Ortho unit 1 Flashcards
what does orthopaedics mean
straight children
define acute illness
sudden polymorphonuclear leucocyte (polymorph)
define chronic illness
long time to develop and may last long time
lymphocytes are produced by BM and spleen
…otomy
open something up
…ectomy
remove something
overall treatment objectives
relieve patients complaints eg pain and stiffness
cause of primary and secondary OA
primary - cause unknown
secondary - obvious causative factor
most common type of OA
primary
overview of treatment of OA
gp - simple analgesia
ortho/rheumatologist when pain is affecting sleep
non operative options or/and then operative
non operative options for OA
non operative options to postpone surgery include
- weight loss (reduce load and improves well being),
- walking stick (normally when walking when weight is on right leg the right glutes contract to tilt left side of pelvis up so left leg can swing forward so efficient walking needs abductor muscles. stick on opposite side means shoulder girdle helps to tilt pelvis to help with wt bearing - stick decreases the work required of the weight bearing abductor muscles so there are decreased muscle induced loads on the hip),
- physio (relieve stiffness and muscle spasm and therefore reduce pain)
young sufferers should avoid excessive exercise but don’t totally rest wither as muscles work most effectively when in regular use. stretching maintains tone. excessive rest causes spasm which is painful and inhibiting
name the operative treatment available for OA
nothing
arthrodesis
osteotomy
arthroplasty
describe arthrodesis and describe times it is useful
surgical stiffening of a joint in a position of function (fusion). painful joint is cut out and raw bone ends are held together with external splint/screws until bony bridge is formed.
good in young patients who have painful range of motion.
disadvantages of athrodesis
- long recovery - 6 months in plaster
- stress on adjacent joints eg in hip fusion extra forces on spine, knee and opposite hip - anticipate the problem by replacing the joint after 5th decade - gives good return of function
- hip fusion affects female sexual activity
- hard to fuse big joints - difficult to keep together (ankle and wrist are good joints to fuse - you also dont replace these joints) -
angle to fuse the hip joint at
30 degrees flexion, some adduction gives functional gait and permits sitting
describe osteotomy
when would you do this and what are the suitable joints
what is the disadvantage
surgical realignment of joint. redirects forces across a joint do the load is evenly distributed.
perform when a joint is deformed - eg in the knee where is they become bow legged all the forces go down the medial side rather than the middle
valuable in arthritis of young who have maintained good ROM despite pain. hip and knee are suitable
- disadvantage is its just a temporary measure (1-10years) as the underlying problem hasn’t been tackled
(bone is cut and angle of joint is changed (eg cut femur or tibia to change joint angle of knee and use a plate to hold the cut at the angle wanted)- useful when arthritic joint damage is confined to one side of the joint eg when bow legged all the pressure goes through the medial side of the knee joint so OA occurs as the bones touch as cartilage is worn away. favourable to knee replacement as you preserve the joint)
what would you do in osteotomy of the hip
performed on the pelvic side by forming a shelf or by total acetabulum realignment
it can be performed on the femoral side by altering the angle of the fem neck to change the attitude of the fem head relative to the acetabulum.
describe arthroplasty
creates a new joint/changes the shape of the joint
how successful is athroplasty and what is teh main aim
> 90% will be in situ after 10 years but remember most of these will be old people whoa rent active. replacement should provide a joint which outlives the likely lifespan of the patient. it must be capable of functional and pain free ROM but also be able to withstand forces without undue wear and working loose, as well as having the same stability as the normal joint.
reasons why goals differ for upper limb and lower limb joint replacement
relationship between pain relief and function id different.
arthroplasty improves pain related loss of function but not intrinsic stiffness as soft tissue distortion of the capsule and ligaments tend to remain the same after replacing articular surfaces. so this poses a problem in the upper limb if you are wanting to do arthroplasty as upper limb as it improved pain related loss of function but not intrinsic stiffness. eg elbow must flex to 90 degrees to eat and must full extend to wipe bum.
most successful joint replacement
hip
describe hip arthroplasty - forces and angles needed for daily life
huge forces but ball and socket is stable and functional ROM of hip is limited. only need 10-15 extension, 30-40 flexion and few degrees of abduction and rotation partic in extension for daily living
it is the 1st successful replacement
arthroplasty in the knee describe
ROM is small but 90 flex needed to get up and down stairs and stability in extension id essential to take body weight especially when on one leg. surgery then must achieve an accurate soft tissue balance through dissection of the capsule and the ligaments.
modern knee replacements consist of 2 new smooth surfaces and the surgeon must balance the collateral ligaments by cutting tight parts of the ligaments and then putting in artificial surface replacements of sufficient thickness to retighten ligaments so that medial an lateral colateral ligaments are under equal tension
describe complications of joint replacement
after any surgery - pressure sores, UTI, chest infection, DVT –> PE
early
- prosthesis not fully supported by soft tissue yet and muscles and propriocepters may be out of action due to surgical trauma and pain and scar tissue hasnt formed yet so risk of dissolacation (even as time goes on can still occur eg in hip in extreme flexion with adduction and internal rotation - so need advice about dressing and aids)
- DVT - give heparin as prophylaxis. stockings?
- infection - hosp bacteria eg staph aureus/commensals on skin eg staph albus . MUST GIVE PROPHYLACTIC ANTIBIOTICS AND ULTRA CLEAN AIR IN THEATRE. (if precautions taken the risk of infection shoudl be <0.1% - but in uk reality is about 1-3%)
late
- can occur as late as 10 years after
- infection - usually at time of insertion but could be blood borne from bacteraemias eg after tooth extraction –> heart valve
- loosening and wear - inevitable but delay as much as poss
describe RA and the role of surgery in treatment
RA - cause unknown. small joints if hands and feet, symmetrical. more common in women and stiffness is worse in morning.
role of surgery - patient as comfortable as possible while retaining as much function as poss. control of RA with drugs must be adequate to get good results from surgery. surgeon must ensure its function rather than deformity the patient wants to improve
soft tissue surgery - disease can damage tendons and sheaths. remove damages synovial tissue by removing synovium (synovectomy). good in teh wrist for clearing damage around the extensor tendons. good in young people with retained ROM as it can reduce pain and stiffness. sometimes tendons about the wrist rupture and need repair
joint surgery - useful at elbow and wrist where it can be combined with a limited excision of the joint (excision arthroplasty). it relieves pain but never get full return of function as some of the joint has been removed.
