髖關(guān)節(jié)表面置換課件

xAMANKHANMBBS,FRCS,FRCS(TRA.&ORTHO.)CONSULTANTHIPANDUPPERLIMBSURGEONCROSSHOUSEHOSP.KILMARNOCKSCOTLAND髖關(guān)節(jié)表面置換HISTORYOFTHR髖關(guān)節(jié)表面置換HISTORYOFTHR

40,000TotalHipReplacementsperformedintheUKeachyear–i.e.@109perdayThisisamajoryetmostcommonlyperformedOrthopaedicprocedureforHipPain.髖關(guān)節(jié)表面置換HISTORYOFTHRIthasbeendocumentedthatSurgeonsfromasearlyasthe17thCenturyhadahugefascinationwithhipreplacementsurgeryforpainfulhip.MaterialsusedthenincludedIvory,Gold,LeatherandGlass.髖關(guān)節(jié)表面置換HISTORYOFTHRIntheearly20thCenturymoresuccessfulandlong-lastingattemptsatHipReplacementsweremadeandthepioneersofthesewereJudeandSmith–Peterson.髖關(guān)節(jié)表面置換HISTORYOFTHRThemostsuccessfulofallthematerialsusedare1. MetalSmallBallandPlasticSocket.2. MetalBigBallandBigSocket.髖關(guān)節(jié)表面置換HISTORYOFTHRSo,therewereTWOmajorphilosophiesrunningsidebysideduringthesameperiod.1.SmallMetalBallattachedtoastemandcementedinFemur,articulatingwithaplastic“polyethylene”cementedsocketinthepelvis髖關(guān)節(jié)表面置換HISTORYOFTHRThiswasalsocalled“l(fā)owfrictionarthroplasty”,pioneeredbySirJohnCharnley,ithasbeenthemostsuccessfulcementedhipreplacementCharnleyin1950’sattemptedresurfacingwithPTFE髖關(guān)節(jié)表面置換HISTORYOFTHR2. LargeMetalBalleitherResurfaced(retainedfemoralhead)orReplaced(stemfemur),andacorrespondinglargemetalsocket.髖關(guān)節(jié)表面置換HISTORYOFTHRThisphilosophyevolvedfromtheworkofMcKeeFarrar,Ring,Jude,WagnerandSmith-Petersonwhopioneeredthisintheearlytomid20thCentury.髖關(guān)節(jié)表面置換TorecapthemostsuccessfulofallhipreplacementfromthaterawastheSirJohnCharnleycementedHipReplacement.髖關(guān)節(jié)表面置換HISTORYOFTHRTheearlymetalonmetalhipreplacements(resurfacing)felloutoffavourbecauseofearlyfailuresandconcernsaboutproductionofmetalions.髖關(guān)節(jié)表面置換髖關(guān)節(jié)表面置換HISTORYOFTHRThecementedhipswerealsonotcompletelycomplicationfreeandtheplasticdebrisproducedfrommetalonplasticarticulationledtolooseningoftheimplants.髖關(guān)節(jié)表面置換HISTORYOFTHRRevisingacementedtotalhipreplacementisamajorundertakingwhichcanleadtomajorcomplicationsandbadoutcomes.髖關(guān)節(jié)表面置換HISTORYOFTHRTraditionallyHipReplacementsurgerywasonlyadvisedifthepatientwasaged60orabove.Thereasonbehindthiswasthatthereplacedhipwouldmostlikelylastfortheremaininglifetimeofthepatientandwouldnotneedanyrevisionprocedure.髖關(guān)節(jié)表面置換HISTORYOFTHRSowhataboutpatientswhowereintheirearly20’s,30’s,40’sand50’swithsevereOsteoarthritis,painanddiscomfort?Theseyoungactivepatientshadpoorqualityoflife,therejobsandfamilylifehadbeenseverelyaffected.髖關(guān)節(jié)表面置換HISTORYOFTHRSothequestwasonforahipreplacement,whichwouldbebetterthanwasalreadyonoffer,forthishugegroupofyoungpeople.SurgeonsandBioengineerswentbacktothedrawingboard髖關(guān)節(jié)表面置換HISTORYOFTHRTheycamebackwithdifferentsolutions1.Un-cementedhips(itwasthoughtthatrevisionswouldbeeasierifhipwasuncemented)髖關(guān)節(jié)表面置換HISTORYOFTHR2.HybridHipReplacement.Hybridisacombinationofun-cementedandcemented(i.e.cementedstemandun-cementedsocket).髖關(guān)節(jié)表面置換HISTORYOFTHR

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HIPREPLACEMENTwithCERAMICBALLandCERAMICACETABULUMCeramicisafantasticarticulatingsurfacesuitableforyoungpeople,buttheearlyceramicsshatteredbecauseofmanufacturingfaults.髖關(guān)節(jié)表面置換HISTORYOFTHRAgain,longandshorttermproblemswereencounteredwithallthesetypesofnewhipreplacements,leadingtorevisionsurgeryofthesamemagnitudeasofacementedhip,withsimilarcomplicationsandoutcomes.髖關(guān)節(jié)表面置換HISTORYOFTHRThisledtosearchforabetterartiulatingsurfaceandacomebackofthemetalonmetalphilosophy.Thistimearoundthebioengineersresearchedhardforbettertribology,finish,qualityofmetalandnewmanufacturingtechniquesinthefactory髖關(guān)節(jié)表