Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
and Techniques
in
THR Surgery
MAIN OBJECTIVE
relief of pain
restore motion
improve function
improve quality of life
ETIOLOGY -
PREDISPOSING FACTORS
age
sex
heredity
obesity
INCITING FACTORS
inflammatory processes
metabolic
biomechanical
hormonal
steroids
INDICATIONS
severe degenerative osteoarthritis
post - traumatic arthritis
rheumatoid arthritis
hip dysplasia
avascular necrosis
seronegative spondyloarthropathies
reconstruction of tumors around the hip
PATIENT PREPARATION
physical
psychological / mental
social interaction
financial
Type of Prosthesis
Cemented
Uncemented
Hybrid
- uncemented cup,
cemented stem
Risk of Hematogenous
Total Joint Infection
Immunocompromised / Immunosuppressed
Patients
- Inflammatory Arthropathies
( SLE, Rheumatoid Arthritis )
10 - 15O anteversion
Acetabular Preparation
adequate exposure
ream until bleeding subchondral bone
multiple fixation holes
- increases torisional resistance
- do not penetrate the pelvis esp. the medial wall
Femoral Head Size
correlated with polyethylene wear
average poly wear = 0.13 mm / year
Femoral Head Size
32 mm Head
- greater volumetric wear due to large
articulating surface area
- cause of wear debris induced loosening
and bone loss
- thin acetabular polyethylene cup
Femoral Head Size
22 mm Head
- greater linear wear, high penetration
into the cup
- reduced volumetric wear, maximizes
poly thickness
- large diameter of neck tapers restricts ROM
increases potential for post-op dislocation
Cementing Technique
FIRST GENERATION
- finger packing of doughy cement
- unplugged femoral canal
- femoral stem: sharp corners, narrow medial
borders
- stainless steel
Cementing Technique
SECOND GENERATION
- canal plug: 2-3 cm distal to stem tip
allows for greater pressure & better filling
- pulsatile lavage
reduces risk of fat / marrow emboli
- cement gun
low vicosity cement / chilling the monomer
- femoral stem: broad medial borders,
rounded corners
- superalloys: CoCr
Cementing Technique
THIRD GENERATION
- porosity reduction
vacuum mixing / centrifugation
- pressurization
cement compressor
- surface modifications on stems
Cementing Technique
FOURTH GENERATION
- third generation techniques plus:
stem centralization - proximally and distally
cannulated instruments
ensure uniform mantle / proper position
Cementing Technique
hypotensive ( spinal ) anesthesia
- to reduce blood at cement - bone interface
cement mantle
- acetabulum: uniform 2mm
- femur: 3 - 4mm proximal; 1.5 - 2mm distal
Uncemented THR
infection
- unexplained post-op pain
- hip joint aspiration is definitive diagnosis
dislocation
- 1 - 5% of cases, due to malposition of components
loosening
- poor fixation / cementing technique
Complications of THR
heterotopic ossification
- 60% of cases
- indomethacin prevents formation
neurovascular
- sciatic nerve / femoral nerve palsy
Complications of THR
femoral fractures
- poor technique / reaming
Thank You