Basics of total hip replacement by DR. D. P. SWAMI

BASICS OF THR WITH CLINICAL ANATOMY, BIO-MECHANICS, INSTRUMENTS, IMPLANTS ANS SURGICAL TECHNIQUE WITH POST OPERATIVE RADIOLOGICAL EVALUATION

1. BASICS OF TOTAL HIP REPLACEMENT: CONCEPT AND STEPS OF PROCEDURE DR. D. P. SWAMI PIONEER: SIR JOHN CHARNLEY CHARNLEY’S PRINCIPLES BIOMECHANICS SURGICAL APPROACHES TEMPLATING ROBUST PRE OPERATIVE PLANNING FAMILARITY WITH INSTRUMENTATION POSSIBLE COMPLICATIONS: KEEP IN MIND

2. APPLIED ANATOMY IN BRIEF FOR DETAILS PLEASE VISIT https://www.slideshare.net/dharampalmazipura/biomechanics-of-hip-by-dr-d-p-swami

3. BIOMECHANICS IN BRIEF FOR DETAILS PLEASE VISIT https://www.slideshare.net/dharampalmazipura/biomechanics-of-hip-by-dr-d-p-swami

4. BIOMECHANICS IN BRIEF…. FOR DETAILS PLEASE VISIT https://www.slideshare.net/dharampalmazipura/biomechanics-of-hip-by-dr-d-p-swami

5. CHARNLEY’S PRINCIPLES OF LOW FRICTION ARTHROPLASTY …. INTERNELISE FROM HEART Short head Medialize acetabulum Increase abductor lever arm

6. COMPONENTS OF THR

7. UNDERSTAND: OFFSET

8. PRE-Step Comprehensive history about co morbid conditions and detailed clinical examination Dtailed informed CONSENT CHECK SURGICAL SITE !

9. PRE-Step …Templating FOR DETAILS ABOUT TEMPLATING PLEASE VISIT TO PREDICT UNUSUAL/ USUAL SIZE OF IMPLANT TO UNDERSTAND INTRAOPERATIVE DIFICULTIES!

10. STEP 1…POSITION AND DRAPING ACORDING TO APPROACH, THIS ONE IS FOR POSTERIOR APPROACH -SOHULDER AND ASIS MUST BE IN LINE -OPPOSITE KNEE MUST BE PALPABLE -OPERATIVE LIMB MUST BE FREE FOR MOVEMENTS - ALL BONY PROMINENCES MUST BE WELL PADED

11. STEP 2…INCISION AND EXPOSURE USE APPORACH WHICH YOU PRACTISED RESPECT SOFT TISSUE PLANES: IT RESIPROCATES ALL REQUIRED ANATOMICAL DETAILS MUST BE VISIBLE/ PALPABLE TAKE YOUR TIME: IT’S MOST CRUCIAL STEP

12. STEP 3…HIP DISLOCATION AND RESECTION OF NECK DISLOCATE : FLEX KNEE AND TRACTION WITH PROGRESSIVE FLEXION AND EXTERNAL ROTATION AFTER PALPATION OF RELAVENT LAND MARKS RESECT NECK WITH OSCILLATING SAW ASK ASSISTANT TO KEEP KNEE FLEXED AT 90 DEGREE AND THIGH PARALLAL TO GROUND: HELPS IN ORIENTAION OF ANTEVERSION

13. STEP 4…INSPECT HEAD FOR PATHOLOGY AND MEASURE IT’S SIZE

14. STEP 5: PREPARE ACETABULUM -KEEP IN MIND: ACETABULAR ANTEVERSION AND INCLIN ATION ( USE ZIG OR UTILIZE SHOULDER- ASIS AXIS -CLEAR ACETABULUM FROM: SOFT TISSUE, CARTILAGE, LABRUM AND OSTEOPHYTES -AVOID EXCESSIVE MEDIALISATION -REAM UNTIL A CIRCUMFERENTIAL GRIP IS ACHIEVED WITH THE REAMER -REAM TO 2 MM UNDER THE ANTICIPATED SIZE OF TRIAL

15. STEP 6… CUP TRIAL MARK POSITION OF FINAL CUP USING DIATHERMY TO MARK DEPTH, VERSION AND ABDUCTION TO HELP WITH DEFINITIVE CUP PLACEMENT

16. STEP 7: IMPLANT DEFINITIVE CUP AND POLYETHYLENE LINER -POSITION CUP: KEEP ANTEVERSION WITH HELP OF ZIG OR SHOULDER –ASIS AXIS -AUDIBLE PITCH CHANGE DURING IMPACTION: CUP IS FULLY SEATED! - FIX CUP WITH SCREWS: MIND SAFE ZONE AREA -INSERT LINER: KEEP PROTRUDED PART POSTEROSUPIRIOR

17. ACETABULAR SCREW…SAFE ZONE

18. STEP 8… FEMORAL PREPARATION

19. STEP 8… FEMORAL PREPARATION… OPEN CANAL -COVER ACETABULUM -USE BOX CHISSEL TO OPEN CANAL: MIND THE FEMORAL ANTEVERSION AND BE LATERAL -USE CANAL OPENER: MIND THE TRAJECTORY OF FEMORAL CANAL

20. STEP 8… FEMORAL PREPARATION… BROACHING AND RASPING KEEP ORIENTATION OF BROACH CONSISTANT THROUGHOUT BROACHING CHANGE IN SOUND! : MIND IT

21. STEP 8… FEMORAL PREPARATION… CEMENT PLUG AND CEMENTING -MEASURE CANAL SIZE AND INTRODUCE CEMENT PLUG -AVOID EXTRA CONSIOUSNESS DURING CEMENTING -HAVE PATIENCE: IT TAKES SOME TIME

22. STEP 9: IMPLANT DEFINITIVE FEMORAL STEM KEEP FEMORAL ANTEVERSION IN MIND MUST NOT ATTEMPT TO CONTINUE IMPACTING FEMORAL COMPONENT IF VISUAL AND AUDITORY CLUES INDICATE THAT STEM IS FIRMLY SEATED IN THE CANAL: MAY END UP WITH FEMORAL FRACTURE

23. STEP 10: TRIAL REDUCTION CHECK: -SUCK TEST -STABILITY -LIMB LENGTH: PALPATE AND COMPARE WITH OPPOSITE KNEE -ROM -DISLOCATION POINT -SATISFIED WITH TRIAL REDUCTION?

24. STEP 11: ATTACH DEFINITIVEFEMORAL HEAD AND REDUCE -FINALLY RE-ASSESS ROM, STABILITY AND LEG LENGTH -REPAIR DETAISED MUSCLES -CLOSE WOUND IN LAYERS -ABDUCTION BAR!!

25. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION NO ONE IS PERFECT! ALWAYS ACCEPT MISTAKES: IT ‘LL IMPROVE SURGICAL SKILLS

26. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION …LEG LENGTH DISCRIPENCY

27. STEP 12 … POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION … CENTRE OF ROTATION

28. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION …ACETABULAR INCLINATION

29. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION …ACETABULAR ANTEVERSION

30. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION …STEM IN VARUS Varus positioning is present when proximal portion of femoral component rests against the medial endosteum and the distal portion rests against the lateral endosteum

31. STEP 12…POSTOPERATIVE RADIOLOGICAL EVALUATION AND INTEROSPECTION …STEM IN VALGUS The component is considered to be in a valgus position if the proximal portion rests against the lateral endosteum and its distal portion rests against the medial endosteum

32. KEEP IN MIND…THAT

33. THANK YOU