THR designs and options for complex hips

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Presentation transcript:

THR designs and options for complex hips Mr. Glenn Boyce MBBS Dip Anat FRACS

Femur uncemented options Proximal metaphyseal fit - 2 neck angles (1270 or 1320) - Offset increases with body size (28- 53mm) Must template to see if the uncemented stem fits

Will not work in all cases Must template to see if the uncemented stem fits

Difficult distal stem fixation Canal flare A/B Wide less than 3 Normal 3- 5 Higher failure rate uncemented A B

Cement gives more options!

More freedom to match centre of rotation

Plus you can adjust anteversion

Modular uncemented options diaphyseal + metaphyseal fit Choices in distal stem morphology

Taper + flutes improved distal stability Taper  immediate axial stability. Higher taper angle (>5 degrees) improves resistance to subsidence 50% cases have mild subsidence within 3 years (> 1.5 mm) 5-10% Significant subsidence >3 years (> 5mm) Flutes provide immediate rotational stability. (Thinner flutes increased torque resistance)

Stem requirements Extensively porous coated stem Bi-cortical contact MUST be 2 cortical widths finish ETO above isthmus Power reaming distal Straight stem creates 3 point fixation

Revision- Uncemented long stem with impaction grafting Option for elderly low demand patients with poor bone stock BUT Demanding Recreate tube and stabilise Remodeling of the endosteum around 6 weeks leads to canal widening New tumour prosthesis easier to use for low demand patients

Support options for bone grafting

Proximal femoral replacement

Primary or revision intact AP rim ?

Jumbo Cup 10-15 year survival 85-95% Intact AP rim and pelvic continuity > 50% bony contact Typically add screws

New versions of jumbo cup Cup placement should be inferior and medial lowers joint reactive forces Decreased impingement on prominent anterior cup

Grafting Small cavitary lesions  Cancellous bone graft Possible for massive defects with mesh alone, but 20% revision rate by 10 years

Addition of mesh and cage Decreased need for cortical graft and amount of cancellous graft Improved ability to restore centre of rotation

Cortical augments Cortical grafts weaken and resorb at 3-5 years Uncemented cups will not bond to graft

Metal Augments Improved long term stability Vs cortical graft

Continuity must be restored

50% plus failure rate with graft and plate Better option

Stabilise pelvis and restore bone stock Antiprotrusio cages with bone ingrowth potential

Prevent dislocation? High risk of dislocation Semi constrained or constrained liner Tips: Don’t increase the anteversion of the acetabular component compared to the native acetabulum!!! These implants lever out from neck impingement on the prosthesis

Thank you