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WHAT MUST BE A WELL-CEMENTED PROSTHESIS? Graham Gie FRCSEd(Orth) PEOC Exeter.

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Presentation on theme: "WHAT MUST BE A WELL-CEMENTED PROSTHESIS? Graham Gie FRCSEd(Orth) PEOC Exeter."— Presentation transcript:

1 WHAT MUST BE A WELL-CEMENTED PROSTHESIS? Graham Gie FRCSEd(Orth) PEOC Exeter

2 WHAT MUST BE A WELL- CEMENTED PROSTHESIS? 1. Surgical Technique 2. Type of Implant

3

4 A good cemented THA :

5 Conducted by a skilled surgeon

6 A good cemented THA : Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures

7 A good cemented THA : Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications

8 A good cemented THA : Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation

9 A good cemented THA : Conducted by a skilled surgeon Through an adequate exposure with consideration for bony & soft tissue structures Minimising complications Using modern cementing techniques & instrumentation And a tried and tested prosthesis

10 A good cemented THA : Conducted by a skilled surgeon Who performs the procedure frequently

11 Skilled Surgeon? Gifted? Performs the procedure frequently PRACTICE MAKES PERFECT

12 Exposure considering bony & soft tissues Reduce soft tissue dissection Post approach preserving piriformis Don’t take trochanter off Repair soft tissues

13 Minimising Complications Avoid trochanteric problems Reduce dislocations Avoid sepsis

14 Using modern techniques & instrumentation Acetabulum Femur

15 ACETABULUM Circumferential view

16 ACETABULUM Circumferential view Exposure of cancellous bone

17 ACETABULUM Circumferential view Exposure of cancellous bone Rim cutter

18 RIM CUTTER

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20

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22 ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry

23 Primary Exeter Cemented Prosthesis : Socket Lavage

24 ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Iliac suction

25 Iliac Sucker

26

27 ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation

28 Primary Exeter Cemented Prosthesis : Pressurizing Cement

29 Primary Exeter Cemented Prosthesis : New Cup Insertion

30 ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter High pressure lavage & dry Ilial suction Cement pressurisation Flanged socket, highly crosslinked poly

31 Primitive technique Contemporary technique The Socket

32 FEMUR Good exposure

33 FEMUR Good exposure Clean & Dry Canal

34 FEMUR Good exposure Clean & Dry Canal Gun insertion of cement

35 FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation

36 FEMUR Good exposure Clean & Dry Canal Gun insertion of cement Pressurisation Delayed insertion of a polished stem, collarless & double-tapered

37 FEMUR

38 Primary Exeter Cemented Prosthesis : Femoral Cementing

39 Post-op 11yrs

40 Post-op 12yrs

41 Cemented THA with a polished stem – up to 33 years follow-up

42 Survivorship curve of the original polished Exeter stems : end point revision for aseptic stem loosening Years since operation SurvIvorshIp%SurvIvorshIp% Survivorship 93.14%: 95% C.L %

43 Survivorship curve of the original polished Exeter stems : patients under age 60 at operation. End point revision for aseptic stem loosening Years since operation SurvIvorshIp%SurvIvorshIp% Survivorship 87.22%: 95%CL – 100% (68 cases)

44 Years since operation SurvIvorshIp%SurvIvorshIp% Original cups ; survivorship with end-point revision for aseptic cup loosening Survivorship 72.45%: 95%CL %

45 A YEAR SURVIVORSHIP STUDY OF THE EXETER UNIVERSAL CEMENTED STEM

46 100% stem survival at 10 – 17 yrs

47 CEMENTED EXETER THA IN PATIENTS AGED 50 OR LESS O 10 to 17 year follow-up

48 DETAILS OF YOUNG HIP REVIEW Patients107 Bilateral arthroplasties 23 TOTAL No. HIPS: 130 Follow-up:Range: 10 – 17 years Average: 12.5 years No case lost to follow-up Died of unrelated causes:7 hips

49 DETAILS OF YOUNG HIP REVIEW Mean age at Sx 42yrs

50 12 REVISIONS LOOSE CUPS 9 (6.8%) CUP FOR LYSIS 1 RECURRENT DISL 1 INFECTION 1 LOOSE STEMS 0

51

52 WHAT MAKES A WELL- CEMENTED THA? Excellent technique with a tried & tested prosthesis

53 Thank you for your attention


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