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Rubin institute for Advanced Orthopaedics

Rubin institute for Advanced Orthopaedics. ui.  I have disclosed no relevant financial relationship with any commercial companies pertaining to this activity. Hip Anatomy. Ball and Socket Joint Acetabulum Femoral Head Joint Capsule Femur Muscular support. History of Joint Replacement.

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Rubin institute for Advanced Orthopaedics

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  1. Rubin institute for Advanced Orthopaedics ui

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

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

  4. 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

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

  6. 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

  7. Hip Replacement

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

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

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

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

  12. Osteoarthritis

  13. Post Traumatic Arthritis

  14. Post Traumatic Arthritis

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

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

  17. 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

  18. 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

  19. 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.

  20. Osteonecrosis

  21. Osteonecrosis MRI

  22. Osteonecrosis MRI

  23. Deformity / Protrusio Hip

  24. Deformity Protrusion hip

  25. Dysplastic hip

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

  27. Indication Femoral neck fracture

  28. Bipolar Hip Replacement • Picture

  29. Bipolar Hip Replacement

  30. Cemented vs Noncemented femoral stems

  31. Hip Resurfacing • Less invasive • Less bone loss

  32. Resurfacing – metal on metal

  33. Resurfacing • Benefit • Maintain bone stock

  34. Implants / Femoral stem

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

  36. Ceramic on Ceramic

  37. Metal on Metal

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

  39. Basics of hip replacement 1. General Anesthesia

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

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