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MSK SM > Surgical Management of an Arthritic Joint > Flashcards

Surgical Management of an Arthritic Joint Flashcards

1
Q

How can we conservatively treat an arthritic joint

A 
Analegsics 
weight loss 
lifestyle change 
splints, braces, orthoses 
Physio
Mobility aids 
Steroids 
DMARDs
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2
Q

What changes can be seen on an X Ray of an arthritic joint

A

Reduced joint space
Sclerosis
Osteophyte formation

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3
Q

When is appropriate to surgically manage an arthritic joint

A

When conservative measures are exhausted

The patient is really struggling - do not base on the xray

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4
Q

What are the 3 aspects of gaining consent for surgery of an arthritic joint

A

Risks vs Benefits
Patient journey
Realistic outcomes and success rates

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5
Q

What are the different surgical optoins for an arthritic joint

A 
Athroscopic debridement 
Cartilage regeneration
Synovectomy for RA 
Open debridement/ cheilectomy 
Joint Excision (excision athroplasty)
Arthrodesis surgical fusion
Osteotomy surgical realignment 
Joint replacement arthroplasty
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6
Q

What joint was Arthroscopic Debridement/ washout usually performed on.
Was the success good or bad

A

Knee

Usually poor results

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7
Q

What is open debridement good for

A

Removing impinging osteophyte = cheilectomy

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8
Q

What joints are operated on in an open debridement

A

Ankle
1st MTP joint
Elbow

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9
Q

What joints are cartilage regeneration performed on

A

Knee and Ankle

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10
Q

What joint are cartilage regeneration poor on

A

Patellofemoral joint

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11
Q

What type of cartilage is produced in a cartilage regeneration

A

fibrocartilage instead of hyaline

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12
Q

What is a excision arthroplasty

A

Surgical removal of the joint

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13
Q

Excision arthroplasty are good for what joints

A

1st CMC joint OA in hand (trapeziectomy)

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14
Q

What can be done for end stage rheumatoid foot in terms of excision arthroplasty

A

Can excise all metatarsal heads

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15
Q

What is arthrodesis

A

Surgical fusion in position of function

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16
Q

What does arthrodesis involve

A

All cartilage removed down to bleeding bone

Heals like fracture, bone graft may help union

17
Q

Arthrodesis is the gold standard for what joints

A 
1st MTPJ OA
Ankle 
Wrist 
PIP and DIPJ hand 
Spine
18
Q

Arthrodesis was formerly used for what ?

A

TB hip and young hip OA

19
Q

What does Arthrodesis cause

A

Abnormal stress on surrounding joints

20
Q

What is ostetomy

A

Surgical realignment of a joint

21
Q

What does osteotomy result in

A

Offloads damaged areas and transfers load onto undamaged areas

22
Q

In what cases would an osteotomy be performed

A

Knee - isolated medial (or lateral) compartment OA

1st MTPJ - Hallux Valgus

23
Q

Describe the success rate etc of an osteotomy

A

70% success
Lasts around 7 years
Gold standard for hallux valgus
May delay arthritis in young hips

24
Q

What is another term for a joint replacement

A

Arthroplasty

25
Q

What is the main indication for a joint replacement

A

Pain relief

26
Q

What does a joint replacement NOT improve

A

Function or ROM

27
Q

What joints can be replaced

A 
Hip
knee
shoulder 
elbow 
ankle 
wrist 
1s MTPJ
28
Q

What are some of the risks of a joint replacement

A

Loosening
Infection
Instability/ dislocation
Fracture

29
Q

What are some of the immediate risks of a joint replacement

A

Blood loss
DVT / PE
Medical complications

30
Q

What can cause vascular necrosis

A

Steroid use

31
Q

What is required for a cartilage injury to properly heal

A

A deep tear to the Tidemark to allow the blood supply to go up and lay down fibrocartilage

32
Q

Patients undergoing a THR usually complain of what

A 
Reduced walking distance 
Pain not controlled by analgesics 
Night pain
Impairment of activities of daily life 
Impairment of hobbies
33
Q

How long would you expect a total hip replacment to last

A

10-15 years

34
Q

How can Trochanteric bursitis be treated

A

Usually conservatively +/- injections

35
Q

How do patients with Trochanteric bursitis present

A

Lying on their hip and complaining of intense pain over the greater trochanter.r Exercise does not affect them

36
Q

What is the name of the operation performed for Perthes disease called

A

Head reshaping - shaving off of part of the bone.

MSK SM (42 decks)

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