Rubin institute for Advanced Orthopaedics

2. Rubin institute for Advanced Orthopaedics ui

3.  I have disclosed no relevant financial relationship with any commercial companies pertaining to this activity.

4. Hip Anatomy • Ball and Socket Joint • Acetabulum • Femoral Head • Joint Capsule • Femur • Muscular support

6. History of Joint Replacement 1840 – Carnochan first surgeon who thought the hip joint could be replaced artificially . He used a wooden block between the damaged ends of a hip joint. 1890- Gluck introduced Ivory Joint 1919 Debit used Rubber in place of femoral head 1925 Smith Peterson used glass

7. Total Hip Replacement History 1960s Sir John Charnley Developed and Proposed principles of Arthroplasty.

8. Principles • Rigid fixation • Resurfacing of both joint surfaces • Use of materials with low friction and wear • Restore normal hip joint biomechanics • Goal of restoring leg length and center of rotation

9. Hip Replacement

10. Types of Hip Replacement • Total Hip Replacement • Bipolar Hip Replacement • Resurfacing Hip Replacement

11. Total Hip Replacement Indications • Osteoarthritis Primary and post traumatic • Osteonecrosis / large lesion • Deformity

12. Indications (less often) • Certain benign and malignant bone tumors • Arthritis associated with paget’s disease • Ankylosing spondylitis • Rheumatoid arthritis

13. Osteoarthritis • Definition: Chronic irreversible degenerative disease of articular cartilage

15. Osteoarthritis

18. Post Traumatic Arthritis

19. Post Traumatic Arthritis

20. Osteonecrosis • Definition: In situ death of bone due to disruption in blood supply

21. Osteonecrosis • Etiology has not been established • But several risk fractures

22. Osteonecrosis Primary Risk Factors • Corticosteriod use / (asthma, RA, Sarcoidosisetc • Heavy alcohol use • Coagulation abnormalities / Sickle Cell Disease • HIV drugs / Chemotherapy • Dysbarism – change in pressure scuba diving

23. Theories of Osteonecrosis • Dysfunction of mesenchymal stem cells may be attributed to changes in the femoral head • Methylprednisolone leads to an inhanced vasonconstriction of the femoral head arteries which decreased femoral head blood flow

24. Osteonecrosis • Most patients with various risk factors do not develop this disease. • Therefore it has been thought that there must be specific genetic predisposition for the development of osteonecrosis.

27. Osteonecrosis

28. Osteonecrosis MRI

29. Osteonecrosis MRI

30. Deformity / Protrusio Hip

31. Deformity Protrusion hip

32. Dysplastic hip

33. Bipolar Hip Replacement • Indication – Femoral Neck Fracture • No acetabular arthritic changes

34. Indication Femoral neck fracture

35. Bipolar Hip Replacement • Picture

36. Bipolar Hip Replacement

37. Cemented vs Noncemented femoral stems

38. Hip Resurfacing • Less invasive • Less bone loss

39. Resurfacing – metal on metal

40. Resurfacing • Benefit • Maintain bone stock

42. Implants / Femoral stem

43. Implants / Acetabular Cup • Metals • Plastic • Ceramic

45. Ceramic on Ceramic

46. Metal on Metal

48. Anesthesia“Many Variables” • Spinal Anesthesia – Epidural supine hips replacement Knee replacement

49. Basics of hip replacement 1. General Anesthesia

50. Anesthesia • General anesthesia • lateral position hip Revision hip or knee replacement • Patient with spinal stenosis / arthritis