1. Mr A Bayan MBChB, FRACS(Ortho) Orthopaedic Surgeon

2. Hip Arthroplasty A Bayan 20092

3.  Definition : An Operation to restore pain-free motion to a joint and function to the soft tissue controlling that joint  History : mid 1800 *resection arthroplasty *Interpositional *Mold interrpositional arthroplasty 1940 *Metal hemiarthroplasty(Moor & Thompson) *Metal on metal Hip replacement *Charnley 1960 Hip Arthroplasty A Bayan 20093

4.  Relieve pain  Restore Function: Motion, Stability, &Correct deformity  Our Goals: 1-the above 2-Lasting 3-No or low complication 4-Cost effective WHY IN WAITAKERE? Hip Arthroplasty A Bayan 20094

5.  Painful, disabling, arthritic joint that is not responding to conservative treatment Pathology Osteoarthritis 1ry or 2ry( Inflammatory, post trauma, non active sepsis) Avascular necrosis Age ? Activity? Expectations? Benefit vs Risks assessment Hip Arthroplasty A Bayan 20095

6. Fixation method Cemented : using bone cement as a grout to fix the metal in the bone Non cemented Hybrid Type of articulation Metal on polyethyline Ceramic on ceramic Ceramic on poly Metal on metal ( larg head ) Conventional Resurfacing Other Implant design Hip Arthroplasty A Bayan 20096

7.  Pre op  Op  Post op  Rehab & Follow up Hip Arthroplasty A Bayan 20097

8.  Information-verbal -written -Audiovisual -Classes -word of mouth PREADMISSION CLINIC Investigations, Q&A  Informed consent  Medication (Routine, NSAID, Aspirin, Warfarin, Steroids, Methotrexate)  Day of Surgery, Skin, Consent, marking  Skin preparation Hip Arthroplasty A Bayan 20098

9.  Setup :Anaesthetic, IDUC, Positioning, Shaving & Skin prep.,pre op templating. Hip Arthroplasty A Bayan 20099

10. Draping Timeout Approaches Hip Arthroplasty A Bayan 200910

11. Surgical technique Closure, dressings, drains Recovery Hip Arthroplasty A Bayan11

12. Femoral preparation Hip Arthroplasty A Bayan12

13. Cementation Hip Arthroplasty A Bayan 200913

14.  Day of surgery-pain control -Observation - position -antibiotics -Thrombo prophylaxis  Day one post op  Mobilisation :HB,WB status, hip precautions, Drains, TROCH  Rehab  Discharge, info: Driving? Airports, Return to work,  Follow up :day 10-14, 6 weeks, ?3months, 1 year, 5year,10 year, then 2 yearly if asymptomatic Hip Arthroplasty A Bayan 200914

15.  Function  Success 95% at 10 years  Complications  intra op  early post op  late post op Hip Arthroplasty A Bayan 200915

16.  Infections: superficial or deep <1%  Bleeding requiring blood transfusion  Thrombo-embolic phenomenon  Dislocation :factors 1%  Leg Length inequality ?intentional  Fractures  Neurovascular injury  Wear and Loosening  Cardiopulmonary, urinary retention, ileus  PONV, Skin pressure injury Hip Arthroplasty A Bayan 200916

17.  Surgeons Support  Availability  Ongoing learning and training, Theatre visits Hip Arthroplasty A Bayan 200917

18.  THJR is the most successful surgery in the history of surgical medicine. THANK YOU Hip Arthroplasty A Bayan 200918

19. Hip Arthroplasty A Bayan 200919

20. Hip Arthroplasty A Bayan 200920

21. Hip Arthroplasty A Bayan 200921