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Small Animal Surgery > Arthritis and Osteochondrosis > Flashcards

Arthritis and Osteochondrosis Flashcards

1
Q

What is arthropathy?

A

Any joint disease

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2
Q

What is arthrosis?

A

“wear and tear”

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3
Q

What is arthritis?

A

Inflammation within a joint

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4
Q

What is polyarthritis?

A

Inflammation in several joints simultaneously

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5
Q

What is a joint capsule?

A

The sac that encloses a joint

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6
Q

What does the suffix “-rrhaphy” mean?

A

To suture in place

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7
Q

What is imbrication?

A

Surgical tightening

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8
Q

What does the suffix “-plasty” mean?

A

Surgical repair or shaping

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9
Q

What is an osteophyte?

A

Forms at synovial or articular margins

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10
Q

What is an enthesiophyte?

A

Forms at tendon/ligament attachment

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11
Q

What is a joint mouse?

A

Mobile fragment within a joint (A loose osteophyte or a fragment of cartilage)

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12
Q

What does ankylosis mean?

A

Spontaneous fusion of joint

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13
Q

When do you see ankylosis?

A

End stage of joint disease

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14
Q

What is arthrodesis?

A

Surgical fusion of a joint

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15
Q

What is arthrotomy?

A

Incision into a joint

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16
Q

What are the 3 types of joint?

A

Synovial
Fibrous
Cartilaginous

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17
Q

What 2 things do you use to classify arthritis?

A

Inflammatory vs. Noninflammatory

Based on process causing pathology

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18
Q

Why do we classify arthritis?

A

Helps to guide diagnostics and therapy

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19
Q

What 2 major divisions are there in inflammatory arthritis?

A

Infectious

Non-infectious (immune mediated)

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20
Q

How is non-infectious inflammatory arthritis subdivided?

A

Erosive vs. Non-erosive

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21
Q

What 2 major divisions are there in noninflammatory arthritis?

A 
Primary (idiopathic) osteoarthritis
Secondary osteoarthritis (DJD)
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22
Q

What species is primary osteoarthritis more common in?

A

Cats

NOTE: Highly unusual in dogs

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23
Q

What species is secondary osteoarthritis more common in?

A

Dogs

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24
Q

What 2 types of secondary osteoarthritis are there?

A

Developmental (OCD, hipdysplasia)

Acquired (trauma, neoplasia)

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25
Q

What are 3 other names for osteoarthritis?

A

OA
Osteoarthrosis
DJD

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26
Q

What is osteoarthritis?

A

Aberrant repair of articular cartilage leading to degradation of articular cartilage

Altered subchondral bone metabolism

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27
Q

What is synovitis?

A

Synovial inflammation

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28
Q

What is surgical treatment for osteoarthritis?

A

Salvage procedures

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29
Q

What are 3 salvage procedures to treat OA?

A

Joint replacement/arthroplasty
Arthrodesis
Amputation

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30
Q

How do you treat inflammatory arthropathies?

A

If septic, arthrotomy

If severe DJD, salvage

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31
Q

What is medical treatment for OA?

A

NSAIDs
Weight management
Exersice moderation
Physical therapy

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32
Q

What 4 ways can weight management help with OA?

A

Reduces signs of arthritis
Reduces prevalence
Delays or prevents radiographic OA
Reduces need for medication/surgery

33
Q

What is the signle most important element of medical OA treatment?

A

Weight management

34
Q

What do you need to make sure your owners understand about weight management?

A

It’s hard and it takes time

35
Q

How does exercise moderation help in the treatment of OA?

A

Restriction during acute periods of inflammation helps minimize pain. When inflammation is controlled, moderate exercise helps maintain muscle strength and muscle flexibility and reduces pain.

36
Q

What are 6 different physical therapies that can help with OA?

A 
Cold/heat therapy
Passiive ROM
Massage
Swimming
Treadmill
Acupuncture
37
Q

What are symptom-modifying agents?

A

Things like NSAIDs, Tramadol, Gaba, and steroids (intra-articular)

38
Q

What do you need to remember when giving cats NSAIDs?

A

They can’t metabolize them properly because they need glucuronidation

39
Q

What is an NSAID approved for cats?

A

Onsior (Robenacoxib)

40
Q

How do disease-modifying agents work?

A

Promote synthesis over breakdown

41
Q

What are 3 types of disease-modifying agents?

A

Polysulfated glycosaminoglycan (PS-GAG)
Pentosan polysulfate
Hyaluronic acid - Synovial fluid

NOTE: Good EBM support for PS-GAG and PPS

42
Q

When using disease-modifying agents, what do you need to keep in mind/be careful of?

A

If animal is on heparin therapy because they are all heparin derivatives

43
Q

What is a neutraceutical?

A

Food or part of a food that provides medical benefit

44
Q

What are 3 major neutraceuticals?

A

Glucosamine/chondroitin
Omega-3 FA
Avocado and soybean unsaponifiables

45
Q

How does glucosamine/chondroitin help with OA?

A

In vitro, stimulated proteoglycan synthesis of hyaline cartilage matrix

NOTE: Efficacy uncertain, but safe

46
Q

How do Omega-3 FAs help with OA?

A

Analogous to NSAIDs, so may decrease need

NOTE: EBM is good

47
Q

How do avocado and soybean unsaponifiables help with OA?

A

Have been shown to be experimentally protective

48
Q

What is autologous platelet therapy?

A

Patient platelets are collected, and injected into the involved joint.

NOTE: Mechanism is unknown

49
Q

What about stem cell therapy?

A

It’s cheaper than a joint replacement, and lots of studies in horses, but EBM is iffy in dogs.

50
Q

When is a salvage procedure indicated?

A

When severe DJD

NOTE: Not an attempt to cure/fix, just preserve limb/life

51
Q

What do you need to make sure owners understand about salvage procedures?

A

It’s not an attempt to cure/fix the DJD, just preserves the limb.

52
Q

What are 4 salvage procedures?

A

Joint replacement arthroplasty (GOLD STANDARD)
Partial joint excision arthroplasty
Arthrodesis
Amputation (NOT an arthroplasty)

53
Q

What is the gold standard salvage procedure?

A

Joint replacement

54
Q

What are the 2 best joints for joint replacement?

A

Hip

Stifle

55
Q

What is the intent of joint replacement?

A

To allow/preserve normal joint fxn

56
Q

What is partial joint excision?

A

Remodeling of the joint without replacement

Eg. FHO or glenoid excision

57
Q

What is arthrodesis?

A

Surgical fusion (ankylosis is slow)

58
Q

Why is arthrodesis better than ankylosis?

A

Faster
More complete
Less discomfort

59
Q

What 4 principles do you apply with arthrodesis?

A

Complete removal of ALL articular cartilage
Cancellous bone graft
Rigid fixation (usually DCP)
Standing angle

60
Q

How long do you need to have an arthrodesis coapted?

61
Q

How long can healing of an arthrodesis take?

A

at least 3 months

62
Q

What is the usualy outcome of an arthrodesis?

A

High motion joint = peg leg

Low motion joint = minimal effect on gait

63
Q

What is osteochondrosis?

A

A developmental orthopedic disorder where there is a defect in the endochondral ossification

64
Q

What is endochondral ossification?

A

Process by which epiphyseal cartilage becomes bone

65
Q

Fact Frog: Osteochondrosis is…

A

a defect in endochondral ossification

66
Q

When is endochondral ossification typically done?

A

Around 6 months

67
Q

What is the pathophysiology of osteochondrosis?

A

Focally thicker cartilage due to failed ossification causes a cleft between calcified and non-calcified bone and forces of normal activity fracture the cartilage

68
Q

Fact Frog: Dissecans or Dessicans?

A

DissEcans for dissection, not DessIcans for dessicated

69
Q

What is osteochondritis dissecans?

A

Necrotic cartilage induces repair which starts with inflammation, defect in the joint surface accelerated DJD.

NOTE: Pain is a result of inflammation

70
Q

What is the typical signalment of osteochondritis dissecans?

A

Large breed dogs

Rapid growth, with delayed maturation of bone and relatively little muscle development

71
Q

Who is predisposed to osteochondritis dissecans?

A

Male, large and giant breed dogs, >20 kg with rapid growth, hereditary

72
Q

What kind of biphasic age distribution do we see with osteochondritis dissecans?

A

Immature - inflammatory arthritis

Mature - Secondary degenerative disease

73
Q

What can we see on RADs that signifies osteochondritis dissecans?

A

Flattened caudal humeral head

74
Q

What are the 3 possible treatments for osteochondritis dissecans?

A

Preventative measures
Conservative treatment
Surgical treatment

75
Q

What are the 2 preventative measures?

A

Diet (energy, Calcium and Vit. D)

Exercise restriction

76
Q

When do we use conservative treatment of osteochondritis dissecans?

A

Small lesion

Young patient

77
Q

What 3 things are included in conservative treatment of osteochondritis dissecans?

A

Diet/exercise restriction
Weight control
+/- NSAIDs

78
Q

What is the general recommended treatment for osteochondritis dissecans?

79
Q

What are the 3 types of surgery for osteochondritis dissecans?

A
  • Arthroscopic fragment removal with subchondral bone debridement
  • Replacement of articular cartilage with fibrocartilage (imperfect because of scar tissue)
  • Osteochondral transplants

NOTE: 3D printing is becoming a possibility

Small Animal Surgery (13 decks)

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