Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
OBJECTIVES
ANATOMY
Blood supply
Piet de Boer, York, UK.; Ian Harris, Adelaide, Australia; Mariusz Bonczar, Crocow , Poland
ANATOMY
Blood supply
Cranial anastomosis
biological effect
The posterior retinacular vessels from the medial circumflex artery
provides the main nutrition of the femoral head
Piet de Boer, York, UK.; Ian Harris, Adelaide, Australia; Mariusz Bonczar, Crocow , Poland
II
III
IV
Classification
GARDEN III
Classification
GARDEN IV
Incidence
Elderly
Majority
Low energy
Osteoporosis
Female
Young
High energy
Male
Diagnosis
Bone scan
Vascular emergency
Displaced fractures
Young patients
UNCEMENTED
First generation - uncemented Austin Moore
HEMIARTHROPLASTY
Minimally ambulatory patients1
Tight pain and acetabular erosion (Ambulatory and active patients) 2
Still an option: medically infirmed patients
minimally or non-ambulatory nursing home residence
advanced dementia or severe cardio-pulmonary
comorbidities
UNCEMENTED
HEMIARTHROPLASTY
Second generation uncemented unipolar hip
prosthesis
Multiple femoral sizes and antirotation fins (better
fit)
Modular neck sleeves (soft tissue balancing and
restoration of leg length and femoral offset
Newer designs offer: improved methapyseal
geometry
roughened surfaces (facilitate
bony ongrowth)
CEMENTED HEMIARTHROPLASTY
Cemented Hemiartrhoplasty provides superior clinical
results versus uncemented Hemiartrhoplasty1
immediate, secure prosthesis fixation
some risk of sudden death ! (1 at 500)2
- elderly patients - diminished pulmonary
reserve
- fatty marrow
contents
- multiple comorbidities and
non
elective operation
carefully lavage and drying the femoral channel
very gentle cement pressurization
1 Lou-Yao JBJS 1994
2. Parvisi Clin Orth Relat 1999
3. Pitto Arch Orthop Trauma Surg 2000
Decreased rate of
embolization3
BIPOLAR VS UNIPOLAR
HEMIARTHROPLASTY
The bipolar design
- benefits of transferring stress from the articular
cartilage
to the internal metal-on-polyetylene bearing1
- preservation of motion at the bipolar bearing
debatable
- rotation in the sagital plane at the bipolar interface?
- amount of bearing motion necessary to decrease
stress in
acetabulum unknown
- excellent long term survivorship few complication 2
- failures: femoral loosening AND not acetabular
1.wear
Dalldorf JBJS AM 1995
2. Haidukewich Clin Ortho Relat Research 2002
BIPOLAR VS UNIPOLAR
HEMIARTHROPLASTY
Bipolar bearing favorable decrease acetabular
erosion rates over unipolar designs1
BUT !
Additional cost of the bipolar
bearing
Higher rates of volumetric
polyethylene wear
osteolysis in more active
patients
1. Lou- Yao JBJS 1994
BIPOLAR VS UNIPOLAR
HEMIARTHROPLASTY
Several studies1,2,3
no differences in function, morbidity, mortality or
other complications at shot to midterm follow-up
some advantages in lower reoperation rates and a
very low rate of symptomatic acetabular wear1
further researches required
PAVI
TiAl4V alloy
no collarette
8 sizes: 9 (dysplasia ) 16
length of 130 - 170 mm
inox and ceramics heads
(diameters of 22, 28 and
32mm)
Dual layering
(T40 +HAP)
VPS
VACUUM
SPRAY
PLASMA
NO cracks, NO failures
following 10 mil cycles
Male 74 yrs
Second day
postop
Female - 80
yrs
48h postop
24 h postop
30 days
postop
Male 55 yrs
Female 78
yrs
Female 78
yrs
2 hours postop
Female 63 yrs
12 hrs
Female 56
yrs
3 weeks
6 weeks
CONCLUSIONS
Smaller operation
Lower dislocation rate
May not last as long as total joint replacement