design

Patella Resurfacing

Options

 

1. Always resurface

2. Never resurface

3. Selectively resurface

 

Decision Making

 

Controversial

- literature divided on issue

 

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

 

Background

Rotator Cuff Arthropathy for Reverse TSR

 

Indications

 

1.  RC arthropathy / > 70 / low functional demand

 

2.  Revision TSR

 

3.  Failed Hemiarthoplasty in proximal humerus fracture

 

Design

 

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

 

Cemented femur

THR Cemented Femur

Goals in femoral cementing

 

Optimize cement-bone interface

Cement mantle free of defects

Minimum 2 mm thickness

Femoral component centred in cement mantle

 

Survival

 

Swedish Joint Registry

 

Reflection All Poly / Spectron 92% 10 year

 

Arthroplasty

Indications

 

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

 

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

 

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

 

Acute unreconstructable fracture > 60