Basics Of THR

Dr Niraj L Vora
Consultant Orthopaedic Joint Replacement
and Trauma Surgeon
Kokilaben Dhirubhai Ambani Hospital
 Evolution

 Osteotomy Arthroplasty

 Interpositional Arthroplasty

 Reconstructive Arthroplasty

 Partial/Hemi Arthroplasty

 Total Hip Arthroplasty

 Evolution
 Earliest record of hip arthroplasty – 1827

 Various materials used, including Glass,

Ivory, Acrylic etc

 Various giants like Judet, McKee, Smith

Petersen etc tried, but were unsuccessful
Interpositional Arthoplasty
 MARIUS SMITH-

PETERSEN (1923)
Boston.
 Vitallium Cup

‘Mould’
Arthroplasty
Interpositional Arthroplasty

OTTO E. AUFRANC

82% success rate in

1000 cases (1957)
 Sir John Charnley
 Initially teflon socket – early failure – wear
 Accidentally stumbled upon HDPE
 Concept of Low Friction Arthroplasty
 22.225mm head and thick
poly socket
 Use of cement - 1953
 Dr K T Dholakia
 Father of Arthroplasty in India

 At one time did more

Arthroplasties than all others
in India put together
Evolution
 Hip Biomechanics

 Centre of Hip
rotation
 Abductor lever arm
 Hip Biomechanics
Frictional torque
proportional to
head diameter

Large head
•Increased arc of motion
•Reduced impingement
 About Hardware
 Cobalt-chrome

 Offset – Vital to prevent

abductor lurch

 Neck length will affect leg

length

 Distal stem diameter

important in mode of
fixation of uncemented
implant
 About Hardware
 Made of UHMWPE (Ultra High Molecular
Weight PolyEthylene) or HDPE

 Flange helps with cement pressurisation

 Long posterior wall helps reduce risk of

dislocation

 Grooves give greater surface area for

cement
 Uncemented Femoral Component
 Titanium-Aluminium-Vanadium
alloy
 Coated with Hydroxyapatite
(HA) or Porous (Ti fibre mesh)
 Good initial primary stability is
a must (Press fit)
 Depend on osteo-integration Corail Hip

for fixation (Biologic Fixation)

Uncemented Femoral Component

Anatomic stem

Straight stem Variable

Coating
 Uncemented Socket
Fixation methods
 Press fit
 Spikes
 Screws
Modular Components

S-ROM
Custom Implants
 Indications

Primarily, alleviation of
incapacitating PAIN
Secondary is improving Hip
Function (Mobility and stability)
Pre-operative Templating
 Surgical Approaches
1. Posterior approach

2. Anterolateral approach (Hardinge)

3. Trans-trochanteric approach (Charnley)

4. Extended Trochanteric Osteotomy (ETO)

for Revision surgery
Posterior approach
 Acetabular Implantation

Avoid ‘Bottoming Out’

Femoral technique
 Femoral technique

Entry Cement gun

Distal plug
 Modern cementing techniques

 Medullary brush
 Cement restrictor (plastic/bone/cement plug)
p
 Medullary Pulsatile Lavage
 Insertion of adrenaline-soaked sponges
 Reduction of cement porosity (Centrifuge and Vacuum
mixing)
 Cement centralizers (applied to femoral stem tip)
 Cement gun for retrograde insertion and pressurization
 Pressurization: may be performed with surgeon's gloved
finger or with a wedge shaped device pushed into the
medullary canal
Femoral technique
 Alternate Bearings
Ceramic on Ceramic
 Very low wear rate

 Much smoother

 Highly biocompatible

 High hardness

 Suitable for the younger patient

Wear Rates
 Articular Surface Replacement
(ASR)
Pros
 Bone conserving
 Increased hip ROM
 ↓dislocation
Cons
 Limited indications
 Steep learning curve
 Computer Assisted Nav
 A GPS system for joint replacement

 Provides individualized information to plan

bony resection

 Improves accuracy in implant positioning

 Excellent training tool

 Computer Assisted Nav
 Used in Resurfacing surgery

 Registration process critical

 No peer reviewed evidence

that use of Nav improves
long term outcomes
 Complications
Osteolysis

Cement Disease

Zones
Cementless Disease
 Complications
Poly Wear
Complications

Dislocation
 Complications
Infections
1. Antibiotic therapy
2. Incision and drainage of the hip
3. Debridement and modified Girdlestone
resection arthroplasty
4. One- or two-stage revision to a total hip
arthroplasty
Complications
2 stage Revision
 Complications
Fractures