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Basics Of THRBasics Of THR
Dr Niraj L VoraDr Niraj L Vora
Consultant Orthopaedic Joint ReplacementConsultant Orthopaedic Joint Replacement
and Trauma Surgeonand Trauma Surgeon
Kokilaben Dhirubhai Ambani HospitalKokilaben Dhirubhai Ambani Hospital
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EvolutionEvolution
Osteotomy ArthroplastyOsteotomy Arthroplasty
Interpositional ArthroplastyInterpositional Arthroplasty
Reconstructive ArthroplastyReconstructive Arthroplasty
Partial/Hemi ArthroplastyPartial/Hemi ArthroplastyTotal Hip ArthroplastyTotal Hip Arthroplasty
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EvolutionEvolution
Earliest record of hip arthroplastyEarliest record of hip arthroplasty 18271827
Various materials used, including Glass,Various materials used, including Glass,Ivory, Acrylic etcIvory, Acrylic etc
Various giants like Judet, McKee, SmithVarious giants like Judet, McKee, SmithPetersen etc tried, but were unsuccessfulPetersen etc tried, but were unsuccessful
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MARIUS SMITHMARIUS SMITH--
PETERSEN (1923)PETERSEN (1923)
Boston.Boston.
Vitallium CupVitallium CupMouldMould
ArthroplastyArthroplasty
InterpositionalInterpositional ArthoplastyArthoplasty
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OTTO E. AUFRANCOTTO E. AUFRANC
Interpositional ArthroplastyInterpositional Arthroplasty
82% success rate in82% success rate in
1000 cases (1957)1000 cases (1957)
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Sir JohnSir John CharnleyCharnley Initially teflon socketInitially teflon socket early failureearly failure wearwear
Accidentally stumbled upon HDPEAccidentally stumbled upon HDPE
Concept of Low Friction ArthroplastyConcept of Low Friction Arthroplasty22.225mm head and thick22.225mm head and thick
poly socketpoly socket
Use of cementUse of cement -- 19531953
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Dr K TDr K T DholakiaDholakiaFather of Arthroplasty in IndiaFather of Arthroplasty in India
At one time did moreAt one time did moreArthroplastiesArthroplasties than all othersthan all others
in India put togetherin India put together
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EvolutionEvolution
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Hip BiomechanicsHip Biomechanics
Centre of Hiprotation
Abductor lever arm
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Hip BiomechanicsHip Biomechanics
Frictional torque
proportional to
head diameter
Large headLarge headIncreased arc of motionIncreased arc of motion
Reduced impingementReduced impingement
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About HardwareAbout Hardware
CobaltCobalt--chromechrome
OffsetOffset Vital to preventVital to prevent
abductor lurchabductor lurch
Neck lengthNeck length will affectwill affect
leg lengthleg length
Distal stem diameterDistal stem diameter
important in mode ofimportant in mode of
fixation offixation of uncementeduncemented
implantimplant
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About HardwareAbout Hardware
Made of UHMWPE (Ultra HighMade of UHMWPE (Ultra High
Molecular WeightMolecular Weight PolyEthylenePolyEthylene) or) or
HDPEHDPE
Flange helps with cementFlange helps with cement
pressurisationpressurisation
Long posterior wall helps reduce risk ofLong posterior wall helps reduce risk ofdislocationdislocation
Grooves give greater surface area forGrooves give greater surface area for
cementcement
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Uncemented Femoral ComponentUncemented Femoral Component
TitaniumTitanium--AluminiumAluminium--VanadiumVanadium
alloyalloy
Coated withCoated with HydroxyapatiteHydroxyapatite((HAHA) or Porous (Ti) or Porous (Ti fibrefibre mesh)mesh)
Good initial primary stability isGood initial primary stability is
a must (a must (Press fitPress fit))
Depend onDepend on osteoosteo--integrationintegration
for fixation (for fixation (Biologic FixationBiologic Fixation))
Corail HipCorail Hip
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Anatomic stemAnatomic stem
Straight stemStraight stem VariableVariable
CoatingCoating
Uncemented Femoral ComponentUncemented Femoral Component
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UncementedUncemented SocketSocket
Fixation methodsFixation methods
Press fitPress fit
SpikesSpikesScrewsScrews
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Modular ComponentsModular Components
SS--ROMROM
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Custom ImplantsCustom Implants
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IndicationsIndications
Primarily, alleviation ofPrimarily, alleviation of
incapacitatingincapacitating PAINPAINSecondary is improving HipSecondary is improving Hip
Function (Mobility and stability)Function (Mobility and stability)
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PrePre--operativeoperative TemplatingTemplating
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Surgical ApproachesSurgical Approaches1.1. Posterior approachPosterior approach
2.2. AnterolateralAnterolateral approach (approach (HardingeHardinge))
3.3. TransTrans--trochanterictrochanteric approach (approach (CharnleyCharnley))
4.4. ExtendedExtended TrochantericTrochanteric OsteotomyOsteotomy (ETO)(ETO)
for Revision surgeryfor Revision surgery
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Posterior approachPosterior approach
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AcetabularAcetabular ImplantationImplantation
Avoid Bottoming OutAvoid Bottoming Out
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Femoral techniqueFemoral technique
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Femoral techniqueFemoral technique
EntryEntry
Distal plugDistal plug
Cement gunCement gun
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Modern cementing techniquesModern cementing techniques
MedullaryMedullary brushbrush
Cement restrictor (plastic/bone/cement pCement restrictor (plastic/bone/cement plug)
MedullaryMedullary PulsatilePulsatile LavageLavage Insertion of adrenalineInsertion of adrenaline--soaked spongessoaked sponges
Reduction of cement porosity (Centrifuge and VacuumReduction of cement porosity (Centrifuge and Vacuummixing)mixing)
Cement centralizers (applied to femoral stem tip)Cement centralizers (applied to femoral stem tip)
Cement gun for retrograde insertion and pressurizationCement gun for retrograde insertion and pressurization
Pressurization: may be performed with surgeon's glovedPressurization: may be performed with surgeon's glovedfinger or with a wedge shaped device pushed into thefinger or with a wedge shaped device pushed into themedullarymedullary canalcanal
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Femoral techniqueFemoral technique
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Alternate BearingsAlternate Bearings
Ceramic on Ceramic Very low wear rate
Much smoother
Highly biocompatible
High hardness
Suitable for the younger patient
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Wear RatesWear Rates
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Articular Surface ReplacementArticular Surface Replacement
(ASR)(ASR)
ProsPros
Bone conserving
Increased hip ROMdislocation
ConsCons
Limited indicationsSteep learning curve
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Computer AssistedComputer Assisted Nav
Nav
A GPS system for joint replacementA GPS system for joint replacement
Provides individualized information to planProvides individualized information to planbony resectionbony resection
Improves accuracy in implant positioningImproves accuracy in implant positioning
Excellent training toolExcellent training tool
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Computer Assisted NavComputer Assisted Nav
Used in Resurfacing surgery
Registration process critical
No peer reviewed evidence
that use of Nav improveslong term outcomes
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ComplicationsComplications
Osteolysis
Cement DiseaseCement Disease
Cementless DiseaseCementless Disease
ZonesZ
ones
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ComplicationsComplications
Poly WearPoly Wear
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ComplicationsComplications
DislocationDislocation
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ComplicationsComplications
InfectionsInfections
1.1. Antibiotic therapyAntibiotic therapy
2.2. Incision and drainage of the hipIncision and drainage of the hip3.3. Debridement and modified GirdlestoneDebridement and modified Girdlestone
resection arthroplastyresection arthroplasty
4.4. OneOne-- or twoor two--stage revision to a total hipstage revision to a total hip
arthroplastyarthroplasty
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2 stage Revision
ComplicationsComplications
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Fractures
ComplicationsComplications
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