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All Things Arthoplasty

All Things Arthoplasty. Outcome and complication Dr. Bahaa Ali Kornah, Prof. Of Orthopedic and Trauma Al-Azhar University Cairo. Egypt. Arthroplasty. Latin arth - joint Greek plastica - molding.

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All Things Arthoplasty

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  1. All Things Arthoplasty Outcome and complication Dr. Bahaa Ali Kornah, Prof. Of Orthopedic and Trauma Al-Azhar University Cairo. Egypt

  2. Arthroplasty • Latin arth - joint • Greek plastica - molding

  3. is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by prosthesis • It is an elective procedure

  4. Goals of Joint Replacement Surgery • Relieve pain!!! • Restore function, mobility

  5. There are many types used to do the procedures • interpositional arthroplasty with interposition of some other tissue like skin, muscle or tendon to keep inflammatorysurfaces apart or  • excisional arthroplasty in which the joint surface and bone was removed leaving scar tissue to fill in the gap. • resection(al) arthroplasty,  • resurfacing arthroplasty,  • mold arthroplasty,  • cup arthroplasty,  • silicone replacement arthroplasty

  6. Indications • Osteoarthritis (OA) • Rheumatoid arthritis (RA) • Avascular necrosis (AVN) or osteonecrosis (ON) • Congenital dislocation of the hip joint (CDH) Hip dysplasia (human) • Acetabular dysplasia (shallow hip socket) • Frozen shoulder, loose shoulder • Traumatized and malaligned joint • Joint stiffness

  7. Background • Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship* *

  8. Background • Total joint replacement (TJR) is one of the most cost-effective procedures in all of medicine.

  9. TJA Volume Estimates

  10. TJA: Indications

  11. Surgical Treatment Options • Joint preserving operations • Arthroscopy • Cartilage transplantation • Osteotomy • Arthroplasty Options: • Hemiarthroplasty • Resurfacing arthroplasty • Total joint arthroplasty

  12. Anatomy—Hip

  13. Anatomy of Hip

  14. Hip Joint • Ball and socket • Ball is the femoral head • Socket is Acetabulum • Half sphere depression • Lined with cartilage • Horseshoe shape

  15. Hip Joint • Femur • Neck-shaft angle ~ 1350 • 2/3 rd of head is covered with cartilage • Head fits into acetabulum • Suction effect during dislocation

  16. Rheumatoid arthritis • Body's immune system attacks synovium and cartilage • Joint arthrosis • Deformity • Stiffness • Women are more often affected than men

  17. Plain X-rays • Loss of joint space • Subchondral sclerosis • Subchondral Cysts • Irregularity of joint surface • Subluxation

  18. THA Implants

  19. Types of Implants • Implants may be • Cemented • Porous coated • Mesh of holes on implant surface • Secured as bone in grows

  20. Implant Choice • Cemented: • Elderly (>65) • Low demand • Better early fixation • ? late loosening

  21. Cemented type

  22. Implant Choice • Cementless: • Younger • More active • Protected weight-bearing first 6 weeks • ? Better long-term fixation

  23. Porous Coated Implants

  24. Implant Choice • Cementless: • Younger • More active • Protected weight-bearing first 6 weeks • ? Better long-term fixation

  25. Implant Choice • Cementless: • Younger • More active • Protected weight-bearing first 6 weeks • ? Better long-term fixation

  26. Acetabular component • Shell is made of metal • Plastic liner • Load bearing • Fits snugly inside shell

  27. Femoral Stem • Made of metal • Usually titanium • Head • Diameter • 28, 32 mm • Material • Cobalt chrome • Ceramic

  28. Surgical Procedure

  29. Anatomic Approach • Anterior Approach • Anterior-Lateral Approach • Posterior Approach • Medial Approach

  30. Surgical Procedure • An incision about eight inches long • Exposure hip joint • Anterior • Posterior

  31. Removal of Femoral Head • Femoral head is dislocated from acetabulum • Neck cut • Femoral head is removed

  32. Femoral Neck Cut

  33. Acetabulum Reaming • Acetabular cup is reamed into a hemisphere • Cartilage is removed

  34. Technique: Total Hip Replacement • Insertion of acetabular component • Acetabular reaming

  35. Inserting the Acetabular component • Acetabular shell • Porous coated • Press fit • Screws for stability • Cemented • A hard smooth plastic liner is inserted into metal shell

  36. Insertion of Acetabular component

  37. Reaming of Femoral Canal • Intramedullary canal finder • Manual insertion of a rod • Distal intramedullary reaming with a straight reamer • Rasping

  38. Femoral Stem Insertion • Press fit • Cemented • Pressurization • Canal plug • Cement vacuum mix • Cement Gun

  39. Inserting Femoral Stem

  40. Technique: Total Hip Replacement • Final implant • Femoral head impaction

  41. Femoral Head • A metallic head is attached to stem

  42. Hip Reduction • Ball is reduced into acetabular liner • Soft tissue tension is tested • Leg length may be a problem

  43. Conventional THA

  44. Hip ArthroplastyTraditional Stem Design Extended Offset

  45. Hip ArthroplastyTraditional Stem Design Standard Offset

  46. Hip ArthroplastyTraditional Stem Design Standard Offset -3.5 Head

  47. Hip ArthroplastyTraditional Stem Design Standard Offset +0 Head

  48. Hip ArthroplastyTraditional Stem Design Standard Offset +3.5 Head

  49. Hip ArthroplastyTraditional Stem Design Extended Offset +0 Head

  50. Hip ArthroplastyTraditional Stem Design Extended Offset +3.5 Head

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