SURGICAL MANAGEMENT OF RA F/A Flashcards
general considerations?
contractors and thin/atrophic skin
- neurovascular insult
- coverage over implants
- delayed wound healing
osteoporosis
nutrition therapy
consider ability to be NWB
silent spine disease affects?
atlantoaxial subluxation
what are the medications used for the surgical management of RA F/A?
aspirin NSAIDs glucocorticoids DMARDs Biologics
aspirin inhibits?
of thromboxane A2 synthesis in platelets
stop aspirin how many days before surgery?
10 days
ibuprofen should be stopped how many days before surgery?
1-2 days
naproxen should be stopped how many days before surgery?
3 days
stopping glucocorticoids could cause?
disease flaring and adrenocorticoid crisis
physiologic cortisol secretion response to major surgery is how many mg? baseline?
75-150 mg/day
48-72 hrs
t/f, 5 mg or less corticosteroids with surgery less than 1 hour, under local anesthesia than no supplementation is needed?
T
perioperative use of this drug can increase infection?
methotrexate
lab abnormalities?
leukocytosis thrombocytosis anemia CRP difficulty in assessing infection using labs alone
surgical considerations?
poor bone quality more fixation fat pad/tissue atrophy longer time NWB leave sutures in longer chronic inflammatory arthritis vasculitis physical therapy more aggressive and operate earlier rheumatoid factor Larsen score CRP high predictor of erosion
how does this manifest in RA patients?
in soft tissue?*
other complications?**
forefoot early in disease process
rearfoot/ankle later on
mid foot not as common
*spontaneous tendon ruptures
tenosynovitis
ankle synovitis
rheumatoid nodules
**synovial hypertrophy, synovectomy, ankle synovitis, rheumatoid nodules (use excision)
osseous modalities?
forefoot
midfoot
rearfoot
ankle
