position

Results 

90% fusion rates

Lose70% sagittal plane ROM

Disadvantages of Arthrodesis 

Non union rates up to 12%

Decreased gait speed

Poor mobility over uneven surfaces

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

Indications

Very few

- young labourer with severe disabling elbow pain

- trial in POP at 90^o for 6 weeks

Poor function

- adjacent joints cannot compensate for loss of function

Contraindications

RA

- high failure rate especially flail elbow with poor bone stock

Indications

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

Aims of arthrodesis

Maximise bony contact

Minimise shortening

Indication

Diagnostic

Pain / Stiffness / Locking

Instability

- exclude OCD

Assess syndesmosis

Therapeutic

Synovitis

Osseous lesions / Tibiotalar impingement spurs

Osteochondral defects

Via the carotid triangle

SCM / posterior belly digastric / superior belly omohyoid

Indication

Exposes inferior body C2 - T1

Position

1.  Supine in tongs

2.  Sit on head board with head taped and slightly extended

Table 30° up

Turn head away from side of incision

Which Side