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Orthopaedic Medicine > Joint conditions > Flashcards

Joint conditions Flashcards

1
Q

cells in acute disease

A

polymorphs (polymorphonuclear leucocyte)

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2
Q

cells in chronic disease

A

lymphocytes

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3
Q

opening up a joint is called …

A

arthrotomy

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4
Q

what is most joint replacement surgery aimed at achieving

A

pain relief

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5
Q

what is gout

A

inflammation of a joint caused by uric acid crystals being deposited on the cartilaginous surfaces

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6
Q

OA - are most cases primary or secondary

A

primary

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7
Q

what is OA

A

condition of pain and limitation of movement of joints assoc with excessive wear of articular cartilage due to breakdown in balance between wear and repair

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8
Q

non surgical arthritis mx

A

rest and physio
weight loss
use of a stick

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9
Q

eg of an infection that can cause OA

A

TB

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10
Q

eg of a childhood disease that can cause OA

A

Perthes

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11
Q

is it common for arthritis to cause stiffness alone?

A

no this is almost always secondary to pain

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12
Q

when is help from a specialist usually sought out in OA

A

when sleep is disturbed

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13
Q

in the hip, joint loading can reach up to ? times body weight

A

5

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14
Q

what is osteotomy

A

surgical realignment of joint

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15
Q

what is arthrodesis

A

surgical stiffening in a position of function

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16
Q

long term disadvantage of arthrodesis

A

puts stress on adjacent joints

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17
Q

what position would the hip usually be fused at in arthrodesis

A

30 degrees of flexion and some adduction

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18
Q

why is hip fusion more straight forward in males than females

A

any hip fusion is likely to interfere with female sexual activity

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19
Q

is recovery straight forward following hip fusion?

A

no, recovery of up to 6 months, often in a plaster splint

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20
Q

name of operation to replace a joint

A

arthroplasty

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21
Q

what is arthroplasty unlike to alleviate

A

disability due to stiffness caused directly by disease within the joint
(b/c soft tissue distortion of the capsule and ligaments tends to remain after replacement)

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22
Q

how many degrees of flexion should be maintained in the knee

A

90 - for going up and down stairs

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23
Q

why is stability in the knee essential

A

for supporting body weight when standing on one leg

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24
Q

principal indication for operative tx

A

pain

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25
Q

most successful and common joint replacement

A

hip

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26
Q

3 requirements of any joint replacement

A
  • capable of pain free, functional range of motion
  • able to withstand forces placed upon it without undue wear/becoming loose
  • same stability as the natural joint
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27
Q

in which group of people may osteotomy be a good operation

A

young people who have retained a good range of motion and have a reasonable preservation of articular cartilage

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28
Q

what may the long term plan of action be following arthrodesis to prevent stress on adjacent joints becoming problematic

A

converting the arthrodesis to arthroplasty in the 5th decade. this is effective in the hip

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29
Q

modern knee replacement consists of two new smooth surfaces but what is another vital part of this operation?

A

balancing the collateral ligaments

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30
Q

specific early complications of arthroplasty

A

dislocation
DVT
infection

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31
Q

what organisms commonly cause infection in joint replacement

A

staph aureus

commensals e.g. staph albus (universally found on skin)

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32
Q

general complications of surgery

A

UTI, chest infection, pressure sores

33
Q

specific late complications of arthroplasty

A

late infection
loosening
wear

34
Q

most obvious symptoms of rheumatoid arthritis

A

deformity of joints
severe pain
swelling

35
Q

RA - principal joints affected?

A

small joints of hand and feet

36
Q

is there a pattern in joint involvement in RA?

A

small joints are affected symmetrically but large joints are not

37
Q

first noticed sign of RA

A

stiffness worse in mornings and improving throughout the day

38
Q

RA - what type of procedure can be done to try to reduce pain and stiffness in early disease. who in particular is it of value in?

A

synovectomy

particularly of value in the younger patient who retains movement but has pain

39
Q

What is avascular necrosis

A

bone tissue death through loss of blood supply

40
Q

causes of avascular necrosis

A

trauma

spontaneous

41
Q

areas at risk of avascular necrosis following trauma

A

femoral head
proximal part of scaphoid
proximal part of talus

42
Q

in what situations is avascular necrosis of the femoral head seen

A

steroid therapy
alcohol abuse
deep sea divers (Caisson’s disease)

43
Q

presentation of avascular necrosis

A

acute and often severe joint pain, made worse by movement and relieved to some degree by rest

44
Q

why is dx for AN difficult

A

may not initially be seen on X-ray

45
Q

X-ray signs of AN

A

bone appears dense (reflecting absence of blood vessels)

46
Q

can AN be reversed?

A

if blood supply can be re-established naturally

47
Q

what is the bone prone to in AN revascularising phase

A

distortion because it is very soft&raquo_space; secondary arthritic changes

48
Q

management of avascular necrosis

A

non specific
rest the affected joint
surgery is of NO value in tx underlying condition
often surgeon is left to salvage the situation with a joint replacement

49
Q

situations where urate crystals are deposited

A

diuretic overuse
dehydration
after chemo for cancer

50
Q

how does septic arthritis present in children

A

very unpleasant acute illness. high temperature. affectsd joint stiff and tender

51
Q

how does septic arthritis present in adults

A

less acute. many px die because of delay in recognition

52
Q

most likely cause of septic arthritis with little constitutional upset in a young adult?

A

gonococcus

53
Q

tx for septic arthritis

A

surgery and IV abx

54
Q

first guess abx for septic arthritis in children

A

anti-staphylococcal

55
Q

what is the px at risk of following inadequate tx for septic arthritis

A

septicaemia

degeneration of articular cartilage&raquo_space; fibrous or bony fusion of the joint

56
Q

which bacterial infection can cause chronic septic arthritis

A

TB

57
Q

joint and ? TB are often found together

A

kidney

58
Q

clinical presentation of chronic septic arthritis

A

chronic ill heath
wt loss
considerable muscle wasting around affected joint
radiographs show marked thinning of bone

59
Q

is surgery necessary for chronic septic arthritis

A

rarely

60
Q

meniscal lesions are relatively rare in men/women?

A

women

61
Q

meniscal lesions - well or poorly localised?

A

poorly

62
Q

which meniscus is more commonly injured?

A

medial

63
Q

cleavage lesion of meniscus - common in which age group? what may this cause?

A

old age

may cause a cyst as the lesion acts like a flap valve that allows build up of synovial fluid

64
Q

name of a vertical meniscal split anchored at both ends

A

bucket handle tear

65
Q

parrot beak tear

A

split off one end of the lateral meniscus

66
Q

how are most meniscal lesions repaired nowadays

A

via arthroscopy

67
Q

advantage of arthroscopy

A

quick recovery - days!

68
Q

what is osteochondritis dissecans

A

spontaneous osteochondral fragments - occurs rarely, in adolescents

69
Q

what is a loose body

A

ostechondral fragment

70
Q

are cruciate ligaments capable of spontaneous healing?

A

no, if torn the blood supply is lost

71
Q

what does loss of a cruciate result in

A

loss of anteroposterior stability, particularly in flexion

loss of rotary stability when twisting and turning

72
Q

when may patients experience symptoms of cruciate injury in particular

A

descending stairs, twisting, turning

73
Q

management of cruciate tear

A

leave it alone for a while and rehabilitate knee muscles

surgery if it interferes with daily life or they want to return to sport

74
Q

why is a replacement cruciate more likely to fail than a natural ligament

A

it has no sensory receptors to let the brain know if its being over stretched

75
Q

what is dislocation of the patella usually associated with and what does this cause

A

malformation of either the patella or the lateral femoral condoyle
this causes mal tracking (patella moving abrasively on the femur) which is painfull because of associated muscle spasm

76
Q

why would a person with a dislocated patella fall to the ground?

A

failure of quads to act as an extensor

77
Q

how are minor degrees of patellar mal tracking dealt with

A

surgical splitting of the vastus lateralis muscle insertion onto the patella, allowing the patella to fall back into a normal relationship with the femur

78
Q

how is recurrent and severe patellar mal-tracking dealt with

A

medial tightening (plication) of the vastus medialis

Orthopaedic Medicine (5 decks)

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