Ortho surgery extravaganza!

I spent some quality time with the orthopedics crew today. They do surgeries on Tuesdays and Thursdays so today was full of orthopedic fantasticness.

First up was a bilateral FHO or Femoral Head Osteotomy. Let's break that down- Femoral head= rounded head of the femur that is supposed to fit ever so nicely into the acetabulum or "hip socket" to form the hip joint, Osteotomy= surgical removal of a bone (in this case, chunk of a bone). FHO's are really pretty amazing because the head of the femur that forms the hip joint with the pelvis is literally removed so there is nothing in the hip joint, the musculature surrounding the hip area and the eventual development of scar/cartilagenous tissue forms a joint-like connection to support the area. Here is a link to a blog that has before and after radiographs(x-rays) of an FHO performed on one side--> Rads . Our patient today had both femoral heads removed, isn't that cool that the body can handle something like that??? No femoral heads? Awesome! Anyway, that was a nerdy outburst, sorry. So the reason for the surgery was hip pain caused by arthritis in the hip joints. Just looking at the pre-operative radiographs was painful. The head of the femur should be smooth and round and articulate wonderously with the (say it with me...) acetabulum. This dog's femoral heads were all uneven and rough and ouchy. So we got the dog anesthetized and I helped hook her up to all of our diagnostic goodies once we transferred her to the surgery suite (ECG leads, pulse ox, temperature probe down the esophagus, ETCO2, blood pressure cuff and fluids).  I think I am finally getting the hand of hooking all of that stuff up in a timely manner. The dog was on fluids as well as a Cefazolin CRI and Morphine CRI (CRI= constant rate infusion, so it's flowing at a specific rate along with regular fluids during the surgery). Cefazolin is an antibiotic to prevent infection, we give about 100 mls during the first hour of surgery then stop it. Morphine is an analgesic (pain reliever) and is given throughout the surgery. It can also be given as a bolus or a larger amount given all at once if the animal is showing signs of pain during surgery.  Prior to surgery, the dog was also given an epidural of pain medication which helps to stop pain before it starts and allows us to use less anesthetic gas to keep the dog anesthetized during surgery (for a safe-ER anesthesia right Janet?).  All of these medications together worked beautifully and we had a pretty stellar anesthesia.

I was basically the circulator during surgery. The circulator (brace yourself Jessie, here comes a definition straight from your manual) is the mediator between sterile and non-sterile fields.  What that means is that the circulator can pass instruments and supplies in a sterile manner to the people that are scrubbed in and must remain sterile. Instruments and other things are sterilized in packs, the outer layer can be peeled back by the circulator and the sterile person can remove the item to use in the surgery without introducing any type of contamination to the surgery site. Maintaining a sterile surgical site and sterile fields for the surgeon to work in is extremely important in preventing infection in the patient.

Anyway, one of the coolest circulator duties I performed today was catching the femoral head that the surgeon dropped into my open hands! COOOOOOOOOL! I could see all the remnants of connective tissue on it and the spongy bone part and the goo all over the bone and it was so neat! (Another nerdy outburst, sorry again) The anesthesia tech that was in there with us was not nearly as excited about the anatomical awesomeness that I held in my hands but everyone's nerdiness is brought out by different things so I'm ok with that.

The surgery went well and the dog recovered nicely. She will most likely not be able to be as active as she was at her peak, but she will be able to move relatively normally and do many of the things she did before. A major concern for post-op FHO patients is ensuring that they maintain a healthy but lean weight so as not to overstress the hip area that has been compromised. Pretty cool stuff if you ask me.

We did a few TPLO's today as well, which I believe I have mentioned before so I won't get back in to that. Surgery is pretty awesome and I'm constantly amazed at what the body can handle and recover from.