Ortho Med Unit 1 Flashcards
What immune cells are associated with acute and chronic infection?
Acute: polymorphs
Chronic: lymphocytes
What type of osteoarthritis is the most common?
Primary (unknown cause) - may be as a result of injury, however the cause is unclear
What can be the causes of secondary arthritis?
Trauma, Childhood disease (Perthes, infection), Congenital (CDH), Metabolic (gout), Infection (TB), Inflammation (RA)
When is secondary referral necessary for osteoarthritis?
When the pain is no longer controlled by analgesia and is disrupting sleep
What is found on examination of osteoarthritis?
Pain
Limited ROM
What are the symptoms of OA compared to RA?
OA: usually later in life, gets worse with movement, pain worsens during the day, usually unilateral
RA: usually in middle age, worse in morning, improves with movement, bilateral
What are the conservative management options for OA?
Weight loss - joint loads can be several times body weight, therefore a small amount of weight loss can have a significant affect on the joint load
Walking stick - transfers weight to the shoulder girdle so the abductors don’t need to contract which hugely reduces muscle induced hip loading
Rest + physio - balance is required, some exercise relieves stiffness and muscle spasm but too much is counterproductive
Analgesia
What are the surgical management options for OA?
Nothing - risks may outweigh benefits
Arthrodesis - joint fusion
Osteotomy - removing a wedge of bone
Arthroplasty - replacement
What are the benefits of arthrodesis in the hip?
If arthroplasty is not a safe choice (such as in a young patient),
Can be revised into joint replacement later in life
Useful in the ankle and wrist
Hip is fused at 30º flexion + some abducton which allows normal gait + sitting (Not popular with women as it interferes with female sexual activity)
What are the pros/cons of osteotomy to manage OA?
Redirects joint forces so they are more evenly distributed
Used when there is a deformed to the joint (ie bow legged walking at the knee)
Useful in early stages for young patients
Once ROM is serenely limited is ineffective
What are the principles of surgical intervention in orthopaedics?
To reduce pain + stiffness (improve functional ROM) and make diseases manageable
What are the principles required by an arthroplasty?
To allow functional and pain free ROM
(will improve pain related loss of function but won’t be able to help with intrinsic stiffness)
Must be able to withstand large forces placed upon it without wear or working loose + have the same stability as the natural joint
What are the limitations of arthroplasty?
Will not alleviate disability due to stiffness, only pain
Wear begins as soon as it is put in (as artificial, a natural joint would regenerate itself) so require a joint that would outlast the likely lifespan of the patient (therefore in younger patients alternatives are required)
What is required of a hip arthroplasty?
Must be able to withstand very large loads
Relatively low functional ROM required for activities of daily living
What is required of a knee arthroplasty?
Requires 90º flexion for stairs, but otherwise very low ROM required
Muse be stable in extension to support full weight on a single leg (ie for walking) - therefore ligaments must be balanced
What is done to the collateral ligaments of the knee during arthroplasty?
They must be balanced so the MLC/LCL are under equal tension (may need to cut tight parts + add artificial replacements)
What are the general complications of an arthroplasty?
Chest infection
UTI
Pressure sores
DVT (+ PE)
Most patients are elderly which means they are more likely to have medical conditions predisposing them to risk
What are the early complications of a joint replacement?
Dislocation
DVT
Infection
What are the later complications of joint replacement?
Infection
Loosening + wear
When is surgery used in the management of RA?
What is the aim of surgery
If control by drugs is inadequate, otherwise doing the patient a disservice
To improve function but not correct any deformities (deformed hands can have very good function)
Describe the surgical procedures used for RA
Synovectomy: removal of diseased synovial tissue (such as tendon sheaths) - useful in young patient who has good function, but pain
Excision arthroplasty: removes part of the joint - will relieve pain but will never have a full return of function so should be thoroughly considered
Where does post traumatic AVN most commonly occur?
Femoral head, scaphoid, talus
What are the non traumatic causes of AVN?
Chronic alcohol abuse
High dose steroids
Deep sea divers (Caisson’s disease)
How does AVN present?
Acute + severe joint pain
Made worse by movement, relieved by rest
Mostly young patients
