Orthopaedic Salvage Procedures Flashcards
Define:
Arthroplasty
Arthrodesis
Amputation
Arthroplasty - joint is excised or replaced
Arthrodesis - joint is surgically fused
Amputation - removal of a body extremity by trauma or surgery
What are indication for arthroplasty?
Dysplasia Intractable arthritis Articular fracture Persistent luxation Avascular necrosis
What are the therapeutic aims of arthroplasy?
Allow movement
Remove pain
Restore ROM
Alter mechanical loads
Which joint is most commonly treated by an excision arthroplasty?
Hip
What joints can be treated with excision arthroplasty?
Hip TMJ Radial head Should MT/MC phalangeal Phalangeal
When is a femoral head and neck excision indicated?
Hip dysplasia Intractable OA/DJD Fractures Persistant luxation Avascular necrosis of femoral head
What post-op care is vital after a femoral head and neck excision?
Controlled exercise
Analgesia
Physio/hydro
What factors can affect the success of a femoral head and neck excision?
Proper aftercare
Obesity
Pre-op muscle wastage
Other orthopaedic problems
What joints in the dog can be treated with replacement arthroplasty?
Hip
Stifle
Elbow
Hock
What are patient requirements for a total hip arthroplasty?
Large, active, working dogs of skeletal maturity
Define ankylosis.
How does it differ from arthrodesis?
The gradual development of joint stiffness due to fibrosis of joint capsule and periarticular tissues
Arthrodesis is artificial ankylosis via surgery
When is arthrodesis indicated?
Joint pain Articular fracture Persistent luxation Pain interfering with performance Revision of failed joint surgery
What are the long-term disadvantages of arthrodesis?
May require ESF or cast
Implants may break
High motion joints may still experience problems
What are the indications for amputation?
Neoplasia Trauma Paralysis Unmanageable joint conditions/deformities Limited finance
Are pelvic or thoracic limgs better to lose, in terms of mechanics?
Pelvic
Where can amputation occur in the forelimb?
Mid humerus
Where can amputation occur in the hindlimb/
Mid-high femur
Coxofemoral transarticular
Hemipelvectomy
Where can amputation occur in the digits?
Proximal interphalangeal in cattle
P1 or P2 in SA
Where should the tail be amputated?
Depends on level of trauma - leave enough to cover perineum if possible
What are the general principles of amputation surgery?
Choose suitable margins
Local block and fresh scalpel for neurectomies
Leave sufficient tisue to cover stump
Reconstruct tissues to eliminate dead space
What are the signs that a limb is salvageable?
Has digital pulses
Warmth
Still bleeds
Neurological status
What are the pros of amputation?
Predictable, straight forward Minor complications Cost-effective Instant palliation signs Short recovery
What are the cons of amputation?
Cannot repeat on other limbs
Worse balance
Change in temperament
Knock on effects on joint/spine
