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3 circumstances when surgery is indicated for management of joint disease.
primary joint disease is diagnosed and sx is standard of care (ie. CCL rupture), mechanical problem is detected (free flap, instability), if secondary joint disease is causing clinical signs
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Indications for surgical debridement? (4)
DJD, loose bodies, free flaps, infection
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2 methods of surgical debridement of a joint.
arthrotomy (open) or arthroscopy (laproscopic)
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What is the surgical approach to repairing a slipped capital physis (detachment of the femoral head)?
femoral head ostectomy (FHO- remove femoral head)
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What is the early treatment for hip dysplasia?
triple pelvic osteotomy (TPO)
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What is the surgical approach to patella luxation?
trocheoplasty and tibial crest transposition
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What are the surgical approaches (2) to a CCL rupture repair?
tibial plateau leveling osteotomy (TPLO), tibial tuberosity advancement (TTA)
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2 methods of enhancing tissue regeneration/repair.
forage (drilling) microfracture for bleeding, penetrate marrow cavity to allow stem cells to enter,
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Enhancing tissue regeneration/repair results in primarily ______________.
fibrocartilage formation
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What is a likely differential for a dog that has fallen/jumped from a height?
carpal hyperextension injury
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Ho can you radiographically observe a carpal hyperextension injury?
stressed view
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The _________________, the more amenable joints are to arthrodesis; __(2)__ are good candidates for arthrodesis.
farther from the trunk; carpal and metacarpal
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What are the 4 goals of arthrodesis?
relieve pain, restore joint stability, prevent joint deformity, prevent further joint collapse
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With arthrodesis, more _______ joints have less effect on gait.
distal
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With arthrodesis, there is removal of ____________ to ____________; there is creation of ____________.
articular cartilage; bleeding subchondral bone; two flat surfaces;
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With arthrodesis, ______________ is packed b/w the two flat bone surfaces, and there is stabilization of the joint at a _______________ and ___________ across the _____________.
autologous cancellous bone graft; functional angle; compression; fusion site
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With arthrodesis, after the surgery, use _________ in the early post-op period.
external coaptation (splint)
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3 reasons bone grafting is important for arthrodesis.
osteogenic, osteoconductive, osteoinductive
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What is the preferred treatment for end-stage hip DJD?
total hip replacement (THR)
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Cementless total hip fixation relies on formation of _____________ b/e implant a bone; initial stability is _____________, late stability is _________.
mechanical interlock; intra-operative fit; biological
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4 potential intra-operative complications with total joint replacement.
fracture, hemorrhage, embolism, heat
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2 early post-op potential complications with total joint replacement.
dislocation (luxation), fracture
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2 late potential complications with total joint replacement.
mechanical wear, aseptic mechanical loosening
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_____________ is a concern for the duration of the implant after total joint replacement.
Infection
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Joint lubrication is provided by... (2)
hydrostatic squeeze film, hyaluronic acid
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Periarticular new bone is a response to increased _______________ in the joint.
inflammatory mediators
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Earliest sign of OA.
periarticular new bone
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3 causes of OA.
developmental joint disease, CCL rupture, trauma
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OA has _______ progression and usually affects __________; there is _________, difficulty ________, and it is worse after _______________.
slow; multiple joints; stiffness on rising; jumping up/down; rest after exercise
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What 4 signs are you looking for during palpation of a joint?
pain, effusion, periarticular fibrosis, symmetry
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What 4 signs are you looking for during manipulation of a joint?
pain, range of motion, crepitus, specific maneuvers (cranial drawer, tibial thrust)
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What is a normal joint angle for range of motion at the metacarpophalangeal joint?
90°
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Labrador retriever with forelimb lameness; what must you be sure to evaluate?
medial coronoid process of the ulna (fragment medial coronoid very common)
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2 locations of osteochondrosis.
metaphyseal GP, articular-epiphyseal cartilage complex
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Osteochondrosis is a defect in _____________; ____________ is asymptomatic, it becomes a problem when...
endochondral ossification; cartilage thickening; cartilage dissects off (OCD)
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4 sites of osteochondrosis.
shoulder, elbow, stifle, hock
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With shoulder OCD, there is pain on __________ and palpation of the ____________.
shoulder extension; caudal humeral head
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Shoulder OCD commonly occurs in _____________.
large breed dogs 4-8 months old
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4 causes of elbow dysplasia.
fragmented medial coronoid process (FMCP), ununited anconeal process (UAP), OCD of the medial portion of the humeral condyle, ununited medial epicondyle
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Symmetric deformation of the distal joints that is immune mediated.
Rheumatoid arthritis
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Synoviocentesis of RA joint shows ______________.
neutrophilic inflammation
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Non-erosive immune-mediated polyarthritis is _______ common than rheumatoid arthritis.
more
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The hallmark of DJD.
degradation of articular cartilage
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Signs of DJD in horses. (5)
lameness, stiffness, and resistance to joint flexion, joint enlargement, pain
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Radiographic signs of DJD in horses. (4)
joint space narrowing/irregularity, osteophyte formation, entheiophyte formation into joint capsule, and subchondral bone lysis
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Histological signs of DJD in horses. (4)
surface fraying of collagen, cracks/fissures in subchondral bone, apoptosis of chondrocytes, eburnation
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Loss of cartilage and exposure of subchondral bone.
eburnation [Bertone]
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_____________ is good for keeping joints limber.
Continued low-level exercise
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Oral NSAIDs for dogs. (3)
firocoxib, carprofen, metacam
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Oral NSAIDs for horses. (3)
phenylbutazone, flunixen meglumine, firocoxib
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2 steroids used for symptom control in horses.
triamcinolone acetate, depomedrol
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Repetitive use of steroids suppresses ______________ and can impede _____________.
chondrocyte metabolism; cartilage healing/health
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In horses with DJD, there is pain on ________ and reduction in ___________.
flexion; range of motion
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Secondary fibrosis of the joint capsule.
ankalosis
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Partial thickness defects in cartilage...
do NOT regain thickness or architecture... THEY DO NOT HEAL
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Full thickness cartilage defects...
may heal depending on characteristics (size, location, depth, exercise, environment)
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IL-1 is called _________ and it causes ________________.
catabolin; cartilage degeneration
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6 therapies for OA.
NSAIDs, physical therapy, topical therapy, injections, arthrodesis, regular exercise
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Exercise in horses with OA decreases __________, improves __________.
inflammatory cytokines; joint mobility
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Massaging a joint with OA will improve ___________.
tissue fluid exchange
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Icing a joint with OA decreases ___________ and _________.
inflammation; pain
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2 topical medications used to relieve pain associated with OA in horses.
Capsaicin cream, DMSO (steroid)
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NSAIDs are selective _________ inhibitors to reduce inflammation, but also suppresses ___________ metabolism and ________________.
Cox II; cartilage; bone and soft tissue healing
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NSAID commonly used in all species.
banamine
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________ produces low levels of prostaglandins that are protective; therefore, NSAIDs selectively target ___________ that produces a high amount of prostaglandins contributing to inflammation.
Cox I; Cox II
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Intra-articular injections of _________ protects cartilage from toxicity and inflammatory mediators; not used for OS, but is effective for synovitis.
hyaluronan
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PSGAGS are given for __________ as an ____________.
cartilage injury; intra-articular injection
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Drug given when you're going into a relatively healthy joint for chondroprotective effects; if given at too high a dose, may cause laminitis.
Triamcinolone
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Nutriceuticals contain __(3)__; an example is _____________.
chondroitin sulfate, glucosamine, manganese; cosequin
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Oral supplements found in the body; given, not as a drug, but to improve health.
nutriceuticals (cosequin)
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Why is platelet therpay effective in treating MSK disease and other joint disorders?
platelets release growth factors that stimulate healing
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Why is IRAP therapy useful in treating DJD?
you put a gene in the joint that shuts off IL-1
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Coated syringe and beads that activate growth factors and cytokine antagonists released from cells.
Arthrex system- IRAP therapy
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