Technique For Total Hip Replacement Research Articles

Is It Possible to Create an “Ideal Endoprosthesis” for an “Ideal Total Hip Replacement”?

Since the end of the 19th and the beginning of the 20th centuries, technological equipment, implant designs (endoprosthesis) and the surgical technique of total hip replacement (THR) have been constantly improved and reached a high level of functionality and quality. Therefore, at present, THR is one of the most high-tech, reliable and popular surgical operations that allow a large number of people suffering from osteoarthritis and other serious diseases of the hip joint to return to an active lifestyle. At the same time, it is known that even operations at this level do not always guarantee the achievement of the desired result and can lead to various complications. The question arises: are there potential opportunities for creating an “ideal endoprosthesis” that allows one to perform an “ideal THR”? In this paper, based on a critical analysis of modern endoprosthesis designs for THR, technologies for their implantation and systemic postoperative complications, the most probable, according to the authors, ways of their development are formulated, which allow asymptotically approaching the “ideal”.

Total hip arthroplasty with a superior approach and in situ preparation of the femoral stem: technique and feasibility in a prospective series of 80 cases.

We report on the feasibility of a technique for total hip replacement with in situ preparation of the femoral stem through a superior approach and with the use of standard instruments. From December 2017 to august 2018, 100 patients were recruited for total hip replacement. 80 patients underwent THA through a superior approach with femoral broaching before femoral neck cut. We evaluated feasibility, complications and early functional outcome. There were no major complications. Postoperative leg length discrepancy was on average +0.6mm and offset -0.5mm. The mean acetabular cup inclination was 42.0° and the mean anteversion was 14.5°. The mean WOMAC score was 46 before, 76 at 1 month and 86 at 3 months after surgery. Functional scores (OARSI) were significantly improved at 3 months. Superior in situ total hip replacement is a reliable and reproducible technique with an excellent clinical outcome. It is an iteration to the posterior approach, hence the learning curve is steep and if needed, conversion to a standard posterior approach is possible.

Kinematic alignment technique for total hip arthroplasty

Concept born from the observation that 1) systematic conventional techniques for implanting hip components are still affected by some complications that technological improvements have not entirely solved, and 2) the increasing awareness that abnormal lumbo-pelvic kinematics are responsible for clinically detrimental poor functional cup orientation and components' interaction (edge loading and articular impingement) that occur during activities of daily living. Following on from this, the kinematic alignment (KA) technique for total hip replacement (THR) has been developed and consists of personalising the implantation of components, with the intention of restoring the pre-arthritic hip joint anatomy: centre of rotation, acetabular anteversion, and proximal femur anatomy. The acetabular component orientation will be adjusted from its native orientation (transverse acetabular ligament) for patients with poor functional acetabular orientation due to an abnormal spine-hip relationship (≍10 to 35% of patients). As the majority of conditions that lead to hip degeneration are automatically corrected when anatomically replacing a hip, there is little-to-no risk of reproducing the hip anatomy, with the exception of developmental disease. The cup adjustment aims, by reaching a compromise, to optimise the components' interaction between the standing and the sitting positions. The intended benefits of the KA technique for THR are primarily to reduce risk of prosthetic instability and failure as a result of the improved functional components' interaction, and secondarily to improve functional performances and patient satisfaction due to the anatomical implantation and subsequent physiological prosthetic hip kinematics. A parallel may be drawn between the KA technique for THR and the concept of “restricted KA technique for total knee replacement”, as in both techniques component positioning primarily aims to reproduce the native joint anatomy, with only a fraction of patients requiring component orientation adjustment in order to compensate for a biomechanically sub-optimal pre-operative joint condition. Planning a KA-THR is simple (physical examination and radiographic measurements to distinguish between hip and spine users, in order to define the individual spine-hip relationship), and surgery can be reliably performed free hand. As the pre-operative individual spine-hip relationship is also influenced by the stiff osteoarthritic hip (hip-spine syndrome), further research is needed to refine the indication and the level of cup orientation adjustment.

The minimally invasive AMIS technique for total hip replacement : Video article

Minimally-invasive implantation of atotal hip arthroplasty without damage to or incision of muscles. Osteoarthritis, femoral neck fracture, general indications for total hip arthroplasty. Contraindications for hip arthroplasty. The surgical technique is demonstrated in detail with the help of avideo of the surgical procedure, which is available online: positioning on afracture table with a special leg holder, anterior approach between tensor fasciae latae and rectus femoris muscle, incision of hip capsule and capsular protection, osteotomy of femoral neck in situ, removal of femoral head and acetabular reaming, minimally invasive implantation of acetabular cup, release of pubofemoral ligament and-if necessary-ischiofemoral ligament, external rotation and hyperextension in leg holder with elevation of the proximal femur by ahypomochlion, femoral preparation and implantation of femoral implant, reposition, capsular suture, wound closure. Weight-bearing as tolerated, free movement without limitation of range of motion. Randomized trials and systematic reviews report faster rehabilitation with early mobilization, within the first 3months after surgery; less postoperative pain, less muscle damage and shorter hospital stay; older patients benefit from reduced morbidity and mortality.

In-hospital costs for total hip replacement performed using the supercapsular percutaneously-assisted total hip replacement surgical technique

PurposeThe supercapsular percutaneously-assisted total hip (SuperPath) surgical technique for total hip replacement (THR) is a tissue-sparing approach that has been shown to improve key variables associated with the economic burden of THR (e.g., length of stay, readmissions). To date, no studies have examined the economic impact of using this technique in the United States. The objective of this study was to compare the in-hospital costs of this technique to all other THRs performed in a large hospital system in the United States.MethodsThe costing database for a large hospital system was retrospectively searched for all in-hospital costs associated with primary THRs performed between January 2013 and September 2015. Data for all SuperPath THRs (group A) were compared to that of all other THRs performed at centres within the hospital system (group B).ResultsUse of the SuperPath technique resulted in significant overall in-hospital cost reductions of 15.0 % (p < 0.000), including reductions in operating room costs of 17.3 % (p < 0.000), physical/occupational therapy costs of 26.8 % (p = 0.005), and pharmacy costs of 25.3 % (p < 0.000). Length of stay (1.2 vs. 2.6 days), transfusion rates (1.9 vs. 15.8 %), and 30-day readmission rates (0.4 vs. 2.9 %) were also lower in group A.ConclusionsThe use of this tissue-sparing surgical technique resulted in reductions in in-hospital costs, length of stay, and readmissions when compared to all other THRs performed in a large hospital system in the United States.

Reemplazo total de cadera en la protrusión acetabular. Nota técnica

The acetabular protrusio is a condition in which the femoral head protrudes into the pelvis. It may be primary or secondary to several pathologies.In young patients without severe osteoarthritis can be managed with femoral or pelvic osteotomies, but in the case of elderly patients with hip arthritis, requires a total hip arthroplasty.The aim of this paper is to describe the technique of total hip replacement in patients with acetabular protrusio.Evidence level IV.

Role of definition of clonogenic activity of stromal bone marrow stem cells in patients with aseptic necrosis of the femoral head

A problem of choice of medical tactic for patients with avascular necrosis of the femoral head (ANFH) is extremely topical. It is very important to focus ones main efforts on either organ salvage surgical interventions or on improvement of a technique for total hip replacement. Largely as a solution to this problem designation of regenerative potential of bone tissue by culturing fibroblast colony-forming units (CFU-F) can help. Objective: To obtain data for the development of a differentiated approach to the treatment strategy by examining the clonogenic activity of stem bone marrow stromal cells in patients with ANFH. Methods: As a material for this study were samples of cancellous bone of the femoral head in 26 patients with ANFH at different stages of the disease. There were grown 36 cultures of stromal fibroblasts. We have estimated such parameters as total number of nucleated cells, the number of stem stromal cells - colony-forming units of fibroblast in the bone marrow of 1 cm3 and the effectiveness of their cloning among 105 nucleated cells. Results: It was found that as the disease progresses the ability to stem bone marrow stromal cells to ensure the reduction reactions in bone tissue loose quite rapidly. According to the results of the research the most significant negative effect on the proliferation and differentiation of stem bone marrow stromal cells of the proximal femur in patients with ANFH are such factors as alcohol abuse and exposure to toxic compounds. Conclusions: ANFH is one of the most critical diseases of the hip joint pathology in terms of oppression of the potential ability of bone remodeling and restoration. The regenerative potential of bone in patients with ANFH is significantly higher in the early stages of the disease.

Automated Preoperative Planning of Acetabulam Size and Angle Detection for Hemi-arthroplasty

Conventional pre-operative planning for Hemi-arthroplasty is performed with caliper, protractor, transparent templates and x-ray sheets. This technique is time consuming with many errors. Computer-aided pre-operative planning systems can assist surgeons in selecting correct sized implantable acetabulam and accurate planning of an operation. This paper describes the pre-operative planning by digital image processing techniques for Total Hip Replacement by using 2D digital X-ray images which leads to the development of a software for surgeons and radiographers. The authors have used advanced image processing techniques and algorithms in image enhancement, calibration, planning, templating and reporting to overcome problems faced while doing all these manually. The proposed methodology provides accurate, computer programmed, user-friendly and dimensionally correct solution. The technique seems to be reliable and acceptable to patients, radiographers and surgeons

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

The development of minimal-incision techniques for total hip replacement with preservation of soft tissue is generally associated with faster rehabilitation, reduction of postoperative pain and increased patient comfort. The aim of this study was to compare a minimal-incision anterior approach with a transgluteal lateral technique for hip replacement surgery with respect to postoperative pain, consumption of rescue medication, length of hospital stay and time to reach a defined range of motion. In this retrospective cohort study we investigated 100 patients with a minimal-incision anterior approach (group I) and 100 patients with a transgluteal lateral approach (group II) retrospectively undergoing unilateral hip replacement. The study variables were pain at rest and during physiotherapy, amount of rescue medication, the time to reach a defined flexion and time in hospital. The patients of group I consumed less rescue medication (19.6 ± 6.9 mg vs. 23.6 ± 11.3 mg; p = 0.005) and experienced less pain on the day of surgery (1.3 ± 1 vs. 2.3 ± 1.3, p = 0.0001) and the first postoperative day (0.41 ± 0.8 vs. 0.66 ± 1.1, p = 0.036). The time to reach the defined range of motion (6.4 ± 2 days vs. 7.4 ± 2.1 days; p = 0.001) and the length of hospital stay were shorter (10.2 ± 1.9 days vs. 13.4 ± 1.6 days; p = 0.0001) for group I. However, pain during physiotherapy was higher on the third and sixth through ninth days after surgery in comparison to group II (p = 0.001-0.013). The implantation of a hip prosthesis through a minimal-incision anterior approach is successful in reducing postoperative pain and consumption of pain medication. Time to recovery and length of hospital stay are also influenced positively. Pain increases during physiotherapy, and may be mitigated by adopting limited weight bearing during the early postoperative period.

Improved Accuracy and Low Fracture and Dislocation Rate with the Two-Incision Total Hip Replacement Technique

We report our early experience with the two-incision hip replacement technique. On the acetabular side, we studied whether a nonoriginating surgeon early in his experience with the minimally invasive two-incision technique for total hip arthroplasty could place components with appropriate accuracy. Thirty-five consecutive hip replacements performed using the two-incision technique were closely matched by height and weight with an equal number of control small-incision arthroplasties. Both leg-length accuracy and abduction angle were significantly superior with the two-incision technique. We also studied our rate of intraoperative femoral calcar or shaft fracture, and early complication rate in 120 two-incision arthroplasties. No displaced shaft or calcar fractures occurred, though two calcar cracks occurred in the first 10, and one nondisplaced shaft split occurred which required no operative treatment. No hip dislocated, and no early infections or femoral or sciatic nerve palsies occurred.

Comparison of Blood Loss according to Different Anesthetic Technique for Total Hip Replacement

The mean blood loss is about 500−1,700 ml by general anesthesia technique in total hip replacement (THR) and the amount of blood loss is dependent on the degree of induced hypotension. We performed this study to evaluate the differences on the amount of blood loss and the number of transfused patients according to different anesthetic technique under the similar hypotension level. Methods: Forty-seven patients of ASA physical status class 1, 2 and 3, scheduled for THR, were randomly assigned into epidural anesthesia group (E group), combined general epidural anesthesia group (GE group) and general anesthesia group (G group). G group was maintained with sevoflurane anesthesia and the monitoring of central and arterial blood pressure was performed. The remifentanil (0.1μg/kg/min) was infused continuously for the target mean arterial pressure of 60 ± 5 mmHg. GE group received general anesthesia with the same technique of G group and epidural anestheia was combined after general anesthesia. The remifentanil (0.1μg/kg/min) was infused continuously for the target mean arterial blood pressure of 60 ± 5 mmHg. E group received epidural anesthesia with 0.75% ropivacaine and additional bolus dose of local anesthetics was injected if the mean arterial blood pressure did not reach 60 ± 5 mmHg. Results: The mean volume of blood loss and the number of transfused patients was significantly less in E or GE group at 24 hour after surgery (P ＜ 0.05), however we could not find any significant differences during intraoperative period. Conclusions: Epidural or combined general epidural anesthesia technique is a good method to reduce bleeding and the number of transfused patients.

Improved Accuracy of Acetabular Component Position and Leg Lengths with the Two-Incision Total Hip Replacement Technique

We sought to determine whether a non-originating surgeon early in his experience with the MIS two-incision technique for THA could place components with appropriate accuracy. Thirty five consecutive hip replacements performed between July of 2003 and March of 2004 using the two-incision technique were closely matched by height and weight with an equal number of control small incision arthroplasties. The two-incision surgeries were performed after the surgeons twentieth case and prior to the surgeons fifty sixth two-incision case. We assessed immediate postoperative films for leg length discrepancy and acetabular position, and compared the two groups by chi squared analysis. Both leg length accuracy and abduction angle were significantly superior with the two-incision technique. No arthroplasty performed with the two-incision technique had a leg length discrepancy of more than 10 mm, versus five in the control group (p<0.025). The abduction of one cup fell outside the 35-49 range in the two-incision group, while ten did so in the control group (p<0.01). With this study, we have shown that a non-originating surgeon early in his experience with the MIS two-incision technique can place acetabular components and equalise leg lengths with superior precision. We believe the fluoroscopic control and supine position greatly enhance the surgeons accuracy, and more than compensate for the potentially decreased direct vision with this technique.

Improved accuracy of acetabular component position and leg lengths with the two-incision total hip replacement technique

We sought to determine whether a non-originating surgeon early in his experience with the MIS two-incision technique for THA could place components with appropriate accuracy. Thirty five consecutive hip replacements performed between July of 2003 and March of 2004 using the two-incision technique were closely matched by height and weight with an equal number of control small incision arthroplasties. The two-incision surgeries were performed after the surgeons twentieth case and prior to the surgeons fifty sixth two-incision case. We assessed immediate postoperative films for leg length discrepancy and acetabular position, and compared the two groups by chi squared analysis. Both leg length accuracy and abduction angle were significantly superior with the two-incision technique. No arthroplasty performed with the two-incision technique had a leg length discrepancy of more than 10 mm, versus five in the control group (p<0.025). The abduction of one cup fell outside the 35-49 range in the two-incision group, while ten did so in the control group (p<0.01). With this study, we have shown that a non-originating surgeon early in his experience with the MIS two-incision technique can place acetabular components and equalise leg lengths with superior precision. We believe the fluoroscopic control and supine position greatly enhance the surgeons accuracy, and more than compensate for the potentially decreased direct vision with this technique.

Rapid Rehabilitation and Recovery with Minimally Invasive Total Hip Arthroplasty

To assess the potential recovery rate of a minimally invasive total hip replacement technique with minimal soft tissue disruption, an accelerated rehabilitation protocol was implemented with weightbearing as tolerated on the day of surgery. One hundred consecutive patients were enrolled in this prospective study. Ninety-seven patients (97%) met all the inpatient physical therapy goals required for discharge to home on the day of surgery; 100% of patients achieved these goals within 23 hours of surgery. Outpatient therapy was initiated in 9% of patients immediately, 62% of patients by 1 week, and all patients by 2 weeks. The mean time to discontinued use of crutches, discontinued use of narcotic pain medications, and resumed driving was 6 days postoperatively. The mean time to return to work was 8 days, discontinued use of any assistive device was 9 days, and resumption of all activities of daily living was 10 days. The mean time to walk (1/2) mile was 16 days. Furthermore, there were no readmissions, no dislocations, and no reoperations. Therefore, a rapid rehabilitation protocol is safe and fulfills the potential benefits of a rapid recovery with minimally invasive total hip arthroplasty.

Minimal invasive surgery for hip replacement: a new technique using the NILNAV hip system.

Minimal invasive surgical techniques are used for cruciate ligament reconstructions, unicondylar knee replacements and, more recently, for fixation of fractures. This is a report of the first instrumented technique for hip replacement using a 5-cm incision without the need for a navigation system or X-rays. It uses the C.F.P stem (LINK) but is universal. It includes jigs for the osteotomy of the neck, a right-angled reamer and spacers (lollipops) to orientate the acetabular cup to the femoral stem. A case series of 14 patients using this new hip replacement technique (called NILNAV Hip System) is reported. The procedure was successfully performed on all seven patients, with reduced postoperative pain and stiffness, and increased quality of life and functional status. All patients were discharged on postoperative Days 1 and 2 with minimal pain and blood loss. This new minimal access total hip replacement technique was successfully performed on seven patients. There are several advantages of using this system compared with the more traditional techniques. Such a technique should help reduce morbidity and mortality rates for those patients undergoing a total hip replacement.

Hypotensive epidural anesthesia for total hip arthroplasty: a review.

Hypotensive epidural anesthesia provides arterial hypotension to maintain a mean arterial pressure of 50 mmHg and it can be used to reduce blood loss during total hip replacement. The technique combines an extensive epidural blockade with an intravenous infusion of low-dose epinephrine. This results in arterial hypotension, but with preservation of central venous pressure, heart rate, stroke volume, cardiac output, and an augmentation of blood flow to the lower extremity. The technique does not appear to adversely affect cardiac, renal, or cerebral function and is used safely in patients with hypertension, ischemic heart disease, and in the elderly. Intraoperative blood losses during primary total hip replacement are between 100 and 300 mL. Perioperative transfusions have declined with the introduction of the technique. Radiological evidence of improved fixation of cemented acetabular components has been observed. Rates of deep-vein thrombosis are low: 2-3% proximal deep-vein thrombosis with an overall rate of 10%. In-hospital mortality is 0.1%; lower than previously published rates. In conclusion, hypotensive epidural anesthesia is safe and provides a number of advantages over conventional anesthetic techniques for total hip replacement.

Co-administration of pethidine and clonidine: a spinal anaesthetic technique for total hip replacement

Co-administration of pethidine 0.75 mg kg-1 and clonidine 75 micrograms intrathecally provided good intraoperative anaesthesia for total hip replacement, similar to that obtained using 0.5% isobaric bupivacaine. Sensory and motor block were of shorter duration than that after 0.5% isobaric bupivacaine and 0.5% isobaric bupivacaine with morphine 0.5 mg (P < 0.001 sensory block, P < 0.001 motor block). Postoperative morphine consumption, measured using a patient-controlled system, was similar to that in patients in the bupivacaine only group (pethidine-clonidine: median 39 mg/24 h; bupivacaine: median 34 mg/24 h) but greater than that in the bupivacaine-morphine group (median 8 mg/24 h) (P < 0.001). Visual analogue pain scores after operation were similar to those with bupivacaine alone at all but one of the recording times but were greater than those in patients who received bupivacaine and morphine at 4, 6 and 10 h after operation (P < 0.001, P < 0.04, P < 0.02). The combination did not offer any major advantage over conventional agents.

For Better Hip Replacement Results, Surgeon's Best Friend May Be a Robot

FRUSTRATION with the standard procedure has led to the development of a new technique for total hip replacement. Instead of the mallet-and-broach approach to preparing sites for cementless joint implantation, two clinicians working with computers have devised what they believe is a better way. Howard A. (Hap) Paul, DVM, University of California (UC), Davis, School of Veterinary Medicine, and William Bargar, MD, UC Davis, School of Medicine and Sutter General Hospital, Sacramento, came up with Robodoc. This surgical robot, an industrial automaton that has been uniquely fitted for its specialjob of milling out the femoral cavity, is the product of Integrated Surgical Systems (ISS) Inc, the company the two researchers have started in Sacramento. Working from input data supplied by another ISS product, the presurgical planning system called Orthodoc, the surgeon-guided robot has produced cavities in cadaver bone with a dimensional accuracy of 0.1mm—up to 40 times more accurate than

Technique for Canine Total Hip Replacement

Between August 1976 and April 1980, a total of 132 canine total hip replacements using a commercially available prosthesis, were performed on clinical patients at The Ohio State University Veterinary Hospital and Berwyn Veterinary Hospital, Chicago. The technique for total hip replacement is described. Details of preoperative evaluation, the operative procedure, and postoperative care are presented.

Advances in Surgical Technique for Total Hip Replacement

Advances in the surgical technique for total hip replacement demonstrate that in most straightforward cases, osteotomy of the greater trochanter is unnecessary. This point of view requires some consideration of the present controversy about the need for osteotomy of the greater trochanter. If the limb is to be shortened or if a graft is to be added to the ilium, the trochanter must be removed. In complex cases necessitating revision operations or correction of severe deformities, or in hips requiring long stem components, osteotomy of the trochanter can be a distinct asset. There are pitfalls and complications of the techniques, both with and without trochanteric osteotomy, as well as with methods of reattachment of the trochanter. In general, total hip replacement can be performed with wide exposure of the socket without osteotomy of the trochanter, and can be performed without damage to the abductor muscle group. New cementing procedures and more accurate positioning of the femoral component have significantly improved the end results of total hip arthroplasty.