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The cemented total hip prosthesis
Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) to eliminate pain and restore joint movement.
There are two major types of artificial hip joint: cemented and uncemented prosthesis. Both types are widely used. The type of prosthesis used for your surgery is usually decided upon by your surgeon based on your age, your lifestyle, and the surgeon’s past experience. Each prosthesis is made up of two parts: the acetabular component—or socket portion—which replaces the acetabulum, and the femoral component—or stem portion—which replaces the femoral head.
The femoral component (femoral stem) is made of a metal stem with a metal ball on the end. Some prosthesis have a ceramic ball attached to the metal stem. The acetabular component is a metal shell with a plastic inner socket liner that acts like a bearing. The type of plastic used is very tough and very slick – so slick and tough that you could ice skate on a sheet of the plastic without much damage to the plastic.
Loosening of the cemented hip prosthesis
When reconstruction of proximal bone stock important
- young patient in whom biological solution more desirable
- choose stem 2 cortical diameters longer than most distal lytic area
- full exposure of proximal femur
- removal stem & cement Can leave distal plug
- not infected
- > 2 cm past planned tip location
Create contained defect
- reconstitute femoral tube
- create contained defect
- wire mesh & cerclage wire
- prophylactically cerclage wire shaft if diaphysis flimsy
- threaded intramedullary plug inserted on guide rod
- impacters tested to see max depth of insertion before abutment on canal
- morsellised allograft inserted
- impactor & slap hammer slid over guide wire
- graft impacted to predetermined depth
- continued by introducing more chips with larger impacters
- stopped when level is 10 cm from tip of GT
- appropriate proximal impactor equivalent to selected stem used
- used to force chips against walls of canal
- then larger distal impactor used
- alternated till canal filled
- should be firm neo-canal
- trial stem inserted
- depth of insertion marked
- proximal impactor driven in another 5 mm
- creates room for cement
- cemented polished collarless double tapered stem
- NWB for ?
Approximately 95% of patients who have hip replacement surgery report that they are satisfied with their new hip. Most patients who have had a hip replacement are unaware of their prosthesis during normal activities.
Cementless Total Hip Prosthesis - Porte Vet
A trial component, which is an exact duplicate of your hip prosthesis, is tested to ensure that the joint you receive will be the right size and fit for you—one with good stability and without obvious dislocation. Once the right size and shape is determined for the acetabulum, the acetabular component is inserted into place. In the uncemented variety of artificial hip replacement, the metal shell is simply held in place by the tightness of the fit or with screws to hold the metal shell in place. In the cemented variety, a special epoxy type cement is used to “glue” the acetabular component to the bone.
The native hip is a ball and socket joint. The ball, formed by the femoral head, is held in the socket, formed by the pelvic acetabulum, by muscles, ligaments and the joint capsule. Hip replacement surgery involves removing the arthritic or diseased bone from the socket and removing the femoral head. The parts of the bone removed are replaced by artificial, or prosthetic, components.
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