Professional Documents
Culture Documents
CME ON
Prepared by -
Dr. Md Nazrul islam, MBBS, M.Sc.
Supervised by -
Dr. Sk. Abbas uddin Ahmed
MS (ortho), ao(basic), ao(spine).
Presenting by -
Dr. Golam Mahamud Suhash
From -
Department Of Orthopaedic & Traumatology,
Shaheed Suhrawardy Medical College Hospital.
Dhaka. 1
Recent Advancement
Hip Surgery And
Hip-Replacement
Hip-disorders
Recent Advancement
Over view
Hip is the joint where your
thigh bone meets your pelvis
bone.
Hips are very stable. When they
are healthy, it takes great force
to hurt them.
Common Hip-disorders are-
Strains
Bursitis
Dislocations
Fractures 3
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Hip Surgery And
Hip-Replacement
Functions of Hip-joint
Contents: Mechanisms Hip injury
Most Common Types of Hip Injury-
Epidemiology
Anatomy of Hip-joint
Pathophysiology of Hip-Injury
Clinical features of Hip-Injury-
Investigations
Diagnosis
Management
Rehabilitations
Complications
Prognosis Of Hip-Replacement-
Conclusions
Total Hip Replacement at Shaheed
Suhrawrdy Medical College Hopital-
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Recent Advancement
Hip Surgery And
Hip-Replacement
Functions of Hip-joint
5
Mechanisms Hip injury-
Direct Stress
o Femoral Neck fracture
o Inter-trochanteric fracture
Repeated stress
o Degenerative joint disease (DJD) of the
Hip
Deformities
o Congenital dislocation of the Hip (CDH)
/ Developmental dysplasia of the Hip (DDH).
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Hip Surgery And
Hip-Replacement
Most Common
Most Common
Types Of Hip Injury-
Types Of Hip Injury-
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Hip Surgery And
Hip-Replacement
Types of dislocation:
Congenitical
Acquired
Anterior
Central
Posterior (90%)
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Hip Surgery And
Hip-Replacement
AO/OTA Classification
Dislocations
Most thorough.
Best for reporting data, to allow
comparison of patients from different
studies.
30-D10 Anterior Hip
Dislocation
30-D11 Posterior Hip
Dislocation
30-D30 Obturator (Anterior-
Inferior) Hip
Dislocation
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Hip Surgery And
Hip-Replacement
HIP can break at any age, but the
Most Common great majority of hip fractures occur
Types Of Hip Injury-
in people older than 65.
Fractures .
Fracture of Acetabular Component
Acetabular fracture
Central dislocation
Fracture of Femoral Components.
1. Femoral Neck fracture (NOF),
2. Femoral head fracture
3. Slipped capital femoral epiphysis in
children
4. Trochanteric fracture
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Hip Surgery And
Hip-Replacement
Epidemiology
Worldwide gender distribution of Hip Fracture
Men: 4-5 per 1,000
Women: 8-10 per 1,000
Men: 30%
Women: 70%
Morbidity and Mortality
Mortality 20% within 1 year Hip Fracture
o Men: 31% mortality in 1 year
o Women: 17% mortality in 1 year
o ADL assistance needed in 50% of Hip Fractures
o Long term care needed in 25% of Hip Fractures.
Cooper (1992) Osteoporos Int 2:285-9
Forsen (1999) Osteoporos Int 10:73-8
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Anatomy of Hip-joint
Hip Surgery And
Hip-Replacement
Anatomy of Hip-joint
Vital
Components of Hip-joint -
Muscles
Muscles which attach to or
cover the hip joint:
• Gluteals.
• Quadriceps-
• Iliopsoas.
• Hamstrings.
• Groin muscles.
Ligaments.
• Iliofemoral ligament:
• Pubofemoral ligament:
• Ischiofemoral ligament:
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Hip Surgery And
Hip-Replacement
Neurovascular Components
Hip Surgery And
Hip-Replacement
Nerve supply
Femoral nerve - Via nerve to
the rectus femoris muscle
Obturator nerve - Via it’s
anterior division.
Sciatic nerve - Via the nerve to
the quadratus femoris muscle.
Superior gluteal nerve - Here
the femoral, sciatic and oburator
nerves also supply the knee joint,
so hip disease may cause a
refered pain to the hipjoint. 18
Pathophysiology of Hip-Injury
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Hip Surgery And
Hip-Replacement
fracture(prox. Femur)
Shortened limb on Fracture side
Hip externally rotated and
Signs - abducted
(But internally rotated and
adducted in post. dislocation of
hip).
Tenderness to palpation over
injured hip
Limited range of motion
oDo not test ROM unless XRay 20
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Hip Surgery And
Hip-Replacement
Hip Xray
Imaging
Usually identifies Fracture and
Dislocation
Hip MRI (T1-weighted)
Indicated for high suspicion
despite normal XRay
Test Sensitivity: 100%
An MRI may identify a
Does not require delay after
injury
hip fracture otherwise
missed on plain X-ray.
Diagnosis
Hip Surgery And
Hip-Replacement
Subjective Assessment
Pain localized in hip region
Exaggerated gait pattern (limp)
Increase in pain when weight
barring
Reduction in the degree of ROM
As the degeneration of the joint
worsen, individual may be awakened
at night with pain
Bone spurs may occur 25
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Hip Surgery And
Hip-Replacement
Objective Assessment
Gait pattern – Adaptive walking
pattern that reduces pressure on the
affected side.
Diagnosis Muscle atrophy – Muscles in affected
area are not used as much due to pain,
therefore, use-it-or-lose-it applies.
Active Range Of Motion – Limited
ROM, stiffness
Passive ROM – End feels causes severe
pain
X-ray – clear degeneration of the bone
MRI – determines underlying
complications (e.g.avascular necrosis) 26
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Hip Surgery And
Hip-Replacement Management
Medical-
Rest,
Medicines,
Physical therapy
Immobilization and/ or
Reduction(dislocation) 27
Management
Surgical-
Osteotomy
ORIF
HIP Resurfacing
Hip replacement. 28
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Hip Surgery And
Hip-Replacement
Common HIP Condition
Fixation Which Requires Internal
Fixation-
Acetabular Component-
Dysplasia, Impingement.
Femoral Components.
1. Femoral Neck
fracture (NOF),
2. Femoral head fracture
3. Slipped capital femoral
epiphysis in children
4. Trochanteric fracture
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Hip Surgery And
Hip-Replacement
HIP Resurfacing-
Surface hip replacements
Developed in late nineties in UK by
Dr.Derek Mcminn
HIP Resurfacing
resurfacing
Young & active patients with hip
arthritis or secondary osteo-
arthritis
Primary OA in young patients
Avascular necrosis
Ankylosing spondylitis
Post traumatic arthritis
DDH
Slipped capital femoral epiphysis
www.hipsurgery.in 31
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Hip Surgery And
Hip-Replacement
HIP
Alternative Names
REPLACEMENT
• Hip arthroplasty;
• Total hip replacement;
• Hip hemiarthroplasty.
Definition of Hip joint
replacement:
Hip joint replacement is
surgery to replace all or part
of the hip joint with an
artificial joint. The artificial
joint is called a prosthesis.
33
Description:
The artificial hip joint has 4 parts:
HIP A. A socket that replaces your old hip
REPLACEMENT socket. The socket is usually made of
metal.
B. The liner fits inside the socket. It is
usually plastic, but some surgeons are
now trying other materials, like
ceramic and metal. The liner allows
the hip to move smoothly.
C. A metal or ceramic ball that will
replace the round head (top) of your
thigh bone.
D. A metal stem that is attached to the
shaft of the bone to add stability to
the joint. 34
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Hip Surgery And
Hip-Replacement
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Hip Surgery And
Hip-Replacement
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Hip Surgery And
Hip-Replacement
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Hip Surgery And
Hip-Replacement
Conventional Total Hip
replacements
Introduced in 1960’s by Dr.John
Charnley, an English Orthopedic
surgeon.
Upper end of the femur is resected
consisting of the head and neck
portion .
Socket of the pelvic bone is deepened
Prosthesis is implanted with bone
cement.
Metal articulates with High density
polyetheylene.
Risk of dislocation results in poor
function
Recovery takes upto three months 41
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Hip Surgery And
Hip-Replacement
Minimally invasive Hip
surgery - What is it?
Surgery-
Traditional Hip Minimally Invasive Hip
Replacement Surgery- Replacement Surgery-
Proven in clinical studies and
successfully performed for Long-term effects and success
decades are being studied
Allows surgeon full Smaller incisions/ Scars (2-4
visualization of operative area inches)
Larger incision/ scar (12-18 Potentially less disruption of
inches) muscles and tissues
More disruption of muscles and May lead to less blood loss
tissues Potential for less postoperative
May lead to more blood loss . pain
May lead to a extendeded May lead to a shortened
hospital stay/ recovery time hospital stay/ recovery time
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Hip Surgery And
Hip-Replacement
PROSTHESIS TYPE
1. Conventional
1. Conventional total hip
2. Metal-on-metal
1. Metal-on-metal total hip
3. Ceramic
1. Ceramic total hip
4. Cemented / Cementless
1. Cemented and cementless
total hip
5. Other prostheses
1. Prostheses for other
operations 44
Recent Advancement
Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
Insertion of acetabular
component
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Acetabular reaming
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Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
Insertion of femoral
component
Reaming/broaching of 48
femoral component
Recent Advancement
Hip Surgery And
Hip-Replacement
Technique:
Total Hip Replacement
Final implant
Rehabilitations
REHAB GOALS
Complications
Hip Surgery And
Hip-Replacement
Complications-
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diseases
FAILURE RATE
HIP DISEASE (during ten years after
operation)
A-vascular necrosis 0%
Slipped epiphysis 3%
Congenital hip dysplasia 5%
Rheumatoid arthritis 15 %
Previous hip fracture 18% 57
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Hip Surgery And
Hip-Replacement
Prognosis Of Hip-
Replacement-
Hip replacement surgery results are
usually excellent. Most or all of your pain
Outlook and stiffness should go away.
(Prognosis):
Some people may have problems with
infection or loosening, or even
dislocation, of the new hip joint.
Over time -- sometimes as long as 20
years -- the artificial hip joint will loosen.
A second replacement may be needed.
Younger, more active, people may wear
out parts of their new hip. It may need to
be replaced before the artificial hip
loosens. 58
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Hip Surgery And
Hip-Replacement
Conclusions-
Next to Spine injury, Hip-joint is the most
important issue in orthopedic surgery.
Hip disorder/ injury needs throughout
assessment before starting treatment.
Treatment strategy/ plan is changing rapidly
with the advent of new research/ investigation
procedures/ biomaterial.
Hip Replacement surgery in orthopedics'
changing our life with rapidly increasing
success.
Successful Hip replacement surgery in
orthopedics’ can play a pivotal role in medical
science. 59
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Hip Surgery And
Hip-Replacement
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Hip Surgery And
Hip-Replacement
“Total Hip Replacement” At-
Shaheed Suhrawrdy Medical College Hopital-2010
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Hip Surgery And
Hip-Replacement
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Hip Surgery And
Hip-Replacement
From-
Department Of Orthopedics’ & Traumatology
Shaheed Suhrawardy Medical College Hospital. 64
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Hip Surgery And
Hip-Replacement