Arthroplasty

the basic arthroplasty description and common type

1. ARTHROPLASTY SANA MASROOR MPT 2 ND SEM. ORTHOPAEDICS SURGERY AND MEDICINE 2018

2. Introduction Arthroplasty is a reconstructive surgery to restore the joint motion and function and to relieve pain. It generally involves the replacement of bony joint structure by a prosthesis . Main varieties:-

3. John Charnely (1979) revolutionized the management of the arthritic hip with the development of low-friction arthroplasty . His three major contribution to the evolution of hip replacement were :- The concept of low-friction torque arthroplasty . The use of acryclic cement to fix the components. The introduction of high-density polyethylene as a bearing materials.

4. Principles Durable . They must permit extraordinary low-friction movement at the articulation. They must be firmly fixed to the skeleton. They must be inert and not provoke any unwanted reaction in the tissue. The prostheses are of various designs and may be fixed to the remaining bone by cement, press fit, or bone ingrowth. Selection of the prosthesis and fixation technique depends on patient’s bone structure, joint stability, and other individual characteristics, including age, weight, and activity level.

5. Hip Arthroplasty Indication: sever OA and RA, fracture, failure of previous surgery, congenital hip disease Implant Type of fixation Cemented Uncemented

6. Techniques Posterior (Moore) :- The posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators off the femur. Lateral ( Hardinge or Liverpool) :- The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus ) to access the joint. Antero-lateral (Watson-Jones) :- The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius . Anterior (Smith-Petersen ) :- The anterior approach uses an interval between the sartorius muscle and tensor fascia latae . Greater trochanter osteotomy. Minimally invasive approach.

7. Complication Intraoperative complication Sciatic nerve injury Postoperative dislocation Heterotropic bone formation Aseptic loosening Osteolysis Infection

8. Knee Arthroplasty Principles: -Restore limb alignment -Achieve soft tissue balance -Use correct implant -Restore joint line -Obtain good range of motion Indication: pain combined with deformity and instability Types of operation -partial replacement -minimally constrained total replacement -constrained joint -minimally invasive total knee replacement

9. Approaches; "simple" primary knee arthroplasty approaches medial parapatellar midvastus subvastus minimally invasive "complex" primary or revision total knee arthroplasty quadriceps snip V-Y turndown tibial tubercle osteotomy

10. Complication Infection Loosening Patellar problem

11. Shoulder Arthroplasty Shoulder replacement was initially introduced by Neer in the 1950s The indications for arthroplasty are: 1. Osteoarthritis causing pain and loss of movement 2. Rheumatoid arthritis 3. Complex fractures of the proximal humerus 4. Avascular necrosis of the humeral head 5. Tumours of the proximal humerus 6. Severe arthritis with cuff arthropathy . Approach: - Deltopectoral

12. Complication Loosening of the components gleno -humeral instability Rotator cuff failure peri -prosthetic fracture infection implant failure