SlideShare une entreprise Scribd logo
1  sur  79
Télécharger pour lire hors ligne
Austin Moore’s Prosthesis
         It’s Relevance Today




Vinod Naneria
Vi d N     i     Gi i h Y tik
                 Girish Yeotikar A j W dh
                                 Arjun Wadhwani    i
                   Consultants
           Department Of Orthopaedics
Choithram Hospital & Research Centre, Indore, India
Why AMP – Disput ?

•   Improper technique
•   Design of Implant
         g        p
•   Design of instruments
•   No long term data from Indian scene
•   THR – dominated
•   Failures / revisions – THR – Rethinking ?
Question?
• All successful long standing AMP develop
  hypertrophy of the bone all around.
• Osteolysis seen early in failed AMP within
  months.
• All successful l
              f l long standing THR d
                        t di        develop
                                         l
  some osteolysis of the bone.
• Osteolysis in THR seen late and damge
  becomes a problem
Answer
• Mechanical loading altering the
  mechanostat of bone after implant surgery
  decides the future of surgery
                         surgery.
• Proximal fixation at or above the level of
  lesser trochanter save the “disuse
                               disuse
  cancellization of cortical bone” in the
  calcar region
         region.
The philosophy
• Proximal fixation of the implant is crucial in
  the success of the surgery.
• A tight fixation gives mechanical stability
                                      stability,
  and allow the grafts in the fenestration to
  consolidate,
  consolidate making it a self locking
                            self-locking
  device.
• Thi prevents over-loading of calcar – no
  This          t      l di      fl
  subsidence, no loosening, no failure.
Mechanostat
• Frost HM Strain and other mechanical
          HM.
   influences on bone strength and
   maintenance.
   maintenance Curr Opin Orthop    Orthop.
   1997;8:60–70.
-----------------------------------------------------------
• Bone loading -           Bone strength
• Bone modeling – hypertrophy / normal
• Bone remodeling – hypotrophy / atrophy
                        g     yp       py          py
-----------------------------------------------------------
Amp Philosophy
Bone modeling by drifts
(A) An infant’s long bone with its original size
and shape shown i solid li
   dh         h     in lid line. T k
                                 To keep it shape
                                          its h
as it grows in length and diameter, modeling
drifts
d ift move it surfaces in tissue space as th
             its   f     i ti                 the
dashed lines suggest. Formation drifts make
and control new osteoblasts t build some
   d      tl         t bl t to b ild
surfaces. Resorption drifts make and control
new osteoclasts to remove bone from other
        t    l tt             b    f      th
surfaces.
A different drift pattern can correct the fracture
(B)
malunion in a child The cross-sectional view to the right
               child.      cross sectional
shows the endocortical as well as the periosteal drifts
that do the correction.

(C) How the drifts in B would move the whole segment
to the reader’s right. Changing the anatomy in that way
       reader s right
reduces the bone’s bending moments; it does not
eliminate bending but it does limit it Drifts are created
           bending,                 it.
when and where they are needed, and they include
capillaries, precursor and supporting cells, and some
wandering cells. They are multicellular entities in the
same sense as renal nephrons, and they usually act to
minimize peak b
  ii i         k bone strains
                        ti
Amp Philosophy
BMU – Renal Nephron

Bone remodeling BMUs. Top row: an activation event on a bone
surface at (A) makes a packet of bone resorption begin
(B),
(B) and then its osteoclasts are replaced by osteoblasts at (C)
                                                            (C).
The BMU makes and controls the new osteoclasts and
osteoblasts that do this. Second row: this emphasizes the
amounts of bone resorbed (E) and formed (F) by completed
BMUs. Third row: in these ‘‘BMU graphs’’ (G) shows a small
excess of formation over resorption. ( ) Equalized resorption and
                               p     (H) q              p
formation as on haversian surfaces and in ‘‘conservation-mode’’
remodeling.
BMU – Renal Nephron

(I) A net deficit of formation, as in disuse-mode
remodeling of endocortical and trabecular bone. Bottom
row: these ‘‘stair graphs’’ show the effects of a series of
BMUs of the kind immediately above on the local bone
‘‘bank.’’ BMUs are created when and where they are
  bank.
needed and include a capillary, precursor and supporting
cells, and some wandering cells. They are multicellular
entities in the same sense as renal.
Strain in Cemented stems
• Adaptive changes in the femur after
  implantation of an Austin Moore
  prosthesis
 SB Murphy, PS Walker and AL Schiller
 J Bone Joint Surg Am. 1984;66:437- 443.

• The calcar and proximal regions are
  understrained because much of the loads
  and moments are transferred to the bone
                           f
  around the distal half of the stem.
Un-cemented stems
          Un cemented
• The broad proximal collar provides good
  resistance to axial force, whereas the distal half
  of the stem may carry little axial load. The varus
  moment on the stem is counteracted by forces at
  the medial part of the calcar and the distal tip, in
  a more concentrated manner than in a
                  t td             th i
  cemented stem. The radiographic appearance
  around uncemented stems suggests bone
  hypertrophy in the whole proximal area,
  especially medially, and local thickening at a
     p      y        y,                      g
  point level with the tip of the prosthetic stem.
More than 1 300 Austin Moore
            1,300
hemiarthroplasties have been reviewed in the
literature,
literature with no reports of fracture of the
stem. Results from our finite-element analysis
indicate that with good calcar collar support
          that,          calcar-collar support,
the stresses in the stem are small because
the stem portion of the prosthesis and the
bone are uncoupled and, consequently, do not
share the resultant bending moment of the
head and abductor forces.
Calcar – Collar Support

If the stem is coupled to the bone so that the
resultant bending moment is shared, high stresses
in the stem are predicted; such stresses are
                 p         ;
inconsistent with the complete absence of fractures
of these prostheses. The results of the finite-
element analysis further showed that loss of calcar-
collar support with proximal fixation through the
fenestrations resulted in high stresses in the stem
and stress shielding of the proximal medial cortex.
Cl
           Calcar – C ll S
                    Collar Support
                                 t
The uncoupled prosthesis also may be modeled with
a free-body diagram as a three-force member loaded
at the head, stem tip, and in the proximal region. With
this model it can be shown that the reaction force of
     model,
the stem tip, and thus the peak bending stress in the
stem,
stem increases as calcar-collar support is decreased
                     calcar collar           decreased.
If there is no calcar-collar support, proximal support
must be provided by some combination of integration
                     y                           g
of bone in the fenestrations and wedging due to the
lateral-medial taper of the device..
Stresses on Stem

Stresses in the stem are largest when there is no
wedging, b t hi h stresses d
   di     but high t         develop i th
                                 l in the
cancellous bone in the fenestrations. When there
is wedging stresses in the stem can be low but
   wedging,                              low,
stresses in the supporting cancellous bone can
be high; additional proximal support through the
     g;             p           pp         g
fenestrations substantially reduces these bone
stresses
Stresses on Stem

. Ifreduced stresses in the
cancellous bone are indicative of a
stable device, these mechanisms
indicate that fractures of the Austin
Moore prosthesis have not occurred
in normally loaded hips because
load was transferred primarily either
through the collar or by wedging,
with additional support at th
  ith dditi     l      t t the
fenestrations
Painful AMP two primary reasons
        AMP-

• Inadequate Proximal Fixation
  – Loose Prosthesis
  –C l
    Calcar absorption
            b     ti
  – Subsidence of the prosthesis
  –LLoss of varus alignment i th canal
          f          li   t in the   l
• Acetabular cartilage erosion
Inadequate Proximal Fixation
• Not under our control
  – Elderly
  – Osteoporotic
  – Wide canal
• U d our control
  Under      tl
  – Faulty operative technique
  – Over reaming by improper Rasp
  – Improper selection of Implant
Effect of neck resection on torsional stability of cementless total hip replacement.

Whiteside LA White SE, McCarthy DS
          LA,      SE           DS.

Biomechanical Research Laboratory, St. Louis, Missouri, USA.

Loosening of the femoral component in total hip
arthroplasty commonly results from inadequate
resistance to torsional loads We evaluated 20 adult
                         loads.
human cadaver femora to determine the effect of
different neck-resection levels on torsional resistance of
          neck resection
the femoral component. All specimens were prepared for
fixation with the Impact modular total hip replacement.
Each femoral diaphysis was overreamed 2 mm to
achieve only proximal fixation. The specimens were then
divided into
di id d i t groups of fi and i l t were i
                      f five d implants        inserted
                                                     td
with the precision press-fit technique.
Without distal fixation, the femoral
component is highly dependent on p
    p            gy p                proximal
geometry for resistance to torsional loading.
Preserving the femoral neck p
           g                   provides an
effective means of resistance. Maintaining
the entire femoral neck most effectivelyy
reduces miromotion at low loads, but
maintaining the midshaft area of the femoral
            g
neck appears to most effectively control
micromotion at higher torsional loads.
                   g
Resection below the midshaft of the neck
markedly decreases the torsional load-
         y
bearing capacity of the proximal femur.
Primary positive calcar collar contact reduced the
                  calcar-collar
incidence of calcar resorption. Sufficient cementation
of the medullary canal significantly reduced the
incidence of calcar resorption, as did neutral and
valgus positioning of the femoral component.
Loosening of the acetabular component occurred
more often in the group with calcar resorption. Middle-
aged patients and men were more prone t develop
     d ti t       d                         to d   l
resorption of the calcar. Calcar resorption may be
influenced by surgical technique Alteration of the
                        technique.
operative technique is recommended, with emphasis
on correct valgus or neutral p
               g              position of the femoral
component, a positive calcar-collar contact, and
improved cementation
Proximal Fixation
                Tips T i k
                Ti & Tricks
•   Pre operative
    Pre-operative assessment of the Canal
                                        Canal.
•   Proper neck cut.
•   Avoid
    A id comminuting C l
                 i ti Calcar F   Femoris.
                                        i
•   Save at least 1cm of neck at Calcar
•   Insert canal finder from Piriformis Fossa
•   In wider canal avoid use of rasp
             canal,               rasp.
Proximal Fixation
              Tips T i k
              Ti & Tricks
• Select proper Implant which will fill the
  proximal femur without increasing
  comminution.
  comminution
• Use a artery forcep in the prosthesis
  proximal hole ( originally for extraction) for
                                 extraction),
  rotation control during insertion.
Proximal Fixation
                Tips T i k
                Ti & Tricks
• Impaction grafting:
  – The most important area is the medial side near
    calcar. Graft should be inserted when nearly half of
    the prosthesis has gone inside.
  – Fill the fenestrations of the prosthesis with bone
    grafts,
    grafts as the prosthesis advances in to the canal
                                                   canal.
  – The color of the implant should not over-hang on the
    calcar.
  – If done properly, it should rest on the neck and will
    compress the grafts.
Intra operative error during implantation of the
Intra-operative
uncemented Austin Moore prosthesis is relatively
common.
common The error rates between junior doctors
and consultants were not significantly different.
Austin Moore hemiarthroplasty is a technically
demanding operation; the prosthesis is difficult to
implant well
        well.
Greater selectivity should be exercised when
considering this prosthesis for management of
femoral neck fractures.
(1)Inadequate length of the neck remnant (≤12
   mm)-measured from the superior margin of the
   lesser trochanter to the resection margin at the
   calcar femorale If an inadequate neck
          femorale.
   remnant was identified on postoperative
   radiographs,
   radiographs the neck length from the lesser
   trochanter to the level of the fracture on
   preoperative radiographs was also measured
                                         measured.
(2) Inadequate calcar seating (>1 mm)-measured
from the medial prosthetic collar to calcar A
                                      calcar.
prosthesis collar seated on the medial calcar was
recorded as zero
             zero.
(3) Difference in prosthetic head size compared
with the contralateral normal femoral head using   g
circular overlays-a diameter of prosthesis up to 2
mm larger to account for articular cartilage was
        g                                  g
considered satisfactory. If the contralateral
femoral head was not suitable for analysis (due to
                                         y    (
disease or previous prosthetic replacement), the
ipsilateral femoral head on p p
 p                           preoperative
radiographs was used for assessment of the
appropriate p
  pp p        prosthetic head size.
(4) Intra-operative periprosthetic fracture- fracture
classification was conducted using the Vancouver
                                    g
system.
147 patients were treated with the unipolar
uncemented Austin Moore prostheses over the
time period: 128 (87%) had surgery performed by
relatively junior doctors 14% by senior medical
                  doctors-14%
officers, 57% by training registrars, and 17% by
principal house officers; 19 (13%) were
performed by a consultant surgeon.
84 errors in implantation were identified in 71
patients; only 76 (52%) had no errors in
implantation,
implantation while 52 (35%) had one error 17
                                        error,
(12%) had 2 errors, and
2 (1.4%) had 3 errors
  (1 4%)          errors.
1: Injury. 2002 Jun;33(5):419-22.
    Austin Moore hemiarthroplasty: technical aspects and their effects on outcome, in patients with fractures of the neck
                           p    y              p                                 ,p
    of femur.
           Parker MJ.
    Sharif KM,

    Orthopaedic Department, Peterborough District Hospital, Peterborough PE3 6DA,
     UK. khalidsharif@doctors.org.uk
                      @            g
    In order to determine which technical aspects of the Austin Moore hemiarthroplasty
     procedure affect the outcome, we reviewed 243 patients with a non-pathological
     intracapsular femoral neck fracture who had, Austin Moore uncemented
    hemiarthroplasty The immediate post operative X rays were assessed for
    hemiarthroplasty.                  post-operative X-rays
    alignment of the prosthetic stem, calcar seating, length of the neck remnant,
    leg length discrepancy and size of the head, compared with the contralateral femur.
     All patients were followed-up for 1 year. Significant pain at 1 year and/or revision
    of the prosthesis for loosening were considered as unfavourable outcomes.
    Inadequate calcar seating was significantly associated with pain and revision
    of the prosthesis (P = 0.04 and 0.01, respectively). Length of the neck remnant
    was also significantly associated with these two outcomes (P = 0 05 and 0 023
                                                                       0.05      0.023,
    respectively). Difference in head size was associated with pain, but not with
    loosening (P = 0.01 and 0.08, respectively). The rest of the parameters were not
    significantly associated with the outcome. We recommend that when inserting an
    Austin Moore hemiarthroplasty, particular attention must be paid to the seating of
    the collar of the prosthesis on the calcar and correct choice of head size.
Injury. 2004 Oct;35(10):1020-4.
    C t ca ad o og ca a a ys s a te ust
    Critical radiological analysis after Austin Moore hemiarthroplasty.
                                                 oo e e a t op asty
    Yau WP, Chiu KY.
    Department of Orthopaedic Surgery, The University of Hong Kong, Queen Mary
     Hospital, No. 102, Pokfulam Road, Hong Kong, PR China. peterwpy@hkucc.hku.hk
    The aim of this study is to investigate the causes of prosthesis loosening in patients
     treated with Austin Moore hemiarthroplasty (AMA). The clinical and radiological
    outcomes were documented in a quantitative manner after 7 years follow-up of 144
     patients. At the time of final follow-up, 52 patients had died and 48 patients were lost
     to follow-up, leaving a total of 44 patients for analysis. Immediate post-operative
    X-rays were studied for the initial alignment of prosthesis, the fit of the prosthesis
    and the degree of osteoporosis. X-rays on latest follow-up were studied for evidence
    of loosening. All patients were assessed clinically with the hip score of hospital for
       loosening
    special surgery. It was found that hip pain was significantly related to subsidence
    and pivoting of the prosthesis (P = 0.014 and 0.035, respectively).
    Significant increase in subsidence was noted if the stem of prosthesis was not fitting
    well within the shaft of femur (P = 0.006). When the patient was younger than
    73 years old at the time of operation, there was more subsidence of the prosthesis at
     the final follow-up (P = 0.001). It was concluded that the fill of AMA within the shaft
    of femur should be greater than 70% to avoid early loosening Relatively younger
                                                            loosening.
    patients with acute fracture of the neck of femur should be treated by methods other
    than cementless AMA.
•Injury. 2004 Oct;35(10):1020-4.
Critical radiological analysis after Austin Moore hemiarthroplasty.
 Yau WP, Chiu KY
It was concluded th t th fill of AMA within th shaft of
             l d d that the    f      ithi the h ft f
femur should be greater than 70% to avoid early
loosening.
loosening Relatively younger patients with acute
fracture of the neck of femur should be treated by
methods other than cementless AMA.
•Injury. 2002 Jun;33(5):419-22.
Austin Moore hemiarthroplasty: technical aspects and their effects on outcome, in
patients with fractures of the neck of femur.
 Sharif KM, Parker MJ.
 Sh if KM P k MJ
Inadequate calcar seating was significantly associated
with pain and revision of the p
     p                        prosthesis ( = 0.04 and
                                         (P
0.01, respectively). Length of the neck remnant was also
significantly associated with these two outcomes (P =
0.05 and 0.023, respectively). Difference in head size
was associated with pain, but not with loosening
J Trauma. 2001 Jul;51(1):84-7.
The effect of intramedullary corticocancellous bone plug for hip hemiarthroplasty.
Kligman M, Zecevic M, Roffman M.


Application of a corticocancellous bone plug in uncemented
hip hemiarthroplasty for treatment of femoral neck fractures
  p            p    y
can decrease the incidence of early thigh pain in the first 6
months.

Scand J Surg. 2002;91(4):357-60.
The long-term results of Lubinus interplanta hemiarthroplasty in 228 acute femoral neck
fractures. A retrospective six-year f ll
ft             t      ti    i       follow-up.
Isotalo K, Rantanen J, Aärimaa V, Gullichsen E.


The Lubinus prosthesis has a greater CCD (caput collum
                                           (caput,collum,
diaphyse) angle and a longer stem compared to Thompson and
Moore implants. The need for resection of calcar cortex is also
limited. These biomechanical facts may explain the good long-
term results of Lubinus hemiarthroplasty.
Amp Philosophy
Loading of the calcar leading to Neck over hang & absorption
Impaction Grafting
                 Reinforcement of the
                 Calcar Femoris




After One year
                     Day One
Three Point Fixation
                       Tight Femoral Canal
Proximal Fixation




10 years follow up came with # Tr
                               Tr.
Proximal Fixation




                    14 years PO




                    Broken stem
                    Not a Failure
Proximal Fixation
Broken Stem –
Not a Failure
20 years FU
   y
Bone in the fenestration




A broken stem is not a failure
Too Much Valgus   Too Mush Varus
Subsidence
S b id
No proximal Fixation
Subsidence
Amp Philosophy
Amp Philosophy
Ideal Prosthesis Fitting
F moderately wide canal
For    d       l id        l
1.Correct offset
2 Correct sitting over calcar
2.Correct
3. Correct Varus setting
4. Three point fixation
         p




For Narrow canal the junction
below the fenestrations is too much
angulated,
angulated Needs a straight stem
Amp Philosophy
Amp Philosophy
Intra-operative error during AMP
       hemiarthroplasty.J.
       hemiarthroplasty J of Ortho Surgery
                   Weinrauch, P
• 147 patients were treated with th unipolar uncemented
          ti t       t t d ith the i l                   td
  Austin Moore prostheses over the time period: 128
  (
  (87%) had surgery p
        )         g y performed by relatively j
                                  y          y junior
• doctors-14% by senior medical officers, 57% by training
  registrars, and 17% by principal house officers; 19 (13%)
  were performed by a consultant surgeon
                                   surgeon.
• 84 errors in implantation were identified in 71 patients;
  only 76 (52%) had no errors in implantation, while 52
     y      (   )                   p           ,
  (35%) had one error, 17 (12%) had 2 errors, and
• 2 (1.4%) had 3 errors.
Burminghum Study
• G H hospital U K
  G.H.hospital U.K.
• 188 patients
               Infection 4 5%
               I f ti 4.5%
               Dislocation 3.4%
               Loosening 3.4%
    Journal of injury - 2001
AOSJ - 1991 June
              quality of life
 185 patients – average 80 yrs
       ti t
    7% dislocation
    4% deep infection
    1% prostr sio
       prostrusio
    2% loosening of prosthesis
  5 yrs -- > 60% mortality in both groups
 Half of pts & most of the controls able to
 move independently.
Peri-prosthetic fracture
AMP was well fixed
Could not be removed
Locking / Mamman’s plate
          Mamman s
Amp Philosophy
Amp Philosophy
Amp Philosophy
“Don’t throw away the AMP
   Don t                AMP”
Says Marcus R ER.E.
From University hospital of Cleveland Ohio
(journal of A th l t 2002)
(j      l f Arthroplasty
   AMP                     Bipolar
7% died(3 months)        11% died
HHS Avg 75(26 mon) 78 Avg
      Avg.75(26
   (55 to 92)             (60 to 94)
Particular attention
 must be paid to the
           p
 seating of collar of
 the
 th prosthesis on
          th i
 the calcar & correct
 choice of head size.
Method is very easy to
 be learnt.
Cost effective, well
 tolerated by aged
 patients
         German article
154 AMP for 10 yrs
At 3yrs       46% community
              ambulance

              10% household

                 35% non functional
                 ambulance
Men had better            than women
Harris hip
H i hi score --             69 – 55yrs
                            59 – 10yrs
Failure rate -- >           5 yrs – 6 5%
                                     6.5%
                            10 yrs – 7.7%
Revision rate -- >          5 yrs - 4.5 %
                              y
                            10 yrs – 5.2%
A case of THR done 14 Years ago
Now the
N th CUP showing d f
              h i deformation ti
No complaints A.M.P. 16 years ago.
Awaiting Revision?
Summary
• In our setup AMP serves purposeful
  satisfactory function in elderly
  individuals
• Average ortho surgeon can perform
  this surgery comfortably in average
  set-up.
• Pl th surgery b f
  Plan the          before h d & ask
                            hand    k
  for appropriate stem width according
  to f
  t femoral canal.
            l     l
Summary
• Carefully reaming in narrow
  femoral canal.
• No reaming in Osteoporotic
  bone.
  bone
• Use bone grafts from femoral
  head for calcar reinforcement
• Always fill the fenestrations
  with bone grafts.
    ith b        ft
Conclusions
• AMP is time tested implant and results are
  satisfactory.
• THR, cemented bipolar has got their own
       ,             p         g
  indications, & they are also not free from serious
  complications.
• AMP is Cost effective,
• Bone cement can be used as last option.
• Further improvement in the implant design is
  recommended.
Amp Philosophy
Amp Philosophy
Amp Philosophy
22 years old Male
Fracture N/F
AVN 1998
AMP working since then
Amp Philosophy
THR - fail
•   Material failure
•   Friction failure
•   Cement di
    C       t disease
•   Design failure
•   Particle disease
•   Material failure
•   Mechanical failure - Mechanostat
Proxima – Depuy
a conservative metaphyseal implant
                   py        p




      Proximal Fixation
Proxima DePuy
Well fixed AMP
AMP Still working
“Don’t throw away
                y

       the
       th AMP”
DISCLAIMER

Information contained and transmitted by this presentation is
based on personal experience and collection of cases at
Choithram Hospital & Research centre, Indore, India, during last
25 years.
It is intended for use only by the students of orthopaedic surgery.
                          yy                        p         gy
Views and opinion expressed in this presentation are personal
opinion.
Depending upon the x-rays and clinical presentations, viewers
can make their own opinion.
                      opinion
For any confusion please contact the sole author for clarification.
Every body is allowed to copy or download and use the material
best suited to him. I am not responsible for any controversies
                him
arise out of this presentation.
For any correction or suggestion please contact
naneria@yahoo.com
          @y

Contenu connexe

Tendances

Knee Arthrodesis
Knee ArthrodesisKnee Arthrodesis
Knee Arthrodesisdrsp46
 
Implant Selection In Revision T.K.R
Implant Selection In Revision T.K.RImplant Selection In Revision T.K.R
Implant Selection In Revision T.K.RMurtuza Rassiwala
 
Prosthesis selection
Prosthesis selectionProsthesis selection
Prosthesis selectionjatinder12345
 
Triple arthrodesis seminar by Dr Chirag Patel
Triple arthrodesis seminar by Dr Chirag PatelTriple arthrodesis seminar by Dr Chirag Patel
Triple arthrodesis seminar by Dr Chirag PatelChirag Patel
 
Osteotomy around elbow
Osteotomy around elbowOsteotomy around elbow
Osteotomy around elbowSushil Sharma
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fracturesRohit Vikas
 
Septic arthritis sequelae
Septic arthritis sequelaeSeptic arthritis sequelae
Septic arthritis sequelaeorthoprince
 
Osteotomies around hip by dr rohit kumar
Osteotomies around hip by dr rohit kumarOsteotomies around hip by dr rohit kumar
Osteotomies around hip by dr rohit kumarDr Rohit Kumar
 
Quadriceps contracture
Quadriceps contractureQuadriceps contracture
Quadriceps contractureorthoprince
 
Modified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesModified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesPonnilavan Ponz
 
Basics of knee arthroscopy for the beginners
Basics of knee arthroscopy for the beginnersBasics of knee arthroscopy for the beginners
Basics of knee arthroscopy for the beginnersBhaskarBorgohain4
 
Total Hip Arthroplasty
Total Hip ArthroplastyTotal Hip Arthroplasty
Total Hip Arthroplastybitounis
 
fracture It femur
fracture It femurfracture It femur
fracture It femurMahak Jain
 
Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Uday Bangalore
 
Ankle fracture : Syndesmosis Injury
Ankle fracture : Syndesmosis  InjuryAnkle fracture : Syndesmosis  Injury
Ankle fracture : Syndesmosis InjuryRiverTsai2
 

Tendances (20)

Knee Arthrodesis
Knee ArthrodesisKnee Arthrodesis
Knee Arthrodesis
 
Implant Selection In Revision T.K.R
Implant Selection In Revision T.K.RImplant Selection In Revision T.K.R
Implant Selection In Revision T.K.R
 
Prosthesis selection
Prosthesis selectionProsthesis selection
Prosthesis selection
 
Protrusio acetabuli
Protrusio acetabuliProtrusio acetabuli
Protrusio acetabuli
 
Triple arthrodesis seminar by Dr Chirag Patel
Triple arthrodesis seminar by Dr Chirag PatelTriple arthrodesis seminar by Dr Chirag Patel
Triple arthrodesis seminar by Dr Chirag Patel
 
Osteotomies around the hip
Osteotomies around the hipOsteotomies around the hip
Osteotomies around the hip
 
Osteotomy around elbow
Osteotomy around elbowOsteotomy around elbow
Osteotomy around elbow
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fractures
 
Septic arthritis sequelae
Septic arthritis sequelaeSeptic arthritis sequelae
Septic arthritis sequelae
 
Poller screw
Poller screwPoller screw
Poller screw
 
Osteotomies around hip by dr rohit kumar
Osteotomies around hip by dr rohit kumarOsteotomies around hip by dr rohit kumar
Osteotomies around hip by dr rohit kumar
 
Quadriceps contracture
Quadriceps contractureQuadriceps contracture
Quadriceps contracture
 
Ctev
CtevCtev
Ctev
 
Modified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesModified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fractures
 
Bearing surfaces
Bearing surfacesBearing surfaces
Bearing surfaces
 
Basics of knee arthroscopy for the beginners
Basics of knee arthroscopy for the beginnersBasics of knee arthroscopy for the beginners
Basics of knee arthroscopy for the beginners
 
Total Hip Arthroplasty
Total Hip ArthroplastyTotal Hip Arthroplasty
Total Hip Arthroplasty
 
fracture It femur
fracture It femurfracture It femur
fracture It femur
 
Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015
 
Ankle fracture : Syndesmosis Injury
Ankle fracture : Syndesmosis  InjuryAnkle fracture : Syndesmosis  Injury
Ankle fracture : Syndesmosis Injury
 

En vedette

Austin Moore’S Prosthesis Surgical Technique
Austin Moore’S Prosthesis Surgical TechniqueAustin Moore’S Prosthesis Surgical Technique
Austin Moore’S Prosthesis Surgical Techniquevinod naneria
 
Manufacturer and suppliers of Hip Prosthesis
Manufacturer and suppliers of Hip ProsthesisManufacturer and suppliers of Hip Prosthesis
Manufacturer and suppliers of Hip ProsthesisNarang Medical Limited
 
Role of hemiarthroplasty -30th aug 2015
Role of hemiarthroplasty -30th aug 2015Role of hemiarthroplasty -30th aug 2015
Role of hemiarthroplasty -30th aug 2015Uday Bangalore
 
Fracture neck femur 6 months old
Fracture neck femur 6 months oldFracture neck femur 6 months old
Fracture neck femur 6 months oldShiva Shankar
 
Broken austin moore prosthesis fatigue or failure
Broken austin moore prosthesis  fatigue or failureBroken austin moore prosthesis  fatigue or failure
Broken austin moore prosthesis fatigue or failurevinod naneria
 
Non union fracture neck of femur
Non union fracture neck of femurNon union fracture neck of femur
Non union fracture neck of femurvinod naneria
 
Instruments orthopaedics for mbbs students
Instruments orthopaedics for mbbs studentsInstruments orthopaedics for mbbs students
Instruments orthopaedics for mbbs studentsTONY SCARIA
 
Dorsal disc prolapse
Dorsal disc prolapseDorsal disc prolapse
Dorsal disc prolapsevinod naneria
 
Craniovertebral junction
Craniovertebral junction Craniovertebral junction
Craniovertebral junction abinash66
 
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibia
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibiaUse of Ilizarov fixator Hexapod apparatus for fracture prox tibia
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibiamangalparihar
 
Perthes disease ADOLESCENT COXA VARA
Perthes disease ADOLESCENT COXA VARAPerthes disease ADOLESCENT COXA VARA
Perthes disease ADOLESCENT COXA VARADr ashwani panchal
 
total hip arthroplasty
total hip arthroplastytotal hip arthroplasty
total hip arthroplastySunil Poonia
 
25. management of pelvic ring injuries
25. management of pelvic ring injuries25. management of pelvic ring injuries
25. management of pelvic ring injuriesMuhammad Abdelghani
 
AVASCULAR NECROSIS OF HIP (AVN HIP)
AVASCULAR NECROSIS OF HIP (AVN HIP)AVASCULAR NECROSIS OF HIP (AVN HIP)
AVASCULAR NECROSIS OF HIP (AVN HIP)Dr.A.Mohan krishna
 
Non union fracture neck of femur
Non union fracture neck of femurNon union fracture neck of femur
Non union fracture neck of femurorthoprince
 
Surgical Approaches to Hip Joint
Surgical Approaches to Hip JointSurgical Approaches to Hip Joint
Surgical Approaches to Hip JointApoorv Jain
 
Fracture neck of femur
Fracture neck of femurFracture neck of femur
Fracture neck of femurRenuga Sri
 

En vedette (20)

Austin Moore’S Prosthesis Surgical Technique
Austin Moore’S Prosthesis Surgical TechniqueAustin Moore’S Prosthesis Surgical Technique
Austin Moore’S Prosthesis Surgical Technique
 
Hemiarthroplasty of Hip joint
Hemiarthroplasty  of  Hip joint Hemiarthroplasty  of  Hip joint
Hemiarthroplasty of Hip joint
 
Manufacturer and suppliers of Hip Prosthesis
Manufacturer and suppliers of Hip ProsthesisManufacturer and suppliers of Hip Prosthesis
Manufacturer and suppliers of Hip Prosthesis
 
Role of hemiarthroplasty -30th aug 2015
Role of hemiarthroplasty -30th aug 2015Role of hemiarthroplasty -30th aug 2015
Role of hemiarthroplasty -30th aug 2015
 
Fracture neck femur 6 months old
Fracture neck femur 6 months oldFracture neck femur 6 months old
Fracture neck femur 6 months old
 
Broken austin moore prosthesis fatigue or failure
Broken austin moore prosthesis  fatigue or failureBroken austin moore prosthesis  fatigue or failure
Broken austin moore prosthesis fatigue or failure
 
Non union fracture neck of femur
Non union fracture neck of femurNon union fracture neck of femur
Non union fracture neck of femur
 
Instruments orthopaedics for mbbs students
Instruments orthopaedics for mbbs studentsInstruments orthopaedics for mbbs students
Instruments orthopaedics for mbbs students
 
Dorsal disc prolapse
Dorsal disc prolapseDorsal disc prolapse
Dorsal disc prolapse
 
Hip implants dr.thahir
Hip implants   dr.thahirHip implants   dr.thahir
Hip implants dr.thahir
 
Craniovertebral junction
Craniovertebral junction Craniovertebral junction
Craniovertebral junction
 
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibia
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibiaUse of Ilizarov fixator Hexapod apparatus for fracture prox tibia
Use of Ilizarov fixator Hexapod apparatus for fracture prox tibia
 
Perthes disease ADOLESCENT COXA VARA
Perthes disease ADOLESCENT COXA VARAPerthes disease ADOLESCENT COXA VARA
Perthes disease ADOLESCENT COXA VARA
 
total hip arthroplasty
total hip arthroplastytotal hip arthroplasty
total hip arthroplasty
 
25. management of pelvic ring injuries
25. management of pelvic ring injuries25. management of pelvic ring injuries
25. management of pelvic ring injuries
 
AVASCULAR NECROSIS OF HIP (AVN HIP)
AVASCULAR NECROSIS OF HIP (AVN HIP)AVASCULAR NECROSIS OF HIP (AVN HIP)
AVASCULAR NECROSIS OF HIP (AVN HIP)
 
Cervical fractures
Cervical fracturesCervical fractures
Cervical fractures
 
Non union fracture neck of femur
Non union fracture neck of femurNon union fracture neck of femur
Non union fracture neck of femur
 
Surgical Approaches to Hip Joint
Surgical Approaches to Hip JointSurgical Approaches to Hip Joint
Surgical Approaches to Hip Joint
 
Fracture neck of femur
Fracture neck of femurFracture neck of femur
Fracture neck of femur
 

Similaire à Amp Philosophy

Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repairSoulderPain
 
Operative treatment of osteoporotic spinal fractures
Operative treatment of osteoporotic spinal fracturesOperative treatment of osteoporotic spinal fractures
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
 
Oper treat osteo spine 3 10-2015
Oper treat osteo spine 3 10-2015Oper treat osteo spine 3 10-2015
Oper treat osteo spine 3 10-2015George Sapkas
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repairSoulderPain
 
Cervical Hybrid Arthroplasty by Pablo Pazmino MD
Cervical Hybrid Arthroplasty by Pablo Pazmino MDCervical Hybrid Arthroplasty by Pablo Pazmino MD
Cervical Hybrid Arthroplasty by Pablo Pazmino MDPablo Pazmino
 
200420 Neck of femur State of the Art
200420 Neck of femur State of the Art 200420 Neck of femur State of the Art
200420 Neck of femur State of the Art Dr MADAN MOHAN
 
Operative treatment osteoporotic fractures
Operative treatment osteoporotic fracturesOperative treatment osteoporotic fractures
Operative treatment osteoporotic fracturesAlexander Bardis
 
ARTHROPLASTY
ARTHROPLASTYARTHROPLASTY
ARTHROPLASTYRIA
 
Centric relation seminar
Centric relation seminarCentric relation seminar
Centric relation seminarnasshhnn
 
PROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxPROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxsindhubapoo1
 
PROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxPROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxsindhubapoo1
 
Clavicle fracture and its management
Clavicle fracture and its management Clavicle fracture and its management
Clavicle fracture and its management BipulBorthakur
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repairSoulderPain
 
howtodotensionbandwire-160809071243.pdf
howtodotensionbandwire-160809071243.pdfhowtodotensionbandwire-160809071243.pdf
howtodotensionbandwire-160809071243.pdfdocshahir
 
How to do tension band wire
How to do tension band wireHow to do tension band wire
How to do tension band wireKhadijah Nordin
 

Similaire à Amp Philosophy (20)

Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
 
Operative treatment of osteoporotic spinal fractures
Operative treatment of osteoporotic spinal fracturesOperative treatment of osteoporotic spinal fractures
Operative treatment of osteoporotic spinal fractures
 
Oper treat osteo spine 3 10-2015
Oper treat osteo spine 3 10-2015Oper treat osteo spine 3 10-2015
Oper treat osteo spine 3 10-2015
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
 
Cervical Hybrid Arthroplasty by Pablo Pazmino MD
Cervical Hybrid Arthroplasty by Pablo Pazmino MDCervical Hybrid Arthroplasty by Pablo Pazmino MD
Cervical Hybrid Arthroplasty by Pablo Pazmino MD
 
200420 Neck of femur State of the Art
200420 Neck of femur State of the Art 200420 Neck of femur State of the Art
200420 Neck of femur State of the Art
 
Operative treatment osteoporotic fractures
Operative treatment osteoporotic fracturesOperative treatment osteoporotic fractures
Operative treatment osteoporotic fractures
 
Pelvic fracture basic
Pelvic fracture basicPelvic fracture basic
Pelvic fracture basic
 
Musculoskeletal Radiology
Musculoskeletal RadiologyMusculoskeletal Radiology
Musculoskeletal Radiology
 
ARTHROPLASTY
ARTHROPLASTYARTHROPLASTY
ARTHROPLASTY
 
Fracture of neck of femur
Fracture of neck of femurFracture of neck of femur
Fracture of neck of femur
 
Corato
CoratoCorato
Corato
 
Centric relation seminar
Centric relation seminarCentric relation seminar
Centric relation seminar
 
PROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxPROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptx
 
PROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptxPROXIMAL FRACTURE OF FEMUR.pptx
PROXIMAL FRACTURE OF FEMUR.pptx
 
DDH
DDHDDH
DDH
 
Clavicle fracture and its management
Clavicle fracture and its management Clavicle fracture and its management
Clavicle fracture and its management
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
 
howtodotensionbandwire-160809071243.pdf
howtodotensionbandwire-160809071243.pdfhowtodotensionbandwire-160809071243.pdf
howtodotensionbandwire-160809071243.pdf
 
How to do tension band wire
How to do tension band wireHow to do tension band wire
How to do tension band wire
 

Plus de vinod naneria

MRI of Interesting Rare Spinal Cases.pptx
MRI of Interesting Rare Spinal Cases.pptxMRI of Interesting Rare Spinal Cases.pptx
MRI of Interesting Rare Spinal Cases.pptxvinod naneria
 
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptx
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxChronic Recurrent Multifocal Osteomyelitis - a care report.pptx
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxvinod naneria
 
Conservative management of Lumbar disc prolapse.pptx
Conservative management of Lumbar disc prolapse.pptxConservative management of Lumbar disc prolapse.pptx
Conservative management of Lumbar disc prolapse.pptxvinod naneria
 
Hemiarthroplasty in Unstable Trochanteric Fractures.pptx
Hemiarthroplasty in Unstable Trochanteric Fractures.pptxHemiarthroplasty in Unstable Trochanteric Fractures.pptx
Hemiarthroplasty in Unstable Trochanteric Fractures.pptxvinod naneria
 
Radiological changes in Patella in Prediabetes.pptx
Radiological changes in Patella in Prediabetes.pptxRadiological changes in Patella in Prediabetes.pptx
Radiological changes in Patella in Prediabetes.pptxvinod naneria
 
Hyperostosis and Prediabetes
Hyperostosis and PrediabetesHyperostosis and Prediabetes
Hyperostosis and Prediabetesvinod naneria
 
Soft tissue calcification
Soft tissue calcificationSoft tissue calcification
Soft tissue calcificationvinod naneria
 
GCT Upper Tibial Pathological Fracture
GCT Upper Tibial Pathological FractureGCT Upper Tibial Pathological Fracture
GCT Upper Tibial Pathological Fracturevinod naneria
 
Migratory reflex transient osteoporosis
Migratory reflex transient osteoporosis Migratory reflex transient osteoporosis
Migratory reflex transient osteoporosis vinod naneria
 
Calcific tendinitis of shoulder
Calcific tendinitis of shoulderCalcific tendinitis of shoulder
Calcific tendinitis of shouldervinod naneria
 
Calcific Myo-necrosis
Calcific Myo-necrosis Calcific Myo-necrosis
Calcific Myo-necrosis vinod naneria
 
Recurrence of Gct lower end femur - a case report
Recurrence of Gct lower end femur -  a case reportRecurrence of Gct lower end femur -  a case report
Recurrence of Gct lower end femur - a case reportvinod naneria
 
L3 l4 disc extrusion
L3 l4 disc extrusionL3 l4 disc extrusion
L3 l4 disc extrusionvinod naneria
 
A case of shattered proximal femur
A case of shattered proximal femurA case of shattered proximal femur
A case of shattered proximal femurvinod naneria
 
Broken AMP stem a case report
Broken AMP stem   a case reportBroken AMP stem   a case report
Broken AMP stem a case reportvinod naneria
 
Slipped Capital Femoral Epiphysis
Slipped Capital Femoral EpiphysisSlipped Capital Femoral Epiphysis
Slipped Capital Femoral Epiphysisvinod naneria
 
Nonunion lower end radius
Nonunion lower end radiusNonunion lower end radius
Nonunion lower end radiusvinod naneria
 
First cadaveric renal transplantation
First cadaveric renal transplantationFirst cadaveric renal transplantation
First cadaveric renal transplantationvinod naneria
 
Synovial Chondromatosis
Synovial ChondromatosisSynovial Chondromatosis
Synovial Chondromatosisvinod naneria
 

Plus de vinod naneria (20)

MRI of Interesting Rare Spinal Cases.pptx
MRI of Interesting Rare Spinal Cases.pptxMRI of Interesting Rare Spinal Cases.pptx
MRI of Interesting Rare Spinal Cases.pptx
 
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptx
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxChronic Recurrent Multifocal Osteomyelitis - a care report.pptx
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptx
 
Conservative management of Lumbar disc prolapse.pptx
Conservative management of Lumbar disc prolapse.pptxConservative management of Lumbar disc prolapse.pptx
Conservative management of Lumbar disc prolapse.pptx
 
Hemiarthroplasty in Unstable Trochanteric Fractures.pptx
Hemiarthroplasty in Unstable Trochanteric Fractures.pptxHemiarthroplasty in Unstable Trochanteric Fractures.pptx
Hemiarthroplasty in Unstable Trochanteric Fractures.pptx
 
Radiological changes in Patella in Prediabetes.pptx
Radiological changes in Patella in Prediabetes.pptxRadiological changes in Patella in Prediabetes.pptx
Radiological changes in Patella in Prediabetes.pptx
 
Hyperostosis and Prediabetes
Hyperostosis and PrediabetesHyperostosis and Prediabetes
Hyperostosis and Prediabetes
 
Soft tissue calcification
Soft tissue calcificationSoft tissue calcification
Soft tissue calcification
 
GCT Upper Tibial Pathological Fracture
GCT Upper Tibial Pathological FractureGCT Upper Tibial Pathological Fracture
GCT Upper Tibial Pathological Fracture
 
Migratory reflex transient osteoporosis
Migratory reflex transient osteoporosis Migratory reflex transient osteoporosis
Migratory reflex transient osteoporosis
 
Calcific tendinitis of shoulder
Calcific tendinitis of shoulderCalcific tendinitis of shoulder
Calcific tendinitis of shoulder
 
Calcific Myo-necrosis
Calcific Myo-necrosis Calcific Myo-necrosis
Calcific Myo-necrosis
 
Recurrence of Gct lower end femur - a case report
Recurrence of Gct lower end femur -  a case reportRecurrence of Gct lower end femur -  a case report
Recurrence of Gct lower end femur - a case report
 
L3 l4 disc extrusion
L3 l4 disc extrusionL3 l4 disc extrusion
L3 l4 disc extrusion
 
Gct lower end femur
Gct lower end femurGct lower end femur
Gct lower end femur
 
A case of shattered proximal femur
A case of shattered proximal femurA case of shattered proximal femur
A case of shattered proximal femur
 
Broken AMP stem a case report
Broken AMP stem   a case reportBroken AMP stem   a case report
Broken AMP stem a case report
 
Slipped Capital Femoral Epiphysis
Slipped Capital Femoral EpiphysisSlipped Capital Femoral Epiphysis
Slipped Capital Femoral Epiphysis
 
Nonunion lower end radius
Nonunion lower end radiusNonunion lower end radius
Nonunion lower end radius
 
First cadaveric renal transplantation
First cadaveric renal transplantationFirst cadaveric renal transplantation
First cadaveric renal transplantation
 
Synovial Chondromatosis
Synovial ChondromatosisSynovial Chondromatosis
Synovial Chondromatosis
 

Dernier

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 

Dernier (20)

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 

Amp Philosophy

  • 1. Austin Moore’s Prosthesis It’s Relevance Today Vinod Naneria Vi d N i Gi i h Y tik Girish Yeotikar A j W dh Arjun Wadhwani i Consultants Department Of Orthopaedics Choithram Hospital & Research Centre, Indore, India
  • 2. Why AMP – Disput ? • Improper technique • Design of Implant g p • Design of instruments • No long term data from Indian scene • THR – dominated • Failures / revisions – THR – Rethinking ?
  • 3. Question? • All successful long standing AMP develop hypertrophy of the bone all around. • Osteolysis seen early in failed AMP within months. • All successful l f l long standing THR d t di develop l some osteolysis of the bone. • Osteolysis in THR seen late and damge becomes a problem
  • 4. Answer • Mechanical loading altering the mechanostat of bone after implant surgery decides the future of surgery surgery. • Proximal fixation at or above the level of lesser trochanter save the “disuse disuse cancellization of cortical bone” in the calcar region region.
  • 5. The philosophy • Proximal fixation of the implant is crucial in the success of the surgery. • A tight fixation gives mechanical stability stability, and allow the grafts in the fenestration to consolidate, consolidate making it a self locking self-locking device. • Thi prevents over-loading of calcar – no This t l di fl subsidence, no loosening, no failure.
  • 6. Mechanostat • Frost HM Strain and other mechanical HM. influences on bone strength and maintenance. maintenance Curr Opin Orthop Orthop. 1997;8:60–70. ----------------------------------------------------------- • Bone loading - Bone strength • Bone modeling – hypertrophy / normal • Bone remodeling – hypotrophy / atrophy g yp py py -----------------------------------------------------------
  • 8. Bone modeling by drifts (A) An infant’s long bone with its original size and shape shown i solid li dh h in lid line. T k To keep it shape its h as it grows in length and diameter, modeling drifts d ift move it surfaces in tissue space as th its f i ti the dashed lines suggest. Formation drifts make and control new osteoblasts t build some d tl t bl t to b ild surfaces. Resorption drifts make and control new osteoclasts to remove bone from other t l tt b f th surfaces.
  • 9. A different drift pattern can correct the fracture (B) malunion in a child The cross-sectional view to the right child. cross sectional shows the endocortical as well as the periosteal drifts that do the correction. (C) How the drifts in B would move the whole segment to the reader’s right. Changing the anatomy in that way reader s right reduces the bone’s bending moments; it does not eliminate bending but it does limit it Drifts are created bending, it. when and where they are needed, and they include capillaries, precursor and supporting cells, and some wandering cells. They are multicellular entities in the same sense as renal nephrons, and they usually act to minimize peak b ii i k bone strains ti
  • 11. BMU – Renal Nephron Bone remodeling BMUs. Top row: an activation event on a bone surface at (A) makes a packet of bone resorption begin (B), (B) and then its osteoclasts are replaced by osteoblasts at (C) (C). The BMU makes and controls the new osteoclasts and osteoblasts that do this. Second row: this emphasizes the amounts of bone resorbed (E) and formed (F) by completed BMUs. Third row: in these ‘‘BMU graphs’’ (G) shows a small excess of formation over resorption. ( ) Equalized resorption and p (H) q p formation as on haversian surfaces and in ‘‘conservation-mode’’ remodeling.
  • 12. BMU – Renal Nephron (I) A net deficit of formation, as in disuse-mode remodeling of endocortical and trabecular bone. Bottom row: these ‘‘stair graphs’’ show the effects of a series of BMUs of the kind immediately above on the local bone ‘‘bank.’’ BMUs are created when and where they are bank. needed and include a capillary, precursor and supporting cells, and some wandering cells. They are multicellular entities in the same sense as renal.
  • 13. Strain in Cemented stems • Adaptive changes in the femur after implantation of an Austin Moore prosthesis SB Murphy, PS Walker and AL Schiller J Bone Joint Surg Am. 1984;66:437- 443. • The calcar and proximal regions are understrained because much of the loads and moments are transferred to the bone f around the distal half of the stem.
  • 14. Un-cemented stems Un cemented • The broad proximal collar provides good resistance to axial force, whereas the distal half of the stem may carry little axial load. The varus moment on the stem is counteracted by forces at the medial part of the calcar and the distal tip, in a more concentrated manner than in a t td th i cemented stem. The radiographic appearance around uncemented stems suggests bone hypertrophy in the whole proximal area, especially medially, and local thickening at a p y y, g point level with the tip of the prosthetic stem.
  • 15. More than 1 300 Austin Moore 1,300 hemiarthroplasties have been reviewed in the literature, literature with no reports of fracture of the stem. Results from our finite-element analysis indicate that with good calcar collar support that, calcar-collar support, the stresses in the stem are small because the stem portion of the prosthesis and the bone are uncoupled and, consequently, do not share the resultant bending moment of the head and abductor forces.
  • 16. Calcar – Collar Support If the stem is coupled to the bone so that the resultant bending moment is shared, high stresses in the stem are predicted; such stresses are p ; inconsistent with the complete absence of fractures of these prostheses. The results of the finite- element analysis further showed that loss of calcar- collar support with proximal fixation through the fenestrations resulted in high stresses in the stem and stress shielding of the proximal medial cortex.
  • 17. Cl Calcar – C ll S Collar Support t The uncoupled prosthesis also may be modeled with a free-body diagram as a three-force member loaded at the head, stem tip, and in the proximal region. With this model it can be shown that the reaction force of model, the stem tip, and thus the peak bending stress in the stem, stem increases as calcar-collar support is decreased calcar collar decreased. If there is no calcar-collar support, proximal support must be provided by some combination of integration y g of bone in the fenestrations and wedging due to the lateral-medial taper of the device..
  • 18. Stresses on Stem Stresses in the stem are largest when there is no wedging, b t hi h stresses d di but high t develop i th l in the cancellous bone in the fenestrations. When there is wedging stresses in the stem can be low but wedging, low, stresses in the supporting cancellous bone can be high; additional proximal support through the g; p pp g fenestrations substantially reduces these bone stresses
  • 19. Stresses on Stem . Ifreduced stresses in the cancellous bone are indicative of a stable device, these mechanisms indicate that fractures of the Austin Moore prosthesis have not occurred in normally loaded hips because load was transferred primarily either through the collar or by wedging, with additional support at th ith dditi l t t the fenestrations
  • 20. Painful AMP two primary reasons AMP- • Inadequate Proximal Fixation – Loose Prosthesis –C l Calcar absorption b ti – Subsidence of the prosthesis –LLoss of varus alignment i th canal f li t in the l • Acetabular cartilage erosion
  • 21. Inadequate Proximal Fixation • Not under our control – Elderly – Osteoporotic – Wide canal • U d our control Under tl – Faulty operative technique – Over reaming by improper Rasp – Improper selection of Implant
  • 22. Effect of neck resection on torsional stability of cementless total hip replacement. Whiteside LA White SE, McCarthy DS LA, SE DS. Biomechanical Research Laboratory, St. Louis, Missouri, USA. Loosening of the femoral component in total hip arthroplasty commonly results from inadequate resistance to torsional loads We evaluated 20 adult loads. human cadaver femora to determine the effect of different neck-resection levels on torsional resistance of neck resection the femoral component. All specimens were prepared for fixation with the Impact modular total hip replacement. Each femoral diaphysis was overreamed 2 mm to achieve only proximal fixation. The specimens were then divided into di id d i t groups of fi and i l t were i f five d implants inserted td with the precision press-fit technique.
  • 23. Without distal fixation, the femoral component is highly dependent on p p gy p proximal geometry for resistance to torsional loading. Preserving the femoral neck p g provides an effective means of resistance. Maintaining the entire femoral neck most effectivelyy reduces miromotion at low loads, but maintaining the midshaft area of the femoral g neck appears to most effectively control micromotion at higher torsional loads. g Resection below the midshaft of the neck markedly decreases the torsional load- y bearing capacity of the proximal femur.
  • 24. Primary positive calcar collar contact reduced the calcar-collar incidence of calcar resorption. Sufficient cementation of the medullary canal significantly reduced the incidence of calcar resorption, as did neutral and valgus positioning of the femoral component. Loosening of the acetabular component occurred more often in the group with calcar resorption. Middle- aged patients and men were more prone t develop d ti t d to d l resorption of the calcar. Calcar resorption may be influenced by surgical technique Alteration of the technique. operative technique is recommended, with emphasis on correct valgus or neutral p g position of the femoral component, a positive calcar-collar contact, and improved cementation
  • 25. Proximal Fixation Tips T i k Ti & Tricks • Pre operative Pre-operative assessment of the Canal Canal. • Proper neck cut. • Avoid A id comminuting C l i ti Calcar F Femoris. i • Save at least 1cm of neck at Calcar • Insert canal finder from Piriformis Fossa • In wider canal avoid use of rasp canal, rasp.
  • 26. Proximal Fixation Tips T i k Ti & Tricks • Select proper Implant which will fill the proximal femur without increasing comminution. comminution • Use a artery forcep in the prosthesis proximal hole ( originally for extraction) for extraction), rotation control during insertion.
  • 27. Proximal Fixation Tips T i k Ti & Tricks • Impaction grafting: – The most important area is the medial side near calcar. Graft should be inserted when nearly half of the prosthesis has gone inside. – Fill the fenestrations of the prosthesis with bone grafts, grafts as the prosthesis advances in to the canal canal. – The color of the implant should not over-hang on the calcar. – If done properly, it should rest on the neck and will compress the grafts.
  • 28. Intra operative error during implantation of the Intra-operative uncemented Austin Moore prosthesis is relatively common. common The error rates between junior doctors and consultants were not significantly different. Austin Moore hemiarthroplasty is a technically demanding operation; the prosthesis is difficult to implant well well. Greater selectivity should be exercised when considering this prosthesis for management of femoral neck fractures.
  • 29. (1)Inadequate length of the neck remnant (≤12 mm)-measured from the superior margin of the lesser trochanter to the resection margin at the calcar femorale If an inadequate neck femorale. remnant was identified on postoperative radiographs, radiographs the neck length from the lesser trochanter to the level of the fracture on preoperative radiographs was also measured measured. (2) Inadequate calcar seating (>1 mm)-measured from the medial prosthetic collar to calcar A calcar. prosthesis collar seated on the medial calcar was recorded as zero zero.
  • 30. (3) Difference in prosthetic head size compared with the contralateral normal femoral head using g circular overlays-a diameter of prosthesis up to 2 mm larger to account for articular cartilage was g g considered satisfactory. If the contralateral femoral head was not suitable for analysis (due to y ( disease or previous prosthetic replacement), the ipsilateral femoral head on p p p preoperative radiographs was used for assessment of the appropriate p pp p prosthetic head size. (4) Intra-operative periprosthetic fracture- fracture classification was conducted using the Vancouver g system.
  • 31. 147 patients were treated with the unipolar uncemented Austin Moore prostheses over the time period: 128 (87%) had surgery performed by relatively junior doctors 14% by senior medical doctors-14% officers, 57% by training registrars, and 17% by principal house officers; 19 (13%) were performed by a consultant surgeon. 84 errors in implantation were identified in 71 patients; only 76 (52%) had no errors in implantation, implantation while 52 (35%) had one error 17 error, (12%) had 2 errors, and 2 (1.4%) had 3 errors (1 4%) errors.
  • 32. 1: Injury. 2002 Jun;33(5):419-22. Austin Moore hemiarthroplasty: technical aspects and their effects on outcome, in patients with fractures of the neck p y p ,p of femur. Parker MJ. Sharif KM, Orthopaedic Department, Peterborough District Hospital, Peterborough PE3 6DA, UK. khalidsharif@doctors.org.uk @ g In order to determine which technical aspects of the Austin Moore hemiarthroplasty procedure affect the outcome, we reviewed 243 patients with a non-pathological intracapsular femoral neck fracture who had, Austin Moore uncemented hemiarthroplasty The immediate post operative X rays were assessed for hemiarthroplasty. post-operative X-rays alignment of the prosthetic stem, calcar seating, length of the neck remnant, leg length discrepancy and size of the head, compared with the contralateral femur. All patients were followed-up for 1 year. Significant pain at 1 year and/or revision of the prosthesis for loosening were considered as unfavourable outcomes. Inadequate calcar seating was significantly associated with pain and revision of the prosthesis (P = 0.04 and 0.01, respectively). Length of the neck remnant was also significantly associated with these two outcomes (P = 0 05 and 0 023 0.05 0.023, respectively). Difference in head size was associated with pain, but not with loosening (P = 0.01 and 0.08, respectively). The rest of the parameters were not significantly associated with the outcome. We recommend that when inserting an Austin Moore hemiarthroplasty, particular attention must be paid to the seating of the collar of the prosthesis on the calcar and correct choice of head size.
  • 33. Injury. 2004 Oct;35(10):1020-4. C t ca ad o og ca a a ys s a te ust Critical radiological analysis after Austin Moore hemiarthroplasty. oo e e a t op asty Yau WP, Chiu KY. Department of Orthopaedic Surgery, The University of Hong Kong, Queen Mary Hospital, No. 102, Pokfulam Road, Hong Kong, PR China. peterwpy@hkucc.hku.hk The aim of this study is to investigate the causes of prosthesis loosening in patients treated with Austin Moore hemiarthroplasty (AMA). The clinical and radiological outcomes were documented in a quantitative manner after 7 years follow-up of 144 patients. At the time of final follow-up, 52 patients had died and 48 patients were lost to follow-up, leaving a total of 44 patients for analysis. Immediate post-operative X-rays were studied for the initial alignment of prosthesis, the fit of the prosthesis and the degree of osteoporosis. X-rays on latest follow-up were studied for evidence of loosening. All patients were assessed clinically with the hip score of hospital for loosening special surgery. It was found that hip pain was significantly related to subsidence and pivoting of the prosthesis (P = 0.014 and 0.035, respectively). Significant increase in subsidence was noted if the stem of prosthesis was not fitting well within the shaft of femur (P = 0.006). When the patient was younger than 73 years old at the time of operation, there was more subsidence of the prosthesis at the final follow-up (P = 0.001). It was concluded that the fill of AMA within the shaft of femur should be greater than 70% to avoid early loosening Relatively younger loosening. patients with acute fracture of the neck of femur should be treated by methods other than cementless AMA.
  • 34. •Injury. 2004 Oct;35(10):1020-4. Critical radiological analysis after Austin Moore hemiarthroplasty. Yau WP, Chiu KY It was concluded th t th fill of AMA within th shaft of l d d that the f ithi the h ft f femur should be greater than 70% to avoid early loosening. loosening Relatively younger patients with acute fracture of the neck of femur should be treated by methods other than cementless AMA. •Injury. 2002 Jun;33(5):419-22. Austin Moore hemiarthroplasty: technical aspects and their effects on outcome, in patients with fractures of the neck of femur. Sharif KM, Parker MJ. Sh if KM P k MJ Inadequate calcar seating was significantly associated with pain and revision of the p p prosthesis ( = 0.04 and (P 0.01, respectively). Length of the neck remnant was also significantly associated with these two outcomes (P = 0.05 and 0.023, respectively). Difference in head size was associated with pain, but not with loosening
  • 35. J Trauma. 2001 Jul;51(1):84-7. The effect of intramedullary corticocancellous bone plug for hip hemiarthroplasty. Kligman M, Zecevic M, Roffman M. Application of a corticocancellous bone plug in uncemented hip hemiarthroplasty for treatment of femoral neck fractures p p y can decrease the incidence of early thigh pain in the first 6 months. Scand J Surg. 2002;91(4):357-60. The long-term results of Lubinus interplanta hemiarthroplasty in 228 acute femoral neck fractures. A retrospective six-year f ll ft t ti i follow-up. Isotalo K, Rantanen J, Aärimaa V, Gullichsen E. The Lubinus prosthesis has a greater CCD (caput collum (caput,collum, diaphyse) angle and a longer stem compared to Thompson and Moore implants. The need for resection of calcar cortex is also limited. These biomechanical facts may explain the good long- term results of Lubinus hemiarthroplasty.
  • 37. Loading of the calcar leading to Neck over hang & absorption
  • 38. Impaction Grafting Reinforcement of the Calcar Femoris After One year Day One
  • 39. Three Point Fixation Tight Femoral Canal
  • 40. Proximal Fixation 10 years follow up came with # Tr Tr.
  • 41. Proximal Fixation 14 years PO Broken stem Not a Failure
  • 43. Broken Stem – Not a Failure 20 years FU y
  • 44. Bone in the fenestration A broken stem is not a failure
  • 45. Too Much Valgus Too Mush Varus
  • 46. Subsidence S b id No proximal Fixation
  • 50. Ideal Prosthesis Fitting F moderately wide canal For d l id l 1.Correct offset 2 Correct sitting over calcar 2.Correct 3. Correct Varus setting 4. Three point fixation p For Narrow canal the junction below the fenestrations is too much angulated, angulated Needs a straight stem
  • 53. Intra-operative error during AMP hemiarthroplasty.J. hemiarthroplasty J of Ortho Surgery Weinrauch, P • 147 patients were treated with th unipolar uncemented ti t t t d ith the i l td Austin Moore prostheses over the time period: 128 ( (87%) had surgery p ) g y performed by relatively j y y junior • doctors-14% by senior medical officers, 57% by training registrars, and 17% by principal house officers; 19 (13%) were performed by a consultant surgeon surgeon. • 84 errors in implantation were identified in 71 patients; only 76 (52%) had no errors in implantation, while 52 y ( ) p , (35%) had one error, 17 (12%) had 2 errors, and • 2 (1.4%) had 3 errors.
  • 54. Burminghum Study • G H hospital U K G.H.hospital U.K. • 188 patients Infection 4 5% I f ti 4.5% Dislocation 3.4% Loosening 3.4% Journal of injury - 2001
  • 55. AOSJ - 1991 June quality of life 185 patients – average 80 yrs ti t 7% dislocation 4% deep infection 1% prostr sio prostrusio 2% loosening of prosthesis 5 yrs -- > 60% mortality in both groups Half of pts & most of the controls able to move independently.
  • 57. AMP was well fixed Could not be removed Locking / Mamman’s plate Mamman s
  • 61. “Don’t throw away the AMP Don t AMP” Says Marcus R ER.E. From University hospital of Cleveland Ohio (journal of A th l t 2002) (j l f Arthroplasty AMP Bipolar 7% died(3 months) 11% died HHS Avg 75(26 mon) 78 Avg Avg.75(26 (55 to 92) (60 to 94)
  • 62. Particular attention must be paid to the p seating of collar of the th prosthesis on th i the calcar & correct choice of head size.
  • 63. Method is very easy to be learnt. Cost effective, well tolerated by aged patients German article
  • 64. 154 AMP for 10 yrs At 3yrs 46% community ambulance 10% household 35% non functional ambulance Men had better than women Harris hip H i hi score -- 69 – 55yrs 59 – 10yrs Failure rate -- > 5 yrs – 6 5% 6.5% 10 yrs – 7.7% Revision rate -- > 5 yrs - 4.5 % y 10 yrs – 5.2%
  • 65. A case of THR done 14 Years ago Now the N th CUP showing d f h i deformation ti No complaints A.M.P. 16 years ago. Awaiting Revision?
  • 66. Summary • In our setup AMP serves purposeful satisfactory function in elderly individuals • Average ortho surgeon can perform this surgery comfortably in average set-up. • Pl th surgery b f Plan the before h d & ask hand k for appropriate stem width according to f t femoral canal. l l
  • 67. Summary • Carefully reaming in narrow femoral canal. • No reaming in Osteoporotic bone. bone • Use bone grafts from femoral head for calcar reinforcement • Always fill the fenestrations with bone grafts. ith b ft
  • 68. Conclusions • AMP is time tested implant and results are satisfactory. • THR, cemented bipolar has got their own , p g indications, & they are also not free from serious complications. • AMP is Cost effective, • Bone cement can be used as last option. • Further improvement in the implant design is recommended.
  • 72. 22 years old Male Fracture N/F AVN 1998 AMP working since then
  • 74. THR - fail • Material failure • Friction failure • Cement di C t disease • Design failure • Particle disease • Material failure • Mechanical failure - Mechanostat
  • 75. Proxima – Depuy a conservative metaphyseal implant py p Proximal Fixation
  • 78. “Don’t throw away y the th AMP”
  • 79. DISCLAIMER Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 25 years. It is intended for use only by the students of orthopaedic surgery. yy p gy Views and opinion expressed in this presentation are personal opinion. Depending upon the x-rays and clinical presentations, viewers can make their own opinion. opinion For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies him arise out of this presentation. For any correction or suggestion please contact naneria@yahoo.com @y