Orthopaedic Salvage Procedures

Question 1

Define:
Arthroplasty
Arthrodesis
Amputation

Answer 1

Arthroplasty - joint is excised or replaced

Arthrodesis - joint is surgically fused

Amputation - removal of a body extremity by trauma or surgery

Question 2

What are indication for arthroplasty?

Answer 2

Dysplasia
Intractable arthritis
Articular fracture
Persistent luxation
Avascular necrosis

Question 3

What are the therapeutic aims of arthroplasy?

Answer 3

Allow movement
Remove pain
Restore ROM
Alter mechanical loads

Question 4

Which joint is most commonly treated by an excision arthroplasty?

Answer 4

Hip

Question 5

What joints can be treated with excision arthroplasty?

Answer 5

Hip
TMJ
Radial head
Should
MT/MC phalangeal
Phalangeal

Question 6

When is a femoral head and neck excision indicated?

Answer 6

Hip dysplasia
Intractable OA/DJD
Fractures
Persistant luxation
Avascular necrosis of femoral head

Question 7

What post-op care is vital after a femoral head and neck excision?

Answer 7

Controlled exercise
Analgesia
Physio/hydro

Question 8

What factors can affect the success of a femoral head and neck excision?

Answer 8

Proper aftercare
Obesity
Pre-op muscle wastage
Other orthopaedic problems

Question 9

What joints in the dog can be treated with replacement arthroplasty?

Answer 9

Hip
Stifle
Elbow
Hock

Question 10

What are patient requirements for a total hip arthroplasty?

Answer 10

Large, active, working dogs of skeletal maturity

Question 11

Define ankylosis.

How does it differ from arthrodesis?

Answer 11

The gradual development of joint stiffness due to fibrosis of joint capsule and periarticular tissues

Arthrodesis is artificial ankylosis via surgery

Question 12

When is arthrodesis indicated?

Answer 12

Joint pain
Articular fracture
Persistent luxation
Pain interfering with performance
Revision of failed joint surgery

Question 13

What are the long-term disadvantages of arthrodesis?

Answer 13

May require ESF or cast
Implants may break
High motion joints may still experience problems

Question 14

What are the indications for amputation?

Answer 14

Neoplasia
Trauma
Paralysis
Unmanageable joint conditions/deformities
Limited finance

Question 15

Are pelvic or thoracic limgs better to lose, in terms of mechanics?

Answer 15

Pelvic

Question 16

Where can amputation occur in the forelimb?

Answer 16

Mid humerus

Question 17

Where can amputation occur in the hindlimb/

Answer 17

Mid-high femur
Coxofemoral transarticular
Hemipelvectomy

Question 18

Where can amputation occur in the digits?

Answer 18

Proximal interphalangeal in cattle

P1 or P2 in SA

Question 19

Where should the tail be amputated?

Answer 19

Depends on level of trauma - leave enough to cover perineum if possible

Question 20

What are the general principles of amputation surgery?

Answer 20

Choose suitable margins
Local block and fresh scalpel for neurectomies
Leave sufficient tisue to cover stump
Reconstruct tissues to eliminate dead space

Question 21

What are the signs that a limb is salvageable?

Answer 21

Has digital pulses
Warmth
Still bleeds
Neurological status

Question 22

What are the pros of amputation?

Answer 22

Predictable, straight forward
Minor complications
Cost-effective
Instant palliation signs
Short recovery

Question 23

What are the cons of amputation?

Answer 23

Cannot repeat on other limbs
Worse balance
Change in temperament
Knock on effects on joint/spine