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Small Animal Final Year > Salvage Procedures > Flashcards

Salvage Procedures Flashcards

1
Q

Define arthroplasty

A

‘Excision’ or ‘replacement’ of joint

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2
Q

Define arthrodesis

A

Surgical fusion of a joint

(Ankylosis = non-surgical slow natural fusion)

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3
Q

What are the 2 types of arthroplasty and what species can we do this in?

A
  • Excision arthroplasty:
    • Dogs, cats (removal of a surface)
  • Joint replacement arthroplasty:
    • -hip (dogs & cats), elbow & stifle (dogs)
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4
Q

Which species can we do a arthrodesis in?

A

All species - jont dependant

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5
Q

Which species ccan we do amputation in?

A

Dogs and cats: limbs, digits, tail

Small caged pets: limbs, tails

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6
Q

Name 3 indication in the hip for an arthroplasty (4)

A
  • Dysplasia = unmanageable juvenile pain
  • Persistent luxation
  • Non-reconstructable articular fracture
  • Intractable degenerative joint disease = pain
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7
Q

Name 5 effects of excision arthroplasty (7)

A
  • Should be pain free
  • Instability of the joint = abnormal movement
  • May have reduced range of motion and regional muscle
    atrophy (cannot extend the hip as much)
  • Mechanical lameness
  • Morbidity highest in first 1-2 months
  • Outcome can be variable / unpredictable
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8
Q

What is a lifelong effect of a replacement arthroplasty?

A

Lifelong ppoteential morbidity

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9
Q

Excision arthroplasty, where is it:

A) Common?

B) Very rare?

C) Occasional?

A

A) Hip

B) Shoulder

C) Temporomandibular joint

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10
Q

What are the benefits of a femoral head and neck excision?

A
  • Technically simple, cheap, few complications
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11
Q

What are the 2 affects of “body size” on a fermoral head and neck excision?

A
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12
Q

What factors inflience the outcome of a femoral head and neck excision?

A

•Patient temperament

  • obese, sedentary dogs (muscles less strong) do less well than fit active individuals

•Age

  • younger animals adapt better than older patients
  • Chronicity, disuse muscle atrophy = poorer outcome
  • Bilateral condition or concurrent problems?
  • Two hips that are poor - harder to manage
  • Do not do in a large dog
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13
Q

What are the crucial “important factors” in a femoral head and neck excision?

A

•Accurate and complete excision of the femoral neck

  • Remember that there is a degree of anteversion and
    hence more of the neck must be removed caudally
  • When you make a cut from a cranial aspect need to take off more caudally due to the anteversion
  • Maintain the lesser trochanter with the insertion of the ilio psoas muscle, an important hip flexor
  • Early and intense physiotherapy with appropriate analgesia
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14
Q

What is the procedure for a femoral head and neck excision?

A
  • Standard craniolateral approach to hip
  • Disarticulate hip
  • Take out the hip
  • Rotate femur 90 degrees to table – see femoral head and neck
  • Cut perpendicularly down onto base of femoral neck
  • Best to use an oscillating saw.
  • Preserve greater and lesser trochanters.
  • Visualise & digital palpation of cut neck for quality of cut.
  • Entire femoral neck and head must be removed
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15
Q

What does this show?

A

The end results of a femoral head and neck excision

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16
Q

Where can we do a replacement arthroplasty in a cat?

A

Hip

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17
Q

Where can we do a replacment arthoroplasty in a dog?

A
  • Hip
  • Elbow
  • Stifle
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18
Q

What is the “ideal patient” for a total hip replacement?

A
  • Painful hip (non-responsive to medication)
  • 10-40kg dog
  • Has had no previous hip surgery – scarring or if recent there is a chance of infection
  • Previously active lifestyle
  • Sensible, well-trained dog
  • Compliant owners - rest
  • Can afford cost
  • Can afford / cope complications
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19
Q

If a client can’t afford a total hip replacement, what can we consider?

A

FHNE

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20
Q

What are the different ways/systems of doing a total hip replacement? (3)

A

Cemented systems: polmethylmetha-crylate (PMMA)

Cementless systems: bone ingrowth

Hybrid systems

21
Q

What type of hip replacement?

A

Biomedtrix
BFX
Biological fixation

22
Q

What type of hip replacement?

A

CFX

23
Q

What type of hip replacement?

A

Hybrid

24
Q

What can be seen about how this hip replacement was done?

A

Cement around the stem

25
Q

What is the complication rate of a total hip replacment? What is the outcome of this?

A

5-10% but potentially disastrous

May have to convert the surgery into a femoral head and neck excision

26
Q

Name some toal hip replacement complications (8)

A
  • Infection: - Surgical
  • Haematogenous: any stage
  • Dislocation: esp. First 8 weeks. See X-ray. Can be put back in but may come back out – especially If associated with cup poorly placed
  • Fracture: - Any stage
  • ‘Stress riser’
  • Aseptic Necrosis of implant (cemented systems) : any stage
  • Loss of bone cement or interface
  • Technical error in preparation of bone, or cement failure of bone-cement interface failure of cement-implant interface
  • Or through accumulation of ‘wear’ products
27
Q

What is the complication rate of a toal elbow replacement and what are the recovery options?

A

High 20% complication rate

Recovery option- arthrodesis, amputation, euthanasia

If it fails – not got much choice

28
Q

What are the 6 Principles of Arthrodesis?

A
  1. Absolute stability, ideally through compression
  2. Remove cartilage from contact areas
  3. Contour opposing joint surfaces
  4. Cancellous bone graft
  5. Fuse at a functional angle

•Plates are designed to have a natural correct angle

6.Temporary external support

  • Rarely needed
  • Complications are risky
29
Q

At what position is arthrodesis more disabling?

A

Proximally

30
Q

What is a common result of stifle and elbow arthrodesis?

A

Poor function

31
Q

What does this show?

A

Arthrodesis

32
Q

Name 4 common amputation reasons (5)

A
  • Neoplasia - malignant or locally invasive
  • E.g. osteosarc. But by the time of diagnosis the chances are there are lung mets
  • Trauma - excessive tissue damage including markedly comminuted fractures particularly those involving joints
  • Paralysis – e.g. brachial plexus avulsion
  • Unmanageable joint conditions, intractable pain,congenital deformity
  • (Financial reasons)
33
Q

How do we undergo an oncological surgery ‘limb sparing’ procedure?

A
  • Oncological surgery
  • Resect bone with appropriate margins
  • Cortical allograft used to maintain limb length
  • (Or excised tumour bone pasteurised and replaced the bone)
  • Arthrodesis if near joint e.G. Distal radius
  • Chemotherapy
  • Complications
34
Q

What is Transcutaneous Prosthetics (ITAP)?

A

Prosthesis retained in bone

35
Q

Transcutaneous Prosthetics (ITAP):

A) Advanatge?

B) Disadvantage?

A

A) Avoids pain / stump tissue issues and proprioceptive issues that arise in people wearing standard prosthetic

B) Difficult to get soft tissues to form seal around metalwork

36
Q

What do we need to consider with an amputation? (5)

A
  • Presence of bilateral problem or other orthopaedic disease
  • Condition / weight
  • Age
  • Owner
  • Temperament
37
Q

Name 3 general principles with an amputation (5)

A
  • Neoplasia - adequate margin of excision
  • Know the extent of the tumour
  • Cut bone short and leave excess skin and soft tissue to cover
  • Peri-neural local anaesthesia and sharp incision through nerves (new scalpel blade – not scissors!)
  • Careful haemostasis and meticulous surgical closure to eliminate dead space
  • Local analgesia / nerve block post-operatively
38
Q

How many ligatures do we need to place on a fermoral artery?

A

At least 3

39
Q

What are the amputation sites of the forelimb? (2)

A
  • Forequarter amputation
  • Mid-humerus
40
Q

What are the amputation sites of the hindlimb? (3)

A
  • Prox. 1/3rd femur
  • Disarticulation at hip
  • Hemipelvectomy
41
Q

What is the effect of amputating digit 3/4?

A

More lame

42
Q

What is the recommendation for digit removal? What do we need to apply post surgery?

A
  • Often recommended to remove cartilage/condyle – rarely causes a problem if left
  • Careful dressing post-surgery
43
Q

What length of tail so we amputate?

A

Should leave enough to cover perineum

44
Q

What is the normal weight distribution HL:FL?

A

40:60

45
Q

What is the gait adaption for a forelimb adaptation?

A

Take more weight on the HL

46
Q

What is the gait adaptation for a HL amputation?

A

More weight on FL

47
Q

Do dogs do better withh a FL or HL amputation?

A

HL

48
Q

When is amputation indicated?

A

If the limb is not salvageable, there is intractable pain, neoplasia or a failure of first line treatment

Small Animal Final Year (317 decks)

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