Surgery

Question 1

What is an arthroplasty?

Answer 1

A joint replacement

Question 2

What are the most common joint replacements?

Answer 2

The hip and knee

Question 3

Is a joint replacement revision harder, easier or the same with better or worse outcomes than the original?

Answer 3

Harder with worse outcomes (complications rate is higher and the functional outcome is poorer)

Question 4

If a fulminant infection is diagnosed early (within the first 2‐3 weeks) __________1__________ can be attempted to salvage the artificial joint. This strategy is around 50% successful. Deep infections present for longer than 3 weeks or so tend not to be salvageable by washout as the infecting bacteria adhere to the foreign surfaces and form a __2_____ which prevents the patient’s immune system attacking. In this situation, removal of the infected implants and all foreign material (including cement) which requires extensive surgery is usually required. The patient is usually left without a joint for around 6 weeks and given parenteral antibiotics. Once the infection is under control (wound healed, clean and dry, CRP reduced) a revision (re‐do) joint replacement is performed with more complex joint replacement components.

Answer 4

1) surgical washout & debridement and prolonged parenteral antibiotic therapy (around 6 weeks)
2) Biofilm

Question 5

What does excision or resection arthroplasty involve?

Answer 5

Involves the removal of bone and cartilage of one or both sides of a joint. Was first done for OA, now done in small joints and occasionally in others.

Question 6

Arthodesis is ______1_________. The remaining hyaline cartilage of the joint and subchondral bone is removed and the joint is stabilized resulting in bony union (like fracture healing) and fusion. Whilst this may be good at alleviating pain, function may be ______2_____. Arthrodesis is good for _________3____________

Answer 6

1) surgical stiffening or fusion of a joint in a position of function
2) limited particularly in large joints and may increase pressure in surrounding joints leading to arthritic change
3) end stage ankle arthritis, wrist arthritis and arthritis of the first MTP joint of the foot (hallux rigidus)

Question 7

What is osteotomy and what is it used for?

Answer 7

Surgical realignment of a bone which can be used for deformity correction or to redistribute load across an arthritic joint.