Unit 1: Joint Conditions Flashcards
What causes cruciate ligament lesions?
The cruciate ligament is commonly injured by either hyperextension or a twist, often in association with the foot being anchored in a studded boot or a ski
Describe the management of meniscal lesions
Peripheral tears can be reattached with sutures. Tears within the substance of the meniscus have no apparent capacity to repair and so the torn peripheral part should be removed. Once clinical suspicion is raised, patients should be examined by arthroscopy. Most meniscal lesions can be removed via the arthroscope (arthroscopic meniscetomy)
Describe the management of cruciate ligament lesions
In general, the ligament should be left untreated for a while and the knee muscles rehabilitated. Treatment should only be offered if symptoms interfere with daily life or if the patient wishes to return to sport. Treatment consists of replacing the torn ligament with a synthetic one
Why do cruciate ligaments not heal spontaneously?
When a cruciate ligament is torn it loses its blood supply and therefore cannot heal spontaneously
Which organism may cause septic arthritis a young adult, often with little constitutional upset?
Gonococcus
Discuss the aetiology of gout
Gout is caused by urate crystal deposition. The most common cause in the West is overuse of diuretics
Discuss the aetiology of inflammatory abnormalities seen in orthopaedics
Inflammatory abnormalities may be associated with bacterial infection causing inflammation of a joint or bone. Sometimes the cause of the inflammation is not known, e.g. rheumatoid arthritis
Discuss the aetiology of congenital abnormalities seen in orthopaedics
Congenital abnormalities are defects associated with development in the womb. They may have a familial or genetic cause or they may be the result of something happening to the mother or to the child whilst in the womb
Name two types of avascular necrosis
Two types of avascular necrosis are post-traumatic and Caisson’s disease
Describe arthrodesis
Arthrodesis, or the surgical stiffening of a joint in a position of function, is an appropriate operation in a young person with a painful and limited range of movement
What is a meniscectomy?
The surgical removal of a meniscus
List the professionals involved in treating orthopaedic conditions
The orthopaedic surgeon is dependent on theatre nurses and porters, orthopaedic nurses, other doctors e.g. GPs, anaesthetists, and paramedical specialists e.g. physiotherapists
What is a synovectomy?
A synovectomy is a surgical procedure used in the management of rheumatoid arthritis. It involves the removal of the diseased synovial tissue (synovium). It is a good operation for clearing up damage around extensor tendons, reducing pain and stiffness
Name the important types of movement of the hip
Flexion, extension and abduction
Describe the overall treatment objectives in the field of orthopaedics
The ideal outcome would be to return people to normal. However, in most orthopaedic cases we cannot achieve a cure but we may try to relieve the patient of their principle complaints - pain and stiffness
What is the important difference between treating tuberculosis and acute septic arthritis?
The important difference between treating TB and acute septic arthritis is that surgery is rarely necessary in the treatment of TB
Why are prosthetic knee ligaments liable to fail?
Prosthetic knee ligaments are liable to fail as they have no sensory receptors and so may be overstretched without the brain ‘knowing’. The brain is therefore unable to initiate protective muscle action
Describe an osteotomy
Osteotomy consists of the surgical realignment of a joint, with the aim being to redirect forces across a joint so that they are more evenly distributed
Name one principle difference between the requirements for an upper limb and lower limb joint replacement
An upper limb joint replacement must be capable of a larger range of movement than a lower limb joint replacement, but it does not require to withstand such large forces
List and classify the causes of osteoarthritis
The classification starts by grouping patients into those whose arthritis has a known cause (secondary osteoarthritis) and those where the cause remains unknown (primary arthritis)
Name the early problems which may occur after a joint replacement
Dislocation is a risk as in the immediate post-operative period the prosthesis will not be fully supported by the surrounding tissues. Deep vein thrombosis and infection are also risks
Name the late problems which may occur after a joint replacement
Infection and loosening and wear
Name the important types of movement of the knee
Flexion and extension
What is the principal indication for operative treatment of arthritis?
Pain is the principle indication for operative treatment
Which late complication of arthroplasty is possibly almost inevitable?
Loosening and wear
What causes meniscal lesions?
The principal cause of meniscal lesions is twisting injury, often associated with skiing, or games where studs are worn on shoes or boots
Discuss the reasons why goals for lower limb joint replacement differ from goals for upper limb joint replacement
The relationship between pain relief and function is quite different from that observed in the lower limb. In the upper limb, the loads involved are quite low but a large range of motion is required. Intrinsic stiffness can still be a problem after arthroplasty as soft tissue distortion of the capsule and ligaments remains after replacing the articular surfaces
Define an effusion
An effusion is excess fluid in the joint
Define the term ‘acute’
An acute disease is one that strikes the patient suddenly. It is characterised by the production of polymorphonuclear leucocyte (polymorph for short)
Which is more significant in arthritis - pain or stiffness?
Pain
What role has the surgeon in the treatment of avascular necrosis?
The surgeon has NO role in the treatment of avascular necrosis until the joint requires replacement
Define chronic septic arthritis
Joint tuberculosis is a bacterial infection resulting in chronic septic arthritis. It is mainly found in underdeveloped countries. AIDS patients are particularly prone to this illness
Define arthroplasty
Surgery which creates a new joint or changes the shape of a joint
Define primary arthritis
Primary arthritis is when there is no known cause. We have little insight into the causes of primary arthritis, but it has been suggested that it is linked to problems with the repair of joint damage
Define acute septic arthritis
Acute septic arthritis is an infection caused by bacteria, which have spread to the joint via the blood from a site of trivial infection, such as a boil. It occurs very rarely from direct penetration of the joint by a sharp object. In adults, joint infection is rare unless the joint is already damaged, or the immune defence system is abnormal
List the types of operative treatment available for osteoarthritis
For most forms of arthritis there are four surgical options:
- Nothing
- Arthrodesis
- Osteotomy
- Arthroplasty
Define the term ‘self-limiting’
Self-limiting means the condition is temporary and will get better
Describe the origins of orthopaedics
Orthopaedics literally means ‘straight children’ as it has its origins in dealing with musculoskeletal abnormalities occurring at birth or in children as they grow. Nowadays the field of orthopaedics has grown to encompass the whole range of diseases affecting the musculoskeletal system
Which is the most successful and common joint replacement?
Hip replacement
Describe three general complications of surgery
General complications of surgery include chest infection, urinary tract infection, and pressure sores
Describe how a doctor may treat arthritis before and after admission to hospital
Conservative treatment options include weight loss, use of a stick, rest and physiotherapy
Discuss the aetiology of pseudogout
Pseudogout is caused by the deposition of pyrophosphate, the origin of which is unknown
Describe the management of loose bodies
Loose bodies should be removed, preferably using the arthrosope. In the case of osteochondritis dissecans, the condition may settle spontaneously or may require removal of the loose bodies
Define plication
Plication is a medial tightening of the vastus medialis muscle
Discuss the aetiology of degenerative disorders seen in orthopaedics
Degenerative disorders are a group of conditions where the normal structure of the joint has been disturbed through deterioration and wear
What is an excision arthroplasty?
An excision arthroplasty is a surgical procedure used in the management of rheumatoid arthritis. It involves a limited excision of the joint. This relieves pain but because some of the joint has been removed there can never be a full return of function
List the common types of meniscal lesion
The parrot beak tear and the bucket handle tear are the most common types of meniscal lesion
The deposition of which crystal causes gout?
Urate
Define secondary arthritis
Secondary arthritis refers to arthritis where there is a known cause e.g. congenital, metabolic, trauma
Discuss the aetiology of dislocation of the patella
Dislocation of the patella is usually associated with a malformation of either the patella or the lateral femoral condyle. This leads to the patella moving abrasively on the femur (maltracking)
What causes loose bodies in the knee?
Small fragments of cartilage and bone (osteochondral fragments) may be sheared off in an injury. These fragments are often not resorbed but floats in the synovial fluid
Osteochondritis dissecans a condition seen very rarely in adolescence where osteochondral fragments occur spontaneously
Discuss the principles of knee replacement
The functional range of movement of the knee is surprisingly small, although ideally ninety degrees of flexion must be achieved to get up and down stairs. Stability in extension is essential so that we can support the full weight of the body whilst standing on a single straight leg
Define rheumatoid arthritis
Rheumatoid arthritis is a chronic disease of many systems of the body, manifesting itself as joint pain
What is the principle difference between primary and secondary arthritis?
The cause of secondary arthritis is known, whereas the cause of primary arthritis is unknown
Describe the management of dislocation of the patella
Minor degrees of maltracking are dealt with by surgical splitting of the vastus lateralis muscle insertion into the patella. If maltracking is recurrent and severe, then a medial tightening (plication) of the vastus medialis muscle may be required. In adulthood, the patellar tendon may be re-sited more medially
Name the four cardinal symptoms of knee disorders
The four main symptoms of knee disorders are swelling, locking, giving way and pain
Discuss the aetiology of metabolic disorders seen in orthopaedics
Metabolic disorder is a term indicating a group of illnesses which usually cause inflammation, but the cause can be traced back to some abnormality in body metabolism
Which joints are most commonly affected in rheumatoid arthritis?
The joints of the fingers, wrists, feet, and ankles are most commonly affected by rheumatoid arthritis
Name the two principle symptoms in orthopaedics
Pain and stiffness
What is a loose body?
A loose body is a fragment of cartilage and bone free in the joint
Discuss the aetiology of trauma seen in orthopaedics
Trauma is where the musculoskeletal system has suffered damage from an outside physical agent
What happens to the menisci in knees affected by pseudogout?
In knees affected by pseudogout the menisci become calcified
How does the surgeon ensure stability in extension after a knee replacement?
The surgeon must balance the collateral ligaments by cutting tight parts of the ligaments and then putting in artificial surface replacements of sufficient thickness to re-tighten the ligaments so that the medial and lateral collateral ligaments are under equal tension
Define the term ‘chronic’
A chronic disease takes a long time to develop and may last a long time. It is characterised by the production of lymphocytes
Name three requirements of any joint replacement
Functional and pain-free range of movement, stability and resistance to forces, wear and loosening
Describe the management of acute septic arthritis
Treatment consists of surgery and IV antibiotics. The ‘first guess’ antibiotic should be an anti-staphlococcal agent
Describe the role of surgery in rheumatoid arthritis
The role of the surgeon is to ensure that the patient is as comfortable as possible whilst retaining as much function as possible. Soft tissue surgery involves synovectomy. This may be combined with an excision arthroplasty of the joint
What kind of cells would you expect the immune defence system of the body to produce in response to tuberculosis?
As it is a chronic disease you would expect the body to produce lymphocytes
What is an arthrotomy?
The surgical opening of a joint
Describe the management of chronic septic arthritis
Treatment is by drugs and only rarely is surgery necessary. Combinations of antibiotics such as streptomycin, ethambutol and rifampicin are given for many months
What is the possible long-term consequence of crystal arthropathy?
Chronic degeneration and secondary arthritis is the possible long-term consequence of crystal arthropathy
Discuss the principles of hip replacement
Although the hip joint has tremendous demands placed upon it, the loads are largely offset by the generally stable configuration of a ball and socket joint. The functional range of hip motion is in practice fairly limited
Define a bacteraemia
A bacteraemia is the presence of bacteria in the bloodstream
