Cortex - Elective surgery 1 Flashcards
What does elective orthopaedic surgery involve ?
Involves the treatment of non‐emergency or “cold” musculoskeletal conditions.
What are some of the common orthopaedic elective surgical procedures ?
- Arthritis
- Soft tissue inflammatory problems eg tendonitis, tendon rupture
- Correction of deformity
- Nerve decompression
- Joint instability
- Joint contractures
- Chronic infection
- Tumour diagnosis and treatment.
Some elective cases are more urgent than others e.g. suspected cancer
What are the 4 main different surgical strategies for the management of an arthritic joint ?
- Arthoplasty / Joint replacement
- Excision or resection arthroplasty
- Arthrodesis
- Osteotomy
What is arthroplasty ?
Means ‘reshaping’ of the joint and is synonymous with joint replacement although it can be used to describe the removal of a diseased joint ‐ excision or resection arthroplasty
Appreciate the different materials joint replacements can be made up of
Stainless steel, cobalt chrome, titanium alloy, polyethylene and ceramic.
Eventually what will happen to a joint replacement ?
It will fail either due to loosesning of the components or breakage of the components
Once a joint replacement fails what happens and what are the patients outcomes like?
A redo procedure is done but they are more difficult, more complicated and usually have poorer outcomes
In joint replacements some of the components can be metal - what can metal particles cause in a joint replacement ?
An inflammatory granuloma (known as a pseudotumour) which can cause muscle and bone necrosis
In joint replacements polyethylene can cause an inflammatory response in bone - what is this known as ?
Osteolysis - inflam reposne with subsequent bone absorption. This can cause loosening and ceramics can shatter with fatigue due to their brittleness.
Label the following potential complications of a joint replacement as either early local or early general complications:
Infection, Shock, dislocation, Hypovolaemia, instability, fracture, PE, leg length discrepancy, MI, ARDS, nerve injury, acute renal failure, bleeding, arterial injury / ischaemia, bleeding, DVT, chest infection, urine infection
Early local complications:
- Infection, dislocation, instability, fracture, leg length discrepancy, nerve injury, bleeding, arterial injury / ischaemia, bleeding, DVT.
Early general complications:
- Hypovolaemia, shock, acute renal failure, MI, ARDS, PE, chest infection, urine infection.
What are some of the late local complications following a joint replacement ?
Infection (from haematogenous spread), loosening, fracture, implant breakage, pseudotumour formation.
What does excision or resection arthroplasty involve ?
Involves the removal of bone and cartilage of one or both sides of a joint.
What is meant by arthrodesis ?
- This means a surgical stiffening or fusion of a joint in a position of function.
- The remaining hyaline cartilage of the joint and subchondral bone is removed and the joint is stabilized resulting in bony union (like fracture healing) and fusion.
What conditions is arthrodesis good for ?
End stage ankle arthritis, wrist arthritis and arthritis of the first MTP joint of the foot (hallux rigidus).
What are the positives and negatives of arthrodesis ?
Positives:
- Good at alleviating pain
Negatives:
- Function may be pretty limited
What is osteotomy ?
Surgical realignment of a bone which can be used for deformity correction or to redistribute load (off diseased part and onto undiseased part) across an arthritic joint.
