1. ARTHRODESIS AND ARTHROPLASTY Dr suhas

2. DEFINTION Arthrodesis is an surgical procedure to eliminate motion in a joint by providing a bony fusion. Aim- to attain stability at the joint Sacrificing mobility for stability 3. INDICATIONS 1. Gross destruction of a joint- dec pain and halt the disease process Rheumatoid arthritis Osteoarthrosis Charcoat arthropathy 2. Tubercular arthritis- quiescent stage 3. Neuromuscular conditions- polio ( deformity or gross insatbility). 4. Deformity correction- 4. PRINCIPLES 1. Fixed in optimal functional position. 2. All articular cartilage must be removed till the level of bleeding cancellous bone. 3. Flat surfaces should be cut on opposing joint ends to ensure optimal bony contact 4. Fixation should be stable 5. Cancellous bone graft 6. Soft tissues should be taken care 7. Joints above & below should be mobilised 5. Methods 1. Intra-articular arthrodesis- open technique 2. Extra-articular arthrodesis- closed technique 3. Combined arthrodesis- 6. FIXATION 1. Plates and screws 2. Intra medullary implants 3. Single or multiple screws 4. External fixation- tubular exfix Charnley apparatus 7. ARTHROPLASTY DEFINITION- A surgical procedure were the joint is replaced or reconstructed. A new joint is created. Functional Mobile Stable Done for hip, knee, ankle, shoulder, elbow, wrist 8. INDICATIONS Joint destruction- 1. Rheumatoid arthritis 2. Osteoarthritis Quiescent tubercular arthritis Correction of deformities Fracture neck of femur > 60 years 9. TYPES 1. hemi-arthroplasty- Either of the articular surface of the joint is removed and replaced by a prosthesis 2. Total replacement arthroplasty- Both articular surfaces of the joint are excised and replaced by prosthesis 3. Excision arthroplasty- One or both articular surfaces are excised but the gap is left to fill by fibrous tissue. 10. COMPARISON ARTHRODESIS Joint is fused No movements in joint Fused in functional position Less ideal for rehabilitation Cheaper Can be done in almost all joints Life long ARTHROPLASTY Joint is reconstructed Joint is mobile Full range of motion possible Good candidate for rehabiliation Costlier Can be done in limited joints Needs revision every 10- 15 years