ORTHOPAEDICS JOINT SURGICAL FUSION

1. ARTHRODESIS
INDICATIONS & CONTRAINDICATIONS
Dr. Pawan K. Yadav
D.ORTHO.,DNB(ORTHO)
BIRRD HOSPITAL, TIRUPATHI

2. ARTHRODESIS
“Bony fusion of a diseased joint”

3. “ Satisfactory solution for infection, tumors,
trauma, and paralytic conditions and in certain
cases of osteoarthritis and rheumatoid arthritis
to relieve pain, joint instability ”

4. INDICATIONS
•Sepsis, articular Tuberculosis, and Instability
caused by poliomyelitis.

5.  Indications for shoulder fusion have
diminished over the years because of:
 excellent results of shoulder arthroplasty
 the near elimination of poliomyelitis and TB
 improved tech. shoulder stabilization.
SHOULDER ARTHRODESIS

7.  Infection
 Post traumatic brachial plexus palsy
 Recurrent dislocation
 Massive unreconstrutble rotator cuff tear
 Failed shoulder arthroplasty
 Stabilization after neoplastic lesion
SHOULDER ARTHRODESIS
INDICATIONS

8. Osteonecrosis
Charcot arthropathy
Ipsilateral elbow fusion
Contralateral shoulder fusion
SHOULDER ARTHRODESIS
CONTRAINDICATIONS

9.  Infection
 Post traumatic arthritis
 Failed elbow arthroplasty
 Severly comminuted intra articular #
ELBOW ARTHRODESIS
INDICATIONS

10. Osteonecrosis
Charcot arthropathy
Ipsilateral elbow fusion
Contralateral shoulder fusion
ELBOW ARTHRODESIS
CONTRAINDICATIONS

11.  Infection
 Post traumatic arthritis
 Failed elbow arthroplasty
 Spastic hemiplegia
 Wrist / Hand paralysis
WRIST ARTHRODESIS
INDICATIONS

12. An open physis of the distal radius(17
years of age).
After partial destruction of the physis
,the remaining part may be excised to
prevent unequal growth.
An elderly patient with a sedentary
lifestyle, especially if the nondominant
wrist is involved.
WRIST ARTHRODESIS
CONTRAINDICATIONS

13.  desire to return to near-normal physical
activity with manual labor;
 20 yrs years after surgery, 80% of pts w/ hip
arthrodesis performed at relatively young age
were working & satisfied w/ their results.
HIP ARTHRODESIS
INDICATIONS

14. Osteonecrosis
Charcot arthropathy
HIP ARTHRODESIS
CONTRAINDICATIONS

15.  Infection
 Post traumatic arthritis
 Failed elbow arthroplasty
 Severly comminuted intra articular #
KNEE ARTHRODESIS
INDICATIONS

17. bilateral knee disease
ipsilateral ankle or hip disease
severe segmental bone loss;
contralateral leg amputation;
KNEE ARTHRODESIS
CONTRAINDICATIONS

18.  Severe Valgus/Varus foot deformities
 Collapsing pes planovalgus deformity
 Tibialis posterior tendon dysfunction
 Tarsal coalition
 Rheumatoid arthritis (RA)
 Degenerative arthritis (e.g., DJD)
 Posttraumatic arthritis & Chronic pain
 Joint instability
ANKLE ARTHRODESIS
INDICATIONS

19. Osteonecrosis
Charcot arthropathy
CHRONIC SMOKING
ANKLE ARTHRODESIS
CONTRAINDICATIONS

20. • SHOULDER hand can comfortably reach the mouth. Arthrodesis of shoulder joint is
usually reserved for a flail joint as may follow a brachial plexus injury.
• ELBOW 90° of flexion .
• WRIST A few degree of extension
• THUMB MCP joint in 20° of flexion. IP joint in slight flexion.
FIXATION POSITIONS