Surgical Management of an Arthritic Joint Flashcards
How can we conservatively treat an arthritic joint
Analegsics weight loss lifestyle change splints, braces, orthoses Physio Mobility aids Steroids DMARDs
What changes can be seen on an X Ray of an arthritic joint
Reduced joint space
Sclerosis
Osteophyte formation
When is appropriate to surgically manage an arthritic joint
When conservative measures are exhausted
The patient is really struggling - do not base on the xray
What are the 3 aspects of gaining consent for surgery of an arthritic joint
Risks vs Benefits
Patient journey
Realistic outcomes and success rates
What are the different surgical optoins for an arthritic joint
Athroscopic debridement Cartilage regeneration Synovectomy for RA Open debridement/ cheilectomy Joint Excision (excision athroplasty) Arthrodesis surgical fusion Osteotomy surgical realignment Joint replacement arthroplasty
What joint was Arthroscopic Debridement/ washout usually performed on.
Was the success good or bad
Knee
Usually poor results
What is open debridement good for
Removing impinging osteophyte = cheilectomy
What joints are operated on in an open debridement
Ankle
1st MTP joint
Elbow
What joints are cartilage regeneration performed on
Knee and Ankle
What joint are cartilage regeneration poor on
Patellofemoral joint
What type of cartilage is produced in a cartilage regeneration
fibrocartilage instead of hyaline
What is a excision arthroplasty
Surgical removal of the joint
Excision arthroplasty are good for what joints
1st CMC joint OA in hand (trapeziectomy)
What can be done for end stage rheumatoid foot in terms of excision arthroplasty
Can excise all metatarsal heads
What is arthrodesis
Surgical fusion in position of function
What does arthrodesis involve
All cartilage removed down to bleeding bone
Heals like fracture, bone graft may help union
Arthrodesis is the gold standard for what joints
1st MTPJ OA Ankle Wrist PIP and DIPJ hand Spine
Arthrodesis was formerly used for what ?
TB hip and young hip OA
What does Arthrodesis cause
Abnormal stress on surrounding joints
What is ostetomy
Surgical realignment of a joint
What does osteotomy result in
Offloads damaged areas and transfers load onto undamaged areas
In what cases would an osteotomy be performed
Knee - isolated medial (or lateral) compartment OA
1st MTPJ - Hallux Valgus
Describe the success rate etc of an osteotomy
70% success
Lasts around 7 years
Gold standard for hallux valgus
May delay arthritis in young hips
What is another term for a joint replacement
Arthroplasty
What is the main indication for a joint replacement
Pain relief
What does a joint replacement NOT improve
Function or ROM
What joints can be replaced
Hip knee shoulder elbow ankle wrist 1s MTPJ
What are some of the risks of a joint replacement
Loosening
Infection
Instability/ dislocation
Fracture
What are some of the immediate risks of a joint replacement
Blood loss
DVT / PE
Medical complications
What can cause vascular necrosis
Steroid use
What is required for a cartilage injury to properly heal
A deep tear to the Tidemark to allow the blood supply to go up and lay down fibrocartilage
Patients undergoing a THR usually complain of what
Reduced walking distance Pain not controlled by analgesics Night pain Impairment of activities of daily life Impairment of hobbies
How long would you expect a total hip replacment to last
10-15 years
How can Trochanteric bursitis be treated
Usually conservatively +/- injections
How do patients with Trochanteric bursitis present
Lying on their hip and complaining of intense pain over the greater trochanter.r Exercise does not affect them
What is the name of the operation performed for Perthes disease called
Head reshaping - shaving off of part of the bone.
