arthroplasty marielle

8/13/2019 Arthroplasty Marielle

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ArthroplastyMarielle Marasigan

Julie Ann Peano


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Avascular Necrosis of Femoral Head

A disease in which the living elements of bone inthe femoral head die


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Pathogenesis of AVN

Sinusoidal occlusion and venous stasis

marrow necrosis and partial osteocyte death Frank bone necrosis and early osteoblast

response

Early bone repair and inc bone density ate repair and distortion of the femoral head

Subchondral fragmentation and articular

breakdown


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Fracture

!isruption in the integrity of the living bone"involving in#ury to the bone marrow" periosteumand ad#acent soft tissue$


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Etiology

%ccurs when force applied to the bone e&ceedsthe strength of the involved bone

Intrinsic Factors:

' (one)s energy absorbing capacity

' *odulus elasticity' Strength

' !ensity


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Extrinsic Factors:

' +ate of load' !uration" !irection and *agnitude of force

Direct Trauma:

' ,rushing" Penetrating -n#uries

Indirect Trauma:

' .raction" ,ompression" +otational Forces


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General Principle of Fracture Healing

Ade/uate (lood Supply

*inimal 0ecrosisAnatomic +eduction

-mmobili1ation

Physiologic Stress

Absence of -nfection


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Fracture Complication

(one 2ealing Abnormalities3

' !elayed 4nion 5 678 months after in#ury' 0on74nion 7 9 : months after in#ury

' *alunion 5 4nacceptable Position

' Avascular 0ecrosis


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Hip Fractures


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2ip fracture is an emergency situation$

-ntertrochanteric fracture and femoral neckfracture accounts ;below lessertrochanter? accounts @= 7


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Categories

-ntracapsular

'ocated distal to the femoral head but pro&imal to thegreater and lesser trochanter s$

' Fre/uently disrupts the blood supply to the femoralhead" therefore associated with nonunion and

osteonecrosis of the femoral head$>eg$ Femoral neck fracture?

E&tracapsular

>eg$ .rochanteric Fracture?


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Femoral Neck Fracture


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Epidemiology

*ore than B@96< years?

Dounger p& 3 high7energy trauma elderly >Byrs?3 low7energy falls

-ncidence of femoral neck f& in 4S is :6$6 andB$ per


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Ris Factors Female se&

Ghite race

-ncreasing age

Poor health

.obacco and alcohol use Previous fracture

Fall history

ow estrogen level


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AnatomyHip Joint

ball and socket #t$

,omposed of femoral head Hthe acetabulum

2as 6 deg$ of freedom

Geight bearing #t$

Femoral epiphysis closes byage of : yrs

Neck-shaft angle3 6


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!igaments

-liofemoral

' D7ligament of (igelow >ant$? Pubofemoral

' anterior

-schiofemoral

' posterior


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"lood #upplyTrochanteric nastamosis

Provides the main blood supply to the head of the femur

0utrient arteries pass along the femoral neck beneath thecapsule

!arts:

Superior gluteal artery -nferior gluteal artery

*edial femoral circumfle& artery

ateral femoral circumfle& artery


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Mechanism of $n%ury

"o#-energ$ trauma >most common inelderly?

' Direct

' A fall onto the greater trochanter >valgus impaction? orforced e&ternal rotation of the E

' Indirect

' *uscle forces overwhelm the strength of the femoralneck


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High-energ$ Trauma

' both younger and older patients

Eg$ *KA or fall from a significant ht$ >osteoporoticp&?

%$clical "oading-stress Fractures

' .hese are seen in athletes" military recruits" ballet

dancers

' P& with osteoporosis and osteopenia are at particularrisk


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Clinical Evaluation P& with displaced femoral neck fractures typically are

non7ambulatory on presentation" with shortening

and e&ternal rotation$

P& with impacted or stress f& may demonstrate subtlefindings$

Pain on attempted +%* of the hip Pain on a&ial compression and tenderness to

palpation of the groin

ook for additional problems


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Classification


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JOINT REPLACEMENT


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Purpose

+elieve of severe disabling pain

,orrect deformities +e7establish function

Prevent meliorate painful secondary effects on

ad#acent #oints


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!imitations

!islocation >post Approach?

-nfection >most fatal? !K.

Periprothetic fracture

oosening


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Common causes of &oint 'estruction

%A

+AAK0

.raumatic Arthritis

egg7,alve7Perthes !se

Slipped capital femoral epiphysis

And failed Previous operation


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Contraindications&solute 'elative

Active sepsis >local or

systemic?

Paralysis about the #oint to bereplaced

0euro pathic Jt disease

Dounger age and obesity

Severe muscle weakness

Severe osteoporosis

Severe uncorrected defectsabout the #oint

Physiological or psychological

deficiencies and proportion


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(ypes

.otal

' (oth sides of the #oint are replaced Partial

' %nly one side is replaced

-nterpositional

+esectional


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Methods of Fi)ation

Polymethylmethacrylate >bone cement?

Porous coated7bony ingrowth 2ydro&yapatite coating

Press7fit stabili1ation


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"earing #urface *etal7on7metal

,eramic7on7ceramic Polyethylene


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Complications .hromboembolic !isease

Prophyla&is' *echanical3 elevation of the limb early

mobili1ation" compression stockings

Aseptic oosening' P& usually complains of pain in the groin or

buttocks or thigh


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Pre*operative Education *uscle Strengthening

Strengthening muscles around the #oint operatedeither by isometrics" isotonic or isokinetic


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Post*op Reha+ilitation Program

(oal:to ma&imi1e the p&)s f&n)l statuswithrespect to mobility" A! and also to minimi1e

post7operative complications

,emented

' -mmediate G(

0on7cemented

' .oe touch for si& wks

' PG( ne&t : wks


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First day

' P& can stand at bedsite if possible

' (egin ambulating with assistive device

Second day

' ambulation should begin transfers to bed" chairand toilet alone safely

Second week

' Perform mobility task at supervision level Si&th week

' *uscle strengthening e&ercise


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Precautions 0o fle&ion the hip past ;

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