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  • Hip Surface Replacements ARTHOPLASTY Technique

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    Hip_Surface_Replacements_ARTHOPLASTY_Technique

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    14 views19 pages

    Hip Surface Replacements ARTHOPLASTY Technique

    Uploaded by

    andresnakes

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 19
    Hipsysrem solutions CONSERVE pus TOTAL SURFACE ARTHROPLASTY SURGICAL TECHNIQUE Pee (fel eee Pree tes Pen EOS ae} eeurn eae cey CONSERVE* PLUS TOTAL SURFACE ARTHROPLASTY SURGICAL TECHNIQUE CONSERVE? Plus total surface ARTHROPLASTY SYSTEM As Described By Harlan Amstutz, VD FIGURES icURE? TEMPLATING Preoperative planning is essential to assoss tho approximate size and orientation of the surface acthroplasiyon the AP pelvis and true lateral ohnson or shoot-through “cross able") | RGURE . Using the scaled x-ray templates provided, the approximate size of the femoral companent is first assessed, Itis recommended to take an AP pelvis with the tube to ssetLe distance of 40 inches (1 meter} This will give a magnitication of approximately 2052 69% (the magnification is greater in large patients ‘and ess in thin patients) ‘The johnson lateral is essential to evaluate anteversion, the size and steucture ofthe enterior osteophyte The moral head is generally posterior to the central axis, Use the anterior cortex and position the sboct stem slighlly anterior to evuid reaming. into the anterior osteophyte but parallel to the centeal axis| leune2. ‘The posterior cortex is semi-circular and hence a poor reference at surgery forthe correct component orientation, In order to save boneon the acetabular side, iis necessary to eearn the fermoral head close to the diameter ofthe neck. Minimize notching of the structural cortical bone. I: may be necessary Lo remove osteophytes itthere is impingement but this should be done carefully and preferably near the endot the procedure. The dotted lineson the templates indicate the reamed head size and should be used for sizing, You may use the central axis line and hada marks to measure the distance from the ligamentum teres more superiorly on the femoral head to the entey point for Steinmann Pin ob 14) degrees tothe neck shall axis| neune. =) CONSERVE® PLUS TOTAL SURFACE ARTHROPLASTY SURGICAL TECHMIQUE SURGICAL APPROACH ‘The patient is positioned lateral with an anterior pelvic stabilizer pressed against the pubis so that the leg can be flexed beyond 90 degrees and ‘adducted so that the femoral head can be delivered betveen the gluteus. ‘maximus spl. [tisalso helpful to support the thorax snteriorly and posteriorly with the table tilted anteriorly and the body neutral, which will enable the maximum roll back of the patient to feclitare acetabular A posterior approach facilitates visualization ofthe entire circumference of the femoral head and neck and the acetabulum. The incision is « hockey ricures stick oommencing shout 6-8 contimotors distal fo the tap of the Lrochanter over the center of the shaft extending proximally just above the ip of the greater trochanter and angling sharply posteriorly for about 4-6 centimetors [FIGURE & Ifthe hip cannot be flexed to atleast ‘9D degrees use the more teaditional slightly curved posterior approact, With siraighter approach the hip will have to be internally rotated more than 90 degrees and the procedure will be more difficult in large or heavily muscled individuals than with the hockey slick and the hip Mexed more. A Charley self retaining retractor ishighly recommended, The skin, subeutancous and fascin lateralis are divided. The gluteus cures ‘maximus fibers are bluntly separated, ‘The gluteus maximus tendon is completaly sectioned at it insets into the linea aspera | laure. The short ratators including pyrifemis and short ratator tendons and the quadrstus femourus muscle fibers are divided and suture tagged for realtachment | RGURES. Hammer in « sharp Hohman to reflect the abductor muscles. Excise or release the capsule circumferential [prefer to entirely excise the capsule although the posterior capsule can be preserved if desired and use Steinmandike pins ora retractor to reflect the capsule. To release the superior capsule, place a Bohman pa retractor under the abductor musdes and contiawe to adduct. and flex sored E . Une hip. Excise the superior and anterior capsule Deep retraciors are ricurce extreanely helpful CONSERVE* PLUS TOTAL SURFACE ARTHROPLASTY SURGICAL TECHNIQUE HIP DISLOCATION Dislocate the hip by flexion, adduction and internal rotation and then release the entire capsule to mobilize the head and neck sufficiently to Insert the neck elevator so thatthe pin-centering guide (PCG) van be placed around the neck with the mobile atm inferiorly | ROURE 7. Measure the neck width with a caliper to assess the smallest possible PIN CENTERING Align the guide with a goniomstar so thatthe diesction of the pin will be superior to the contral axis of the neck at « 140° pin shalt angle oune7 "Tho distance from ligamentum terosto the entry point position (10-15 mmm lateral) | RGURE®. Accurate placement of the pin down the central axis of the neck in the AP plane rotating the dislocated hip 9 in either direction is achieved by obtaining « assessment of the head and neck The axis of the neck is generally parallel to the e

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