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WHAT MUST BE A WELL-CEMENTED PROSTHESIS?

WHAT MUST BE A WELL-CEMENTED PROSTHESIS?. Graham Gie FRCSEd(Orth) PEOC Exeter. WHAT MUST BE A WELL- CEMENTED PROSTHESIS?. Surgical Technique Type of Implant. A good cemented THA :. A good cemented THA :. Conducted by a skilled surgeon. A good cemented THA :.

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WHAT MUST BE A WELL-CEMENTED PROSTHESIS?

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  1. WHAT MUST BE A WELL-CEMENTED PROSTHESIS? Graham Gie FRCSEd(Orth) PEOC Exeter

  2. WHAT MUST BE A WELL- CEMENTED PROSTHESIS? Surgical Technique Type of Implant

  3. A good cemented THA:

  4. A good cemented THA: Conducted by a skilled surgeon

  5. A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures

  6. A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications

  7. A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation

  8. A good cemented THA: Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation And a tried and tested prosthesis

  9. A good cemented THA: Conducted by a skilled surgeon Who performs the procedure frequently

  10. Skilled Surgeon? Gifted? Performs the procedure frequently PRACTICE MAKES PERFECT

  11. Exposure considering bony & soft tissues Reduce soft tissue dissection Post approach preserving piriformis Don’t take trochanter off Repair soft tissues

  12. Minimising Complications Avoid trochanteric problems Reduce dislocations Avoid sepsis

  13. Using modern techniques & instrumentation Acetabulum Femur

  14. ACETABULUM Circumferential view

  15. ACETABULUM Circumferential view Exposure of cancellous bone

  16. ACETABULUM Circumferential view Exposure of cancellous bone Rim cutter

  17. RIM CUTTER

  18. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry

  19. Primary Exeter Cemented Prosthesis : Socket Lavage

  20. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Iliac suction

  21. Iliac Sucker

  22. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation

  23. Primary Exeter Cemented Prosthesis : Pressurizing Cement

  24. Primary Exeter Cemented Prosthesis : New Cup Insertion

  25. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation Flanged socket, highly crosslinked poly

  26. The Socket Contemporary technique Primitive technique

  27. FEMUR Good exposure

  28. FEMUR Good exposure Clean & Dry Canal

  29. FEMUR Good exposure Clean & Dry Canal Gun insertion of cement

  30. FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation

  31. FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation Delayed insertion of a polished stem, collarless & double-tapered

  32. FEMUR

  33. Primary Exeter Cemented Prosthesis : Femoral Cementing

  34. Post-op 11yrs

  35. Post-op 12yrs

  36. Cemented THA with a polished stem – up to 33 years follow-up

  37. Survivorship curve of the original polished Exeter stems - 1970-75: end point revision for aseptic stem loosening S u r v I v o r s h I p % Survivorship 93.14%: 95% C.L. 74.39-100% Years since operation

  38. Survivorship curve of the original polished Exeter stems 1970- 75: patients under age 60 at operation. End point revision for aseptic stem loosening S u r v I v o r s h I p % Survivorship 87.22%: 95%CL 54.55 – 100% (68 cases) Years since operation

  39. Original cups 1970-75; survivorship with end-point revision for aseptic cup loosening S u r v I v o r s h I p % Survivorship 72.45%: 95%CL 39.12-100% Years since operation

  40. A 12-17 YEAR SURVIVORSHIP STUDY OF THE EXETER UNIVERSAL CEMENTED STEM

  41. 100% stem survival at 10 – 17 yrs

  42. CEMENTED EXETER THA IN PATIENTS AGED 50 OR LESS 10 to 17 year follow-up O

  43. DETAILS OF YOUNG HIP REVIEW Patients 107 Bilateral arthroplasties 23 TOTAL No. HIPS: 130 Follow-up: Range: 10 – 17 years Average: 12.5 years No case lost to follow-up Died of unrelated causes: 7 hips

  44. DETAILS OF YOUNG HIP REVIEW Mean age at Sx 42yrs

  45. 12 REVISIONS LOOSE CUPS 9 (6.8%) CUP FOR LYSIS 1 RECURRENT DISL 1 INFECTION 1 LOOSE STEMS 0

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