Orthopaedic Salvage Procedures Flashcards
In which species can an arthroplasty be performed?
Dogs, cats, small ponies (Shetlands and smaller), other small animals, alpacas
What is an arthoplasty?
Elective orthopaedic procedure where the joint is either commonly excised or replaced
What are the indications for an arthroplasty?
Dysplasia causing juvenile pain Intractable arthritis or joint pain Articular fracture that is un-reconstructable Persistent luxation Avascular necrosis
What are the similarities and differences between excision and replacement?
Both allow movement
Replacement aims to remove pain and restore/maintain normal movement and range of motion
Excision removes pain and has altered movement and range of motion
Load transfer mechanics differ
What joints can an excision arthroplasty be performed on?
Hip, TMJ, radial head, shoulder, MT/MC phalangeal joint, phalangeal joint
In what conditions is a Femoral Head and Neck Excision (FHNE) indicated?
Juvenile hip dysplasia, intractable OA/DJD, femoral head/acetabular fractures, persistent luxation and Legg-Calve-Perthes disease
What is Legg-Calve-Perthes disease?
Avascular necrosis of the femoral head
What sizes of dog is a FHNE suitable for?
Can be used on all sizes however as size increases there is a worse result when compared to a total hip replacement
Is there any difference in ROM?
Yes and it will affect athletic performance
How do you perform a FHNE?
Cut between greater trochanter and just proximal to lesser trochanter to ensure neck is removed to prevent impingement
What aftercare is needed for a FHNE?
Early return to controlled exercise
Pain-relief
Physio/hydrotherapy
What is the outcome of a FHNE determined by?
Obesity, pre-op muscle wastage and presence of other orthopaedic diseases
What joints can a replacement arthroplasty be performed in?
Canine and feline hip
Canine stifle, elbow and hock
Which animals is a total hip replacement (THR) performed in?
Any dog but typically large, active or working dogs over 20kgs any time after skeletal maturity
What influences the outcome of a THR?
Obesity and other orthopaedic problems
What are the disadvantages of THR?
Expensive but gold standard of care
Has to be referred due to surgical and post-op risks
What is an ideal patient for THR?
Large breed, previously active, sensible, well-trained dog with compliant owners and insurance
What is arthrodesis?
Artificial induction of joint ossification between two bones via surgery
What are the indications for an arthrodesis?
Intractable arthritis/joint pain
Articular fracture that is unreconstructable
Persistent luxation or instability
Low grade pain interfering with performance
Revision of failed joint surgery
What are the principles of arthrodesis surgery?
Absolute stability through compression, remove cartilage from contact areas, contour opposing joint surfaces, bone graft for source of cells for osteogenesis, source of cytokines for osteoinduction and scaffolding for osteoconduction, fuse at a functional angle with possible need for external support
What needs to be considered long term with arthrodesis?
Long recovery may require transarticular support (ESF or cast)
Implants are mechanically vulnerable and may break or back out over time
Problems with high motion joints
What is amputation?
Removal of a body extremity by trauma or surgery
What are the indications for amputation?
Neoplasia either malignant or locally invasive
Trauma due to excessive tissue damage or ischaemia
Paralysis such as brachial plexus avulsion
Unmanageable conditions, intractable pain or congenital deformity
Client finances
What considerations need to be made prior to amputation?
Animal temperament
Concurrent orthopaedic diseases
Owner
Mechanically better to lose pelvic rather than thoracic limb
What are the sites for amputation?
Forelimb = forequarter (scapula as well) or mid humerus Hindlimb = mid/high femur, transarticular or hemipelvectomy Digit = proximal interphalangeal joint with cartilage removal in cattle, distal P1/P2 in small animals Tail = leave enough to cover perineum
What are the principles of amputation?
Choose suitable margin of excision, local block and fresh scalpel for neurectomies, make sure it isn’t possible for stump to get traumatised post-op by leaving enough skin and muscle to cover it, carefully reconstruct the tissue to eliminate dead space and place a drain if necessary
How can you tell if a limb is salvageable?
Distal pulse, nails bleed when cut short, limb warm, neurologically fine
What are the advantages of amputation?
Predictable, straight-forward, minor complications, cost-effective, instant palliation and short recovery period
What are the disadvantages of amputation?
Get out of jail free card used up, worse balance, temperament change, knock on effects to other joints/spine, posturing problems, phantom limb or neuropathic pain
