Pelvic replacement is a surgical procedure in which the hip joint is replaced with a prosthetic implant, ie, hip prosthesis . Hip replacement surgery can be performed as a total replacement or a hemi substitute (half). Such joint-replacement surgery is generally performed to relieve arthritic pain or to some hip fractures. Total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Pelvic replacement is currently one of the most common orthopedic surgeries, although short-term and long-term patient satisfaction varies greatly. The average cost of total hip replacement in 2012 is $ 40,364 in the United States, and about $ 7,700 to $ 12,000 in most European countries.
Video Hip replacement
Medical use
Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis. The purpose of this procedure is pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medication, have failed.
Maps Hip replacement
Modern processes
Modern-made joints owe much to the 1962 Sir John Charnley's work at Wrightington Hospital. His work in the field of tribology produced a design that almost completely replaced other designs in the 1970s. Charnley's design consists of three parts:
- stem and head femoralis one part of stainless steel
- polyethylene (origin Teflon), acetabular component, both fixed to bone using
- PMMA (acrylic) cement bone
The joint replacement, known as Low Friction Arthroplasty, is lubricated with synovial fluid. The small femoral head ( 7 / 8 at (22.2 mm)) was chosen for Charnley's belief that it would have a lower friction on the component acetabular and thus aus acetabulum is slower. Unfortunately, the smaller head shifts easier. An alternative design with a larger head such as the Mueller prosthesis is proposed. Stability is improved, but acetabular wear and subsequent failure rates increase with this design. The acetabular Teflon component of Charnley's initial design failed in one or two years of implantation. This encourages the search for more suitable material. A German seller shows a polyethylene tooth sample to a Charnley engineer, sparking the idea of ​​using this material for acetabular components. Ultra high molecular weight polyethylene or UHMWPE acetabular component was introduced in 1962. Charnley's other major contribution was to use bone cement polymethylmethacrylate (PMMA) to attach the two components to the bone. For more than two decades, Charnley Low Friction Arthroplasty, and derivative designs are the most widely used systems in the world. This forms the basis for all modern hip implants.
Exeter's hip base was developed in England during the same time as the Charnley device. The development took place after the collaboration between Orthopedic Surgeon Robin Ling and Exeter University engineer Clive Lee and was first planted at the Princess Elizabeth Orthopedic Hospital in Exeter in 1970. Exeter Hip is a cemented device, but with slightly different geometry of stems. Both designs have demonstrated excellent long-term durability when correctly placed and are still widely used in slightly modified versions.
Early implant designs have the potential to loosen from their attachment to bone, usually becoming painful ten to twelve years after placement. In addition, bone erosion around the implant is seen on x-rays. Initially, the surgeon believes this is caused by an abnormal reaction to the cement that holds the implant in place. That conviction prompted the search for alternative methods for installing implants. The Austin Moore device has a small hole in the stem where the bone graft is placed before implanting the stem. It is expected that the bone will then grow through the window over time and hold the stem in position. Success is unpredictable and fixation is not too strong. In the early 1980s, surgeons in the United States applied a small bead layer to Austin Moore's device and planted it without cement. The beads were built so that the gaps between the beads fit the pore size in the original bone. Over time, the bone cells of the patient will grow into these spaces and fix the stems in position. The trunk is modified slightly to be more tightly into the femoral canal, resulting in the design of Anatomic Medullary Locking (AML) rods. Over time, other forms of surface stem treatment and rod geometry have been developed and improved.
The initial hip design is made up of one-piece femoral components and one-piece acetabular components. The current design has a femoral rod and a separate head section. Using an independent head allows the surgeon to adjust the length of the leg (some of the head of the chair more or less to the rod) and to select from the various materials from which the head is formed. The modern acetabulum component also consists of two parts: a metal shell with layers for bone and liner separation. First shell placed. Its position can be adjusted, unlike the original cemented cup design mounted on the cement set. When the exact position of the metal shell is obtained, the surgeon may choose a liner made of various materials.
To combat loosening caused by polyethylene wear debris, enhanced hip manufacturers are enhanced and new materials for acetabular liners. Ceramic heads mated with ordinary polyethylene liners or ceramic liners are the first important alternatives. Metal coatings for mating with metal heads are also developed. At the same time this design is being developed, the problems causing the wear of polyethylene are determined and the manufacture of this material increases. UHMWPE is highly cross-linked in the late 1990s. Recent data comparing various bearing surfaces showed no clinically significant differences in performance. Potential initial problems with each of the materials are discussed below. Performance data after 20 or 30 years may be required to indicate a significant difference in the device. All of the newer materials allow the use of a larger diameter femoral head. The use of a larger head significantly reduces the likelihood of pelvic dislocation, which remains the biggest complication of surgery.
When currently available implants are used, cemented stems tend to have better longevity than un-cemented stems. No significant differences were observed in the clinical performance of various methods of surface treatment of uncemented devices. Accidental stems are selected for patients with good quality bones that can withstand the forces needed to push the stems tightly. Cemented devices are usually selected for patients with poor quality bones at risk of fracture during stem insertion. Cemented sticks are cheaper because of lower production costs, but require good surgical techniques to place them properly. Unprocessed stems can cause pain with activity in up to 20% of patients during the first year after placement when bones adapt to the device. This is rarely seen with cemented stems.
After a rare operation for weak patients with limited life expectancy, hip replacements are now common, even among active athletes including car racers Bobby Labonte and Dale Jarrett, and American winner 8 times Tom Watson, who shot 67 in the opening round Masters tournament in the following year after its operation.
Technique
There are several incisions, which are defined by their relation to the gluteus medius. The approach is posterior (Moore), lateral (Hardinge or Liverpool), antero-lateral (Watson-Jones), anterior (Smith-Petersen) and major trochanter osteotomy. There is no convincing evidence in the literature for a particular approach, but the consensus of professional opinion supports a modified anterolateral (Watson-Jones) or posterior approach.
Posterior Approach
The posterior (Moore or Southern) approach seeks accessing the joints and capsules through the back, taking the piriformis muscle and the short external rotator of the femur. This approach provides excellent access to acetabulum and femur and retains kidney abduction and thus minimizes the risk of abduction of postoperative dysfunction. This has the advantage of being a wider approach if needed. Critics cite higher dislocation rates, although improvements in capsules, piriformis and short external rotators along with the use of modern large diameter headballs reduce this risk.
Lateral approach
The lateral approach is also commonly used for hip replacement. This approach requires elevation of the kidnapper's hip (gluteus medius and gluteus minimus) to access the joint. The kidnappers may be removed by osteotomy from the greater trochanter and reapply thereafter using wires (such as Charnley), or can be divided on their tendinous portions, or through functional tendons (corresponding to Hardinge) and repaired using stitches. Although this approach has a lower dislocation risk than the posterior approach, critics note that sometimes the kidnapper muscle does not heal again, leading to pain and weakness that are often very difficult to treat.
The antero-lateral approach
The anterolateral approach develops intervals between fasciae latae and gluteus medius tensors. Gluteus medius, gluteus minimus and hip capsules are released from the anterior (front) to the major trochanter and neck femoral and then repaired with heavy stitches after joint replacement.
Anterior Approach
The anterior approach uses the interval between sartorius muscle and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas has adapted this approach, which is usually used for hip fracture repair surgery, for use when performing hip replacements. When used with older hip implant systems that have small head diameters, the dislocation rate is reduced compared with operations performed by the posterior approach. With modern implant design, the level of dislocation is similar between anterior and posterior approaches. An anterior approach has been shown in the study to improve variably early functional recovery, with possible complications of ejection of the femoral component and early revision compared to other approaches.
Minimally invasive approach
Multiple incision approaches and other minimally invasive operations seek to reduce soft tissue damage through reduced incision size. However, component positioning accuracy and visualization of bone structure can be significantly impaired because of the smaller approach. This can lead to unintentional fractures and soft-tissue injuries. The majority of orthopedic surgeons today use a "minimally invasive" approach compared to a comparatively large traditional approach.
Computer-assisted surgery and robotic surgery techniques are also available to guide surgeons to provide improved accuracy. Some commercial CAS and robotic systems are available for worldwide use. Increased patient outcomes and reduced complications have not been proven when the system is used when compared to standard techniques.
Implant
The prosthetic implant used in hip replacement consists of three parts: acetabular cup, femoral component, and articular interface. Options exist for different people and indications. Evidence for a number of new devices is not very good, including: ceramic-on-ceramic pads, modular femoris neck, and unmapped monoblock cups. Choosing the right prosthesis is important.
Acetabular cup
The acetabular cup is a component that is placed into the acetabulum (hip socket). Cartilage and bone removed from acetabulum and acetabular cups mounted using friction or cement. Some acetabular cups are one part, while others are modular. A one-piece (monobloc) shell is UHMWPE (ultra-high-molecular-weight polyethylene) or metal, they have an articular surface working on the inner surface of the cup and do not rely on a locking mechanism to hold the liner in place. The monobloc polyethylene cup is cemented in place while the metal cup is held in place by a metal layer on the outside of the cup. The modular cup consists of two parts, a shell and a liner. Shell made of metal; the outer has a porous layer while the inside contains a locking mechanism designed to receive liners. Two types of porous layers used to form suitable friction are sintered beads and foam metal designs to mimic traces of the cancellous bone and initial stability is affected by the lack of insertion and insertion power. Permanent fixation is achieved when the bone grows upward or into a porous layer. Screws can be used to hold the shell to the bone providing even more fixation. The polyethylene liner is placed into the shell and connected to the rim locking mechanism; ceramic and metal liners attached with morse taper.
Femoral component
The femoral component is a fitting component in the femur (thigh). The bone is removed and the femur is formed to receive the femoral stem with the prosthetic femur head attached (the ball). There are two types of fixation: cemented and not cemented. The cemented stem uses acrylic bone cement to form a mantle between the stem and bone. Unsold rods use friction, shape and surface coating to stimulate the bone to remodel and bind to the implant. Rods are made of various materials (titanium, cobalt chromium, stainless steels, and polymer composites) and they can be monolithic or modular. The modular component consists of different head dimensions and/or modular neck orientation; this is attached via a taper similar to a Morse taper. This option allows variability in length, offset, and leg version. The femoral head is made of metal or ceramic material. The metal head, made of chromium cobalt for hardness, is worked out to size and then polished to reduce liner socket wear. The ceramic head is smoother than a polished metal head, has a lower coefficient of friction than the cobalt chrome head, and in theory will reduce the liner socket more slowly. In early 2011, follow-up studies in patients have not shown a significant reduction in wear rates between different types of femoral heads in the market. Ceramic implants are more fragile and can be broken after being planted.
Articular interface
The articular interface is not part of the implant either; it is an area between the acetabular cup and the femoral component. The hip articular interface is a simple ball and a socket joint. The size, material properties and machining tolerances of the articular interface can be selected based on the patient's request to optimize implant function and longevity while reducing related risks. The interface size is measured with the outer diameter of the head or inner diameter of the socket. The general size of the femoral head is 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm ( 7 / 8 is common in the first modern prosthesis, now larger sizes are available from 38 to over 54 mm. The larger diameter head leads to increased stability and range of motion while lowering the risk of dislocation. At the same time they also experience higher pressures such as friction and inertia. Combinations of different materials have different physical properties that can be combined to reduce the amount of debris used by friction. Common pairs of materials include metals in polyethylene (MOP), metals in crosslinked polyethylene (MOXP), ceramics in ceramics (COC), ceramics in crosslinked polyethylene (COXP) and metal metals (MOM). Each combination has different advantages and disadvantages.
Configuration
Postoperative projection radiography is routinely performed to ensure proper configuration of hip prostheses.
The direction of the acetabular cup affects the range of footwork, and also affects the risk of dislocation. For this purpose, acetabular inclination and acetabular anteversion are the measurement of cup angulation in the coronal and sagittal planes, respectively.
Risk
The risks and complications of hip replacement are similar to those associated with all joint replacements. They can include infection, dislocation, limb-length inequality, loosening, throwing, osteolysis, metal sensitivity, nerve paralysis, chronic pain and death. Weight loss surgery before hip replacement does not seem to change the results.
Infection
Infection is one of the most common causes for revision of total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is about 1% or less in the United States. Risk factors for infection include obesity, diabetes, smoking, drugs or immunosuppressive disease, and history of infection.
The modern diagnosis of infection around total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criterion. They:
1. There is a sine channel that communicates with the prosthesis; or 2. The pathogen is isolated by culture of at least two separate tissue or liquid samples obtained from the affected prosthetic joint; or
Four of the following six criteria exist:
1. erythrocyte serum sedimentation rate (ESR & gt; 30mm/h) and serum concentrations of C-reactive protein (CRP & gt; 10 mg/L),
2. Calculate the number of synoval leukocytes,
3. Percentage of enhanced synovial neutrophils (PMN%),
4. Presence of purulence in affected joints,
5.Isolation of microorganisms in a culture of periprosthetic or fluid tissue, or
6. Greater than five neutrophils per high power field in the five high power fields observed from histologic analysis of periprosthetic tissue in ÃÆ'â € 400 enlargement.
None of the above laboratory tests had a 100% sensitivity or specificity for diagnosing the infection. The specificity increases when the tests are performed on patients suspected of clinical suspicion. ESR and CRP remain a good 1st line test for screening (high sensitivity, low specificity). The joint aspirate remains the test with the highest specificity to confirm the infection.
Dislocation
Dislocations are the most common complication of hip replacement surgery. The most common causes vary by duration since surgery.
Dislocations of the hip prosthesis mostly occur in the first 3 months after insertion, mainly due to the formation of scar tissue that is not perfect and soft tissue is relaxed. It takes eight to twelve weeks for soft tissue to be injured or cut during surgery to heal. During this period, the hip balls can get out of the socket. This opportunity is reduced if less tissue is cut, if the piece of tissue is repaired and if a large diameter head ball is used.
Dislocations occur between 3 months and 5 years after insertion usually occurs due to component malposition, or nearby muscle dysfunction.
The final dislocation risk factor (after 5 years) mainly includes:
- Female gender
- Younger age at primary pelvic arthroplasty
- Previous submission without complete dislocation
- Previous trauma
- Losing big weight
- New onset or development of dementia or neurological disorders
- Malposition of the bowl
- liner wear, especially when causing head movements of more than 2 mm in a cup compared to its original position
- Prostheses loosen with migration
Surgeons who perform more operations each year tend to have fewer dislocated patients. Operating from the anterior approach seems to decrease dislocation rates when small diameter heads are used, but the benefits have not been demonstrated when compared with modern posterior incisions with greater use of head diameter. The use of larger head diameter size does reduce the risk of dislocation, although this correlation is found only in head size up to 28 mm, after which no additional decrease in dislocation level is found. Patients can reduce the risk further by keeping the foot out of a certain position during the first few months after surgery.
Leg length imbalance
Most adults before hip replacement have a limb-length inequality of 0-2 cm of legs that they are born and that do not cause a clinical deficit. It is common for patients to sense limb-length inequality after total hip replacement. Sometimes the feet look long after surgery when in fact both are the same length. An arthritic hip may develop contractures that make the leg behave as if it were short. When this is relieved by replacement surgery and normal movement and functionality is restored, the body feels that the limbs are now longer than that. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The causes of these feelings vary, and are usually associated with abductor muscle weakness, pelvic flexibility, and small elongation of the hip during surgery (& lt; 1 cm) to achieve stability and restore joints to pre-rheumatic mechanics. If the difference in limb length remains disturbing to the patient more than 6 months after surgery, lift the shoe can be used. Only in extreme cases is surgery required for correction.
Fracture
Bones with internal in situ fixation devices are at risk of periprosthetic fracture at the tip of the implant, the area of ​​relative mechanical stress. Postoperative femur fractures are grouped by Vancouver classification.
Vein thrombosis
Venous thromboses such as deep venous thrombosis and pulmonary embolism are relatively common after hip replacement surgery. Standard treatment with anticoagulants is for 7-10 days; However treatment for more than 21 days may be superior. Research from 2013 has on the other hand suggested that anticoagulants in healthy patients undergoing fast-track protocols with hospital stays under five days may be necessary only while in hospital.
Some doctors and patients may consider having ultrasound for deep vein thrombosis after hip replacement. However, such screening should only be done when indicated because to do so on a regular basis would be unnecessary health care.
Osteolysis
Many long-term problems with hip replacement are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene using debris, fine plastic pieces that come out of the cup liner over time. The inflammatory process leads to bone resorption which can lead to further hip implants and even fractures around the implant. In an effort to eliminate the generation of worn particles, ceramic cushion surfaces are used in the hope that they will have fewer wear and fewer osteolysis with better long-term outcomes. Metal cupers joining metal heads (metal-on-metal hip arthroplasty) were also developed for the same reason. In this lab shows excellent wear characteristics and benefits of different lubrication modes. At the same time that these two bearing surfaces are being developed, a very related polyethylene plastic pallet is also developed. The greater the cross link significantly reduces the amount of plastic disposable debris that is released from time to time. Newer ceramic and metal protists do not always have a long-term track record of metal established on poly bearings. Ceramic pieces may break which causes catastrophic failure. This occurs in about 2% of the implant placed. They can also cause high-pitched sounds that sound with activity. Metal-on-metal artroplasty releases metal debris into the body causing concern about the potential danger of this accumulation over time. Highly crosslinked polyethylene is not as strong as ordinary polyethylene. These plastic coatings can be cracked or free from the metal shells that hold them.
Allowance
On radiography, it is normal to see a thin radiolucent area of ​​less than 2 mm around the prosthetic hips component, or between the cement and bone coats. However, this still indicates prosthesis easing if they are new or changed, and areas larger than 2 mm may be harmless if they are stable. The most important prognostic factor of the cement cup is the absence of radiolucent lines in DeLee and Charnley zone I, as well as the thickness of the cement mantle sufficient. In the first year after insertion of the unaffected femoral stem, it is normal to experience mild decrease (less than 10 mm). The immediate anterior approach has proven itself to be a risk factor for loosening the initial femoral component.
Metal sensitivity
Concerns are being raised about the metal's sensitivity and potential dangers of metal particulate debris. New publications have shown the development of pseudotumors, a soft tissue mass containing necrotic tissue, around the hip joint. Apparently this mass is more common in women and these patients show higher levels of iron in the blood. The cause is unknown and may be multifactorial. There may be toxic reactions to excess debris using metal particulates or hypersensitivity reactions to the normal amount of metallic debris.
Metal hypersensitivity is an established and common phenomenon, affecting about 10-15% of the population. Contact with metals may cause immune reactions such as skin itching, eczema, redness and itching. Although little is known about the short-term and long-term pharmacodynamics and bioavailability of in vivo circulating metal degradation products, there are many reports of immunologic type responses attributable to implantation of metal components temporally. Individual case reports link immersed hypersensitivity reactions with poor performance of surgical and cardiovascular, orthopedic and plastic clinical dental implants.
Metal poisoning
Most hip replacements are made up of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All the implants release their constituent ions into the blood. Usually this is excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants involving metal-on-metal contact, microscopic fragments of cobalt and chromium can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.
Nerve palsy
Postoperative sciatic nerve paralysis is another possible complication. The incidence of these complications is low. Femoral nerve paralysis is another much less frequent complication. Both of these things will usually be completed from time to time, but the healing process is slow. Patients with existing nerve injuries are at a greater risk of experiencing these complications and are also slower to recover.
Chronic pain
Some patients with pelvic replacement experience chronic pain after surgery. Groin pain may develop if the hip-lifting muscle (iliopsoas) rubs against the edges of the acetabular cup. Bursitis may develop in the trochanter where the surgical scar cuts off the bone, or if the femoral component used pushes the legs too far apart. Also some patients may experience pain in cold or wet weather. The incision made at the front of the hip (anterior approach) can cut the nerves that flow in the thigh causing numbness in the thigh and sometimes chronic pain at the point where the nerves are cut (neuroma).
Death
The mortality rate for elective pelvic replacement is significantly less than 1%.
Metal-in-metal hip implant failure
In 2010, reports in orthopedic literature cited the problem of early metal failure on metal prostheses in a small percentage of patients. Failure may be related to the release of minute metal particles or metal ions from implant wear, causing severe pain and disability, requiring revision surgery in 1-3% of patients. The design deficits of some models of prothesis, especially with heat treated alloys and lack of specialized surgical experience that causes most of the failures. Surgeons at prominent medical centers such as the Mayo Clinic have reported reducing the use of metal-on-metal implants by 80 percent over the past year and supporting those made from other materials, such as metal and plastic combinations. The cause of this failure is controversial, and may include design factors, technical factors, and factors associated with the patient's immune response (allergic reaction). In the UK, the Medicines and Healthcare Products Regulatory Agency started an annual monitoring regime for metal-to-metal hip replacement patients beginning in May 2010. Data shown in the substitute registration of the National Joint Association Orthopedic Association 2008, a record of almost every hip was implanted in the country for 10 the previous year, tracked 6,773 BHR (Suburban Birmingham) and found that less than one-third of one percent may have been revised because of the patient's reaction to metal components. Other similar metal-on-metal designs are also not the same fate, where some reports show 76% to 100% of people with these metal-on-metal implants and have aseptic implant failure requiring revision also have evidence of histologic inflammation accompanied with extensive lymphocyte infiltrates, characteristic of slow type hypersensitivity response. It is unclear how far this phenomenon has had a negative impact on orthopedic patients. However, for patients showing signs of an allergic reaction, evaluation for sensitivity should be performed. Unnecessary removal of the device should be considered, as removal may relieve symptoms. Patients who have an allergic reaction to cheap jewelry are more likely to have a reaction to orthopedic implants. There is an increased awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implants are optimal for each patient.
On March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, found that metal-on-metal hip implants failed at a much greater rate than other types of implants hips and called for a ban on all metal-in-metal hips. Analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants have failed in five years, compared with 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase in failure. Surgeons from the British Hip Society recommend that large metal-on-metal implants should no longer be performed.
On February 10, 2011, the US FDA issued advice on metal-metal hip implants, stating that it continues to collect and review all available information about metal-in-metal hips systems. On 27-28 June 2012, the advisory panel meets to decide whether to apply the new standards, taking into account research findings in The Lancet . No new standards, such as routine checks of blood metal ion levels, are established, but guidelines are updated. Currently, the FDA does not require hip implants to be tested in clinical trials before it can be sold in the US. In contrast, companies that make new hip implants just need to prove that they are "substantially equivalent" to other hip implants already on the market. The exception is metal-on-metal implants, which are not tested in clinical trials but due to the high revision rate of metal-in-metal hips, in the future the FDA has stated that clinical trials will be required for approval and market-Study posts will be required to keep the metal on metal hip implants in the market.
Alternatives and variations
Conservative management
The first-line approach as an alternative to hip replacement is conservative management involving multimodal treatment approaches, activity modification and physical therapy. Conservative management can prevent or delay the need for hip replacement.
Preoperative treatment
Current preoperative education is an important part of patient care. There is some evidence that may slightly reduce anxiety before hip or knee replacement, with a low risk of negative effects.
Hemiarthroplasty
Hemiarthroplasty is a surgical procedure that replaces half of a joint with an artificial surface and leaves another part in its natural state (pre-surgery). This class of procedure is most commonly performed on the pelvis after subcapital fracture (just below the head) the neck of the femur (hip fracture). This procedure is performed by lifting the head of the femur and replacing it with a metal or composite prosthesis. The most commonly used prosthesis design is the Austin Moore and Thompson Prosthesis prosthesis. Recently, metal and HDPE composites forming two interphases (bipolar prosthesis) have also been used. Monopolar prostheses have not been shown to have an advantage over bipolar design. This procedure is recommended only for elderly and weak patients, as their life expectancy and activity are lower. This is because with the passage of time the prosthesis tends to loosen or erode the acetabulum.
hip replacement
Hip resurfacing is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and became a common procedure. Measurements of quality of life associated with real health are increased and patient satisfaction is profitable after hip resurfacing.
The minimally invasive pelvic flooring procedure is a further enhancement for hip coating.
Viscosupplementation
The current alternatives also include viscosupplementation, or artificial lubricant injection into the joint. The use of these drugs in the hip is off label. Maintenance costs are usually not covered by health insurance organizations.
Some believe that the future of osteoarthritis treatment is biotechnology, targeting growth and/or repairing damaged joints, rheumatism. Centeno et al. have reported on partial regeneration of the spinal joint of human arthritis using mesenchymal stem cells in one patient. It is not known that these results will apply to a larger group of patients and yield significant benefits. The FDA has stated that this procedure is being practiced without complying with regulations, but Centeno claims that it is exempt from FDA regulations. This has not been proven in controlled clinical trials to be effective, and costs more than $ 7,000.
Prevalence and cost
The number of hip replacement events varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year. About 0.8% of Americans have undergone this procedure.
According to the International Federation of Healthcare Plans, the average cost of total hip replacement in 2012 is $ 40,364 in the United States, $ 11,889 in the UK, $ 10,987 in France, $ 9,574 in Switzerland, and $ 7,731 in Spain. In the United States, the average cost of total hip replacement varies considerably by geographic region, ranging from $ 11,327 (Birmingham, Alabama) to $ 73,927 (Boston, Massachusetts).
History
The earliest recorded attempt at hip replacement was done in Germany in 1891 by Themistocles Gluck (1853-1942), who used ivory to replace the femoral head (bone in the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.
On September 28, 1940 at Columbia Hospital in Columbia, South Carolina, American surgeon Dr. Austin T. Moore (1899-1963) performed the first metallic hip replacement surgery. The original prosthesis he designed was the replacement of the proximal femoral, with a large fixed head made of Vitallium cobalt-chrome alloy. It's about one foot long and bolted to the end of the resected femoral shaft (hemiarthroplasty). The newer version, the so-called Austin Moore Prosthesis introduced in 1952, is still used today, though rarely. Like modern hip implants, it is inserted into the medullary tube of the femur, and is dependent on bone growth through a hole in the stem for long-term attachment.
See also
- Being a thief
- Femoral Acetabular Impingement
- The Gruen Zone
- Pelvic examination
- 2010 DePuy Hip Recall
References
External links
- Virtual Hip Surgery Edge Surgery Photos
- AAOS Hip Replacement
Source of the article : Wikipedia
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