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OBJECTIVES
WHAT IS ARTHROPLASTY?
INTRODUCTION TO TOTAL HIP ARTHROPLASTY
INTRODUCTION TO TOTAL KNEE ARTHROPLASTY.
BIOMECHANICAL INFLUENCES IN ARTHROPLASTY
FORCES ACTING AT HIP JOINT
MEASUREMENT OF FORCES ACTING ON A JOINT WITH INSTRUMENTAL
IMPLANTS

ARTHROPLASTY
ARTHROPLASTY IS AN OPERATIVE PROCEDURE OF ORTHOPEDIC SURGERY
PERFORMED, IN WHICH THE ARTHRITIC OR DYSFUNCTIONAL JOINT SURFACE IS
REPLACED WITH SOMETHING BETTER OR BY REMODELING OR REALIGNING THE
JOINT BY OSTEOTOMY OR SOME OTHER PROCEDURE.

COMMONLY REPLACED JOINTS

HIP JOINT
KNEE JOINT
SHOULDER JOINT
OTHERS

INDICATION OF ARTHOPLASTY
OSTEOARTHIRITIS (OA)
RHEUMATOID ARTHRITIS(RA)
AVASCULAR NECROSIS(AVN) OR OSTEONECROSIS (ON)
CONGENITAL DISLOCATION OF THE HIP JOINT
ACETABULAR DYSPLASIA (SHALLOW HIP SOCKET)
FROZEN SHOULDER, LOOSE SHOULDER
TRAUMATIZED AND MALALIGNED JOINT
JOINT STIFFNESS
FAILURE OF OTHER SURGERIES OR CONSERVATIVE TREATMENT

IMPLANT MATERIALS
THE METAL AND PLASTIC ARE THE MOST COMMONLY USED IMPLANTS.
SURFACES JOINT ARE REPLACED WITH A METAL PROSTHESIS, AND A
PLASTIC SPACER IS PLACED IN BETWEEN.

THE METALS USED INCLUDE TITANIUM, STAINLESS STEEL, AND COBALT

CHROME.

THE PLASTIC IS CALLED POLYETHYLENE.

CEMENTED V/S NON CEMENTED

THE IMPLANT IS SECURED TO THE BONE BY ONE OF TWO METHODS

CEMENTED

WHEN AN IMPLANT IS CEMENTED, A SPECIAL BONE CEMENT IS USED TO SECURE

THE PROSTHESIS IN
NON-CEMENTED
IN THE PRESS-FIT METHOD, THE IMPLANT IS FIT SNUGGLY INTO THE BONE, AND
NEW BONE FORMS AROUND THE IMPLANT TO SECURE IT IN POSITION.

TOTAL HIP ARTHROPLASTY

INDICATIONS FOR SURGERY

SEVERE HIP PAIN WITH MOTION AND WEIGHT BEARING
JOINT DETERIORATION AND LOSS OF ARTICULAR CARTILAGE
OSTEOARTHRITIS
RHEUMATOID OR TRAUMATIC ARTHRITIS
ANKYLOSING SPONDYLITIS
OSTEONECROSIS (AVASCULAR NECROSIS)
NONUNION FRACTURE
BONE TUMORS
FAILURE OF CONSERVATIVE MANAGEMENT OR PREVIOUS JOINT
RECONSTRUCTION PROCEDURES

CONTRAINDICATIONS TO TOTAL
HIP ARTHROPLASTY
ABSOLUTE

1.
2.
3.
4.
5.
6.

ACTIVE JOINT INFECTION

SYSTEMIC INFECTION
CHRONIC OSTEOMYELITIS
SIGNIFICANT LOSS OF BONE
NEUROPATHIC HIP JOINT
SEVERE PARALYSIS OF THE
MUSCLE

RELATIVE

1.
2.
3.
4.

5.
6.

LOCALIZED INFECTION
PROGRESSIVE NEUROLOGICAL DISORDER
INSUFFICIENT FUNCTION OF THE GLUTEUS
MEDIUS MUSCLE.
HIGHLY COMPROMISED/INSUFFICIENT
FEMORAL OR ACETABULAR BONE STOCK
PATIENTS REQUIRING EXTENSIVE DENTAL
WORK.
YOUNG PATIENTS WHO MUST OR ARE
MOST LIKELY TO PARTICIPATE IN HIGHDEMAND ACTIVITIES.

COMPONENTS OF THERAPY-RELATED
PREOPERATIVE MANAGEMENT: PREPARATION
FOR TOTAL HIP ARTHROPLASTY

1. EXAMINATION AND EVALUATION

PAIN,
ROM
MUSCLE STRENGTH,
BALANCE,
AMBULATORY STATUS,
LEG LENGTHS,
GAIT CHARACTERISTICS,
USE OF ASSISTIVE DEVICES,
GENERAL LEVEL OF FUNCTION,
PERCEIVED LEVEL OF DISABILITY

2.INFORMATION FOR PATIENTS AND THEIR

FAMILIES ABOUT JOINT DISEASE AND THE

OPERATIVE PROCEDURE IN NONMEDICAL TERMS

3.POSTOPERATIVE PRECAUTIONS AND THEIR

RATIONALE INCLUDING POSITIONING AND
WEIGH.

4.FUNCTIONAL TRAINING FOR EARLY

POSTOPERATIVE DAYS INCLUDING BED

MOBILITY, TRANSFERS, GAIT TRAINING WITH
ASSISTIVE DEVICES.

5.EARLY POSTOPERATIVE EXERCISES

6.CRITERIA FOR DISCHARGE FROM THE HOSPITAL

METHODS OF FIXATION

CEMENTED.
CEMENTLESS
HYBRID

CEMENTED VERSUS CEMENTLESS

FIXATION

CEMENTED FIXATION

ACRYLIC CEMENT ALLOW EARLY POSTOPERATIVE WEIGHT

BEARING

DISADVANTAGE

ASEPTIC (BIOMECHANICAL) LOOSENING OF THE PROSTHETIC

COMPONENTS AT THE BONECEMENT INTERFACE IN YOUNGER,

PHYSICALLY ACTIVE PATIENTS

 CEMENTLESS (BIOLOGICAL) FIXATION

POROUS-COATED PROSTHESES
CEMENTLESS PRESS-FIT TECHNIQUE
SMOOTH (NONPOROUS) FEMORAL COMPONENTS WITH

CEMENTLESS ARTHROPLASTY
COATING OF A BIOACTIVE COMPOUND CALLED
HYDROXYAPATITE
UNDER 60 YEAR OF AGE

DISADVANTAGE

LATE WEIGHT BEARING

CEMENTED OR CEMENT LESS

TOTAL KNEE ARTHROPLASTY

TOTAL KNEE ARTHROPLASTY

INDICATIONS FOR SURGERY

SEVERE JOINT PAIN WITH WEIGHT BEARING

OR MOTION

EXTENSIVE DESTRUCTION OF ARTICULAR

CARTILAGE

MARKED DEFORMITY OF THE KNEE

FAILURE OF NONOPERATIVE MANAGEMENT.

GROSS INSTABILITY OR LIMITATION OF

MOTION

TYPES OF KNEE ARTHROPLASTY

TOTAL KNEE ARTHROPLASTYDESIGN

SURGICAL APPROACH, FIXATION
NUMBER OF COMPARTMENTS
REPLACED

UNICOMPARTMENTAL
BICOMPARTMENTAL
TRICOMPARTMENTAL

TOTAL KNEE ARTHROPLASTYDESIGN

SURGICAL APPROACH, FIXATION
IMPLANT DESIGN

UNCONSTRAINED
SEMICONSTRAINED
FULLY CONSTRAINED
FIXED-BEARING OR MOBILE-BEARING
DESIGN

CRUCIATE-RETAINING

TOTAL KNEE ARTHROPLASTYDESIGN

SURGICAL APPROACH, FIXATION
SURGICAL APPROACH

STANDARD/TRADITIONAL OR
MINIMALLY INVASIVE

QUADRICEPS-SPLITTING OR
QUADRICEPS-SPARING

TOTAL KNEE ARTHROPLASTYDESIGN

SURGICAL APPROACH, FIXATION
IMPLANT FIXATION

CEMENTED
UNCEMENTED
HYBRID

OPERATIVE OVERVIEW
STANDARD APPROACH

COMPLICATIONS
INTERCONDYLAR FRACTURE
DAMAGE TO A PERIPHERAL NERVE
MALUNION
LOOSENING OF PROSTHESIS.

FLASHBACK
WHAT IS ARTHROPLASTY?
INTRODUCTION TO TOTAL HIP ARTHROPLASTY
INTRODUCTION TO TOTAL KNEE ARTHROPLASTY.