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Total Hip and Knee Replacement

An Introduction to the Principles underlying Total Hip and Knee Replacement/Arthroplasty. Credit to Dr Bleakney for X-rays!
by

Rej Bhumbra

on 3 November 2014

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Transcript of Total Hip and Knee Replacement

Rej Bhumbra. PhD FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Barts Health Orthopaedic Centre

Pain
Reduced Mobility
ADLs
Pathophysiology
Management
Operative Intervention. TKR
A good surgeon knows
HOW to operate,
a better surgeon knows
WHEN to operate,
To Operate
Materials that make it work....
Most common orthopedic procedure after fracture fixation

Hemiarthroplasty
Unipolar
Bipolar

Total Hip Arthroplasty
Cemented
Non cemented
Hybrid
Hip Arthroplasty
Unipolar hemiarthroplasty
Unipolar hemiarthroplasty

Treatment of intracapsular hip fractures

Elderly with lower life expectancy

Head diameter matches acetabulum and articulates with the articular cartilage
Bipolar hemiarthroplasty
Bipolar hemiarthroplasty

Motion occurs at 2 sites

Less prone to dislocation

Less prone to wear of
acetabular cartilage
Revision non cemented
bipolar hemiarthroplasty
Long stem femoral component
Lateral fibular strut grafting
Cerclage wires
Total Hip Arthroplasty
In 2000 - 309,000 THA in US
- 32,000 revision THA in US
Over 1 million THA worldwide / yr
Chance of THA lasting 20 yrs ~ 80%
Increase rate of failure
males
patients > 165lbs
1800s primitive attempts at replacing femoral head with wood, rubber, ivory, pig bladders

Earliest recorded attempt at THR – Germany 1891

Professor Sir John Charnley
(1911–1982) 1962 the Charnley THR
1. Metal femoral stem

2. Polyethylene acetabular component

3. Fixed with cement
“Low friction” arthroplasty
“MOP” – metal on polyethyelene prothesis
Multiple types of arthroplasty
Classic articulating surface is metal on polyethylene
Ceramic heads used to decrease polyethelyne wear
Non cemented
Total Hip Arthroplasty
Non cemented
Total Hip Arthroplasty
Ceramic femoral head
Cemented
Total Hip Arthroplasty
Hybrid
Total Hip Arthroplasty
Cemented femoral stem
“cement restrictor” – plug
(bone, plastic, cement, metal, bioabsorbable)
Hybrid
Total Hip Arthroplasty
Cemented femoral stem
Periprosthetic fracture
Hardware Failure
Dislocation
Loosening
Mechanical
Small particle disease
Infection
Heterotopic ossification
Complications of arthroplasty
Demineralized / atrophic cortex
Normal cortex
Positioning of acetabular component
Lateral inclination of acetabular component
Total Joint Replacement
Non-operative interventions
Unipolar
Bipolar
Total Hip Arthroplasty
40° +/- 10°
Improved stability only applies to a desirable
acetabular component orientation
Kenneth McKee 1951 THR
With high abduction acetabular component
orientation, the use of larger femoral heads
contributes little to joint stability
Increasing the head size from 22 to 40mm increases the required displacement for dislocation by 5mm
A
N
R
The Best Surgeon Knows
WHEN NOT
to Operate
Full transcript