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MSK CORTEXT > 4- Elective Surgery > Flashcards

4- Elective Surgery Flashcards

1
Q

When would you consider surgical management

A

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

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2
Q

What are the types of joint replacement

A

Hemiarthroplasty - replace one half of the joint

Total joint replacement

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3
Q

What are the most successful arthroplasties

A

Hip and knee
Good function and pain relief
Low complication rates

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4
Q

List the materials that can be used in arthroplasty

A 
Stainless steel 
Cobalt chrome 
Titanium alloys 
Polyethylene 
Ceramic
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5
Q

What is one negative of using metal in joint replacements

A

Particles can cause inflammatory granuloma

This can go on to cause muscle and bone necrosis

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6
Q

What is one negative of using polyethylene in joint replacements

A

Particles can cause inflammatory response in bone with subsequent reabsorption
Results in loosening

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7
Q

What is one negative of using ceramic in joint replacements

A

Can shatter with fatigue

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8
Q

Revision arthropathies are just as successful as the first operation - true or false

A

FALSE

more difficult the 2nd time and outcomes are usually poorer

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9
Q

List some common early local complications of arthroplasty

A 
Infection 
Dislocation 
Instability 
Fracture 
Nerve injury 
Bleeding 
DVT
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10
Q

List some common early general complications of arthroplasty

A 
Hypovolaemia 
Shock 
Renal failure 
MI 
ARDS 
PE
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11
Q

List some common late local complications of arthroplasty

A

Infection - haem spread
Loosening
Fracture
Implant breaking

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12
Q

For which joints is excision or resection arthroplasty effective

A

Small joints - CMC or in hallux valgus

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13
Q

For which conditions is arthrodesis useful for

A

End stage ankle arthritis
Wrist arthritis
Arthritis of first MTP joint

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14
Q

Arthrodesis is good at relieving pain and maintaining ROM - true or false

A

FALSE

good at pain relief but function is often limited

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15
Q

What are osteotomies used for

A

Deformity correction

Redistribute load across arthritic joint

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16
Q

What is an osteotomy

A

Surgical realignment of a bone

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17
Q

What are osteotomies used to treat

A

Early arthritis of knee and hip

18
Q

What can lead to soft tissue problems

A 
Degeneration 
Injury or overuse 
Inflammatory conditions 
Drugs - steroids, quinolone antibiotics 
Chronic disease
19
Q

For which tendons are steroid injections not advised and why

A

Achilles
Extensor mechanism of knee

High risk of rupture

20
Q

What is surgical debridement

A

Removal of diseased tissue

21
Q

What is surgical decompression and give example of when it is used

A

Making more space

Supraspinatus tendonitis

22
Q

When might a synovectomy be performed

A

Extensor tendons of wrist in RA

Inflammation of tibialis posterior to prevent rupture

23
Q

What can cause joint instability

A

Injury
Ligament laxity
Predisposed by anatomical variation - femoral neck anteversion
Underlying disease - RA

24
Q

List non-surgical treatments for joint instability

A

Physio - strengthens surrounding muscles

Splints, braces etc for extra support

25
Q

Which soft tissue procedures can help joint stability

A

Ligament tightening
Ligament reconstruction -uses tendon graft
Soft tissue reattachment

26
Q

Which bony procedures can help joint stability

A

Osteotomy

Fusion in spine

27
Q

How can you surgically treat trapped/compressed nerves

A

Nerve decompression surgery

Used in carpal and cubital tunnel syndromes and the spine

28
Q

What is osteomyelitis

A

Infection of the bone

Can occur through penetrating trauma, surgery or indirectly through blood

29
Q

what is a involucrum

A

New bone that forms around the area of necrosis

30
Q

Who can get acute osteomyelitis

A

Recent surgical patients

Children
Immunocompromised patients

31
Q

What is a sequestrum

A

Dead fragment of bone that can break off

32
Q

How does chronic osteomyelitis develop

A

From untreated acute osteomyelitis
Haematogenous spread
May be associated with sequestrum or involucrum

33
Q

How do you treat acute osteomyelitis

A

Best guess IV antibiotics
Surgical drainage if there is ab abscess

If doesn’t resolve then surgery to gain samples and wash out

34
Q

Can you treat chronic osteomyelitis with antibiotics alone

A

Nope

35
Q

How do you treat chronic osteomyelitis

A

Antibiotics to supress active infection
Surgery to gain cultures and excise infected bone
Stabilisation if needed

36
Q

Who is at risk of osteomyelitis of the spine

A

Poorly controlled diabetics
Intravenous drug abusers
Immunocompromised patients

37
Q

What are the symptoms of spinal osteomyelitis

A

Insidious onset of back pain
Muscle spasm
Spinal tenderness
Fever (+/- systemic upset)

38
Q

How do you treat spinal osteomyelitis

A

CT guided biopsy to get culture
High does IV antibiotics based on results

Surgery if no response or severe case (debridement, fusion etc)

39
Q

List common virulent organisms that produce early prosthetic infections

A

Staph aureus

Gram negative bacilli - coliforms

40
Q

Which organisms cause low grade prosthetic infections

A

Staph epidermidis

Enterococcus

41
Q

Which organisms cause late onset haematogenous infections

A

Staph aureus
B- haemolytic strep
Enterobacter

42
Q

How do you treat orthopaedic infection

A

Surgery - debridement

MSK CORTEXT (13 decks)

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