Recommandé
Contenu connexe
Tendances
Tendances (20)
En vedette
Similaire à total hip arthroplasty
Similaire à total hip arthroplasty (20)
Plus de Sunil Poonia
Plus de Sunil Poonia (14)
Dernier
Dernier (20)
total hip arthroplasty
- 2. HISTORY OF HIP REPLACEMENT SURGERY Deformed and ankylosed joints surfaces were contoured with Biological material e.g. Fascia lata grafts as interpositional layer to resurface the joint and allow movement in UK an Europe in early 20th century.
- 3. 1912- Jones used gold foil as inter- positional layer 1923- Smith-Petrson introduced “mould arthroplasy” Later- Backelite and Celluloid derivatives 1937- Vitallium implants
- 4. Professor John Charnley (1911-1982) A British Orthopedician, Pioneer of modern hip replacement Arthroplasty. Developed the techniques of THR in 1960s.
- 7. STRESS TRANSFER TO BONE IMPORTANCE OF QUALITY OF BONE- APPROPIATE IMPLANT OPTIMAL METHOD OF FIXATION RESPONSE OF BONE TO IMPLANT ULTIMATE SUCCESS OF ARTHROPLASTY
- 8. RADIOGRAPHIC CATEGORISATION BY DORR ET AL TYPE A THICK CORTEX AND CANAL DIMENSION LARGE POSTERIOR CORTEX-LAT VIEW CHAMPAGNE FLUTE APPEARANCE MEN AND YOUNGER PATIENTS GOOD FIXATION IN BOTH CEMENTED AND CEMENTLESS
- 9. SOME BONE LOSS SHAPE IS MAINTAINED IMPLANT FIXATION IS NOT A PROBLEM TYPE B
- 10. TYPE C MUCH OF THE CORTEX LOST FROM MEDIAL AND POSTERIOR CORTX IM CANAL IS WIDE LESS FAVORABLE FOR IMPLANT FIXATION
- 11. COMPARISON
- 12. STRESS TRANSFER IS DESIRABLE LESS MODULUS OF ELASTICITY = MORE ELASTIC =LESS DIAMETER MORE STRESS TRANSFER TO BONE
- 13. PROXIMAL MEDIAL CORTEX-MOST BONE LOSS COLLAR-PREVENTS BONE LOSS CEMENTLESS IMPLANTS ARE MORE PHYSIOLOGICAL
- 14. INDICATIONS OF THR 1. Arthritis : Rheumatoid Juvenile rheumatoid (Still disease) Ankylosing spondylitis 2. Degenerative joint disease : : Primary : Secondary : Slipped capital femoral epiphysis Congenital dislocation or dysplasia of hip Coxa plana (Legg-Calvé-Perthes disease) Paget disease Traumatic (Fracture/ dislocations) Hemophilia
- 15. INDICATIONS OF THR Osteonecrosis : Post fracture or Post dislocation Idiopathic Slipped capital femoral epiphysis Hemoglobinopathi es Renal disease Steroid induced Alcoholism Caisson disease Lupus Gaucher disease 4. Nonunion following # NOF 5. Femoral neck fractures and trochanteric fractures with head involvement
- 16. INDICATIONS OF THR 6. Pyogenic arthritis or osteomyelitis : Hematogenous Postoperative 7. Tuberculosis 8. Congenital subluxation or dislocation 9. Hip fusion and pseudarthrosis 10. Failed reconstruction following: Osteotomy Cup arthroplasty Femoral head prosthesis Girdlestone procedure Total hip replacement Resurfacing arthroplasty 11. Bone tumor involving proximal femur or acetabulum 12. Hereditary disorders (e.g., achondroplasia)
- 19. Goal of THR Biomechanically sound, stable hip joint by restoration of normal center of rotation of femoral head
- 20. The location of center of rotation of femoral head is determined by 1. Vertical offset 2. Horizontal(medial) offset 3. Anterior offset (Anteversion)
- 21. WHAT WILL HAPPEN IF THERE IS INADEQUATE RESTORATION OF MEDIAL OFFSET? WHAT WILL HAPPEN IF THERE IS INADEQUATE RESTORATION OF VERTICAL OFFSET
- 22. MEDIAL RESTORATION IS SIMPLY CORRECTED BY MAKING NECK ADJUSTMENT BUT…… LIMB LENGTH INCREASES
- 24. VERSION NORMAL FEMUR IS 10 TO 15 DEGREE ANTEVERTED. USUALLY ACCOMPLISHED BY ROTATING THE COMPONENT IN FEMORAL CANAL. IN PRESS FIT FIXATION IS USED –MODULAR FEMORAL COMPONENT IS USED.
- 26. HEAD NECK RATIO AFFECTS ROM ,IMPINGEMENT,STABILITY OF ARTICULATION.
- 27. TYPES OF FEMORAL COMPONENTS Cemented stems Cementless stems porous surface nonporous surface Specialized custom-made
- 28. CEMENTED STEMS Most designers favour- cobalt chrome alloy PMMA cement is the standard for femoral component fixation Pitfalls-Debonding, Mechanical loosening, Extensive bone loss with fragmented cement
- 30. 2. Cementless stems with porous surface Fixation is more biological. Material- titanium alloy/ Cobalt-Chromium alloy Bone ingrowth into porous metal surface Requires: a)immediate mechanical stability at the time of surgery b) intimate contact between porous surface and viable host bone So, surgical technique and instrumentation need to be more precise than cemented counterpart
- 33. Specialized femoral components for replacement of variable lengthth of proximal femur. Stem can be combined with TKR to replace entire femur
- 35. Cemented acetabular component PMMA spacers (3 mm) are incorporated into polymerizing cement, yeilding uninterrupted cement mantle Satisfactory in elderly, low demand patient, Tumour reconstruction, and in revision arthroplasty.
- 36. Cementless acetabular components 1. Porous coated for bone-ingrowth 2. Fixation with trans acetabular screw
- 37. Constrained acetabular components Mechanism to lock the prosthetic femoral head into the polythene liner Indications- -Insufficient soft tissue, -Deficient hip abductors, -Neuromuscular disease, -Hip with recurrent dislocation despite well- positioned implants.
- 38. Alternative bearings Highly cross linked polyethylene Metal on metal bearings Ceramic on ceramic bearings
- 39. Metal on metal bearings Low wear rate High carbon cobalt chromium alloy Diametral clearance-gap between the two implants at the equator of articulation. Smaller clearance produce films for lubrication and reduced wear. Elevated metal ions in blood that excreted through urine.
- 40. So contraindicated in impending renal failure. Placental transfer occur of these metal ions. Delayed type hypersensitivity (aseptic lymphocytic vasculitis associated lesions) Pseudotumour Recommendation for symptomatic patients is measurement of blood cobalt and chromium ion level and/MRI or USG.
- 41. CERAMIC ON CERAMIC BEARINGS ALUMINA CERAMIC IS USED. HIGH DENSITY, HYDROPHILLIC, SMOOTHER THAN METAL. CERAMIC IS HARDER THAN METAL AND MORE RESISTANT TO SCRATCHING. LINEAR WEAR RATE IS 4000 TIME LESS THAN COBALT CHROME ALLOY ON POLYETHYLENE.
- 42. DISADVANTAGE IMPINGEMENT BETWEEN THE FEMORAL NECK AND RIM OF THE CERAMIC ACETABULAR COMPONENT. IMPLANT MALPOSITION STRIPE WEAR SQUEAKING OSTEOLYSIS
- 43. OXIDIZED ZIRCONIUM CERAMIC METAL ALLOY. NOT SUSCEPTIBLE TO CHIPPING,FLAKING,OR FRACTURES.
- 44. Templating of radiograph for pre-operative planning
- 45. 1. Determination of the amount of limb shortening 2. Acetabular over-lay templating and center marking
- 46. 3. Femoral overlay templating and measurement of precise size of proximal canal 4. Selection of appropriate neck-length to restore limb length and femoral offset
- 47. 5. If no shortening present, we match the center head with previously marked center of the acetabulum 6. If a discrepancy exists, the distance between the femoral head center and acetabular center should be equal to the measured limb length discrepancy
- 50. POSITION OF THE PATIENT FOR POSTERIOR APPROACH
- 56. Femur is retracted anteriorly to allow clear access to acetabulum
- 59. Safe and unsafe quadrants of acetabulum POSTEROSUPERIOR QUADRANT- SAFEST
- 60. FIXATION HOLES FOR CEMENT IN ACTABULUM
- 62. PRECAUTIONS FIXATION MUST BE AUGMENTED BY SCREWS OR SPIKES. PERIPHERAL PART OF POSTEROSUPERIOR SEGMENT ARE SAFEST. PALPATION OF GREATER SCIATIC NOTCH IS MUST. INTRAOPERATIVE CHANGE IN THE POSITION.
- 64. POSITIONING OF FEMUR FOR REAMING
- 65. Neck is cut planned at appropriate level and angle by using trial components of templeted size
- 66. Removal of remining lateral edge of femoral neck and medial portion of GT with box osteotome
- 67. Reaming of femoral canal Hand or power reamer must be lateralized into GT to maintain neutral alignment of femoral canal
- 68. Femoral broaching Progressively larger broaches are inserted, lateralizing each one to maintain neutral alignment
- 71. Assembly of trial head and neck segments determined from pre- operative templating
- 72. Canal blocking
- 73. Retrograde injection of cement with gun in early dough phase
- 76. HIP SHOULD BE STABLE IN IN FULL EXTENSION WITH 40 DEGREE OF EXTERNAL ROTATION. IN FLEXION TO 90 DEGREE WITH ATLEAST 45 DEGREE OF INTERNAL ROTATION WITH THE HIP FLEXED 40 DEGREE WITH ADDUCTION AND AXIAL LOADING- IF HIP DISLOCATE OR SUBLUXATE –USE LONGER NECK.
- 77. WHAT IF FRACTURE OCCUR STOP THE INSERTION EXPOSE THE FRACTURE IF AN INCOMPLETE FRACTURE OCCUR WITH EXTENSION ONLT AT THE LEVEL OF LT-ENCIRCLAGE ,REINSERT AND REASSESS THE STABILITY. BELOW LT –LONGER STEM GT IS # AND UNSTABLE-FIX THE GT WITH WIRES.
- 80. SURGICALS PROBLEMS RELATIVE TO SPECIFIC HIP DISORDER
- 81. OSTEOARTHRITIS MC INDICATION REMOVAL OF OSTEOPHYTES MAY BE NECESSARY. Difficulty in delivering femoral head.
- 82. RHEUMATOID ARTHRITIS THEY GENERALLY RECEIVES IMMUNOSUPPRESSIVE DRUGS. IF BOTH HIP AND KNEE IS INVOLVED EQUALLY, HIP ARTHROPLASTY SHOULD BE DONE FIRST .
- 83. OSTRONECROSIS STAGE 1 AND 2-CORE DECOMPRESSION ,VASCULARISED GRAFT OR BY VALGUS OSTEOTOMY RESURFACING ARTHROPLASTY IF < 50 % OF HEAD MOSTLY AGE GROUP IS 25 TO 45 YEARS-THR IS NOT VERY SUCCESSFUL. IMPROVED RESULT WITH ALUMINA CERAMIC HEAD HIGHLY CROSSLINKED POLYETHYLENE.
- 84. DWARFISM/DYSPLASIA NARROW CANAL BOWING ALTERD FEMORAL ANATOMY PREVIOUS FEMORAL OSTEOTOMY SHORT FEMORAL COMPONENT IS USED .
- 85. ACUTE FEMORAL NECK FRACTURE THR > HRA>INTERNAL FIXATION THOSE WHO ARE LESS HEALTHY,COGNITIVELY IMPAIRED OR REQUIRE ASSISTIVE DEVICE FOR AMBULATION ARE BETTER SUITED FOR HRA.
- 86. Post operative hip re-dislocation can be avoided by: Maintaining abduction using pillows Avoiding crossing legs Avoiding squating Using chairs with armrest Not bending forward past 90 degrees Using a high-rise toilet seat if necessary Avoiding pronation the legs Avoiding stairs
- 88. Exercise Prescription - Later Stages -
- 89. COMPLICATIONS OF THR 1. Hematoma formation 2. Heterotropic ossification 3. Thromboembolism 4. Nerve injuries (sciatic, femoral, obturator or sup gluteal nerve) 5. Vascular injuries
- 90. COMPLICATIONS OF THR 6. Limb length Discrepency 7. Dislocation and subluxation 8. Fractures of acetabulum and femur 9.Trochenteric nonunion and migration 10. Infection 11. Loosening ( Femoral and acetabular component) 12. Osteolysis
- 92. THANK YOU
Notes de l'éditeur
- STANCE PHASE 3 BW,,,,,,,IN ARTHRITIS DDH EXT ROTN DEFORMITY…LEVER ARM IS SHORTENED