1. All Things Arthoplasty Outcome and complication Dr. Bahaa Ali Kornah, Prof. Of Orthopedic and Trauma Al-Azhar University Cairo. Egypt

2. Arthroplasty Latinarth - joint Greekplastica - molding

3. is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by prosthesisorthopedic surgical procedure It is an elective procedure

4. Goals of Joint Replacement Surgery Relieve pain!!! Restore function, mobility

5. There are many types used to do the procedures interpositional arthroplasty with interposition of some other tissue like skin, muscle or tendon to keep inflammatorysurfaces apart or tissueskinmuscletendoninflammatory excisional arthroplasty in which the joint surface and bone was removed leaving scar tissue to fill in the gap.scar resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, silicone replacement arthroplasty

6. Indications Osteoarthritis (OA) Osteoarthritis Rheumatoid arthritis (RA) Rheumatoid arthritis Avascular necrosis (AVN) or osteonecrosis (ON) Avascular necrosis Congenital dislocation of the hip joint (CDH) Hip dysplasia (human)Hip dysplasia (human) Acetabular dysplasia (shallow hip socket) Frozen shoulder, loose shoulder Traumatized and malaligned joint Joint stiffness

7. Background Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship* *

8. Background Total joint replacement (TJR) is one of the most cost-effective procedures in all of medicine.

9. TJA Volume Estimates

10. TJA: Indications

11. Surgical Treatment Options Joint preserving operations – Arthroscopy – Cartilage transplantation – Osteotomy Arthroplasty Options: – Hemiarthroplasty – Resurfacing arthroplasty – Total joint arthroplasty

12. Anatomy—Hip

13. Anatomy of Hip

14. Hip Joint Ball and socket –Ball is the femoral head –Socket is Acetabulum Half sphere depression Lined with cartilage –Horseshoe shape

15. Hip Joint Femur –Neck-shaft angle ~ 135 0 –2/3 rd of head is covered with cartilage –Head fits into acetabulum Suction effect during dislocation

16. Rheumatoid arthritis Body's immune system attacks synovium and cartilage –Joint arthrosis –Deformity –Stiffness –Women are more often affected than men

17. Plain X-rays Loss of joint space Subchondral sclerosis Subchondral Cysts Irregularity of joint surface Subluxation

18. THA Implants

19. Types of Implants Implants may be –Cemented –Porous coated Mesh of holes on implant surface Secured as bone in grows

20. Implant Choice Cemented Cemented: Elderly (>65) Low demand Better early fixation ? late loosening

21. Cemented type

22. Implant Choice Cementless Cementless: Younger More active Protected weight- bearing first 6 weeks ? Better long-term fixation

23. Porous Coated Implants

24. Implant Choice Cementless Cementless: Younger More active Protected weight- bearing first 6 weeks ? Better long-term fixation

25. Implant Choice Cementless Cementless: Younger More active Protected weight- bearing first 6 weeks ? Better long-term fixation

26. Acetabular component Shell is made of metal Plastic liner –Load bearing –Fits snugly inside shell

27. Femoral Stem Made of metal –Usually titanium –Head Diameter –28, 32 mm Material –Cobalt chrome –Ceramic

28. Surgical Procedure

29. Anatomic Approach l Anterior Approach l Anterior-Lateral Approach l Posterior Approach l Medial Approach

30. Surgical Procedure An incision about eight inches long Exposure hip joint –Anterior –Posterior

31. Removal of Femoral Head Femoral head is dislocated from acetabulum Neck cut –Femoral head is removed

32. Femoral Neck Cut

33. Acetabulum Reaming Acetabular cup is reamed into a hemisphere Cartilage is removed

34. Technique: Total Hip Replacement Acetabular reaming Insertion of acetabular component Insertion of acetabular component

35. Inserting the Acetabular component Acetabular shell –Porous coated Press fit Screws for stability –Cemented A hard smooth plastic liner is inserted into metal shell

36. Insertion of Acetabular component

37. Reaming of Femoral Canal Intramedullary canal finder –Manual insertion of a rod Distal intramedullary reaming with a straight reamer Rasping

38. Femoral Stem Insertion Press fit Cemented –Pressurization Canal plug Cement vacuum mix Cement Gun

39. Inserting Femoral Stem

40. Technique: Total Hip Replacement Femoral head impaction Final implant Final implant

41. Femoral Head A metallic head is attached to stem

42. Hip Reduction Ball is reduced into acetabular liner –Soft tissue tension is tested –Leg length may be a problem

43. Conventional THA

44. Hip Arthroplasty Traditional Stem Design Extended Offset

45. Hip Arthroplasty Traditional Stem Design Standard Offset

46. Hip Arthroplasty Traditional Stem Design Standard Offset -3.5 Head

47. Hip Arthroplasty Traditional Stem Design Standard Offset +0 Head

48. Hip Arthroplasty Traditional Stem Design Standard Offset +3.5 Head

49. Hip Arthroplasty Traditional Stem Design Extended Offset +0 Head

50. Hip Arthroplasty Traditional Stem Design Extended Offset +3.5 Head

51. Acrylic Cement Fixation

52. Cementless Fixation

53. Hybrid Fixation Acetabular cup – Press fit Femoral stem – Cemented

54. Care after Surgery A suction drain –May be used for 1-2 days after surgery Intravenous fluids & antibiotics Pain medication Elastic stockings, compression stockings and blood thinners –To decrease chances of blood clots For first 6-8 weeks –Low sitting may cause dislocation

55. Rehabilitation FWB immediately Range of motion, strengthening exercises Progress as quickly as possible

56. Care after Surgery Physical therapy –Getting in and out of bed –Standing and walking Crutches or a walker Discharge from hospital –Usually in 3-5 days Continued PT, OT

57. Complications Thrombophlebitis –Blood clots within deep veins –Swelling of leg Become warm to touch Painful –May lead to pulmonary embolus and death Infection Dislocation Loosening

58. Anatomy—Knee

59. TKA State-of-the Art Posterior cruciate retention Posterior cruciate sacrificing Both achieve 95%+ success at 10 yrs Metal/PE articulation

66. Knee Replacement—Implants Patellar component

67. Knee Replacement—Bone Cuts

68. Knee Replacement—Implants

70. Complications Infection Bleeding Per Prosthetic fracture dislocation Loosening Mechanical wear Failure

71. Causes of TJR Failure Wear of articular bearing surface Aseptic/mechanical loosening Osteolysis Infection Instability Peri-prosthetic fracture Implant Failure

72. TJR Failure Despite the success achieved with most primary TJR procedures, factors related to implant longevity and a younger, more active patient population have led to a steady increase in the number of failed TJR’s

73. Timing of TJR Failure Early (<10%) – Dislocation – Infection – Implant failure Late (> 5 yrs post op) – Wear of articular bearing surface – Osteolysis – Mechanical loosening – Peri-prosthetic fracture

74. Dislocation/Instability

75. Infection

76. Wear of Articular Bearing Surface

78. Osteolysis Osteolysis is an active resorption of bone matrix by osteoclastsresorptionboneosteoclasts

80. Aseptic/Mechanical Loosening

81. Peri-Prosthetic Fracture Sri: PP fracture

82. Implant Failure

83. Major Osseous Defects

92. Bahaa Ali Kornah bkornah@gmail.com د / بهاء قرنة

93. Questions??

94. The End