Orthopaedic

Intruments and
Surgeries

Dr Tejasvi Agarwal
Senior Resident
Dept of Orthopaedics
Prosthesis
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Fig. 4.2.15 : Austin Moore's prosthesis.
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TONY KRISHNAKUMAR 2010 MBBS
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Unassembled Total Hip Assembled Total Hip

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 Total Hip
Replacement
Osteotomies
Chisel & osteotome

Chisel Osteotome
• one edge • both the edges
beveled beveled.
• used to • used to cut
chip the bone. /divide the bone.
Chisel Osteotome
Chisel & osteotome

TONY KRISHNAKUMAR 2010 MBBS

Stapler

To Arrest growth of epiphysis on

one side
• Correct genu valgum/varum
Arthrodesis
TONY KRISHNAKUMAR 2010 MBBS
In OA (closed wedge osteotomy)
Arthodesis
Arthrodesis
• The term arthrodesis refers to surgical fusion of a
joint.

• The indications for this are pain & instability in a

joint and, in some situations, following the failure
of joint replacement .
• In the lower limb, because of the larger stresses
brought about by wt-bearing, arthrodesis as a primary
procedure should only be used if adjacent joints and
the joints of other leg are sound.
• This applies to a much lesser degree in the upper
limb where, for e.g. arthrodesis of a painful, unstable
wrist in RA may in fact considerably improve the
function of involved fingers & thumb.
• A successful arthrodesis is a sure way of permanently
relieving pain but it is bought at the price of stiffness.
 Arthrodesis

• Ideally arthrodesis is carried out as an intra-articular

procedure. All articular cartilage is removed from both
surfaces of the joint and the bone ends shaped
to fit in the required position.
• They are held there by internal fixation , an external
fixator device or external splintage (e.g. POP) or a
combination of these methods, until the fusion is
sound.
• Where possible compression is applied to the bone
ends to promote fusion. Occasionally extra-articular
arthrodesis is carried out.

This usually applies to hip and shoulder joints.

 FIXATION POSITIONS
The optimum positions for arthrodesis in different joints are as follow

SHOULDER: In such a position that the hand can comfortably reach the
mouth. Arthrodesis of shoulder joint is usually reserved for a flail joint as may
follow a brachial plexus injury. Stabilization of this joint may lead to
improvement in the remaining distal function of the arm.

ELBOW : 90° of flexion .

WRIST: A few degree of extension

MCP joint: in 20° of flexion. IP joint in slight flexion.

 Elbow Arthodesis

05/04/14 dibyendu 10
 Wrist arthrodesis
• Lateral view
following wrist
fusion
demonstrating
dorsiflexion
Fusion
 HIP: In 10° -15° of flexion (to permit comfortable
sitting); 10 abduction; and 5° of external rotation.

• KNEE: Slight flexion or straight.

• ANKLE: 90°;

• SUBTALAR: Neutral (i.e. no varus or valgus).

Hip Arthrodesis
- indications:
- desire to return to near-normal physical activity

fixation:
- AO Cobra Plate: stable but disrupts abductors:
- trans-articular sliding hip screw:
- lag screw is inserted across the joint and just superior to the
dome of the acetabulum;
- disadvantage of this technique includes poor fixation and need for
postoperative hip spica casting;
- Complications:
- malposition (most common)
- nonunion
- instability of ipsilateral knee, back, and contralateral hip;
- low back pain is present in over 50% of patients with hip fusion;

- excessive hip flexion may cause excessive compensatory lumbar

lordosis (leads to back pain);
- more than 10 deg of hip adduction or abduction may lead to
varus/valgus knee instability;
Arthrodesis Using a Cobra Plate
 Knee Arthrodesis
Charnleys compression device
Ankle arthrodesis

OMMG 24>l>2
 Triple arthrodesis consists of the surgical fusion of the
talocalcaneal (TC), talonavicular (TN), and calcaneocuboid
(CC) joints in the foot.

The primary goals of a triple arthrodesis are to relieve pain from

arthritic, deformed, or unstable joints.

Other important goals are the correction of deformity and

creation of a stable, balanced plantigrade foot.
• Lateral view showing
subtalar joint
arthrodesis with 7.3
cannulated screw
going from talus to
calcaneus.
Thank you