Elective Surgery Flashcards
treatment of deep joint infection in a replaced joint
within 2-3 weeks - washout and 6 weeks of parenteral antibiotics
more than 3 weeks - remove implant, leave without joint for 6 weeks and give parenteral antibiotics then a revision replacement
why are infections of joint replacement difficult to treat
the bacterio forms a biofilm over the join surface
when is excision or resection arthroplasty done
This involves the removal of bone and cartilage of one or both sides of a joint. Whilst this may be quite disabling for larger joints (this was the first surgical procedure for hip OA), it can be an effective procedure for smaller joints (eg first carpometacarpal joint in hand, Keller’s procedure for Hallux Valgus). It is also occasionally utilized after failure of hip or shoulder replacement.
when is arthrodesis used
more for pain as function is poor after - joints are fused
Arthrodesis is good for end stage ankle arthritis, wrist arthritis and arthritis of the first MTP joint of the foot (hallux rigidus).
what is osteotomy
Osteotomy is surgical realignment of a bone which can be used for deformity correction or to redistribute load across an arthritic joint
used in treatment of early arthritis
what is osteomyelitis
infection of the bone
who usually gets acute osteomyelitis in the absence of recent surgery and why
children - metaphyses of long bones have lots of tortuous blood vessels meaning flow is sluggish and bacteria can accumulate
what is chronic osteomyelitis
Chronic osteomyelitis develops from an untreated acute osteomyelitis and may be associated with a sequestrum and/or involucrum. In adults the infection tends to be in the axial skeleton (spine or pelvis) with haematogenous spread from pulmonary or urinary infections, or from infection of the intervertebral disc (discitis).
what causes osteomyelitis most commonly
staph aureus
what causes osteomyelitis in sickle cell patients
staph aureus still most common
SALMONELLA is unique to these patients
who is at particular risk of osteomyelitis in the spine
diabetics
IVDU
immunocompromised patient
complication of spinal osteomyelitis
epidural abscess
vertevral collapse - kyphosis
bacteramia and endocarditis
investigation of choice in osteomyelitis
MRI
what should always be done prior to antibioite treamtnet if possinle
ct guided biopsy
if septic start antibiotics then still get ct guided biopsy
organisms which cause early prostehtic infections in joint replacement
staph aureus
coliforms
