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Hip Arthroplasty

Hip Arthroplasty . Chris Oser. Presentation. Why hip replacement? How? –Surgery! Different materials Pros and Cons Resurfacing Patient post-op. Reasons for Hip Replacement. #1: Osteoarthritis Rheumatoid arthritis Trauma - Injury Osteonecrosis

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Hip Arthroplasty

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  1. Hip Arthroplasty Chris Oser

  2. Presentation Why hip replacement? How? –Surgery! Different materials Pros and Cons Resurfacing Patient post-op

  3. Reasons for Hip Replacement #1: Osteoarthritis Rheumatoid arthritis Trauma - Injury Osteonecrosis Bone tumors that break down the hip joint.

  4. Who needs a THR • Generally acknowledged indications: • Jointpain • Functional limitation • Radiographic evidence ofjoint damage

  5. Which hip needs a replacement?

  6. Shortening

  7. Prosthesis Femoral Stem Femoral Neck Femoral Head (Liner) Acetabular Cup

  8. Be-WEAR!!! Wear leads to failure -Shedding of materials due to friction -Causes: -Irritation -Pain -Decreased Mobility -Joint Failure “Aseptic loosening due to wear debris-induced osteolysis has been identified as the leading cause of late failure in total hip arthroplasty”

  9. Revision 2nd Surgery – Not as effective as 1st -Added cost -Additional down-time and recovery -Loss of faith in procedure

  10. Materials Metal-on-Metal Metal-on-Poly Ceramic-on-Ceramic Ceramic-on-Poly

  11. Metal on Metal - Pros Strong! Very low wear properties -10X Longevity Greater diameter femoral head. Dancers, Athletes, who value an extended mobility and stability. Younger Patients.

  12. Metal on Metal - Cons • Lose ability to affix with screws. • Shedding of metal ions • Cobalt • Chromium  Pregnant women or renal impaired, loss of hip bone.

  13. Metal on Poly - Pros • Most common • 10 yrs - 90% functioning well • 20 years – 80% • Liner replacement • Highly cross-linked poly vs. non. -Decreased wear with cross-linked, even with larger heads. -Aids in decreasing chances of revision Older patients (majority), less bone, trauma pts.

  14. Metal on Poly - Cons • Large amount of particles shed -> osteolysis and aseptic loosening. • Highly cross-linked poly liners: • Cost of being more susceptible to fatigue fracture.  Younger patients

  15. Ceramic on Ceramic - Pros Strongest! Most inflexible surface. 100x less wear than Metal on Poly Aluminum Oxide Ceramic  Same as Metal on Metal. Younger Patients.

  16. Ceramic on Ceramic - Cons Can become a surgeon’s worst nightmare! -Fracture -Impingement -Ease of revision -Squeaking!  Older patients. Those with risky behavior.

  17. Ceramic on Poly - Pros Many of same properties of Metal on Poly Decreased wear on Poly liner Less ceramic on the joint, less to fracture.  Younger patients. Especially younger Women

  18. Ceramic on Poly - Cons • Poly Wear --> Osteolysis • Ceramic fracture. • Less ceramic to fracture, but it still can! •  Older patients. Those with risky behavior.

  19. ResurfacingThe New Kid on the Block

  20. Resurfacing • New Alternative • Acetabulum and Femoral Head. • Preserves the femoral neck and avoids exposing the femoral canal. • Unsuccessful early with liner use, now all metal • In use for about 10 years. • Usually less than 55. • If not had deformity due to arthritis.

  21. THR Resurfacing

  22. Resurfacing - Pros Expected high longevity out of them, even in younger patients ~ 30 yrs. Preserve femoral neck and canal. Critical for success of a revision surgery. Larger size of the implanted head reduces the risk of dislocation. More likely than total hip replacement patients to recover a natural gait. Younger patients, good hip bone strength.

  23. Resurfacing - Cons • Metal on metal articulation: • Ion shedding. • Inability to affix the acetabular head with screws. • Possibility that the femoral neck can break. • Lack of a long-term track record: ~10 years • Longer surgical time and requires somewhat more skill. –Still a learning curve. • Older, Pregnant, Poor Bone Strength.

  24. Outcome For the majority of people who have hip replacement surgery, the procedure results in: a decrease in pain increased mobility improvements in activities of daily living improved quality of life. 92% success rate

  25. THE (rear)END

  26. Post-Op Instructions 3-4 Day recovery in hospital For atleast 6 weeks, NO: Lifting Twist or squat Extreme movements Cross your legs Lift your knee higher than your hip Sporting activities (golf). Drive Bath – Showers only

  27. Post-Surgical Activities

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