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Hip Arthroplasty

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Page 1: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hip Arthroplasty

Page 2: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Anatomy of Hip

Page 3: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hip Joint

• Ball and socket• Ball is the femoral head

• Socket is Acetabulum • Half sphere depression

• Lined with cartilage– Horseshoe shape

Page 4: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hip Joint

• Femur• Neck-shaft angle ~ 1350

• 2/3 rd of head is covered with cartilage

• Head fits into acetabulum • Suction effect during dislocation

Page 5: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hip OA

• Cartilage gradually wear down• Femoral head and

acetabulum grind on each other (bone-on-bone arthrosis)

Page 6: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Traumatic arthritis

• Occurs following injury to hip

• Direct trauma• damage to cartilage

• Femoral neck fracture

• Hip dislocation• Blood supply may be lost

– Avascular necrosis

Page 7: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Rheumatoid arthritis

• Body's immune system attacks synovium and cartilage • Joint arthrosis

• Deformity

• Stiffness

• Women are more often affected than men

Page 8: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Plain X-rays

• Loss of joint space

• Subchondral sclerosis

• Subchondral Cysts

• Irregularity of joint surface

• Subluxation

Page 9: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 10: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Types of Implants

• Implants may be • Cemented

• Porous coated• Mesh of holes on implant surface

• Secured as bone in grows

Page 11: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Cemented type

Page 12: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Porous Coated Implants

Page 13: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Acetabular component

• Shell is made of metal

• Plastic liner • Load bearing

• Fits snugly inside shell

Page 14: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Femoral Stem

• Made of metal• Usually titanium

• Head• Diameter

– 28, 32 mm

• Material– Cobalt chrome– Ceramic

Page 15: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Surgical Procedure

• An incision about eight inches long (dotted line)

• Exposure hip joint• Anterior

• Posterior

Page 16: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Removal of Femoral Head

• Femoral head is dislocated from acetabulum

• Neck cut• Femoral head is

removed

Page 17: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Femoral Neck Cut

Page 18: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Acetabulum Reaming

• Acetabular cup is reamed into a hemisphere

• Cartilage is removed

Page 19: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Reaming the Acetabulum

• Lateral View

Page 20: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Inserting the Acetabular component

• Acetabular shell • Porous coated

• Press fit

• Screws for stability

• Cemented

• A hard smooth plastic liner is inserted into metal shell

Page 21: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Insertion of Acetabular component

Page 22: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Reaming of Femoral Canal

• Intramedullary canal finder• Manual insertion of a

rod

• Distal intramedullary reaming with a straight reamer

• Rasping

Page 23: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Femoral Stem Insertion

• Press fit

• Cemented • Pressurization

• Canal plug

• Cement vacuum mix

• Cement Gun

Page 24: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Inserting Femoral Stem

Page 25: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Femoral Head

• A metallic head is attached to stem

Page 26: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Attaching Femoral Head

Page 27: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hip Reduction

• Ball is reduced into acetabular liner• Soft tissue tension is

tested

• Leg length may be a problem

Page 28: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

THA

Page 29: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Animation of hip replacement

• http://www.hipandkneesurgery.net/hip.html

Page 30: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Acrylic Cement Fixation

Page 31: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Cementless Fixation

Page 32: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hybrid Fixation

• Acetabular cup• Press fit

• Femoral stem• Cemented

Page 33: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 34: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 35: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 36: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 37: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Hemi-Surface Replacement

• Bone stock preservation • Replacing only

diseased part

Page 38: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

Surface Replacement

Page 39: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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

Page 40: Hip Arthroplasty. Anatomy of Hip Hip Joint Ball and socket Ball is the femoral head Socket is Acetabulum Half sphere depression Lined with cartilage

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