THR

Arthroplasty

Indications

 

Patient > 70

 

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

 

Options

 

Hemiarthroplasty

- unipolar monoblock

- unipolar modular

Perthes

Issues

 

Femur

 

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

 

Acetabulum

 

Dysplasia often present

- not as severe as in DDH

 

LLD

 

Can be significant

 

Abductors

 

Have been short for long time

- difficult to restore length

Vascular Injury

Vessels at risk

 

Extra-pelvic blood vessels

 

Femoral Artery

MCFA

LCFA

Profunda Femoris

Obturator artery

 

Intrapelvic vessels

 

External iliac artery and vein

Obturator artery

Superior and inferior gluteal

 

External Iliac Vessels

 

Anatomy

- anterior division of common iliacs / L5-S1

Technique

Cemented cup and femur via posterior approachTHR Cemented Exeter

 

Set up

- on side

- charnley supports posterior on sacrum

- anteriorly on ASIS

- patient slightly tilted backwards

- avoids cup retroversion

 

Posterior Approach

- identify short ER

Uncemented femur

GoalTHR Uncemented

 

Initial press fit

- implant geometry fits the cortical bone in the proximal femur

- good initial mechanical stability

 

Biological fixation for success

- good press fit

- minimal micromotion

- bony or fibrous tissue ingrowth or ongrowth

 

Head size

THR Large Head

Issues

 

Wear

Stability

Normal feel of hip

Increased ROM

 

Wear

 

Large head

- increase volumetric wear

- less penetrative / linear  wear

 

Small head

- increased linear wear

- decreased volumetric wear