Total Hip Replacement – Study Guide

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Hip replacements The logic behind choosing different hip implants NICE study

 

When to do a THR – alternatives

  • Requirements for a succesful osteotomy
  • Acetabular osteotomy
  • femoral osteotomy
  • trapdoor procedure for AVN

 

Choosing a type of THR

  • Composite beam and cement engagement type stems
  • Torsional resistance
  • Cemented vs uncemented

 

Acetabulum

  • Dollar Bill; poor results with cemented acetabulae
  • How to get good results with cemented acetabulum:
  • preparation reamer skirt
  • containment and bone graft
  • pressurisation
  • polyethylene – x link; aging; thickness; low frictional torque
  • types of uncemented – not as bone conserving as you might think
  • hemisphere; apatite
  • screws – safe zone; liner wear and snap fit; risk of backside wear
  • Charnley zones
  • direction of wear vector
  • volumetric vs linear wear

 

Head

  • size – reasons for small and large
  • material steel or ceramic
  • consequences of modularity

 

Stem

  • two types
  • nature of loosening process; loosening and osteolysis macrophages etc wear; size of particles and source. third body wear. nature of scratches etc Gruen zones
  • proximal vs distal loading in femoral stems detection of loosening possible definite loosening; RSA how to institute a follow up system
  • Which type of cement?

 

Which to choose – data

  • Swedish studies
  • Randomised studies
  • RSA studies

Quality of surgery – how many do you do each year, how good are your x rays etc.

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