anterior approach total hip replacement: cutting edge treatment for the relief of hip pain vahan...
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Anterior Approach Total Hip Anterior Approach Total Hip Replacement: Cutting Edge Replacement: Cutting Edge Treatment for the Relief of Treatment for the Relief of
Hip PainHip PainVahan Cepkinian, M.D.Vahan Cepkinian, M.D.
Orthopaedic SurgeryOrthopaedic Surgery
IntroductionIntroduction
•Hip arthritis affects hundreds of Hip arthritis affects hundreds of thousands of people each yearthousands of people each year
•Many people suffering from Many people suffering from arthritis alter their lives to deal arthritis alter their lives to deal with pain.with pain.
IntroductionIntroduction
•Non-surgical treatmentNon-surgical treatment– MedicationsMedications– Physical TherapyPhysical Therapy– Assistive DevicesAssistive Devices
If these do not work then hip If these do not work then hip replacement may be the solutionreplacement may be the solution
Total Hip ReplacementTotal Hip Replacement
• The goal is to The goal is to reduce hip pain and reduce hip pain and improve the motion improve the motion in your hip.in your hip.
• More than 345,000 More than 345,000 people in the United people in the United States annually States annually undergo hip undergo hip replacement replacement surgery.surgery.
Anatomy of the HipAnatomy of the Hip
• Ball and socket Ball and socket jointjoint
• Femoral head or Femoral head or ball is at the end ball is at the end of thighbone or of thighbone or femur.femur.
• Socket or Socket or acetabulum holds acetabulum holds the ball.the ball.
Anatomy of the HipAnatomy of the Hip
• The arthritic hip The arthritic hip has worn down has worn down cartilage and cartilage and rough bone rough bone which cause painwhich cause pain
Total Hip ReplacementTotal Hip Replacement
• Involves surgically Involves surgically removing the removing the arthritic parts of the arthritic parts of the joint (cartilage and joint (cartilage and bone), and bone), and replacing the ball replacing the ball and socket part of and socket part of the joint with the joint with artificial artificial components components
Total Hip ReplacementTotal Hip Replacement
• Acetabular Acetabular component - component - consists of two consists of two componentscomponents– Cup - usually made Cup - usually made
of titaniumof titanium– Liner - can be Liner - can be
medical grade medical grade plastic, metal or plastic, metal or ceramicceramic
Total Hip ReplacementTotal Hip Replacement
• The femoral The femoral component (stem component (stem and neck portion), is and neck portion), is made of metal. made of metal.
• Femoral head is Femoral head is made either of metal made either of metal or ceramic.or ceramic.
• Stem is shaped to fit Stem is shaped to fit into the bone and into the bone and support the new support the new joint.joint.
Total Hip ReplacementTotal Hip Replacement
• One of the most successful adult One of the most successful adult reconstructive procedures performed reconstructive procedures performed in orthopaedicsin orthopaedics
• With newer materials, hip With newer materials, hip replacements can last up to (and replacements can last up to (and sometimes beyond) 20 years!sometimes beyond) 20 years!
Total Hip ReplacementTotal Hip Replacement
• The Traditional approachThe Traditional approach– The hip is approached from the backThe hip is approached from the back– Disrupts the tissue and muscles Disrupts the tissue and muscles
important for the stability of the hipimportant for the stability of the hip– Involves detachment of muscles from Involves detachment of muscles from
bonebone– Large incision (12-18 inches)Large incision (12-18 inches)
Total Hip Replacement Total Hip Replacement Traditional ApproachTraditional Approach
• Disrupts Disrupts the tissue the tissue and and muscles muscles important important for the for the stability of stability of the hipthe hip
Total Hip Replacement Total Hip Replacement Traditional ApproachTraditional Approach
• There is the risk of hip dislocationThere is the risk of hip dislocation
• Limitations on hip motion and Limitations on hip motion and positionspositions
• There is the risk of a persistent limpThere is the risk of a persistent limp
• Greater reliance on assistive devices Greater reliance on assistive devices (walker, cane) post-operatively(walker, cane) post-operatively– Over 6 weeksOver 6 weeks
• Greater need for pain medicationGreater need for pain medication
Total Hip Replacement Total Hip Replacement Traditional ApproachTraditional Approach
• All of these factors make people All of these factors make people hesitant to proceed with a hip hesitant to proceed with a hip replacement…..and they continue to replacement…..and they continue to live in pain!live in pain!
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
•The Anterior ApproachThe Anterior Approach– Approach the hip from the frontApproach the hip from the front– NO DISRUPTION of MUSCLE NO DISRUPTION of MUSCLE – MINIMAL TRAUMA to the TISSUESMINIMAL TRAUMA to the TISSUES– MUSCLE SPARING APPROACHMUSCLE SPARING APPROACH– MUCH SMALLER INCISION (4-5 MUCH SMALLER INCISION (4-5
inches)inches)
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• The hip is The hip is exposed by exposed by going in going in between the between the muscles muscles WITHOUT WITHOUT DISRUPTING DISRUPTING THEMTHEM
• Muscle SparingMuscle Sparing
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• Compare the depth Compare the depth of muscle and of muscle and tissue one has to tissue one has to go throughgo through
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• This approach is made possible with the This approach is made possible with the use of a special orthopaedic table called use of a special orthopaedic table called the HANA table which is found at Glendale the HANA table which is found at Glendale Memorial HospitalMemorial Hospital
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• A small amount of X-A small amount of X-ray is also used during ray is also used during the surgery to get an the surgery to get an exact picture of the exact picture of the position of the position of the implantsimplants
• This ensures that all of This ensures that all of the hip components the hip components are in the perfect are in the perfect place and that the leg place and that the leg lengths are equallengths are equal
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• Essentially NO risk of dislocationEssentially NO risk of dislocation
• NO limitation of hip range of motion NO limitation of hip range of motion and positionsand positions
• Less Reliance on Assistive DevicesLess Reliance on Assistive Devices– Usually 2 weeksUsually 2 weeks
• Less pain!Less pain!
• FASTER RECOVERY!FASTER RECOVERY!
Total Hip Replacement Anterior Total Hip Replacement Anterior ApproachApproach
• These advantages when compared to These advantages when compared to the traditional approach can the traditional approach can eliminate apprehensioneliminate apprehension
• QUICKER RECOVERY TO AN QUICKER RECOVERY TO AN IMPROVED QUALITY OF LIFE !IMPROVED QUALITY OF LIFE !
THANK YOUTHANK YOU