroplasty
Stainless steel Cobalt chrome Titanium alloys Polyethylene Ceramic
What is one negative of using metal in joint replacements
Particles can cause inflammatory granuloma
This can go on to cause muscle and bone necrosis
What is one negative of using polyethylene in joint replacements
Particles can cause inflammatory response in bone with subsequent reabsorption
Results in loosening
What is one negative of using ceramic in joint replacements
Can shatter with fatigue
Revision arthropathies are just as successful as the first operation - true or false
FALSE
more difficult the 2nd time and outcomes are usually poorer
List some common early local complications of arthroplasty
Infection Dislocation Instability Fracture Nerve injury Bleeding DVT
List some common early general complications of arthroplasty
Hypovolaemia Shock Renal failure MI ARDS PE
List some common late local complications of arthroplasty
Infection - haem spread
Loosening
Fracture
Implant breaking
For which joints is excision or resection arthroplasty effective
Small joints - CMC or in hallux valgus
For which conditions is arthrodesis useful for
End stage ankle arthritis
Wrist arthritis
Arthritis of first MTP joint
Arthrodesis is good at relieving pain and maintaining ROM - true or false
FALSE
good at pain relief but function is often limited
What are osteotomies used for
Deformity correction
Redistribute load across arthritic joint
What is an osteotomy
Surgical realignment of a bone
What are osteotomies used to treat
Early arthritis of knee and hip
What can lead to soft tissue problems
Degeneration Injury or overuse Inflammatory conditions Drugs - steroids, quinolone antibiotics Chronic disease
For which tendons are steroid injections not advised and why
Achilles
Extensor mechanism of knee
High risk of rupture
What is surgical debridement
Removal of diseased tissue
What is surgical decompression and give example of when it is used
Making more space
Supraspinatus tendonitis
When might a synovectomy be performed
Extensor tendons of wrist in RA
Inflammation of tibialis posterior to prevent rupture
What can cause joint instability
Injury
Ligament laxity
Predisposed by anatomical variation - femoral neck anteversion
Underlying disease - RA
List non-surgical treatments for joint instability
Physio - strengthens surrounding muscles
Splints, braces etc for extra support
