1. Cementless hip Cementless hip Dr. Clemens Menapace Dr. Clemens Menapace FA für Orthopädie und orthop. Chirurgie FA für Orthopädie und orthop. Chirurgie Ritter v. Schwarzstr. 8, 5400 - Hallein Ritter v. Schwarzstr. 8, 5400 - Hallein Dr. Clemens Menapace Dr. Clemens Menapace FA für Orthopädie und orthop. Chirurgie FA für Orthopädie und orthop. Chirurgie Ritter v. Schwarzstr. 8, 5400 - Hallein Ritter v. Schwarzstr. 8, 5400 - Hallein www.menapace.com

2. Cementless hip Cementless hip Dr. Clemens Menapace Departement for orthopedic and endoskopic Departement for orthopedic and endoskopic joint surgery www.menapace.com

3. Cementless hip Cementless hip Director of the Departement for orthopedic and endoskopic joint surgery Ritter v. Schwarzstr. 8 5440-Hallein Guggenbichlerstr, 20 5020-Salzburg www.menapace.com M.D. Orthopedy and orthopedic surgery ClemensMENAPACE

4. Cementless hip Cementless hip Director of the Departement for orthopedic and endoskopic joint surgery Ritter v. Schwarzstr. 8 5440-Hallein Guggenbichlerstr, 20 5020-Salzburg www.menapace.com M.D. Orthopedy and orthopedic surgery ClemensMENAPACE

5. Cementless hip Cementless hip

7. Modern cementless hip implant design

8. Cementless hip NEW YORK - 1940: Chrom-Kobalt-Molybdän-Endoprotheses PARIS - 1950: Judet-brothers VIENNA - 1948: Endler-Stadler, Kunstharzprothese (300) Total-Endoprotheses in the 1970s Zementless Implants, Titanium 192619492000

9. Cementless hip 195019701985

10. 195019701985

11. aktivpassiv interface Contact area between biological and non-biological material = interface cement titanium alloys cobalt-chrome alloys design surface type of material ceramics f i x a t i o n

12. Cementless hip Advantage of cement-fixation : Instant stability congruency of minor importance less requiremnts as to materilal and design of the implant less expensive

13. Cementless hip Advantage of cementless-fixation (titanium-alloy) One interface (metal-bone) excellent biocompatibilty (actual bony ingrowth) excellent metallurgical properties line of retreat open during surgery and later (revision)

14. Cementless hip Problems with cement-fixation Two interfacess: metal- cement-bone No line of retreat Toxic charcteristics Aging of cement (mechanically, chemically)

15. Problems with cementless-fixation Cementless hip More challinging surgical tecnique (longer learning curve) Expensive implant (double the price)

16. What we want different stem sizes different neck lengths different neck angels different materials of femoral haed diffent cup designs different acetabular desing different acetabular material Cementless hip

17. Cementless hip: stem Rectangular Other custom made Stem-design

18. Cementless hip: stem rectangular design The stem is wedged into the oval femur after exact reaming

19. Cementless hip: stem Other stem designs rounded left-rigt-design

20. Cementless hip: neck Choice of varus and anteversion Choice of overlap

21. Cementless Hip: stem custom made What you wish is not always what you get

22. Cementless Hip: stem Materials Titanium based alloys Cobalt based alloys Resistent to corrosion, highly inert excellent fatigue, sufficent elasticity exellent bony integration high friction coefficent, diffucult to maschine, expensive except low friction coefficent and lower price All properties mentioned less then titanium,

23. Cementless Hip: stem surface Porous coated CERAMICS Rough Smooth METAL Designed surface

24. Cementless Hip: material 1= Titanium alloy 2= trabecular bone

25. Cementless Hip: cup Cup - bone interface: design smooth smooth press fit screw fixations screw-type screw-type smooth smooth press fit screw fixations screw-type screw-type

26. Cementless Hip: cup Tintanium based alloys Ceramics Cobalt based alloys Polymethylenmeth- axcrylate Cup - bone interface: materials Ceramic coated

27. Cementless Hip: cup Acetabular material PMMA Ceramics Metal

28. Cementless Hip: cup Acetabular desgin Be sure PMMA never gets in contact with bone

29. Cementless Hip: femoral head material Cobalt alloy ceramics design Necklength 28/32 mm

30. Surgical room with highest class of sterility Surgical room with highest class of sterility Only people involved enter No fooling around Cementless Hip: sterility

31. Perioperative antibíotic prophylaxis Postop blood recovery 2 drains removed day after surgery Mobilisation 2 days aftger surgery Initial full weight bearing if bone quality is OK Hospitalized for 2-3 weeks, or rehabilitation clinic Checks 3 month and 1 year postop Cementless Hip: that is the truth

32. Sometimes helpful, not necessary, but nice to have Preop construction drawing 3D-CT Scanner Cementless Hip

33. Cementless Hip: case study Incision

34. Femoral neck before resection

35. Cementless Hip: case study Resection of femoral head with jig-saw

36. Cementless Hip: case study Destroyed surface of femoral head

37. Cementless Hip: case study Acetabulum with rest-cartilage

38. Cementless Hip: case study acetabulum reaming of acetabulum

39. Cementless Hip: case study acetabulum before implantation

40. Cementless Hip: case study titanium cup inlay

41. Cementless Hip: case study trial cup trial cup

42. Cementless Hip: case study reaming the femur

43. Cementless Hip: case study

45. femur ready to accept implant

46. Cementless Hip: case study checking length of neck with trial femoral head

47. Cementless Hip: case study femoral implant cup implant

48. Cementless Hip: case study definite implant after reduction

49. Cementless Hip: case study

50. Cementless hip

51. Cementless Hip: Navigation-systems Planning of Cup and Stem Accurate Positioning of Components

52. Cup Placement Reduce complications by correct placement of the cup Cementless Hip:

53. What is it ? How does it work ? Applications ? Surgical Navigation Cementless Hip:

54. Combination of Medical Image and Surgical Action What is it ? Cementless Hip:

55. Image Action Navigation Concept Cementless Hip:

56. CT Basic principle Cementless Hip:

57. Instument tracking

58. Image Transfer Tracking Referencing Matching How does it work ? Cementless Hip:

59. Medivision Station DAT/ Net Radiology: CT, MRI Medical images are loaded into the computer Cementless Hip:

60. Multiscanning - 3D - Cam Data-Processor (Cam/CT) Cementless Hip:

61. Tool Set Hip Prosthetics Cementless Hip:

62. Execution Phase Cementless Hip:

63. OR Setup Cementless Hip:

64. Cup Planning optimal implant optimal placement 45 15 Cementless Hip:

65. Execution Phase Cementless Hip:

66. The RoboDoc System Some steps along the surgical procecdure are physically performed by a computer. More precise? Very expensive Complicated handling Timeconsuming More invasive Higher bloodloss Infectionrate?

67. Cementless hip Surgical managability Excuse me Doc, can I see your diploma? Managable for the average orthopedic surgeon

68. Cementless hip Durability

69. Cementless hip Affordability

70. Cementless hip Discussion welcomed BILIS you will be answered

71. Cementless hip www.menapace.com