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 An orthopedic implant is a medical device manufactured to 
replace a missing joint or bone or to support a damaged bone. 
 Internal fixation is an operation in orthopedics that involves the 
surgical implementation of implants for the purpose of repairing 
a bone. 
 Among the most common types of medical implants are the 
pins, rods, screws and plates used to anchor fractured bones 
while they heal.
The material used in orthopedic implants must 
be biocompatible to avoid rejection by the body. 
Other risks associated with orthopedic implants 
include implants coming loose or breaking in the 
bone causing painful inflammation and infection to 
surrounding tissue.
Bone is anisotropic - its modulus is dependent upon 
the direction of loading. 
Bone is weakest in shear, then tension, then 
compression. 
Bone is viscoelastic: its force-deformation 
characteristics are dependent upon the rate of 
loading. 
BONE 
PROPERTIES 
Density – 2.3g/cm3 
Tensile Strength – 3-20MPa 
Compressive Strength – 
15,000 psi 
Shear Strength – 4,000 psi 
Young’s Modulus – 10-40 
MPa
ORTHOPEDIC TERMS 
Osteoinductive – Characteristic in materials that promote 
new bone growth. 
Bioresorbable – The ability of a material to 
be entirely adsorbed by the body. 
Osteoconductive – The property of a 
material that allows for the possible 
integration of new bone with the host bone. 
Trochanter 
The second segment of the leg, after the coxa and 
before the femur
MATERIAL USED 
Composite Metal :rough& polished 
Polymer 
Ceramics
An orthopedic hip implant, exhibiting the use of all 
three classes of biomaterials: metals, ceramics and 
polymers. 
 In this case, the stem, which is implanted in the 
femur, is made with a metallic biomaterial. 
 The implant may be coated with a ceramic to 
improve attachment to the bone, or a polymeric 
cement. 
At the top of the hip stem is a ball (metal or 
ceramic) that works in conjunction with the 
corresponding socket to facilitate motion in the 
joint. 
 The corresponding inner socket is made of either 
a polymer (for a metallic ball) or ceramic (for a 
ceramic ball) and attached to the pelvis by a 
metallic socket.
VARIOUS fIxATION METHODS 
(a) direct interference or (passive) 
noninterference fit; 
(b) mechanical fixation using 
screws, bolts, nuts, wires, etc.; 
(c) bone cement; 
(d) porous in growth (biological) fixation; 
(e) direct chemical bonding 
using adhesives or after coating 
with direct bonding material layer; 
(f) bone cement with resorbable particles; 
(g) porous in growth controlled by using 
electrical or electromagnetic stimulation
BONE CEMENT 
Used to fill gaps between bone and implant 
•PMMA homopolymer 
•MMA/styrene copolymer 
•MMA/methyl acrylate copolymer 
Poly methylmethacrylate (PMMA) bone cement: 
made from methylmethacrylate, poly methylmethacrylate, esters of 
meth acrylic acid, or copolymers containing poly 
methylmethacrylate and polystyrene 
Stable interface between metal and bone
COMPOSITION Of A METHACRyLIC CEMENT
PROPERTIES OF BONE CEMENT 
Bone cement is supplied as two separate components, a polymer powder 
and a monomer, which is a colourless and inflammable liquid. 
The powder consists of a spherical polymer, an initiator(dibenzoyl 
peroxide), a radio pacifier (zirconium oxide or Barium sulphate) and often an 
antibiotic. 
As the powdered polymer and liquid monomer are mixed, a viscous dough 
is formed. Free radicals initiate the polymerization 
This process is exothermic, with a maximum in vivo temperature of 40° to 
47°C and this thermal energy is dissipated into the circulating blood, the 
prosthesis and the surrounding tissue 18 as the cement cures 
The chemical composition, the powder to liquid ratio and the cement 
temperature in turn determine the viscosity. There are high viscosity and low 
viscosity cement types. 
High viscosity bone cements have a short wetting phase and a longer 
working phase. 
Low viscosity cements have a longer wetting phase and a shorter 
working phase.
LIMITATIONS 
Inherently weak 
Stronger in compression than tension 
Weakest in shear 
Exothermic reaction 
May lead to bone necrosis 
By handling improperly or less than 
optimally 
Weaker 
Extra care should be taken to 
Keep debris out of the cement mantle (e.g., 
blood, fat) 
Make uniform cement mantle of several mm 
Minimize voids in the cement : mixing 
technique 
Pressurize
KNEE AND ITS INjURIES
JOINT REPLACEMENTS 
 The hip and shoulder joints have a ball and socket articulation, 
while other joints such as the knee and elbow have a hinge-type 
articulation 
 They all possess to opposing smooth cartilaginous articular 
surfaces that are lubricated by viscous synovial fluid. 
 This fluid is made up of polysaccharides that adhere to the 
cartilage and upon loading can be permeated out onto to the 
surface to reduce friction. 
 The cartilage is not vascularized , and nutrition of the tissues 
appears to be a diffusional process. 
 The articulation of the joints is stabilized by the body s 
coordination of the ligaments, tendons, and muscles.
Most femoral head replacements are made with installation of an acetabular 
cup. This is called total hip joint replacement (arthroplasty). 
The diseased femoral part head is cut off, and the medullary canal of the femur is 
drilled and reamed to prepare it for the stem of the prosthesis. 
The cartilage of the acetabulam is also reamed. The PMMA bone cement is 
prepared from polymer powder and monomer liquid. 
It is packed into the medullary canal of the femur and the femoral stem is inserted. 
The acetabular component is similarly cemented. 
The alignment and articulation of the artificial ball- and-socket joint are then 
verified. 
UHMWPE and cross linked UHMWPE for the cup and stainless steel and Ti-based 
alloys used for femoral head and stem.
KNEE JOINT REPLACEMENTS 
 The development and acceptance of knee joint prosthesis have been 
slower than that of the hip joint due to the knees more complicated 
geometry and biomechanics of movement, and lesser stability in 
comparison with the hip. 
 It can be classified into hinged and non hinged type and it is further 
divided into uni – and biocompartmental. 
ANATOMy Of ThE KNEE 
Made up of 3 bones 
•Femur (thigh bone) 
•Tibia (lower leg bone) 
•Patella (kneecap)
CAuSES Of KNEE PAIN 
•Osteoarthritis (wear and tear) 
•Rheumatoid arthritis 
•Post-traumatic arthritis caused by: 
•Fractures 
•Ligament injuries 
•Meniscus tears 
GOALS Of TOTAL JOINT REPLACEMENT 
ARE TO hELP: 
Relieve pain 
Restore motion 
Improve function 
Improve fitness and health 
Restore quality of life
TOTAL KNEE REPLACEMENT 
•Partial knee replacement 
(unicompartmental) 
– Replacement of one or two parts of knee 
instead of total. 
– Retain more of patient natural knee. 
• Total knee replacement 
– Resurfaces the bones (tibia and femur) 
with an implant made of metal and 
plastic parts. 
– Medical-grade plastic spacer providing 
a smooth surface as cartilage 
Femoral- replaces arthritic portion of thigh 
bone 
Tibial- replaces arthritic portion of shin 
bone 
Tibial insert- replaces cartilage and acts as 
shock absorber 
Patella- replaces knee cap
Two major types of total knee replacement systems: 
Fixed Bearing- does not allow full range of motion 
Rotating Platform Bearing- closely simulates the 
action of the normal knee joint 
BENEfITS Of fIxEd BEARING KNEE JOINT REPLACEMENTS 
Provides pain relief. 
Restores the motion of your knee. 
Improves quality of life. 
Good results in appropriate patients 
ROTATING PLATfORM BEARING 
Provides pain relief. 
Restores the motion of your knee. 
Rotation similar to a normal knee. 
Reduces potential of early wear and 
loosening. 
Improves quality of life.
KNEE REPLACEMENT PROCEduRE
hIP JOINTS 
The hip is one of the body's largest 
joints. It is a ball-and-socket joint. 
The socket is formed by the 
acetabulum, which is part of the large 
pelvis bone. 
 The ball is the femoral head, which 
is the upper end of the femur 
(thighbone). 
The bone surfaces of the ball and 
socket are covered with articular 
cartilage, a smooth tissue that cushions 
the ends of the bones and enables 
them to move easily.
hIP JOINTS 
 A joint is formed by the 
ends of 2 or more bones. 
The hip must bear the full 
force of your weight and 
consists of two main 
parts: 
 A ball (femoral head) 
at the top of your thigh 
bone (femur) 
 A rounded socket 
(acetabulum) in your 
pelvis
CAuSES Of hIP JOINTS 
One of the most common causes of 
joint pain is arthritis. The most 
common types of arthritis are: 
Osteoarthritis (OA) 
Rheumatoid Arthritis (RA) 
Post-traumatic Arthritis 
Avascular Necrosis 
Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually 
occurs in people more than50 year old . The cartilage cushioning the bones of the 
hip wears away. The bones then rub against each other, causing hip pain and 
stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities 
in how the hip developed in childhood.
Rheumatoid arthritis. This is an autoimmune disease in which the synovial 
membrane becomes inflamed and thickened. This chronic inflammation can 
damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the 
most common type of a group of disorders termed "inflammatory arthritis 
Avascular necrosis. An injury to the hip, such as a dislocation or 
fracture, may limit the blood supply to the femoral head. This is called 
avascular necrosis. The lack of blood may cause the surface of the 
bone to collapse, and arthritis will result. Some diseases can also 
cause avascular necrosis. 
Post-traumatic arthritis. This can follow a serious hip injury or fracture. The 
cartilage may become damaged and lead to hip pain and stiffness over 
time.
TOTAL hIP REPLACEMENTS 
Hip replacement is a surgical procedure in which the hip joint is replaced 
by a prosthetic implant. Using metal alloys, high-grade plastics, and 
polymeric materials, orthopaedic surgeons can replace a painful, 
dysfunctional joint with a highly functional, long-lasting prosthesis. 
PROCEduRE 
The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the 
damaged cartilage and bone and then position new metal, plastic, or ceramic implants to 
restore the alignment and function of your hip.
hIP IMPLANTS 
Acetabular shell Acetabular shell 
Plastic insert 
Ceramic 
insert 
Metal 
femoral 
stem 
Ceramic 
femoral 
stem 
Femoral 
stem
Benefits of hip implants 
Reduced hip pain. 
Increased mobility and movement. 
Correction of deformity. 
Equalization of leg length (not guaranteed). 
Increased leg strength. 
Improved quality of life, ability to return to normal 
activities. 
Enables you to sleep without pain.
SPINE 
Each vertebra has two sets of facet joints. These spinal joints are called 
facet, apophyseal, or zygapophyseal joints . 
this joint are gliding joints and link vertebrae together. Facet joints are 
synovial joints surrounded by a capsule of collagenous tissue . 
the surface of synovial joints are coated with cartilage allowing joints for 
smooth motion. These joints allow flexion (bend forward) , extension (bend 
backward) and rotating or twisting motion. The spinal discs are located 
between pairs of vertebrae and it act as a shock absorbers and allow 
deformation of the spine.
normal function of the 
spine 
 Protect spinal cord and nerves 
 Support the body weight and 
external load 
 Stability 
 Allow motion of the body for various 
activities 
 Flexibility 
 
Cervical (7) 
Thoracic (12) 
Lumbar (5) 
Sacral 
(5)- 
fused
SPINAL INJURIES 
The nucleus pulposus is made of a gel like material mostly composed of 
collagen fibers, proteins and water makes up 90 % of the disc weight at birth 
but decreases to 70 % by age 50. excess disc bulging or complete herniation 
may takes place by injury or aging, allowing the disc materials to escape the 
disc. This will may compress the nerves or spinal cord, causing pain and the 
blood supply to the disc decreases ; some disc may degenerate. The disc 
begins to lose water and shrinks . The range of motion and shock-absorbing 
ability of the spine are decreased .this may result in damage to the nerve and 
vertebrae.
fleXion inJuries 
•Stable Injury 
•Affects Cervical, dorsal and Lumbar 
spine 
•Wedge -Superior Anterior of vertebra 
•Spinal cord injury unlikely 
hYpereXtension 
•Stable injury 
•Affects mainly cervical spine 
•Anterior Longitudinal Ligament damage ? 
Whiplash injury 
• possibly rupture of intervertebral disc may 
cause cord compression
compression inJurY 
•Stable injury 
•Affects cervical or lumbar spine 
•Retro pulsed bony fragment may 
compress the cord 
shearing inJurY 
Shearing = Tearing 
Usually with rotation 
Unstable 
Affects any segment of the spine 
Leads to Dislocation or Dislocation 
Spinal cord injury is common
spinal implant materials 
 316L Stainless steel: 
 Biocompatible 
 Strong and stiff 
 Poor imaging compatibility: artifact to CT and MRI 
 Titanium Alloy (Ti6Al4V ELI): 
 Biocompatible 
 No artifacts during CT and MRI 
 Excellent fatigue strength, high strength, high elasticity 
 High resistance to fretting corrosion and wear (surface 
treatments)
spinal instrumentation 
 Goals of Spinal Instrumentation: 
 Correction of deformities or misaligned segments; 
 Enhancement of solid fusion; 
 Maintain anatomic alignment until a solid fusion takes place; and 
 Allow early mobilization of patients 
 by providing an immediate stability 
cervical spine instrumentation
thoracolumBar spine 
instrumentation 
Z-plate (Danek) Kaneda (AcroMed)
spinal fiXation device
factors in spinal instrumentation 
 Materials: 
 Bio-compatibility and Imaging compatibility 
 Stiffness (or elasticity) and strength 
 Corrosion 
 Implant Strength: 
 Component (screw, rod, plate, wire, etc.) strength 
 Metal-metal interface strength 
 Construct strength 
 Bone-metal interface strength: Bone–wire, -hook, and -screws 
 Construct Stability: 
 Segmental stiffness or flexibility 
 Profile: 
 Ease of Use:
anKle Joint replacements 
 The ankle joint is made up of three bones: the lower end of 
the tibia(shinbone), the fibula (the small bone of the lower leg), and 
the talus, the bone that fits into the socket formed by the tibia and 
fibula. The talus sits on top of the calcaneus (the heelbone). The talus 
moves mainly in one direction. It works like a hinge to allow your foot to 
move up and down 
The large Achilles tendon at the back of the ankle is 
the most powerful tendon in the foot. It connects the 
calf muscles to the heelbone and gives the foot the 
power for walking, running, and jumping.
Certain movements may cause a grinding or catching 
sensation as the arthritic bone surfaces move against one 
another. The ankle joint may swell. This swelling cause 
problems in the ankles 
The benefit of an artificial joint is to ease the symptoms 
of ankle osteoarthritis 
surgical procedure 
The Artificial Ankle 
Each artificial ankle prosthesis is made of two parts: 
The tibial component is the part of the artificial joint 
that replaces the socket portion of the ankle (the top 
section). 
The talus component replaces the top of the talus.
Ankle Joint ReplAcement 
The tibial component is usually made up of two parts: a 
flat metal piece called a metal tray that is attached directly 
to the tibia bone, and a plastic cup that fits onto the metal 
piece, forming a socket for the artificial ankle joint. The 
talus component is made of metal and fits into the socket 
of the tibial component. 
The main advantage of an ankle transplant replacement is 
the potential for replacement of the entire ankle joint with 
viable living cartilage cells.
ShouldeR Joint ReplAcementS 
 The major shoulder joint motion originates from the ball-and-socket 
articulation of the glenohumeral joint. 
 The hemispherical , incongruent joint provides the largest motion in 
the body
shoulder is made up of three bones: your upper arm bone 
(humerus), your shoulder blade (scapula), and your collarbone 
(clavicle). The shoulder is a ball-and-socket joint: The ball, or head, 
of your upper arm bone fits into a shallow socket in your shoulder 
blade. This socket is called the glenoid. 
the surfaces of the bones where they touch are covered with articular cartilage, a 
smooth substance that protects the bones and enables them to move easily. A 
thin, smooth tissue called synovial membrane covers all remaining surfaces 
inside the shoulder joint. In a healthy shoulder, this membrane makes a small 
amount of fluid that lubricates the cartilage and eliminates almost any friction in 
your shoulder. 
The muscles and tendons that surround 
the shoulder provide stability and support.
SuRgicAl pRoceduRe 
The surgeon begins by separating the deltoid and pectoral muscles, 
accessing the shoulder in a largely nerve-free area to minimize nerve 
damage. The shoulder is covered by the rotator cuff, which must be 
opened by cutting one of the anterior (front) rotator cuff muscles. This 
“opens the door,” allowing the surgeon to view and manipulate the 
arthritic parts of the shoulder ball and socket. 
After the arthritic sections have been removed, the surgeon inserts the 
implant socket, ball, and stem components, closes and stitches the 
rotator cuff muscle, and stitches and cleans the incision, after which a 
bandage is applied as a temporary covering.
FRActuRe plAteS 
A bone fracture is a medical condition in which there is a break in 
the continuity of the bone. A bone fracture can be the result of high 
force impact or stress, or trivial injury as a result of certain medical 
conditions that weaken the bones, such as osteoporosis, bone 
cancer, or osteogenesis imperfecta, where the fracture is then 
properly termed a pathologic fracture.
Bone plates are surgical tools, which are used to assist in the 
healing of broken and fractured bones 
Currently osteotemy equipment is made primarily of titanium 
and stainless steel. The broken bones are first surgically reset into 
their proper position. Then a plate is screwed onto the broken 
bones to hold them in place, while the bone heals back together. 
Bone plates can also be fabricated using shape 
memory alloys, in particular nickel titanium 
Traumatic fracture - This is a fracture due to 
sustained trauma. e.g.- Fractures caused by a fall, 
road traffic accident, fight etc. 
Pathological fracture - A fracture through a bone 
which has been made weak by some underlying 
disease is called pathological fracture. e.g.- a 
fracture through a bone weakened by metastasis. 
Osteoporosis is the most common cause of 
pathological fracture.
tYpeS oF FRActuReS 
 Type I Fractures 
These fractures break through the bone at the growth plate, separating 
the bone end from the bone shaft and completely disrupting the growth 
plate. 
 Type II Fractures 
These fractures break through part of the bone at the growth plate and 
crack through the bone shaft as well. 
 Type III Fractures 
These fractures cross through a portion of the growth plate and break 
off a piece of the bone end. 
 Type IV Fractures 
These fractures break through the bone shaft, the growth plate, and the 
end of the bone. 
 Type V Fractures 
These fractures occur due to a crushing injury to the growth plate from 
a compression force. They are rare fractures.
tYpe oF plAteS 
Plates are some of the most common general purpose fixation devices. 
They contain holes for screws and pins that are used to fix the plate to intact 
bone and to fractures 
For simple fractures of long bones, screws are often used to reduce the 
fractures and apply compression to the fracture site (lag screws). These 
screws, however, withstand external compressive and bending forces . 
Plates that span the fracture site and reduced the fracture are called 
neutralization plates .since they resist or neutralize external forces at the 
fracture site protecting the lag screw fixation.
A compression plate is most commonly used with diaphyseal fractures of 
the long bones. The geometry of its screw holes allows compression of a 
fracture spanned by the plate as the screw head contacts the plate during 
insertion 
Reconstruction plates are flexible and can be cut to length to fit irregular 
surfaces. They are used primarily for fractures of the pelvis 
Blade plates are used for fractures of the condylar regions of the long bones. They 
are simpler alternative devices that can be used in place of a plate with a separate 
condylar screw. 
The LISS (Less Invasive Stabilization System) plate is a recently introduced type 
of plate that is a modification of the standard compression plate used for long bone 
fracture
SCREWS
LAG SCREW FIXATION 
Screw compresses both sides of fix together 
•Best form of compression 
•Poor shear, bending, and rotational force ,resistance 
Partially-threaded screw (lag by design) 
Fully-threaded screw (lag by technique) 
• Step One: Gliding hole = drill outer thread diameter of screw & 
perpendicular to fix 
• Step Two: Pilot hole= Guide sleeve in gliding hole & drill far 
cortex = to the core diameter of the screw
Step Three: counter sink near cortex so screw head will sit flush 
Step Four: screw inserted and glides through the near cortex & 
engages the far cortex which compresses the fix when the screw 
head engages the near cortex
thAnk You

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Ortho appns

  • 1.
  • 2.  An orthopedic implant is a medical device manufactured to replace a missing joint or bone or to support a damaged bone.  Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone.  Among the most common types of medical implants are the pins, rods, screws and plates used to anchor fractured bones while they heal.
  • 3. The material used in orthopedic implants must be biocompatible to avoid rejection by the body. Other risks associated with orthopedic implants include implants coming loose or breaking in the bone causing painful inflammation and infection to surrounding tissue.
  • 4. Bone is anisotropic - its modulus is dependent upon the direction of loading. Bone is weakest in shear, then tension, then compression. Bone is viscoelastic: its force-deformation characteristics are dependent upon the rate of loading. BONE PROPERTIES Density – 2.3g/cm3 Tensile Strength – 3-20MPa Compressive Strength – 15,000 psi Shear Strength – 4,000 psi Young’s Modulus – 10-40 MPa
  • 5. ORTHOPEDIC TERMS Osteoinductive – Characteristic in materials that promote new bone growth. Bioresorbable – The ability of a material to be entirely adsorbed by the body. Osteoconductive – The property of a material that allows for the possible integration of new bone with the host bone. Trochanter The second segment of the leg, after the coxa and before the femur
  • 6. MATERIAL USED Composite Metal :rough& polished Polymer Ceramics
  • 7. An orthopedic hip implant, exhibiting the use of all three classes of biomaterials: metals, ceramics and polymers.  In this case, the stem, which is implanted in the femur, is made with a metallic biomaterial.  The implant may be coated with a ceramic to improve attachment to the bone, or a polymeric cement. At the top of the hip stem is a ball (metal or ceramic) that works in conjunction with the corresponding socket to facilitate motion in the joint.  The corresponding inner socket is made of either a polymer (for a metallic ball) or ceramic (for a ceramic ball) and attached to the pelvis by a metallic socket.
  • 8. VARIOUS fIxATION METHODS (a) direct interference or (passive) noninterference fit; (b) mechanical fixation using screws, bolts, nuts, wires, etc.; (c) bone cement; (d) porous in growth (biological) fixation; (e) direct chemical bonding using adhesives or after coating with direct bonding material layer; (f) bone cement with resorbable particles; (g) porous in growth controlled by using electrical or electromagnetic stimulation
  • 9. BONE CEMENT Used to fill gaps between bone and implant •PMMA homopolymer •MMA/styrene copolymer •MMA/methyl acrylate copolymer Poly methylmethacrylate (PMMA) bone cement: made from methylmethacrylate, poly methylmethacrylate, esters of meth acrylic acid, or copolymers containing poly methylmethacrylate and polystyrene Stable interface between metal and bone
  • 10. COMPOSITION Of A METHACRyLIC CEMENT
  • 11. PROPERTIES OF BONE CEMENT Bone cement is supplied as two separate components, a polymer powder and a monomer, which is a colourless and inflammable liquid. The powder consists of a spherical polymer, an initiator(dibenzoyl peroxide), a radio pacifier (zirconium oxide or Barium sulphate) and often an antibiotic. As the powdered polymer and liquid monomer are mixed, a viscous dough is formed. Free radicals initiate the polymerization This process is exothermic, with a maximum in vivo temperature of 40° to 47°C and this thermal energy is dissipated into the circulating blood, the prosthesis and the surrounding tissue 18 as the cement cures The chemical composition, the powder to liquid ratio and the cement temperature in turn determine the viscosity. There are high viscosity and low viscosity cement types. High viscosity bone cements have a short wetting phase and a longer working phase. Low viscosity cements have a longer wetting phase and a shorter working phase.
  • 12. LIMITATIONS Inherently weak Stronger in compression than tension Weakest in shear Exothermic reaction May lead to bone necrosis By handling improperly or less than optimally Weaker Extra care should be taken to Keep debris out of the cement mantle (e.g., blood, fat) Make uniform cement mantle of several mm Minimize voids in the cement : mixing technique Pressurize
  • 13. KNEE AND ITS INjURIES
  • 14. JOINT REPLACEMENTS  The hip and shoulder joints have a ball and socket articulation, while other joints such as the knee and elbow have a hinge-type articulation  They all possess to opposing smooth cartilaginous articular surfaces that are lubricated by viscous synovial fluid.  This fluid is made up of polysaccharides that adhere to the cartilage and upon loading can be permeated out onto to the surface to reduce friction.  The cartilage is not vascularized , and nutrition of the tissues appears to be a diffusional process.  The articulation of the joints is stabilized by the body s coordination of the ligaments, tendons, and muscles.
  • 15. Most femoral head replacements are made with installation of an acetabular cup. This is called total hip joint replacement (arthroplasty). The diseased femoral part head is cut off, and the medullary canal of the femur is drilled and reamed to prepare it for the stem of the prosthesis. The cartilage of the acetabulam is also reamed. The PMMA bone cement is prepared from polymer powder and monomer liquid. It is packed into the medullary canal of the femur and the femoral stem is inserted. The acetabular component is similarly cemented. The alignment and articulation of the artificial ball- and-socket joint are then verified. UHMWPE and cross linked UHMWPE for the cup and stainless steel and Ti-based alloys used for femoral head and stem.
  • 16. KNEE JOINT REPLACEMENTS  The development and acceptance of knee joint prosthesis have been slower than that of the hip joint due to the knees more complicated geometry and biomechanics of movement, and lesser stability in comparison with the hip.  It can be classified into hinged and non hinged type and it is further divided into uni – and biocompartmental. ANATOMy Of ThE KNEE Made up of 3 bones •Femur (thigh bone) •Tibia (lower leg bone) •Patella (kneecap)
  • 17. CAuSES Of KNEE PAIN •Osteoarthritis (wear and tear) •Rheumatoid arthritis •Post-traumatic arthritis caused by: •Fractures •Ligament injuries •Meniscus tears GOALS Of TOTAL JOINT REPLACEMENT ARE TO hELP: Relieve pain Restore motion Improve function Improve fitness and health Restore quality of life
  • 18. TOTAL KNEE REPLACEMENT •Partial knee replacement (unicompartmental) – Replacement of one or two parts of knee instead of total. – Retain more of patient natural knee. • Total knee replacement – Resurfaces the bones (tibia and femur) with an implant made of metal and plastic parts. – Medical-grade plastic spacer providing a smooth surface as cartilage Femoral- replaces arthritic portion of thigh bone Tibial- replaces arthritic portion of shin bone Tibial insert- replaces cartilage and acts as shock absorber Patella- replaces knee cap
  • 19. Two major types of total knee replacement systems: Fixed Bearing- does not allow full range of motion Rotating Platform Bearing- closely simulates the action of the normal knee joint BENEfITS Of fIxEd BEARING KNEE JOINT REPLACEMENTS Provides pain relief. Restores the motion of your knee. Improves quality of life. Good results in appropriate patients ROTATING PLATfORM BEARING Provides pain relief. Restores the motion of your knee. Rotation similar to a normal knee. Reduces potential of early wear and loosening. Improves quality of life.
  • 21. hIP JOINTS The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone.  The ball is the femoral head, which is the upper end of the femur (thighbone). The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.
  • 22. hIP JOINTS  A joint is formed by the ends of 2 or more bones. The hip must bear the full force of your weight and consists of two main parts:  A ball (femoral head) at the top of your thigh bone (femur)  A rounded socket (acetabulum) in your pelvis
  • 23. CAuSES Of hIP JOINTS One of the most common causes of joint pain is arthritis. The most common types of arthritis are: Osteoarthritis (OA) Rheumatoid Arthritis (RA) Post-traumatic Arthritis Avascular Necrosis Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people more than50 year old . The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
  • 24. Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis. Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
  • 25. TOTAL hIP REPLACEMENTS Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Using metal alloys, high-grade plastics, and polymeric materials, orthopaedic surgeons can replace a painful, dysfunctional joint with a highly functional, long-lasting prosthesis. PROCEduRE The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.
  • 26. hIP IMPLANTS Acetabular shell Acetabular shell Plastic insert Ceramic insert Metal femoral stem Ceramic femoral stem Femoral stem
  • 27. Benefits of hip implants Reduced hip pain. Increased mobility and movement. Correction of deformity. Equalization of leg length (not guaranteed). Increased leg strength. Improved quality of life, ability to return to normal activities. Enables you to sleep without pain.
  • 28. SPINE Each vertebra has two sets of facet joints. These spinal joints are called facet, apophyseal, or zygapophyseal joints . this joint are gliding joints and link vertebrae together. Facet joints are synovial joints surrounded by a capsule of collagenous tissue . the surface of synovial joints are coated with cartilage allowing joints for smooth motion. These joints allow flexion (bend forward) , extension (bend backward) and rotating or twisting motion. The spinal discs are located between pairs of vertebrae and it act as a shock absorbers and allow deformation of the spine.
  • 29. normal function of the spine  Protect spinal cord and nerves  Support the body weight and external load  Stability  Allow motion of the body for various activities  Flexibility  Cervical (7) Thoracic (12) Lumbar (5) Sacral (5)- fused
  • 30. SPINAL INJURIES The nucleus pulposus is made of a gel like material mostly composed of collagen fibers, proteins and water makes up 90 % of the disc weight at birth but decreases to 70 % by age 50. excess disc bulging or complete herniation may takes place by injury or aging, allowing the disc materials to escape the disc. This will may compress the nerves or spinal cord, causing pain and the blood supply to the disc decreases ; some disc may degenerate. The disc begins to lose water and shrinks . The range of motion and shock-absorbing ability of the spine are decreased .this may result in damage to the nerve and vertebrae.
  • 31. fleXion inJuries •Stable Injury •Affects Cervical, dorsal and Lumbar spine •Wedge -Superior Anterior of vertebra •Spinal cord injury unlikely hYpereXtension •Stable injury •Affects mainly cervical spine •Anterior Longitudinal Ligament damage ? Whiplash injury • possibly rupture of intervertebral disc may cause cord compression
  • 32. compression inJurY •Stable injury •Affects cervical or lumbar spine •Retro pulsed bony fragment may compress the cord shearing inJurY Shearing = Tearing Usually with rotation Unstable Affects any segment of the spine Leads to Dislocation or Dislocation Spinal cord injury is common
  • 33. spinal implant materials  316L Stainless steel:  Biocompatible  Strong and stiff  Poor imaging compatibility: artifact to CT and MRI  Titanium Alloy (Ti6Al4V ELI):  Biocompatible  No artifacts during CT and MRI  Excellent fatigue strength, high strength, high elasticity  High resistance to fretting corrosion and wear (surface treatments)
  • 34. spinal instrumentation  Goals of Spinal Instrumentation:  Correction of deformities or misaligned segments;  Enhancement of solid fusion;  Maintain anatomic alignment until a solid fusion takes place; and  Allow early mobilization of patients  by providing an immediate stability cervical spine instrumentation
  • 35. thoracolumBar spine instrumentation Z-plate (Danek) Kaneda (AcroMed)
  • 37. factors in spinal instrumentation  Materials:  Bio-compatibility and Imaging compatibility  Stiffness (or elasticity) and strength  Corrosion  Implant Strength:  Component (screw, rod, plate, wire, etc.) strength  Metal-metal interface strength  Construct strength  Bone-metal interface strength: Bone–wire, -hook, and -screws  Construct Stability:  Segmental stiffness or flexibility  Profile:  Ease of Use:
  • 38. anKle Joint replacements  The ankle joint is made up of three bones: the lower end of the tibia(shinbone), the fibula (the small bone of the lower leg), and the talus, the bone that fits into the socket formed by the tibia and fibula. The talus sits on top of the calcaneus (the heelbone). The talus moves mainly in one direction. It works like a hinge to allow your foot to move up and down The large Achilles tendon at the back of the ankle is the most powerful tendon in the foot. It connects the calf muscles to the heelbone and gives the foot the power for walking, running, and jumping.
  • 39. Certain movements may cause a grinding or catching sensation as the arthritic bone surfaces move against one another. The ankle joint may swell. This swelling cause problems in the ankles The benefit of an artificial joint is to ease the symptoms of ankle osteoarthritis surgical procedure The Artificial Ankle Each artificial ankle prosthesis is made of two parts: The tibial component is the part of the artificial joint that replaces the socket portion of the ankle (the top section). The talus component replaces the top of the talus.
  • 40. Ankle Joint ReplAcement The tibial component is usually made up of two parts: a flat metal piece called a metal tray that is attached directly to the tibia bone, and a plastic cup that fits onto the metal piece, forming a socket for the artificial ankle joint. The talus component is made of metal and fits into the socket of the tibial component. The main advantage of an ankle transplant replacement is the potential for replacement of the entire ankle joint with viable living cartilage cells.
  • 41. ShouldeR Joint ReplAcementS  The major shoulder joint motion originates from the ball-and-socket articulation of the glenohumeral joint.  The hemispherical , incongruent joint provides the largest motion in the body
  • 42. shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid. the surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder. The muscles and tendons that surround the shoulder provide stability and support.
  • 43. SuRgicAl pRoceduRe The surgeon begins by separating the deltoid and pectoral muscles, accessing the shoulder in a largely nerve-free area to minimize nerve damage. The shoulder is covered by the rotator cuff, which must be opened by cutting one of the anterior (front) rotator cuff muscles. This “opens the door,” allowing the surgeon to view and manipulate the arthritic parts of the shoulder ball and socket. After the arthritic sections have been removed, the surgeon inserts the implant socket, ball, and stem components, closes and stitches the rotator cuff muscle, and stitches and cleans the incision, after which a bandage is applied as a temporary covering.
  • 44. FRActuRe plAteS A bone fracture is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.
  • 45. Bone plates are surgical tools, which are used to assist in the healing of broken and fractured bones Currently osteotemy equipment is made primarily of titanium and stainless steel. The broken bones are first surgically reset into their proper position. Then a plate is screwed onto the broken bones to hold them in place, while the bone heals back together. Bone plates can also be fabricated using shape memory alloys, in particular nickel titanium Traumatic fracture - This is a fracture due to sustained trauma. e.g.- Fractures caused by a fall, road traffic accident, fight etc. Pathological fracture - A fracture through a bone which has been made weak by some underlying disease is called pathological fracture. e.g.- a fracture through a bone weakened by metastasis. Osteoporosis is the most common cause of pathological fracture.
  • 46. tYpeS oF FRActuReS  Type I Fractures These fractures break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate.  Type II Fractures These fractures break through part of the bone at the growth plate and crack through the bone shaft as well.  Type III Fractures These fractures cross through a portion of the growth plate and break off a piece of the bone end.  Type IV Fractures These fractures break through the bone shaft, the growth plate, and the end of the bone.  Type V Fractures These fractures occur due to a crushing injury to the growth plate from a compression force. They are rare fractures.
  • 47. tYpe oF plAteS Plates are some of the most common general purpose fixation devices. They contain holes for screws and pins that are used to fix the plate to intact bone and to fractures For simple fractures of long bones, screws are often used to reduce the fractures and apply compression to the fracture site (lag screws). These screws, however, withstand external compressive and bending forces . Plates that span the fracture site and reduced the fracture are called neutralization plates .since they resist or neutralize external forces at the fracture site protecting the lag screw fixation.
  • 48. A compression plate is most commonly used with diaphyseal fractures of the long bones. The geometry of its screw holes allows compression of a fracture spanned by the plate as the screw head contacts the plate during insertion Reconstruction plates are flexible and can be cut to length to fit irregular surfaces. They are used primarily for fractures of the pelvis Blade plates are used for fractures of the condylar regions of the long bones. They are simpler alternative devices that can be used in place of a plate with a separate condylar screw. The LISS (Less Invasive Stabilization System) plate is a recently introduced type of plate that is a modification of the standard compression plate used for long bone fracture
  • 50. LAG SCREW FIXATION Screw compresses both sides of fix together •Best form of compression •Poor shear, bending, and rotational force ,resistance Partially-threaded screw (lag by design) Fully-threaded screw (lag by technique) • Step One: Gliding hole = drill outer thread diameter of screw & perpendicular to fix • Step Two: Pilot hole= Guide sleeve in gliding hole & drill far cortex = to the core diameter of the screw
  • 51. Step Three: counter sink near cortex so screw head will sit flush Step Four: screw inserted and glides through the near cortex & engages the far cortex which compresses the fix when the screw head engages the near cortex