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Locomotor > Salvage - arthroplasty and arthrodeses > Flashcards

Salvage - arthroplasty and arthrodeses Flashcards

1
Q

Define arthroplasty

A

= joint moulding

  • replacement or excision both allow movement
  • elective orthopaedic procedure where the joint is either commonly excised or replaced
  • replacement aims to remove pain and restore/maintain normal movement (ROM)
  • Excision removes pain and has altered movement (ROM)
  • load transfer mechanics differ
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2
Q

Define arthrodesis

A

= joint binding
- irreversible sx fusion of 2 or more joints. Creation of osseous bridging that prevents joint motion and allows the joint to withstand weight bearing forces

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3
Q

Define amputation

A

normally considered as a fallback after other tx has proved ineffective but may be used if finance is a problem

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4
Q

Species indications - arthroplasties

A
  • dogs
  • cats
  • (small ponies)
  • other small animals
  • alpacas
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5
Q

Species indications - arthrodesis

A
  • all spp depending on joint

- e.g. pancarpal/ partial carpal and pantarsal/ partial tarsal

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6
Q

Species indications - amputation

A
  • dogs
  • cats (limb, digit, tail)
  • limbs in small caged pets
  • occasionally larger animals
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7
Q

Indications - arthroplasty

A
  • dysplasia (juvenile pain)
  • intractable arthritis/ joint pain
  • articular fx (un-reconstructable)
  • persistent luxation
  • avascular necrosis
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8
Q

What is the most common joint for excision arthroplasty?

A
  • HIP

- Also described in: TMJ, radial head (humans), shoulder, MT/MC phalangeal joint, phalangeal joints

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9
Q

Define FHNE

A

Femoral Head and Neck Excision

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10
Q

Indications - FHNE

A
  • hip dysplasia (juvenile pain)
  • intractable OA / DJD
  • femoral head and neck fractures/ acetabular fractures
  • persistent luxation
  • Legg-Calve-Perthes disease (avascular necrosis of the femoral head)
  • all dog sizes, good results up to 30kg
  • some restriction in ROM will affect full athletic performance
  • sx technique critical
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11
Q

Aftercare - FHNE

A
  • vital to outcome
  • early return to controlled exercise
  • pain-relief
  • physio/hydro
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12
Q

What is FHNE outcome influenced by? 3

A
  • obesity
  • preop mm wastage
  • other orthopaedic problems
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13
Q

Where is the femur cut in FHNE?

A
  • cut medial to greater trochanter of femur

- cut exits above lesser trochanter

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14
Q

What is another name for replacement arthroplasty?

A

joint replacement

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15
Q

Which joints can undergo replacement arthroplasty?

A
  • canine and feline hip
  • canine stifle (limited case reports for feline)
  • canine elbow
  • canine hock? (anecdotal)
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16
Q

Define THA

A

Total Hip Arthroplasty (= hip replacement, THR)

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17
Q

Describe THA

A
  • any dog
  • typically large, active or working dogs >30kg
  • any time after skeletal maturity
  • outcome influenced by: obesity, other orthopaedic problems
  • expensive but excellent results thus gold standard.
18
Q

Ideal patient for a THA

A
  • painful hip (non-responsive to meds)
  • large breed dog
  • previously active lifestyle
  • sensible, well-trained dog
  • compliant owners
  • (insured)/ committed owners
19
Q

How do THA and FHNE compare?

A
  • THA more expensive
  • 10% risk of severe complications in THA but low risk of minor cx for FHNE
  • THA aftercare is cage rest for 6 weeks whilst for FHNE activity encouraged asap
  • THA function is excellent/ normal but for FHNE is reduced but often acceptable in smaller animals
20
Q

Ideal patient joint arthroplasty in joints other than hips

A
  • similar indications/ ideal patient
  • currently elbow (and knee)
  • long term outcome for elbow and knee replacement are not as established as the hip
21
Q

Outline total arthroplasty

A
  • sx technique complex and critical
  • variable risk of serious complications in sx and postop
  • infxn control critical
  • variety of techniques and equipment based on cemented or un-cemented bone-implant interface/ prosthesis
22
Q

What is arthrodesis also known as?

A

= ‘artificial ankylosis’
= ‘syndesis’
- the artificial induction of joint ossification b/w two bones via sx

23
Q

Define ankylosis

A

the gradual development of joint siffness d/t pathologic processes. Joint stiffness develops d/t fibrosis of the joint capsule and the periarticular tissues, and the formation of intra-articular adhesions and OPs

24
Q

Arthrodesis - indications - 5

A
  • intractable arthritis/ joint pain
  • articular fx (un-reconstructable)
  • persistent luxation or instability
  • low grade pain interfering with performance
  • revision of failed joint sx
25
Q

Principles - arthrodesis (REALLY IMPORTANT TO REMEMBER)

A
  • absolute stability, ideally though compression
  • remove cartilage from contact areas
  • contour opposing joint surfaces
  • bone graft (osteogenesis, osteoinduction and osteoconduction)
  • fuse at functional angle
  • external support?
26
Q

Define osteogenesis (bone graft)

A

source of osteoprogenitor cells

27
Q

Define osteoinduction (bone graft)

A

scaffold for bone to grow across

28
Q

Define osteoconduction (bone graft)

A

conduction of bone growth factors

29
Q

Outline long term implications of arthrodesis

A
  • long recovery may require transarticular support (ESF, cast)
  • implants mechanically vulnerable (break or back out over time)
  • problems with high motion joints
30
Q

Generally what should you expect form stifle arthrodesis?

A

high motion joint so might expect poor function but there are exceptions

31
Q

Indications - amputation

A
  • neoplasia (malignant or locally invasive)
  • trauma (excessive tissue damage or ischaemia)
  • paralysis (brachial plexus avulsion)
  • unmanageable joint conditions, intractable pain, congenital deformity
  • client finances
32
Q

Amputation - considerations

A
  • temperament
  • concurrent orthopaedic dz
  • paralysis (brachial plexus avulsion, less good an option if there is a chance sensation will come back)
  • owner
  • mechanically better to lose a HL than TL
33
Q

Name 2 sites for TL amputation

A
  • forequarter amputation has cosmetic and margin advantage (take scapula and whole TL off)
  • mid. humerus (technically easier but cosmetically worse because mm whither)
34
Q

Name 2 sites for HL amputation

A
  • mid/high femur
  • transarticular (coxofemoral - best if OSA in distal limb, care in males as will increase exposure of prepuce)
  • hemipelvectomy
35
Q

Name digit amputation sites

A
  • PIPJ with cartilage removal in cattle
  • Distal P1 or P2 in SA
  • careful dressing postop
36
Q

Describe tail amputation

A

normally related to trauma - leave enough to cover perineum if possible

37
Q

Principles - amputation

A
  • choose suitable margin of excision (remember neoplasia considerations)
  • local block + fresh scalpel for neurectomies
  • make sure its not possible for stump to be traumatised postop and leave sufficient tissue (mm/ skin) to cover
  • careful reconstruction of tissue to eliminate dead space +/- drain
38
Q

How do you know if a limb is salvageable?

A
  • limb has distal pulse
  • cut nails short (if quick bleeds - limb viable)
  • limb cold/warm/ does it bleed?
  • neuro status of limbs
  • time is your friend!
39
Q

Pro’s - amputaiton

A
  • predictable
  • straightforward
  • minor complications
  • cost-effective
  • instant palliation of signs
  • short recovery period
40
Q

Con’s amputation

A
  • worse balance?
  • temperament change?
  • knock-on effects on other joints/ spine?
  • posturing problems?
  • phantom limb?
  • neuropathic pain?
41
Q

Tx choice considerations

A
  • cost (owner, animal morbidity)
  • risk (complications, side-effects, success rate)
  • benefit (predictability of return to full function)
  • animal/limb/joint outcome are not the same
42
Q

Define ITAP

A

Intraosseous Transcutaneous Amputation Prosthesis

  • think supervet!
  • big risk of infxn ascending up prosthesis

Locomotor (31 decks)

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