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a presentation of how to do total hip replacement
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Technique of THR
Indications of Op THR
• OA – Pain, Disability, ROM• AVN• Fr NOF• Fr acetabulum• Tumours
Contraindications
• Recent Sepsis (?Remote)• Neuropathic joint• Weak Abductors/ myopathy• Stable arthrodesis
Type of Prosthesis
• Un cemented• Cemented• Hybrid
Types of Prosthesis
• Unconstrained• Semi-constrained• Fully constrained
Pre-Op Workup
• Patient• X-rays• Instruments• OT
Pre-Op Workup - Patient
• Co-morbidities• Fitness for anaesthesia• Anticoagulant therapy• Skin Condition• Pre-Op deformities• Pre-Op ROM
Pre-Op Workup –X rays
• Hip AP & lateral View• Pelvis AP view• CT Scan in Fr acetabulum/ Fr dislocation hip• Templating• Size & cuts
X rays
Fr NOF
1 Yr post injury2 Month after injury
AVN Hip
Posterior dislocation
GCT Femoral Neck
Pre-Op Workup Instruments
• Op technique brochure• Practice on saw bone• Dry run
Instruments
Instruments - Advantage
• Acetabular positioner
Trial handle
Pre-Op Work up -OT
• Sterilization• OT • Laminar flow• ORAs • Visitors
Surgery
• Position• Incision• Exposure
Exposure
• Dislocation of hip• Osteotomy of neck• Removal of head • Capsular excision• Placement of Hohmann’s retractors
Acetabular Preparation
• Removal of osteophytes & soft tissues• Identification of rim and medial wall• Reaming• Peg holes• Trial implants – non cemented implants• Pulse lavage• Cemented acetabular component• Anteversion
Femoral Preparation
• Entry point• Femoral canal preparation• Trial implant & Trial reduction• Pulse lavage• Cement restrictor• Cement gun
Implantation
• Final implants• Neck & head size• Hip reduction• Drain• Closure
Post Op• Position of limb• Antibiotics• Pain relief• Anti-coagulation – Physical/ pharmaceutical• Early mobilization• Discharge • Stitch removal – 2 wk• Walker x4 wk• Stick x2 wk
Early Complications
• Intraoperative fracture of femur• Trochanter Fractures• Dislocation• Infection• Bleeding• DVT & PE• Sciatic Nerve injury
Long Term Complications
• Wear • Loosening• Peri-prosthetic fractures• Late infection
Polyethelyene Wear
• Mechanical - Thickness of liner
• Wear particle in cement bone interface• Metal backing -
Thinner liner - Even weight distribution
Follow Up
• Scoring System• For life• National Registry