Orthopaedic Salvage Flashcards
Define arthroplasty
- replacement or excsision (joint molding)
- elective orthopaedic procedure where joint is either commonly excised or replaced
Define arthrodesis
- joint binding
- irreversible surgical ion of 2 or more joints
- creation of osseus bridging that prevents joint motion and allows the joint to withstand weight bearing forces
Define amputation
- all-around cuting off
- normally considereed as a fallback after other tx has proved ineffective
- can be used first line if finance is a problem
Indications for arthroplasty? Which species?
(joint replacement or excision) - dogs, cats, small ponies, alpacas - hip most common - also TMJ, radial head, shoulder, MT/MCP joint, phlangeal > dysplasia (juvenile pain) > intractiable arthritis / joint pain > unreconstructable articular fx > persistnet luxation > avascular necrosis (Carth Perthes Dz)
Indications for Arthrodesis? Which species?
> all species depending on jointi (eg. pancarpal/partial carpal and pantarsal/partial tarsal)
INdications for amputation? Which species?
- dogs , cats (limbs, digits, tails)
- limbs small caged aets
- occasionally larger animals
Aims and goals of arthroplasty?
- excision and replacemen both allow movement
- replacement aims to remove pain and resotre/maintain normal ROM
- excision removes pain and has altered ROM
- load transfr mechanics differ
INdications of femoral head and neck excision?
- hip dysplasia (juvenile pain)
- intractable OA/DJD
- femoral head and neck fx/acetbular fx
- persistent luxation
- Legg-Calve-Perthes disease (avascular necrosis of the femoral head)
> suitable all sizes of dogs, good results easier to achieve up to 30kg - some restriction in ROM will affect full athletic performance
- surgical technique critical
Aftercare with FHNE? Outcome affected by?
> vital to outcome
- return to controlled exercise needed to encourage fibrosis
- analgese!!!
- physiotherapy/hydrotherapy
outcome affected by obesity, pre-operative muscle wastage, ther orthopaedic problems
Outline surgial procedure of FHNE
- remove head and neck
- neck will cause impingement if left
- leave greter trochanter, cut to lesser trochanter
- fibrosis of the joint will occour
What replacement arthroplastys are available/
- canine and feline hip
- canine stifle
- canine elbow
- canine hock?
Which dogs are best indicated for total hip arthroplasty (THA) )Hiip replacement) Price and results?
- can be done in any dog
- trypically large, active, working dogs
- any time AFTER skeletal maturity
- outcome influenced by obesity and other orthopaedic problems
- expensive but good results - Gold standard
Ideal patient for hp replacmeent?
- painful hip non-responsive to medication
- large breed dog
- previously active lifestyle
- sensible, well-trained dog
- compliant owners that are committed!!
Is hip dysplasia an indication for hip replacement?
Not necessarily!
- 75% managed medically
Pros and cons comparing Total Hip Replacmeent and FHNE? LOOK UP
> Cost - THR $4000 - FHNE $400-1500 > Complications - THR post-op luxation - FHNE low risk > Aftercare - THR cage rest 6 weeks - FHNE activity encourae > Function - THR excellent - FHNE reduced but often acceptabel in smaller animals
Which joints can be replaced?
Hip
Elbow
Knee
Whats is involved in a total arthroplasty
-
What is arthrodesis? What is the natural form of this?
- artificial ankylosis
> ankylosis bodys pathological thing
Indications for arthrodesis
- intractible arthritis /joint pain
- ## articular fx (unreconstructable)
LEARN THIS - principles of arthrodesis
- absolute stability (ideally through compression)
- remove cartilage from contact areas
- contour opposing joint surfaces
- bone graft
> osteogenesis - source of progenitor cells to grown bone
> osteoconduction - scaffold
> osteoinduction - mediators - fuse at a functional angle
- external support? many dont
Long term impliccations of arthrodesis?
- long recovery may require transarticular support (ESF/cast)
- implants mechanically vulnerable (may break or back out)
- problems with high motion joints)
Why may stifle arthrodesis cause problems?
- long lever arm
- high motion joint
> catastrophic fx can occour
> lots of risk of Cx!
Indications for amputation?
> neoplasia - malignant/locally invasive > trauma - excessive tissue dmage/ischameia > paralysis - brachial plexus avulsion (not plegia, check deep pain) > unmanageable joint conditions, intractable pain, congenital deformity > client finances
Considerations for amputations?
- temprement
- concurrent orthopeadic dz
- owner
- mechanically better to lose pelvic rather than thoracic limb
Gait adaptation forces with amputation
- If forelimb removed, higher forces act on the remaining forelimb
- If hindlimb removed, same force acts on remaining hindlimb, forelimbs take most of the weight
Potential amputation sites of the limbs SA?
> FL
- forequarter (good cosmetic and margins)
- mid. humerus (easier but withered stump)
HL
- mid/high femur
- transarticlar coxo-femoral [aware prepuce exposure]
- hemipelvectomy
Which digits can be amputated?
- PIP joint with cartilage removal in cattle
- Distal P1 and P2 in smallies
- careful dressing post surgery
Risks of amputating digits?
Insertion of collaterals on 1st or 5th digit
- dont cut too high
How much tail should be left for tail amputation?
- cover perineum
General principles of amputation
- choose suitable margins of excision (NB. neoplasia)
- local block + fresh scalpel for neurectomy
- make sure its not possible for stump to get traumatised post-op
- leave sufficient tissue to cover the stump
- careful reconstruction of tissue to eliminate dead space
- drain
Signs that a limb is salvagable
- distal pulse
- cut nails short and look for quick bleeding
- limb cold?
- neurological status (deep pain)
- time is your friend!! see if wound gets worse or better
Pros and cons of amputation
> pros - predictable, straightfoward - minor Cx - cost effective - instant palliation of signs - short recovery > cons - worse balance? - temperament change? = knock-on effects of other joints/spine - phantom limb/neuropathic pain?
2 main typeso f prosthesis?
> endo
- encorpoated into bone eg. ITAP
exoprosthesis
- stick on end of stump
Define salvage
- no going back procedure
What should tx choice be based on?
- cost (financial and morbidity to animal)
- risk (success rate, complicatinos of op)
- benefit ( predictablilty of return to function)
> NB: animal, limb and joint outcome are not the same thing!!
