hip arthroplasty. anatomy of hip hip joint ball and socket ball is the femoral head socket is...
TRANSCRIPT
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Hip Arthroplasty
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Anatomy of Hip
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Hip Joint
• Ball and socket• Ball is the femoral head
• Socket is Acetabulum • Half sphere depression
• Lined with cartilage– Horseshoe shape
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Hip Joint
• Femur• Neck-shaft angle ~ 1350
• 2/3 rd of head is covered with cartilage
• Head fits into acetabulum • Suction effect during dislocation
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Hip OA
• Cartilage gradually wear down• Femoral head and
acetabulum grind on each other (bone-on-bone arthrosis)
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Traumatic arthritis
• Occurs following injury to hip
• Direct trauma• damage to cartilage
• Femoral neck fracture
• Hip dislocation• Blood supply may be lost
– Avascular necrosis
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Rheumatoid arthritis
• Body's immune system attacks synovium and cartilage • Joint arthrosis
• Deformity
• Stiffness
• Women are more often affected than men
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Plain X-rays
• Loss of joint space
• Subchondral sclerosis
• Subchondral Cysts
• Irregularity of joint surface
• Subluxation
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Objectives
• Joint replacement • Femoral stem
• IM Metal implant • Modular
– Titanium stem and cobalt-chrome head
• Acetabular cup• A low-wearing plastic insert
• Press fit to acetabulum • Porous coated
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Types of Implants
• Implants may be • Cemented
• Porous coated• Mesh of holes on implant surface
• Secured as bone in grows
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Cemented type
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Porous Coated Implants
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Acetabular component
• Shell is made of metal
• Plastic liner • Load bearing
• Fits snugly inside shell
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Femoral Stem
• Made of metal• Usually titanium
• Head• Diameter
– 28, 32 mm
• Material– Cobalt chrome– Ceramic
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Surgical Procedure
• An incision about eight inches long (dotted line)
• Exposure hip joint• Anterior
• Posterior
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Removal of Femoral Head
• Femoral head is dislocated from acetabulum
• Neck cut• Femoral head is
removed
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Femoral Neck Cut
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Acetabulum Reaming
• Acetabular cup is reamed into a hemisphere
• Cartilage is removed
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Reaming the Acetabulum
• Lateral View
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Inserting the Acetabular component
• Acetabular shell • Porous coated
• Press fit
• Screws for stability
• Cemented
• A hard smooth plastic liner is inserted into metal shell
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Insertion of Acetabular component
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Reaming of Femoral Canal
• Intramedullary canal finder• Manual insertion of a
rod
• Distal intramedullary reaming with a straight reamer
• Rasping
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Femoral Stem Insertion
• Press fit
• Cemented • Pressurization
• Canal plug
• Cement vacuum mix
• Cement Gun
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Inserting Femoral Stem
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Femoral Head
• A metallic head is attached to stem
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Attaching Femoral Head
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Hip Reduction
• Ball is reduced into acetabular liner• Soft tissue tension is
tested
• Leg length may be a problem
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THA
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Animation of hip replacement
• http://www.hipandkneesurgery.net/hip.html
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Acrylic Cement Fixation
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Cementless Fixation
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Hybrid Fixation
• Acetabular cup• Press fit
• Femoral stem• Cemented
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Care after Surgery
• A suction drain • May be used for 1-2 days after surgery
• Intravenous fluids & antibiotics • Pain medication• Elastic stockings, compression stockings and
blood thinners • To decrease chances of blood clots
• For first 6-8 weeks • Low sitting may cause dislocation
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Care after Surgery
• Physical therapy • Getting in and out of bed
• Standing and walking • Crutches or a walker
• Discharge from hospital• Usually in 3-5 days
• Continued PT, OT
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Complications
• Thrombophlebitis• Blood clots within deep veins
• Swelling of leg • Become warm to touch
• Painful
• May lead to pulmonary embolus and death
• Infection
• Dislocation
• Loosening
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Other Types of Hip Replacement
• Surface Replacement of the Hip• In younger patients
• Complication of a neck fracture
• Hemi-arthroplasty• Only the femoral side is replaced
• When acetabulum is intact
• May not be efficient in pain relief
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Hemi-Surface Replacement
• Bone stock preservation • Replacing only
diseased part
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Surface Replacement
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References
• http://www.hipandkneesurgery.net/hip.html
• http://www.yoursurgery.com/ProcedureDetails.cfm?BR=5&Proc=27
• http://www.jri-oh.com/hipsurgery/Hip_Types.asp
Surface Replacement of the Hip
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The End