Hip Arthroplasty: Current and Future Directions

✍ Scribed by Mrinal Sharma (editor)

• Publisher: Springer
• Year: 2024
• Tongue: English
• Leaves: 832
• Category: Library

✦ Synopsis

This book brings together the latest updates and current trends in arthroplasty of the hip covering the basics as well as complex and revision surgery. Eminent arthroplasty surgeons across the globe have contributed to the chapters and shared their clinical experiences. There are separate sections on primary hip arthroplasty, complex scenarios requiring hip replacement, and detailed management of related complications. It covers revision hip replacement in detail with the latest updates on surgical techniques and implants. There are separate sections on computer navigation and robotic-assisted hip replacement surgeries. A special section on implants and tribology has been added.

The language of the book is easy-to-read, user friendly with pictorial representation of relevant surgical steps. Case-based discussions, surgical tips, and summary has been added in each chapter. The references given at the end of each chapter would be useful for those doing research.

This book is an essential on-the-desk book for practicing orthopedic surgeons across the globe, beginners in arthroplasty surgery, postgraduate students of orthopedics, DNB students, and those interested in research.

✦ Table of Contents

Foreword
Foreword
Foreword
Preface
Acknowledgment
Contents
Editor and Contributors
About the Editor
Contributors
Part I: Primary Total Hip Arthroplasty
1: Hip Biomechanics and Preoperative Assessment in Total Hip Arthroplasty
1.1 Introduction
1.2 Kinematics and Kinetics
1.3 Biomechanics of Total Hip Arthroplasty
1.3.1 Acetabular Cup Positioning
1.3.2 The Femoral Component
1.3.3 Position of Stem
1.3.4 Size of Head
1.4 Preoperative Assessment
1.4.1 Clinical Examination
1.4.2 Preoperative Templating
1.5 Summary
References
2: Direct Anterior Approach Total Hip Arthroplasty
2.1 Introduction
2.2 Why Direct Anterior Approach?
2.3 Patient Selection
2.4 Patient Position and Set Up
2.5 Surgical Techniques
2.5.1 Approach
2.5.2 Acetabular Preparation and Component Placement
2.5.3 Femoral Preparation and Component Placement
2.6 Complications: How to Avoid Them, How to Solve Them, Tips, and Pearls to Surgeons
2.7 Current Concepts and Recent Advances
2.7.1 Simultaneous Bilateral THA
2.7.2 Prosthesis Selection
2.7.3 Navigation and Robotic-Assisted DAA THA
2.7.4 Revision THA via DAA
2.7.5 Handling Hip–Spine Mobility with DAA
2.8 Discussion
2.9 Case-Based Discussion
2.10 Summary
References
3: Direct Lateral Approach to the Hip
3.1 Introduction
3.2 The Technique of Direct Lateral Approach (After Kevin Hardinge) [2]
3.2.1 Principle
3.2.2 Advantages of the Approach
3.2.3 Disadvantages
3.2.4 Steps
3.2.5 Intra-operative Precautions
3.2.6 Closure
3.2.7 How to Enlarge [17]
3.2.8 Rehabilitation [17–19]
3.3 Discussion
3.3.1 Functional Results
3.3.2 Dislocation
3.3.3 Abductor Weakness
3.3.4 Superior Gluteal Nerve Injury
3.4 Summary
References
4: Posterior Approach in Total Hip Arthroplasty
4.1 Introduction
4.2 Indications
4.3 Surgical Technique
4.4 Advantages of Posterior Approach
4.5 Complications
4.5.1 Nerve Palsy
4.5.2 Dislocation
4.6 Discussion
4.6.1 Posterior vs. Lateral Approach
4.6.2 Posterior vs. Anterior Approach
4.7 Summary
References
5: Cemented Total Hip Arthroplasty
5.1 Introduction
5.2 Features of Cemented Implant Design
5.2.1 Cemented Stems
5.2.2 Cemented Acetabular Cups
5.3 Bone Cement
5.3.1 Powder Components
5.3.2 Liquid Components
5.3.3 Types of Bone Cement
5.3.3.1 Low-Viscosity Cement
5.3.3.2 Medium-Viscosity Cement
5.3.3.3 High-Viscosity Cement
5.3.3.4 Antibiotic Cement
5.4 Technique for Achieving Optimal Bone Cement Mantle
5.4.1 Generations of Cementing Techniques
5.4.2 Preparation of the Femoral Canal
5.4.3 Acetabular Cementing
5.4.4 Phases of Cement Polymerization
5.4.5 Methods of Application of Bone Cement
5.5 Surgical Steps
5.6 Case Examples
5.7 Discussion
5.7.1 Survivorship
5.7.2 Implantation of Components in Desired Position
5.7.3 Osteoporosis
5.7.4 Improved Short-Term Clinical Outcomes
5.7.5 Lower Rates of Peri-prosthetic Fracture
5.7.6 Femoral Impaction Grafting
5.7.7 Ease of Revision
5.7.8 Affordability
5.8 Concerns Regarding Cemented Total Hip Arthroplasty
5.8.1 Bone-Cement Implantation Syndrome and Associated Mortality
5.9 Summary
References
6: Cementless Total Hip Arthroplasty
6.1 Introduction
6.2 Historical Background
6.3 Comparison of Cemented vs. Uncemented THA
6.4 Advantages and Disadvantages of Uncemented THA
6.5 Surgical Technique
6.5.1 Exposure
6.5.2 Acetabular Preparation
6.5.3 Femoral Preparation
6.6 Surgical Tips and Pearls
6.7 Case Studies
6.8 Discussion
6.9 Summary
References
7: Hybrid Total Hip Replacement
7.1 Introduction
7.2 Indications for Hybrid THR
7.3 Preoperative Planning
7.3.1 Patient Selection
7.3.2 Preoperative Templating
7.3.3 Anesthetic and Intraoperative Plans
7.4 Surgical Technique
7.5 Relative Contraindications to Hybrid Concept
7.5.1 Contraindications of Uncemented Cup
7.5.2 Contraindication for Cemented Stem
7.6 Discussion
7.7 Case Examples
7.8 Summary
References
8: Bipolar Hemiarthroplasty for Fracture Neck Femur
8.1 Introduction
8.2 Preoperative Planning
8.3 Surgical Approaches
8.4 Discussion
8.5 Summary
References
9: Minimally Invasive Total Hip Arthroplasty
9.1 Introduction
9.2 Advantages of Minimally Invasive Hip Arthroplasty
9.3 History of Minimally Invasive Hip Arthroplasty
9.4 Anatomical Considerations
9.5 Indications for Minimally Invasive Hip Arthroplasty
9.6 Pre-operative Imaging and Templating
9.7 Surgical Considerations
9.8 MIS Posterior Approach: Surgical Steps
9.8.1 Exposure
9.8.2 Acetabular Preparation
9.8.3 Femoral Preparation
9.8.4 Wound Closure
9.9 Complications: How to Avoid Them and How to Solve Them
9.9.1 Implant Complications
9.9.2 Intra-operative Complications
9.9.3 Post-operative Complications
9.10 Discussion
9.10.1 Current Concepts and Recent Advances
9.10.2 Navigation and Computer Assistance
9.10.3 Peri-operative Characteristics
9.10.4 Functional Outcomes
9.10.5 Future Developments
9.11 Summary
References
10: Radiological Assessment in Total Hip Arthroplasty
10.1 Introduction
10.1.1 Radiological Modalities
10.2 Conventional or Plain Radiography
10.2.1 How to Obtain the Ideal Radiographs After THA?
10.2.1.1 Guidelines for Optimising the AP View
10.2.1.2 Imaging Techniques for a Lateral View
10.2.2 What to Look for in a Post-operative Radiograph: A Step-by-Step Approach
10.2.2.1 Fixation Method and Prosthesis Identification Used in the THA
10.2.2.2 Assessment of Limb-Length
10.2.2.3 Assessment of Acetabular Component Positioning
Acetabular Inclination
Acetabular Anteversion
10.2.2.4 Assessment of Femoral Component Alignment
10.2.2.5 Evaluation of Offset and Restoration of Offset After THA
Definitions of Offset [23–25] (Fig. 10.11)
10.2.2.6 Assessment of Acetabular Component Fixation and Radiolucencies
Method of Evaluation for Loosening and Quantification
10.2.2.7 Assessment of Femoral Component Fixation and Radiolucencies
Zonal Classification for the Femoral Component
10.2.2.8 Radiological Signs of Osseo-Integration or Failure
10.3 Role of Fluorocopy in Total Hip Arthroplasty
10.4 Imaging of Complications and the Painful Total Hip Arthroplasty
10.4.1 Imaging in Complications of THA: Heterotopic Ossification
10.4.2 Imaging in Complications After THA: Peri-prosthetic Fractures
10.4.2.1 Peri-prosthetic Fractures Around the Acetabular Cup
10.5 Computed Tomography in Evaluation of THA
10.5.1 Assessment of Component Position
10.5.2 Assessment of Radiolucent Lines and Osteolysis
10.5.3 Categorisation of Acetabular Defects
10.5.3.1 Recent Advances in Computed Tomography
10.6 Magnetic Resonance Imaging in THA
10.6.1 Recent Developments in Magnetic Resonance Imaging
10.6.2 Merits and Demerits of Magnetic Resonance Imaging
10.6.3 Adverse Soft Tissue Reactions or Metallosis
10.7 Nuclear Medicine and Bone-Scintigraphy Scans
10.7.1 Three-Phase Bone Scintigraphy
10.7.2 Phases of Bone Scans
10.7.3 Recent Advances in Scintigraphy Scanning
10.8 Role of Ultrasound in the Post-operative Evaluation of THA
10.9 Summary
References
Part II: Implants and Tribology
11: Bearing Surfaces in Total Hip Arthroplasty
11.1 Introduction
11.2 Materials Used as Bearing Surfaces
11.2.1 Polyethylene
11.2.1.1 Ultrahigh Molecular Weight Polyethylene (UHMWPE)
Limitations of Conventional PE
Clinical Repercussions
11.2.1.2 Highly Cross-linked UHMWPE (XLPE)
Manufacturing of XLPE
Advantages of XLPE
Clinical Repercussions
11.2.1.3 Antioxidant-Doped UHMWPE
Manufacturing of Antioxidant-Doped UHMWPE
11.2.1.4 Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)
Manufacturing
In Vitro Data
11.2.2 Ceramics
11.2.2.1 Alumina
11.2.2.2 Zirconia
11.2.2.3 Alumina–Zirconia Composites
11.2.2.4 Silicon Nitride
11.2.3 Ceramicized Metal (Oxidised Zirconium-Oxinium™)
11.3 Types of Bearing Surfaces in THA
11.3.1 Metal on Poly (MoP) Articulation
11.3.2 Metal on Metal (MoM) Articulation
11.3.3 Ceramic on Ceramic (CoC) Articulation
11.3.4 Ceramic on Poly (CoP) Articulation
11.4 Future Scope
11.4.1 Silicon Nitride Bearings
11.4.2 Compliant Bearings
11.5 Summary
References
12: Polyethylene Cups in Total Hip Arthroplasty
12.1 Introduction
12.2 Properties of Bearing Surfaces
12.2.1 Features of Ideal Bearing Surface in THR Prosthesis [4]
12.2.2 Broadly Bearing Surfaces Have Been Classified into Two Types (Table 12.1)
12.2.2.1 Hard-on-Soft Bearings
12.2.2.2 Hard-on-Hard Bearings
12.3 History of Bearing Surfaces and Polyethylene
12.4 Developments in Polyethylene Overtime (Fig. 12.1)
12.4.1 Second Generation of Highly Cross-Linked Polyethylene
12.4.2 Third Generation of Highly Cross-Linked Polyethylene [17]
12.5 Road Ahead for Bearing Surfaces and Possible Place for Polyethylene in Future
12.5.1 Change in Design
12.5.1.1 Larger Femoral Head
12.5.1.2 Monoblock Metal Shell with Preassembled Ceramic Liner
12.5.1.3 Ceramic-on-Metal Bearing
12.5.2 Surface Modification of Metal
12.5.2.1 Titanium Nitride
12.5.2.2 Titanium Niobium Nitride
12.5.3 Further Improvement in Ceramic
12.5.4 Further Improvement of Polyethylene
12.5.4.1 Ensuring Uniformly Distributed Vitamin E-Stabilized Polyethylene
12.5.4.2 Multiwalled Carbon Nanotubes: Reinforced Polyethylene
12.5.4.3 Surface Modification of Polyethylene with Biomembrane: Mimic Polymers
12.6 Summary
References
13: Cementless Cups in Total Hip Arthroplasty
13.1 Introduction
13.2 Evolution of the Cementless Cup
13.3 Biologic Surfaces and Factors Affecting Fixation
13.4 Modular Bearing Surfaces
13.5 Cementless Cups in Protrusio Acetabuli and Revision Acetabular Reconstruction
13.6 Complications
13.6.1 Polyethylene Wear
13.6.2 Osteolysis
13.6.3 Loosening
13.6.4 Fracture
13.6.5 Dislocation
13.7 Summary
References
14: Femoral Stems in Total Hip Arthroplasty
14.1 Introduction
14.2 Cemented Femoral Stems
14.2.1 Composite Beam/Shape-Closed Stems
14.2.2 Load Tapering/Force-Closed Stems
14.3 Cementless Femoral Stems
14.3.1 Type 1 or ‘Single Wedge’ Stem
14.3.2 Type 2 or Dual Wedge Stem
14.3.3 Type 3 Stems
14.3.4 Type 4 Stems
14.3.5 Type 5 or Modular Stems
14.3.6 Type 6 or Anatomical Stems
14.4 Short Femoral Stems
14.5 Calcar Replacement Stems
14.6 Revision Stems
14.7 Summary
References
15: Implant Selection and Rationale for Use in Primary Total Hip Arthroplasty
15.1 Introduction
15.2 Choice of Acetabular Component
15.2.1 Cemented Acetabular Component
15.2.1.1 All Polyethylene Cemented Acetabular Component (Fig. 15.1a–d)
15.2.1.2 Metal-Backed Cemented Acetabular Component
15.2.1.3 Monoblock Acetabular Component (Fig. 15.2a, b)
15.2.2 Uncemented Acetabular Component
15.2.2.1 Hydroxyapatite (HA)-Coated Cup (Fig. 15.3a, b)
15.2.2.2 Cementless Cup with Traditional Coating (Fig. 15.4a, b)
15.2.2.3 Modern Porous Metal Cups (Fig. 15.5)
15.2.2.4 Dual Mobility Cup
15.3 Choice of Femoral Component
15.3.1 Cemented Femoral Stem (Fig. 15.9a, b)
15.3.2 Uncemented Femoral Stem
15.4 Choice of Articulation
15.5 Choice of Femoral Head Size
15.5.1 Range of Motion
15.5.2 Dislocation
15.5.3 Wear Characteristics
15.5.4 Taper Corrosion
15.6 Summary
References
Part III: Total Hip Arthroplasty in Complex Scenario
16: Total Hip Arthroplasty in Avascular Necrosis of Hip
16.1 Introduction
16.2 Causes of Avascular Necrosis of Hip Joint
16.3 Clinical Presentation
16.4 Radiographic Evaluation
16.5 Treatment
16.5.1 Nonoperative Management
16.5.2 Surgical Management
16.5.3 Femoral Head Sparing Procedures (FHSPs)
16.5.3.1 Core Decompression
16.5.3.2 Multiple Drilling
16.5.3.3 Bone Grafting Procedures
16.5.3.4 Tantalum Implants
16.5.3.5 Biologics
16.5.3.6 Osteotomy
16.5.4 Femoral Head Replacement Procedures
16.5.4.1 Bipolar Hemiarthroplasty
16.5.4.2 Resurfacing Arthroplasty
16.5.4.3 Total Hip Arthroplasty
Preoperative Planning
Implant Options
THA in High-Risk Patients
Short Femoral Stem
16.6 Summary
References
17: Total Hip Arthroplasty in Dysplastic Hips
17.1 Introduction
17.2 Patho-Anatomy and Classification
17.3 Preop Planning and Evaluation
17.3.1 Clinical Examination
17.3.2 Investigations
17.4 Surgical Technique
17.4.1 Best Location for Socket Placement
17.4.2 Rationale of Reaming Technique
17.4.3 Stem Preparation
17.4.4 Surgical Technique in Crowe 4 Hips Using Subtrochanteric Shortening Osteotomy (STSO) (Fig. 17.11)
17.5 Case Discussions
17.6 Discussion
17.7 Summary
References
18: Hip Arthroplasty for Inter-Trochanteric Fractures in Elderly
18.1 Introduction
18.2 Hip Arthroplasty in Fresh Cases of IT Fracture
18.2.1 Preoperative Planning and Fitness
18.2.2 Operative Steps
18.2.2.1 Position
18.2.2.2 Incision
18.2.2.3 Deeper Dissection
18.3 Hip Arthroplasty in Old Non- Unions/Failed Fixation of IT it Fractures
18.4 Discussion
18.5 Summary
References
19: Total Hip Arthroplasty in Ankylosed/Fused Hips
19.1 Introduction
19.2 Pre-Operative Evaluation
19.2.1 Pre-op Optimisation
19.2.2 Decision About Operating Both Hips Simultaneously or Sequentially in Cases of Bilateral Hip Involvement
19.2.2.1 Advantages of Single-Stage Bilateral THA
19.2.3 Preop Planning
19.2.4 Radiological Evaluation
19.2.5 Limb Length Discrepancy
19.3 Surgical Considerations
19.3.1 Anaesthesia (Fig. 19.3)
19.3.2 Positioning of Patient for THA Surgery
19.3.3 Surgical Approaches
19.3.3.1 Trans-Trochanteric Approach
19.3.3.2 Posterior Approach
19.3.3.3 Anterior Approach
19.3.3.4 Lateral Approach
19.3.3.5 Dual Approach to Hip (Bhosale’s Approach by Sr. Author)
19.3.4 Identification of the True Acetabulum
19.3.5 Completion of THA Implantation
19.4 Special Issues for Takedown of Fused Hips by THA
19.4.1 Spinopelvic Relation Affecting Cup Anteversion
19.4.1.1 Pelvic Tilt in Sagittal Plane
19.4.1.2 Pelvic Tilt in Coronal Plane
19.4.1.3 Pseudo Kyphosis
19.4.2 Deformity Correction with Fused Hips
19.4.3 Poor Bone Quality
19.4.4 Implants
19.4.5 Large Head Size
19.4.6 Capsular Closure
19.5 Post-operative Complications
19.5.1 Heterotrophic Ossification
19.5.2 Nerve Injury
19.5.2.1 Tips to Avoid Nerve Injuries
Sciatic Nerve
Superior Gluteal Nerve
Femoral Nerve
Obturator Nerve
19.5.3 Hip Dislocation
19.5.3.1 Important Tips to Reduce Incidence of Dislocation
19.6 Post op Rehabilitation
19.7 Outcomes
19.7.1 Pain Relief
19.7.2 Hip Mobility
19.7.3 Gait
19.7.4 Survivorship
19.8 Revision THA Surgery
19.9 Summary
References
20: Total Hip Arthroplasty for Protrusio Acetabuli: Principles of Reconstruction and Technique
20.1 Introduction
20.2 Evaluation and Pre-operative Planning
20.3 Surgical Considerations
20.3.1 Anaesthesia and Patient Positioning
20.3.2 Exposure
20.3.3 Dislocation of Hip
20.3.4 Normalization of the Hip Centre of Rotation
20.3.5 Impaction Bone Grafting and Acetabular Socket Preparation
20.3.6 Cemented vs. Cementless Cups
20.3.7 Protrusio Support Devices
20.3.8 Femoral Side
20.4 Post-operative Rehabilitation
20.5 Potential Complications and Solutions
20.5.1 Sciatic Nerve Injury
20.5.2 Inadequate Working Space
20.5.3 Acetabular Fracture
20.5.4 Penetration of the Medial Acetabular Wall
20.5.5 Limb Length Discrepancy
20.5.6 Trochanteric Non-union
20.6 Discussion
20.7 Case Scenarios
20.8 Summary
References
21: Total hip Arthroplasty in Tubercular Hip Arthritis
21.1 Introduction
21.2 THA in Healed/Old TB Hip Arthritis
21.3 THA in Active TB Hip Arthritis
21.4 THA in TB Hip with Discharging Sinus
21.5 The Role of Antitubercular Treatment (ATT)
21.6 Surgical Considerations
21.6.1 Surgical Challenges
21.6.2 Preoperative Planning
21.6.3 Patient Positioning
21.6.4 Surgical Approach
21.6.5 Surgical Tips and Tricks
21.6.5.1 Wandering/Traveling Acetabulum
21.6.5.2 Protrusio Acetabulum
21.6.5.3 Dislocating Type
21.6.5.4 Stem
21.6.5.5 Soft Tissue Release
21.7 Reactivation
21.8 Summary
References
22: Total Hip Arthroplasty in Proximal Femoral Deformity
22.1 Introduction
22.2 Classification
22.3 Preoperative Planning
22.4 Surgical Goals and Prosthesis Selection
22.4.1 Femoral Head and Neck Deformities
22.4.2 Greater Trochanter Abnormalities
22.4.3 Metaphyseal Level Deformities
22.4.4 Diaphyseal Level Deformities
22.5 Surgical Pearls
22.5.1 Retained Hardware
22.5.2 Subtrochanteric Shortening Osteotomy and THA
22.5.3 Diaphyseal Fixing Stems
22.6 Complications
22.7 Summary
References
23: Total Hip Replacement After Acetabulum Fractures
23.1 Introduction
23.2 Indications
23.3 Preoperative Planning
23.4 Preoperative Workup for Infection
23.5 Surgical Approach
23.6 Acetabulum Reconstruction
23.6.1 Circumferential Defect
23.6.2 Posterior Wall Defect
23.6.3 Posterior Column Defect
23.6.4 Transverse Defect
23.6.5 Anterior Column Defect
23.7 Surgical Considerations
23.7.1 Sciatic Nerve Injury
23.7.2 Hardware In Situ
23.7.3 Heterotopic Ossification
23.7.4 Occult Infection
23.7.5 Avascular Necrosis of the Acetabulum
23.8 Case Studies
23.9 Discussion
23.10 Summary
References
24: Conversion Total Hip Arthroplasty Following Failed Fixation
24.1 Introduction
24.2 Preoperative Evaluation and Planning
24.3 Surgical Technique
24.4 Failure of Proximal Femur Fractures
24.4.1 Failed Cannulated Screws Fixation for Femoral Neck Fractures
24.4.2 Failed Intertrochanteric Fracture Fixation
24.4.2.1 Sliding Hip Screws
24.4.2.2 Cephalomedullary Nails
24.5 Failed Acetabular Fracture Fixation
24.6 Summary
References
25: Total Hip Arthroplasty for Fracture Neck of Femur
25.1 Introduction
25.2 Preoperative Planning
25.3 Surgical Consideration
25.3.1 Surgical Steps
25.4 Presentation of Fracture Neck of Femur (Flowchart 25.1)
25.4.1 Acute Traumatic
25.4.2 Pathological Fractures
25.4.3 Neglected Posttraumatic
25.4.4 Failed Fixations
25.5 Discussion
25.6 Summary
References
26: Total Hip Replacement in Rheumatoid Arthritis
26.1 Introduction
26.2 Perioperative Considerations
26.2.1 Medical Management
26.2.2 Perioperative Antibiotic Prophylaxis
26.2.3 Radiological Findings in RA of Hip
26.2.4 Choice of Implant
26.2.4.1 Cemented or Uncemented THR
26.3 Management of Rheumatoid Hip with Protrusio Acetabuli
26.4 Surgical Technique for Treating Protrusio Acetabuli
26.5 Complications Following THR in RA Patients
26.6 Summary
References
27: Total Hip Arthroplasty in Neglected Hip Dislocations
27.1 Introduction
27.2 Preoperative Considerations
27.2.1 Anatomical Considerations
27.2.2 Biomechanical Considerations
27.3 Preoperative Planning
27.3.1 Acetabular Templating
27.4 Classification
27.5 Surgical Considerations
27.5.1 Acetabular Reconstruction
27.5.1.1 Identify the True Acetabulum
27.5.1.2 Surgical Approach
27.5.2 Femoral Lowering and Shortening
27.5.3 Implant Selection
27.5.3.1 Cemented Cups
27.5.3.2 Cementless Cups
27.5.3.3 Monoblock Stems
27.5.3.4 Modular Stems
27.5.3.5 Customized Femoral Components
27.5.3.6 Bearing Surface
27.6 Case Scenarios
27.7 Discussion
27.8 Summary
References
28: Conversion of Excision Arthroplasty to Total Hip Arthroplasty
28.1 Introduction
28.2 Patient Selection
28.3 Anticipating Surgical Challenges
28.4 Pre-Operative Considerations
28.4.1 Local Examination
28.4.2 Infection Work-Up
28.4.3 Radiological Work-Up
28.5 Surgical Technique
28.5.1 Exposure
28.5.2 Acetabulum Preparation
28.5.3 Femoral Preparation
28.6 Post-Operative Protocol
28.7 Post-Operative Complications
28.8 Brief Overview of Relevant Studies
28.9 Summary
References
29: Juvenile Rheumatoid Arthritis and Total Hip Arthroplasty
29.1 Introduction
29.2 Preoperative Planning
29.3 Surgical Considerations
29.3.1 Surgical Exposure Using Modified Hardinge’s Approach
29.4 Discussion
29.5 Summary
References
Part IV: Complications in Total Hip Replacement
30: Periprosthetic Fracture After Total Hip Arthroplasty
30.1 Introduction
30.2 Predisposing Factors/Risk Factors
30.2.1 Patient’s Risk Factors
30.2.2 Surgical Factors
30.3 Clinical Evaluation
30.4 Classification
30.5 Management of Periprosthetic Hip Fractures
30.5.1 Non-operative Management
30.5.2 Managing Type A Fractures
30.5.3 Managing Type B1 Fractures
30.5.4 Managing Type B2 and B3 Fractures
30.5.4.1 Bone Graft
30.5.4.2 Cortical Strut Grafts and Impaction Grafting
30.5.4.3 Proximal Femoral Replacement
30.5.4.4 Polished Taper Slim Stems (PTS)
30.5.4.5 Outcomes of B2 and B3 Fractures
30.5.5 Type C Fractures
30.5.6 Type D Fractures
30.6 Management of Acetabular Fractures
30.7 Post-Operative Complications and Recovery
30.8 Prevention
30.9 Summary
References
31: Instability After Total Hip Replacement: Aetiology, Prevention and Management
31.1 Introduction
31.2 Factors Predisposing to Dislocation
31.2.1 Patient Factors Affecting Hip Stability
31.2.2 Disease Pathology Affecting Hip Stability
31.2.3 Implant Design Characteristics Influencing Hip Stability
31.3 The Dual Mobility Hip
31.4 Surgical Technique to Preserve Hip Stability
31.4.1 Patient Positioning
31.4.2 Soft Tissue Handling
31.4.3 Choice of Approach
31.4.4 Removal of Osteophytes
31.4.5 Component Positioning
31.5 Prevention of Dislocation in THR
31.5.1 Pre-operative Planning
31.5.2 Intra-operative Tests of Hip Stability
31.5.3 Special Precautions in High-Risk Patients
31.6 Management of a Dislocated Total Hip Replacement
31.6.1 Management of an Early Dislocation
31.6.2 Management of Late Dislocation
31.6.3 Management of Recurrent Dislocation in THR
31.6.4 Diagnosis of Recurrent Instability
31.7 Summary
References
32: Management of Limb Length Discrepancy in Total Hip Arthroplasty
32.1 Introduction
32.2 Preoperative Examination of the Patient
32.3 Radiographic Examination and Templating
32.3.1 Three-Dimensional Templating
32.4 Intraoperative Techniques to Measure the Limb Length
32.4.1 Charnley’s Shuck Test
32.4.2 Dropkick Test
32.4.3 Leg to Leg Test
32.4.4 On Table Radiographs
32.4.5 Wire and Caliper Fixed to Iliac Wing
32.4.6 Steinmann Pin in Infra-acetabular Groove
32.4.7 Skin Suture Technique
32.4.8 Reference Point on Femur
32.5 Summary
References
33: Heterotopic Ossification Following Hip Replacement
33.1 Introduction
33.2 Pathophysiology
33.3 Classification
33.4 Risk Factors
33.5 Clinical Features
33.6 Diagnosis
33.7 Prophylaxis Pharmacotherapy and Radiotherapy
33.8 Treatment
33.9 Summary
References
34: Management of Sciatic Nerve Palsy After a Total Hip Arthroplasty
34.1 Introduction
34.2 Anatomy of Sciatic Nerve
34.3 Mechanism of Sciatic Nerve Injury
34.4 Risk Factors for Sciatic Nerve Injury
34.5 Clinical Presentation of Sciatic Nerve Injury
34.6 Investigations for Sciatic Nerve Injury
34.6.1 Electrophysiology
34.6.2 Nerve Imaging
34.7 Management of Sciatic Nerve Injury After THA
34.8 Prognosis of Sciatic Nerve Injury During THA
References
35: Trunnionosis in Total Hip Arthroplasty
35.1 Introduction
35.2 Pathophysiology
35.3 Risk Factors
35.3.1 Implant-Based Risk Factors
35.3.1.1 Taper Geometry
35.3.1.2 Taper Topography
35.3.1.3 Head Size
35.3.1.4 Flexural Rigidity
35.3.1.5 Material Properties
35.3.2 Surgery-Based Risk Factors
35.3.3 Patient-Based Risk Factors
35.4 Diagnosis
35.4.1 History
35.4.2 Physical Examination
35.4.3 Laboratory Tests and Imaging
35.5 Treatment
35.6 Summary
References
36: Single-Stage Revision for a Prosthetic Joint Infection After Total Hip Arthroplasty
36.1 Introduction
36.2 Pathogenesis, Classification and Diagnosis of PJIs
36.2.1 Pathogenesis
36.2.2 Diagnosis
36.2.3 Classification
36.3 Indications for Single-Stage THA Revision
36.4 Contraindications of Single-Stage Revision THA
36.5 Surgical Technique
36.6 Advantages of Single-Stage Revision
36.7 Summary
References
37: Two-Stage Revision for an Infected Total Hip Arthroplasty
37.1 Introduction
37.2 Risk Factors for PJI
37.3 Single-Stage Vs Two-Stage Treatment Dilemma
37.4 Author’s Method of  Two-Stage Revision
37.4.1 First Stage of Revision
37.4.2 Second Stage of  Definitive Surgery
37.5 Discussion
37.6 Summary
References
Part V: Navigation and Robotics in Total Hip Arthroplasty
38: Computer-Assisted Navigation in Total Hip Arthroplasty
38.1 Introduction
38.2 Potential Advantages
38.3 Potential Disadvantages
38.4 Operative Technique
38.4.1 System Setup
38.4.2 Registration of Pelvis and Acetabulum
38.4.3 Femoral Registration
38.4.4 Acetabular Cup
38.4.5 Femoral Stem
38.4.6 Final Steps
38.5 Discussion
38.6 Summary and Future of CAOS
References
39: Overview of Robotics in Total Hip Arthroplasty
39.1 Introduction
39.2 Stages of Robotic- Assisted THA
39.2.1 Preoperative Planning
39.2.2 Intraoperative Calibration
39.2.3 Bone Resections
39.2.4 Fine-Tuning and Definitive Implant
39.3 Accuracy of Implant Position
39.4 Accuracy of Restoring Hip Biomechanics
39.5 Functional Outcomes
39.6 Cost-Effectiveness and Other Challenges
39.7 Future Directions
39.8 Summary
References
Part VI: Revision Total Hip Arthroplasty
40: Modes of Failure in Total Hip Arthroplasty
40.1 Introduction
40.2 Modes of Failure in Total Hip Arthroplasty
40.2.1 Dislocation
40.2.2 Periprosthetic Fractures
40.2.3 Periprosthetic Infection
40.2.4 Aseptic Loosening
40.3 Pathogenesis of Aseptic Loosening
40.3.1 Generation of Wear Particles
40.3.1.1 Modes of Wear in THA (Fig. 40.5)
40.3.1.2 Trunnionosis
40.3.2 Immune Reaction and Osteolysis
40.3.3 Prosthesis Micromotion
40.3.4 Debris Dissemination
40.4 Clinical Evaluation
40.5 Radiographic Evaluation
40.5.1 Normal Radiological Findings
40.5.1.1 Cemented THA
40.5.1.2 Cementless THA
40.5.2 Radiological Signs of Loosening
40.5.2.1 Cemented THA
40.5.2.2 Cementless THA
40.6 Prevention
40.7 Summary
References
41: Surgical Exposure in Revision Hip Arthroplasty: A Step-Wise Approach
41.1 Introduction
41.2 Posterolateral Approach
41.2.1 Indications
41.2.2 Contraindications
41.2.3 Surgical Technique
41.3 Direct Anterior Approach
41.3.1 Indications
41.3.2 Contraindications
41.3.3 Surgical Technique
41.3.3.1 Socket Exposure
41.3.3.2 Femoral Revision
41.4 Femoral Episiotomy to Extended Trochanteric Osteotomy: A Stepwise Approach
41.5 Discussion
References
Untitled
42: Acetabular Component Extraction in Revision Hip Surgery
42.1 Introduction
42.2 Indications and Assessment
42.3 Preoperative Planning and Surgical Tactic
42.4 Surgical Approaches
42.4.1 Trochanteric Osteotomy
42.5 Surgical Techniques
42.5.1 Well-Fixed Cemented Acetabular Component
42.5.2 Cementless Acetabular Component
42.5.2.1 Removal of the Polyethylene Liner
42.5.2.2 Removal of Ceramic Liner
42.5.2.3 Removal of the Uncemented Shell
42.6 Removal of Intra-pelvic Components
42.7 Summary
References
43: Removal of Femoral Stem During Revision Hip Arthroplasty
43.1 Introduction
43.2 Indications for Stem Removal
43.3 Clinical Assessment
43.4 Radiological Assessment
43.5 Technique of Stem Extraction
43.5.1 Surgical Approach
43.5.2 Cemented Stem Extraction
43.5.2.1 Endofemoral Cement Extraction
43.5.2.2 In Cement Revision
43.5.3 Cementless Stem Extraction
43.6 Extended Trochanteric Osteotomy (ETO)
43.6.1 Technique of ETO
43.7 Broken Stem Removal
43.8 Summary
References
44: Implant Selection in Revision Total Hip Arthroplasty
44.1 Introduction
44.2 Implant Selection for Revision of the Femoral Component
44.2.1 Paprosky Classification of Bone Loss Around the Femoral Component [5]
44.2.2 Paprosky Type I Bone Loss
44.2.3 Paprosky Type II Bone Loss
44.2.4 Paprosky Type III Bone Loss
44.2.5 Paprosky Type IV Bone Loss
44.3 Stem Characteristics
44.3.1 Standard Porous-Coated Uncemented Stems
44.3.2 Proximally Modular Femoral Stems
44.3.3 Extensively Porous-Coated Stems
44.3.4 Modular Tapered Femoral Stems
44.3.5 Non-modular Tapered Femoral Stems
44.4 Revision of the Acetabular Component
44.4.1 Radiological Evaluation
44.4.2 Acetabular Bone-Loss Classification Systems
44.5 Options for Acetabular Revision
44.5.1 Hemispherical Porous-Coated Uncemented Acetabular Components
44.5.2 High-Hip Center
44.5.3 Jumbo-Cup Principle
44.5.4 Trabecular-Metal Components and Augments
44.5.5 Use and Role of Oblong or Bilobed Implants for Revision
44.5.6 Role of Cup-Cage Constructs
44.5.7 Role of Tri-flange Reconstruction
44.6 Summary
References
45: Dual Mobility Cups in Primary and Revision Total Hip Arthroplasty
45.1 Introduction
45.2 Mechanism of Dual Mobility
45.3 Preoperative Planning
45.4 Surgical Considerations
45.5 Current Concepts and Recent Advances
45.6 Complications
45.7 Discussion
45.8 Case-Based Discussion
45.9 Summary
References
46: Acetabular Revision in Total Hip Arthroplasty: Porous Metal Cups and Augments
46.1 Introduction
46.2 Preoperative Evaluation
46.2.1 History
46.2.2 Physical Exam
46.2.3 Labs
46.2.4 Radiographic Evaluation
46.3 Acetabular Bone Loss Classifications
46.4 Intra-operative Bone Loss Assessment
46.5 What Is the Function of Your Augment?
46.6 Acetabular Revision for a Paprosky IIIA Defect Using Tantalum/Porous Metal Cups and Augments
46.7 Acetabular Revision for a Paprosky IIIB Defect Using Tantalum/Porous Metal Cups and Augments
46.8 Postoperative Management
46.9 Summary of Clinical Outcomes
46.10 Summary
References
47: Structural Bone Grafts in Primary and Revision Total Hip Arthroplasty
47.1 Introduction
47.2 Indications of Bone Grafts in Primary and Revision Total Hip Arthroplasty
47.2.1 Indication in Primary THA
47.2.1.1 Acetabular Bone Loss Reconstruction
47.2.2 Indication in Revision THA
47.3 Discussion
47.4 Case Discussions
47.4.1 Case Report 1
47.4.2 Case Report 2
47.5 Summary
References
48: Impaction Bone Grafting for Management of Acetabular Bone Defects in Revision Total Hip Arthroplasty
48.1 Introduction
48.2 Preoperative Assessment
48.3 Surgical Exposure
48.3.1 Type of Bone Graft and Its Preparation
48.3.2 Preparation of the Host Bed
48.3.3 Impaction Grafting
48.4 Recent Advances
48.5 The Fate of the Graft
48.6 Case Reports
48.7 Discussion
48.8 Summary
References
49: Revision of Acetabulum Using Rings and Cages
49.1 Introduction
49.2 Assessment and Classification of Acetabular Defects
49.3 Acetabular Reconstruction
49.3.1 Reinforcement Rings
49.3.1.1 Mueller Ring
49.3.1.2 Ganz Ring
49.3.1.3 Kerboull Acetabular Reinforcement Device
49.3.1.4 Eichler Ring
49.3.2 Antiprotrusio Cages (APCs)
49.3.2.1 Burch-Schneider Ring (BS)
49.3.3 Custom-Made Acetabular Components (CMACs)
49.3.3.1 Triflanged Cups
49.3.3.2 Monoflanged Cup
49.3.4 Cup-Cage Construct
49.3.4.1 Surgical Technique
49.3.4.2 MRS-TITAN Comfort System
49.4 Recent Advances
49.5 Summary
References
50: Acetabular Constraints in Revision Hip Arthroplasty
50.1 Introduction
50.2 Classification of Chronic Instability
50.3 Evaluation for Dislocation
50.4 Constrained Acetabular Liner (CAL): How Does It Work?
50.4.1 Constriction Ring
50.4.2 The Tripolar Constrained Cup
50.5 Disadvantages of Constrained Acetabular Liners
50.6 Discussion
50.7 Summary
References
51: Chronic Pelvic Discontinuity
51.1 Introduction
51.2 Classification
51.3 Pre-operative Assessment
51.3.1 Patient History
51.3.2 Physical Examination
51.3.3 Laboratory Studies
51.3.4 Imaging
51.3.4.1 Radiographs
51.3.4.2 Computed-Tomography (CT) Scan
51.3.4.3 General Considerations
51.4 Principles of Acetabular Reconstruction
51.5 Surgical Considerations
51.5.1 Approach
51.5.2 Implant Removal
51.6 Acetabular Reconstruction
51.6.1 Acute Pelvic Discontinuity
51.6.2 Chronic Pelvic Discontinuity
51.6.2.1 Cup-Cage Construct
51.6.2.2 Custom Triflange Acetabular Components (CTAC)
51.6.2.3 Acetabular Distraction
51.6.3 Conclusion
51.7 Summary
References
52: Jumbo Cups in Revision Total Hip Arthroplasty
52.1 Introduction
52.2 Indications
52.3 Surgical Technique
52.4 Case-Based Discussion
52.5 Discussion
52.6 Summary
References
53: Femoral Component Revision Using Impaction Bone Grafting and a Cemented Stem
53.1 Introduction
53.2 History and Evolution
53.3 Bone Graft Source and Processing
53.4 Graft Stability and Biomechanics
53.4.1 Force of Impaction
53.4.2 Size of the Graft Chips
53.4.3 Washing/Rinsing of the Graft
53.4.4 Histological Appearances
53.4.5 Cemented or Uncemented Implants
53.4.6 Additives to the Graft
53.5 Surgical Aspects
53.5.1 Indications
53.5.2 Wrightington Technique
53.5.2.1 Preoperative Planning
53.5.2.2 Templating
53.5.2.3 Surgical Technique
53.5.2.4 Post-operative Management
53.6 Discussion
53.7 Summary
References
54: Cement-in-Cement Technique for Revision of the Femoral Stem
54.1 Introduction
54.2 Indications and Contraindications (Table 54.1)
54.3 Advantages and Disadvantages [6–9]
54.4 Cement-in-Cement Technique for the Femur
54.5 Pictorial Case Illustration
54.6 Cement-in-Cement Technique for the Acetabulum
54.7 Discussion
54.8 Summary
References
55: Uncemented Tapered Femoral Stems in Revision Total Hip Arthroplasty
55.1 Introduction
55.2 Uncemented Femoral Component Revision
55.2.1 Non-Modular Tapered Stems in Revision THA
55.2.1.1 The Design Principle
55.2.1.2 Indications
55.2.1.3 Challenges
55.2.1.4 Advantages
55.2.1.5 Contraindications
55.2.1.6 Results with Non-modular Tapered Stems
55.2.2 Modular Tapered Stems in Revision THA
55.2.2.1 Design Principles
55.2.2.2 Surgical Implications
55.2.2.3 Indications
55.2.2.4 Challenges
55.2.2.5 Advantages
55.2.2.6 Disadvantages
55.2.2.7 Results and Outcomes of Revision THA with Tapered Modular Stem Revision
Evidence on Failure of Modular Tapered Revision Stems
55.3 Summary
References
56: Proximal Porous Coated Modular Metaphyseal Stems in Primary and Revision THA
56.1 Introduction
56.2 Metaphyseo-Diaphyseal Modularity
56.2.1 Historical Perspective
56.2.2 Design Philosophy
56.2.3 Modified S-ROM Stem: “S-ROM-A”
56.3 Surgical Technique
56.4 Indications
56.5 Subtrochanteric Shortening Osteotomy
56.6 Advantages
56.7 Disadvantages
56.8 Clinical Survivorship
56.8.1 Complex Primary THA
56.8.2 Revision THA
56.9 Complications
56.10 Summary
References
57: Extensively Porous Coated Stems in Revision Total Hip Arthroplasty
57.1 Introduction
57.2 Historical Background
57.3 Pre-requisites for Success of Extensively Porous Coated Stems
57.4 Indications and Contraindications
57.5 Surgical Technique
57.5.1 Preoperative Templating
57.5.2 Exposure
57.5.3 Component Extraction
57.5.4 Canal Preparation
57.5.5 Prosthesis Placement
57.5.6 Rehabilitation
57.6 Case Discussions
57.7 Discussion
57.7.1 Complications
57.8 Summary
References
58: Custom Prostheses for Acetabular Reconstruction in Revision Hip Arthroplasty
58.1 Introduction
58.2 Patho-Anatomy of the Acetabulum
58.3 History and Evolution
58.4 The Need for a Custom Acetabular Component
58.5 Components and Manufacturing
58.6 Preoperative Work Up and Planning
58.7 Surgical Technique
58.8 Complications
58.9 Clinical Results
58.10 Summary
References
59: Megaprosthesis Reconstruction as a Salvage Option for Revision THR
59.1 Introduction
59.2 Indications
59.3 Preoperative Planning
59.4 Surgical Technique of Megaprosthesis
59.5 Complications After Megaprosthesis Reconstruction
59.6 Case Study
59.7 Discussion
59.8 Summary
References
60: Conversion of Failed Hemiarthroplasty to Total Hip Arthroplasty
60.1 Introduction
60.2 How Often Hemi Fails?
60.3 Mechanisms of Failure of Hemiarthroplasties
60.4 Assessment of a Painful Hemi
60.5 Planning for the Surgery of Conversion of Hemi to THA
60.6 What Are the Options for Revision Surgery?
60.6.1 Changing the Acetabulum with Acetabular Component
60.6.2 Cement-in-Cement Revision
60.6.3 Complete Revision
60.7 Summary
References
61: Allograft Prosthetic Reconstruction in Revision Total Hip Arthroplasty
61.1 Introduction
61.2 Epidemiology of Revision THA (rTHA)
61.3 Radiological Assessment
61.4 Acetabular Defect Classification
61.5 Indications for Use of APC in Acetabular Reconstruction
61.6 Revisions for Cemented/Uncemented Cup
61.7 Allograft Prosthetic Composite (APC) in Acetabular Revision
61.7.1 APC Using Morselised Allograft
61.7.2 Surgical Technique
61.7.3 APC in Uncontained Acetabular Defects
61.8 Classification of Femoral Bone Loss
61.9 Indications for Femoral Allograft Prosthetic Reconstructs
61.10 Allograft prosthetic Composites (APCs) in Femoral Reconstruction
61.10.1 Harvesting and Storage
61.10.2 Surgical Approaches
61.10.3 APC Constructs
61.10.4 Techniques of APC-Host Bone Fixation
61.11 Allograft Incorporation in APC Constructs
61.12 Survival, Complications and Literature review
61.13 Summary
References
Untitled
62: Re-revision Total Hip Arthroplasty
62.1 Introduction
62.2 Epidemiology
62.3 Causes for Re-Revision and Failure Modes
62.4 Issues and Challenges
62.5 Approach to Re-Revision Surgery
62.6 Acetabular Revisions
62.6.1 Fixation and Reconstructive Options
62.6.1.1 Cementless Porous-Coated Hemispherical Sockets
62.6.1.2 Acetabular Cages
62.7 Re-Revisions for Instability
62.7.1 Role of Hooded Liners
62.7.2 Dual Mobility Cups
62.7.3 Constrained Cups
62.7.4 Soft Tissue Procedures
62.7.5 Femoral Revisions for Instability
62.8 Re-Revision for Infection
62.9 Case Discussions
62.10 Discussion
62.11 Summary
References
63: The Past, Present and Future of Hip Arthroplasty
63.1 Introduction
63.2 Early Techniques and Development
63.3 Current Concepts
63.3.1 Fixation and Implant Design
63.3.1.1 Cemented Femoral Stems
63.3.1.2 Uncemented Stems
63.3.1.3 Mini Stems
63.3.1.4 Acetabular Fixation and Design
63.3.2 Cementing Technique
63.3.3 Bearing Surfaces
63.3.3.1 Polyethylene
63.3.3.2 Metal and Ceramic on Polyethylene
63.3.3.3 Metal-on-Metal
63.3.3.4 Ceramic-on-Ceramic
63.3.4 Femoral Head Diameter
63.3.5 Dual-Mobility Liners
63.3.6 Resurfacing
63.3.7 Accuracy of Implantation
63.3.7.1 Computer-Assisted Surgery: Navigation
63.3.7.2 Computer-Assisted Surgery: Robotics
63.3.7.3 Patient-Specific Instrumentation
63.3.8 Advances in Surgical Approach to THA
63.3.9 Hospital Length of Stay: Rapid Recovery Protocols and Outpatient Arthroplasty
63.3.10 Assessing Outcomes: Registry
63.3.11 Future Developments
63.3.11.1 3D Printing of Implants
63.3.11.2 Implant Surface Modification
63.3.11.3 Extended Reality and Machine Learning
63.4 Summary
Refeences