Operative Orthopaedics John Ebnezar
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1Arthroplasty2

Cemented Total Hip ReplacementChapter 1

Hip Arthroplasty
S Venkat
Sam S Morgan
4S Venkat
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S Venkat is a Consultant Trauma and Orthopaedic Surgeon based in the UK. He graduated from Stanley Medical College, Madras in 1975 and immigrated to the UK in 1979. After basic surgical training in the UK he branched out to Trauma and Orthopaedics. Dr. S. Venkat had his higher surgical speciality training in Trauma and Orthopaedics in London, Cambridge, Birmingham, Edinburgh and Norwich. He worked as a Consultant Orthopaedic Surgeon in the UK before returning to India in 1991. From 1991 to 2003 he had been an active academician and successful trauma and Orthopaedic Surgeon in India based at Coimbatore. He organized annual international conference under the brand name of Orthocon since 1990 which has become one of the most successful privately run orthopaedic conference in India. Orthocon is still being conducted on regular basis. He was the editor and publisher of Orthopaedic Update (India) an international journal on trauma and orthopaedics. He was the Managing Director of the United Hospital, an exclusive Trauma and Orthopaedic center in Coimbatore. He returned to the UK in 2003 and worked as Consultant Orthopaedic Surgeon at The Royal Orthopaedic Hospital, Birmingham, the home of Birmingham Hip Resurfacing. At present he is working as a Consultant Trauma and Orthopaedic Surgeon at Countess of Chester Hospital, Chester near Liverpool.5
Sam S Morgan
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Fig. 1.1: Skin marking
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Fig. 1.2: Painting and preparation
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Fig. 1.3:
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Fig. 1.4:
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Fig. 1.5:
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Fig. 1.6: Skin Incision. Straight lateral incision
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Fig. 1.7:
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Fig. 1.8:
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Fig. 1.9:
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Fig. 1.10:
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Fig. 1.11:
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Fig. 1.12:
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Fig. 1.13:
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Fig. 1.14:
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Fig. 1.15:
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Fig. 1.16: Modified Hardinge approach
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Fig. 1.17:
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Fig. 1.18:
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Fig. 1.19:
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Figs 1.17 to 1.20: Dislocation of femoral head by gentle internal rotation and adduction
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Fig. 1.21:
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Fig. 1.22:
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Fig. 1.23:
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Figs 1.21 to 1.24: Femoral neck osteotomy based on both the intraoperative radiographic measurements and the intraoperative anatomic landmarks
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Fig. 1.25: Instruments for acetabular preparation
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Fig. 1.26: Excision of remnants of acetabular labrum
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Fig. 1.27:
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Fig. 1.28:
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Fig. 1.29:
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Fig. 1.30:
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Fig. 1.31:
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Figs 1.27 to 1.32: Use of acetabular reamers to prepare the acetabulum. Start with a small reamer
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Fig. 1.33:
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Fig. 1.34:
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Fig. 1.35:
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Figs 1.33 to 1.36: Insertion of the acetabular component's shell using the insertion device
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Fig. 1.37:
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Fig. 1.38:
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Figs 1.37 to 1.39: Insertion of the polyethylene liner
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Fig. 1.40: Image intensifier of the acetabular component
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Fig. 1.41: Using box osteotome to remove remnants of bone from the superior femoral neck
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Fig. 1.42: Reaming of the femoral canal
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Fig. 1.43:
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Fig. 1.44:
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Figs 1.43 to 1.45: Broaching of the proximal femur with sequentially larger broaches until a reasonably snug fit occurs
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Fig. 1.46: Insertion of the trial implant
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Fig. 1.47:
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Fig. 1.48:
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Fig. 1.49:
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Fig. 1.50: Insertion of the femoral canal plug. It should reside in the femoral canal approximately 2 cm distal to where the end of the stem will sit
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Fig. 1.51: Cement mix. Consider using vacuum mixing technique to enhance cement consistency and reduce overall cement porosity
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Fig. 1.52:
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Figs 1.52 and 1.53: Use a cement gun to insert the cement when it reaches a “doughy” state and no longer adheres to the surgical gloves
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Fig. 1.54:
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Fig. 1.55:
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Fig. 1.56: tem insertion using predominately a manual force rather than the mallet
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Fig. 1.57: Insertion of the appropriate modular head based on the trial reduction
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Fig. 1.58:
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Fig. 1.59:
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Fig. 1.60: Hip reduction and reassessment of stability
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Fig. 1.61: Closure of the abductors using absorbable sutures
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Fig. 1.62: Use of superficial suction drain and closure of the subcutaneous layer
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Fig. 1.63:
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Figs 1.63 and 64: Skin closure
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