Joint Replacement Procedures and Soft Tissue Repair Procedures

Orthopedics

is the branch of surgery concerned with conditions involving the musculoskeletal system.

Repair, Reattachment, Reconstruction, Stabilization, Replacement, Realignment, Transfer, Release, Resection, Fixation, Fusion

11 Classification of Orthopedics

Repair

Example of Procedure: Tenorraphy

Repair

Example of Procedure: Meniscus Repair

Release

Example of Procedure: Capsulotomy

Release

Example of Procedure: Muscle-Tendon Lengthening

Resection

Example of Procedure: Synovectomy

Resection

Example of Procedure: Meniscectomy

Realignment

Example of Procedure: Capsulorrhaphy

Realignment

Example of Procedure: Osteotomy

Reconstruction

Example of Procedure: Tenoplasty

Reconstruction

Example of Procedure: Chondroplasty

Fusion

Example of Procedure: Arthrodesis

Fusion

Example of Procedure: ORIF

Muscle Repair

� Causes:

�Complete tear or rupture of a muscle

�May occur if a muscle that is already in a state of contraction

� Takes a direct blow or is forcibly stretched

Tendon Repair

� Causes:

�Young: it is usually the result of severe trauma

�Elderly with a history of chronic impingement: progressive deterioration of a tendon coupled with a sudden, unusual motion

Reconstruction

Repair involves approximating and suturing the torn ligament

Capsulorrhaphy

using an arthroscopic or an open approach, a specific portion of the capsule is incised and tightened by overlapping and then suturing the redundant tissue.

Capsulolabral reconstruction

involves arthroscopic or open repair of a capsular lesion and labral tear by reattaching the labrum to the rim of the glenoid combined with stabilization of the capsule.

Electrothermally assisted capsulorrhaphy

assisted capsulorrhaphy, using an arthroscopic approach, thermal energy (laser or radiofrequency) is delivered to the capsule to shrink selective portions

Transfer and Realignment

Distal attachment of the muscle-tendon unit is removed from its bony insertion and reattached to a different bone, to a different location on the same bone, or to adjacent soft tissues

Synovectomy

Involves removal of the synovium (lining of the joint) in the presence of chronic joint inflammation

knee, elbow, wrist, and metacarpophalangeal (MCP) joints

�Synovectomy of a joint is usually performed using an arthroscopic approach and is most commonly performed on

Arthroscopic Débridement

Arthroscopic removal of fibrillated cartilage, unstable chondral flaps, and loose bodies (fragments of cartilage or bone) in a joint

abrasion chondroplasty and subchondral drilling

involves abrasion or drilling of an articular surface to the superficial layer of subchondral bone with a motorized, arthroscopic burr or drill.

Chondrocyte Transplantation

Is designed to stimulate growth of hyaline cartilage for repair of focal defects of articular cartilage and prevention of progressive deterioration of joint cartilage.

Osteochondral Autografts and Allografts

Involve transplantation of intact articular cartilage along with some underlying bone, resulting in a bone-to-bone graft

Arthroplasty

Any reconstructive joint procedure, with or without joint implant, designed to relieve pain and improve function.

Excision Arthroplasty

Also known as resection arthroplasty, involves removing periarticular bone from one or both articular surfaces

Interposition Arthroplasty

Essentially is biological resurfacing of a joint to provide a new articulating surface.

Total joint replacement procedures

involve resecting both affected articulating surfaces of a joint and replacing them with artificial components

Hemireplacement arthroplasty

involves resection and replacement of just one of the articulating surfaces of a joint

Arthrodesis

Surgical fusion of the surfaces of a joint

15-30 degrees of abduction and flexion and 45 degrees of IR

Optimal Position for Arthrodesis of the Shoulder Joint

Dominant Upper Ex: 70-90 degrees of flexion and midposition of the forearm
Non Dominant limb: more extension

Optimal Position for Arthrodesis of the Elbow

Slight Extension

Optimal Position for Arthrodesis of the Wrist

At 20 degrees of flexion

Optimal Position for Arthrodesis of the MCP of the Thumb

10-15 degrees of flexion

Optimal Position for Arthrodesis of the Hip

Tibiotalar Joint: 90 degrees
Subtalar Joint: Neutral to valgus

Optimal Position for Arthrodesis of the Ankle

Neutral

Optimal Position for Arthrodesis of the Spine

Osteotomy

The surgical cutting and realignment of bone—is an extra-articular procedure indicated for the management of impairments associated with a number of musculoskeletal disorders