Elective surgery (lower and upper limb)

Question 1

Give examples of surgical strategies for the management of an arthritic joint?

Answer 1

1. Arthroplasty / Joint replacement
2. Excision or resection arthroplasty - involves the removal of bone cartilage of one or both sides of a joint
3. Arthrodesis - surgical stiffening/fusion of a joint in a position of function
4. Osteotomy- surgical realignment of a bone which can be used for deformity correction

Question 2

Give examples of joints you would use Arthroplasty for?

Answer 2

1. Hip
2. Knee
3. Shoulder
4. Elbow
5. Ankle
6. 1st MTP of the great toe
7. MCP joints of the hand and wrist

Question 3

What are the complications of arthroplasty?

Answer 3

Serious complications: Deep infection, recurrent dislocation, neurovascular injury, pulmonary embolism and medical complications ( renal failure, MI, chest infections)

Early local complications: Infection, dislocation, instability, fracture, leg length discrepancy, nerve injury, DVT and arterial injury

Early general complication: Hypovolaemia, shock, acute renal failure. MI, ARDS, PE, chest infection and urine infection

Late local complication: Infection, loosening, fracture, implant breakage, pseudotumor formation

Question 4

Give example of joints which you would use excision or resection arthroplasty?

Answer 4

Generally smaller joints

1. 1st carpometacarpal joint in hand
2. Keller’s procedure for Hallux valgus

sometimes used after failure of hip or shoulder replacement

Question 5

Give example of joints in which you would use arthrodesis?

Answer 5

1. End stage ankle arthritis
2. Wrist arthritis
3. Arthritis of the first MTP joint of the foot (hallux rigidus)

Question 6

Give example of joints in which you would use Osteotomy?

Answer 6

1. Early arthritis of the knee

2. Early arthritis of the hip

Question 7

How would you generally manage Soft tissue problems?

Answer 7

Vast majority of problems manage rest, analgesia and anti-inflammatory medications

Refractory cases may benefit from surgical debridement or decompression. Synovectomy can be performed for the extensor tendosns of the wrist in RA

Major tendon tears - splintage, surgical or tendon transfer

cartilage tear in the knee - arthroscopic removal if the pain fails to settle

Question 8

How would you generally manage Joint instability?

Answer 8

Most cases can be managed with physiotherapy to strengthen up surrounding muscle and to improve proprioception and splints, calipers or braces

Surgical strategies for instability consist of soft tissue procedures and bony procedures

soft tissue procedures: Ligament tightening, ligament reconstruction using tendon graft or soft tissue reattachment

Bony procedures: fusion