Use of the spider limb positioner in oncologic lower extremity surgery

Abstract

Orthopedic extremity surgery presents a unique set of restraints and difficulties relative to other surgical specialties. Among these is the positioning of heavy limbs in sometimes awkward positions for long periods of time. Ideal positioning of an extremity allows accurate and precise surgery to occur at otherwise difficult to access joints and proximal bones and soft tissues. Numerous solutions to this problem have been proposed, one such solution is the Smith and Nephew Spider Limb Positioning System. The table-mounted pneumatic arm features three fully articulating joints and a simple repositioning mechanism. Classic uses of the Spider Limb Positioner System include shoulder and elbow surgery, total knee replacement and ankle procedures. In our institution, the Spider Limb Positioner is used primarily for shoulder arthroscopy and total shoulder arthroplasty. In addition, we have had success using the system for orthopedic oncology cases. This manuscript addresses the conventional as well as unconventional uses implemented at our institution. Limb positioning in orthopedics provides a unique challenge for prepping, draping and surgery. The use of positioning aids can improve exposure, decrease contamination and reduce the risk of surgeon strain. Our institution has developed a solution to positioning of heavy lower limbs for hip disarticulation via the Smith and Nephew ‘Spider’. This pneumatic, full articulating device used primarily for shoulder surgery can be modified to allow lower extremity use in the setting of hip disarticulation. This paper describes the standard and novel use of this device.

Keywords::

• ‘hip disarticulation’
• ‘spider limb positioner’
• positioning

Financial & competing interests disclosure

This work was performed at Dartmouth-Hitchcock Medical Center. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Positioning of extremities for orthopedic surgery provides a unique set of constraints, which may lead to surgeon fatigue or requirement of additional surgical personnel.

• The Spider Limb Positioning System from Smith and Nephew is a pneumatic arm with three fully articulating joints, which move freely and lock rigidly with simple and sterile pedal operation.

• The Spider Limb Positioning System is typically used for shoulder surgery and can hold a limb up to 50 lbs.

• During hip disarticulation, the heavy, lower extremity, is held in multiple positions for long periods of time to allow visualization of neurovascular structures. We have utilized the Spider Limb Positioning System in an unconventional manner to allow lower limb positioning during hip disarticulation for metastatic melanoma confined to the lower extremity.

• The Spider Limb Positioning System lacks a dedicated lower extremity positioner attachment. We have found utility in application of a short leg cast that incorporates the lower limb and the upper extremity Spider attachment.

• We have found that utilization of the system has allowed for lower fatigue, improved exposure and a lower blood loss compared with customary, surgical assistant-based techniques.