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Cementless hip

Cementless hip. Dr. Clemens Menapace FA für Orthopädie und orthop. Chirurgie Ritter v. Schwarzstr. 8, 5400 - Hallein . www.menapace.com. Cementless hip . Dr. Clemens Menapace Departement for orthopedic and endoskopic joint surgery. www.menapace.com. Cementless hip. Clemens

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Cementless hip

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  1. Cementless hip Dr. Clemens Menapace FA für Orthopädie und orthop. Chirurgie Ritter v. Schwarzstr. 8, 5400 - Hallein www.menapace.com

  2. Cementless hip Dr. Clemens Menapace Departement for orthopedic and endoskopic joint surgery www.menapace.com

  3. Cementless hip Clemens MENAPACE M.D. Orthopedy and orthopedic surgery Director of the Departement for orthopedic and endoskopic joint surgery Ritter v. Schwarzstr. 8 5440-Hallein Guggenbichlerstr, 20 5020-Salzburg www.menapace.com

  4. Cementless hip Clemens MENAPACE M.D. Orthopedy and orthopedic surgery Director of the Departement for orthopedic and endoskopic joint surgery Ritter v. Schwarzstr. 8 5440-Hallein Guggenbichlerstr, 20 5020-Salzburg www.menapace.com

  5. Cementless hip

  6. Cementless hip

  7. Cementless hip Modern cementlesship implant design

  8. Cementless hip 1926 1949 2000 NEW YORK - 1940: Chrom-Kobalt-Molybdän-Endoprotheses PARIS - 1950:Judet-brothers VIENNA - 1948:Endler-Stadler, Kunstharzprothese (300)Total-Endoprotheses in the 1970s Zementless Implants, Titanium

  9. Cementless hip 1950 1970 1985

  10. Cementless hip 1950 1970 1985

  11. Cementless hip f i x a t i o n Contact area between biological and non-biological material = interface design surface type of material interface cement aktiv passiv titanium alloys ceramics cobalt-chrome alloys

  12. Cementless hip Advantage of cement-fixation: Instant stability congruency of minor importance less requiremnts as to materilal and design of the implant less expensive

  13. Cementless hip Advantage of cementless-fixation (titanium-alloy) One interface (metal-bone) excellent biocompatibilty (actual bony ingrowth) excellent metallurgical properties line of retreat open during surgery and later (revision)

  14. Cementless hip Problems with cement-fixation Two interfacess: metal- cement-bone No line of retreat Toxic charcteristics Aging of cement (mechanically, chemically)

  15. Cementless hip Problems with cementless-fixation More challinging surgical tecnique (longer learning curve) Expensive implant (double the price)

  16. Cementless hip What we want different stem sizes different neck lengths different neck angels different materials of femoral haed diffent cup designs different acetabular desing different acetabular material

  17. Cementless hip: stem Stem-design Rectangular Other custom made

  18. Cementless hip: stem rectangular design The stem is wedged into the oval femur after exact reaming

  19. Cementless hip: stem Other stem designs rounded left-rigt-design

  20. Cementless hip: neck Choice of varus and anteversion Choice of overlap

  21. Cementless Hip: stem custom made Does it make sense? What you wish is not always what you get

  22. Cementless Hip: stem Materials Titanium based alloys Resistent to corrosion, highly inert excellent fatigue, sufficent elasticity exellent bony integration high friction coefficent, diffucult to maschine, expensive Cobalt based alloys except low friction coefficent and lower price All properties mentioned less then titanium,

  23. Cementless Hip: stem surface METAL Smooth Rough Porous coated Designed surface CERAMICS

  24. Cementless Hip: material 1= Titanium alloy 2= trabecular bone

  25. Cementless Hip: cup Cup - bone interface: design smoothpress fitscrew fixations screw-type

  26. Cementless Hip: cup Cup - bone interface: materials Tintanium based alloys Ceramics Cobalt based alloys Polymethylenmeth-axcrylate Ceramic coated

  27. Cementless Hip: cup Acetabular material Ceramics PMMA Metal

  28. Cementless Hip: cup Acetabular desgin Be sure PMMA never gets in contact with bone

  29. Cementless Hip: femoral head material Cobalt alloy ceramics design Necklength 28/32 mm

  30. Cementless Hip: sterility Surgical room with highest class of sterility Only people involvedenter No fooling around

  31. Cementless Hip: that is the truth The way we do it Perioperative antibíotic prophylaxis Postop blood recovery 2 drains removed day after surgery Mobilisation 2 days aftger surgery Initial full weight bearing if bone quality is OK Hospitalized for 2-3 weeks, or rehabilitation clinic Checks 3 month and 1 year postop

  32. Cementless Hip Sometimes helpful, not necessary, but nice to have Preop construction drawing 3D-CT Scanner

  33. Cementless Hip: case study Incision

  34. Cementless Hip: case study Femoral neck before resection

  35. Cementless Hip: case study Resection of femoral head with jig-saw

  36. Cementless Hip: case study Destroyed surface of femoral head

  37. Cementless Hip: case study Acetabulum with rest-cartilage

  38. Cementless Hip: case study reaming of acetabulum

  39. Cementless Hip: case study acetabulum before implantation

  40. Cementless Hip: case study titanium cup inlay

  41. Cementless Hip: case study trial cup

  42. Cementless Hip: case study reaming the femur

  43. Cementless Hip: case study

  44. Cementless Hip: case study

  45. Cementless Hip: case study femur ready to accept implant

  46. Cementless Hip: case study checking length of neck with trial femoral head

  47. Cementless Hip: case study femoral implant cup implant

  48. Cementless Hip: case study definiteimplant after reduction

  49. Cementless Hip: case study

  50. Cementless hip

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