in 1826 john rhea bartonii was the first person to

8/14/2019 In 1826 John Rhea Bartonii Was the First Person To

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THR


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In 1826 John Rhea Bartonii was the first person to perform a bonesurgery. The operation was a success for the first 3 months, butseveral years after the surgery the patient lost all motion in the

joint.

In 1891 the German Professor Themistocles Glck crafted an ivory

hip ball joint with nickel plated hardware.

In 1942 Dr. Austin T. Moore credited a metal prosthetic made fromthe metal Vitalliumin.

In 1960, Dr. San Baw used ivory hip pieces to refuse hip bones thathad fractured.

In 1962, Englishman Sir John Charnley was able to successfullyreplace an arthritis patient's hip socket with a plastic concave

replacement. He also replaced thefemoral head joint on the same patient with a metal prosthetic. This


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The hip joint is where the top of the femur

meets the socket of the pelvic bone.The top of the femur is ball-shaped and fitssnugly in the socket formed by the socket of thepelvic bone.

The Hip


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What Causes Hip Pain?o OsteoarthritisOsteoarthritis:

a disease which affects the tissues that allowjoints to move smoothly.

most common in people over sixty.- Its the most common type which causes

THR.

o Rheumatoid arthritis:Rheumatoid arthritis:the bodys immune system produces a chemical

which targets and then destroys the synoviallining, the cartilage, and joint surface alsoresulting in joint pain and loss of mobility.

o trauma-related arthritis:trauma-related arthritis:


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Symptoms that might lead you to consider hipreplacement:

o usually begin as pain when bearing weight on theaffected hip.

o You may limp, which is the bodys way of reducing theforces that the hip has to deal with.

o The degeneration will lead to a reduction in therange-of-motion of the affected hip.

o Bone spurs will usually develop, which limitmovement of the hip joint.

o Difficulty walking up or down stairs.o Trouble rising from a seated position.

o Finally, as the condition becomes worse, the pain maybe present all the time and may keep you awake at

night.


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Complete history and physical examination.

X-rays will be taken to determine the extent ofthe degenerative process and suggest a cause for thedegeneration. If standard x-rays do not indicate hip problems, the

following additional tests are available:o Aspiration and ArthrogramsoBone Scans Technetium Diphosphonaten (TDP). Sulfur Colloid Scan. A Gallium Scan is ordered if there is concern aboutinfection. Indium-111 Radioisotope Scan: if infection issuspected.

Diagnosis and Tests


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Not all hip conditions require a hip replacement as

the initial treatment.The doctor may suggest several alternative

treatments to put off replacing the hip as long aspossible.

Using a cane may help alleviate some of yourpain and allow you to walk more comfortably.

Anti-inflammatorymedications may reducethe inflammation from the arthritis and reduce

your pain.


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A total hip replacement is a surgical procedurewhereby the diseased cartilage and bone of

the hip joint is surgically replaced withartificial materials.


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The Artificial Hip Joint, called a hip prosthesis, there are twomajor types of artificial hip joint:

Cemented Prosthesis: is held in place by a type ofepoxycement that attaches the metal to the bone.

Un-cemented Prosthesis: has a fine mesh of holes on thesurface area that touches the bone. The mesh allows the bone togrow into the mesh and "become part of" the bone.

For older patients For younger patients

Cemented Un-Cemented


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Each prosthesis is made up of two parts:1. The acetabular component, or socketportion, which replaces the acetabulum.

2.The femoral component, or stem portion,which replaces the femoral head.


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The femoral component is made of ametal stem with a metal ball on theend.

The acetabular component is a

metal shell with a plastic innersocket liner that acts like abearing.


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The Operation

It begins with making an incision about 8 inches

long over the hip joint.

After the incision is made, the ligaments andmuscles are separated to allow the surgeon

access to the bones of the hip joint.this part of the surgery that makes the ligamentsand muscles somewhat weak after surgery.

Until they heal, which takes about a month tosix weeks.


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Removing the FemoralHeadOnce the hip joint is entered,

the femoral head isdislocated from theacetabulum. Then thefemoral head is removed by

cutting through the femoralneck with a power saw.

Reaming the Acetabulum

The cartilage is removed fromthe acetabulum using a powerdrill and a special reamer.

Then the new socket isinserted.


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Preparing the Femoral

CanalSpecial rasps are used toshape and hollow out femur tothe exact shape of the metal

stem of the femoralcomponent.

Inserting the Femoral StemThe stem is inserted into thefemoral canal.


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Attaching the Femoral HeadThe metal ball that replaces the

femoral head is attached to thefemoral stem.

Before your incision is closed, anx-ray is made to make sure

your new prosthesis is in thecorrect position.


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The Completed HipReplacement

The surgeon will make every effort to maintain the leglength that you had before surgery, but there is noguarantee. Once you are up and walking around, youmay find that your leg is now a fraction of an inch


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The most common complications following hip replacement are:

oThrombophlebitis: the most common complication of hipreplacement surgery.

the blood in the large veins of the leg forms bloodclots within the veins. This may cause the leg to swell andbecome warm to the touch and painful.

o Infection in the joint, occur in fewer than 2% of patients.

o Dislocation of the jointDislocation is when the ball comes out of the socket.

here is a greater risk of dislocation right after surgery, beforethe muscles and tendons around the new joint have healed.

o Loosening of the joint (wearing out).

Complications of Total HipReplacement


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Wound Care

DietSome loss of appetite is common for severalweeks after surgery. A balanced diet, often

with an iron supplement.Activity

Exercise particularly during the first few weeksafter surgery. Some discomfort with activity

and at night is common for several weeks.

o Activity program should include:

A walking program, initially in home andlater outside, to slowly increase your mobility. Resuming normal household activities.

Resuming sitting, standing, and walking upand down stairs.Supportive devices such as walker or crutches are

used.


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Exercises

1. Your weight is applied to the un-

operated leg, and the leg that hadsurgery is lifted forward about fortydegrees and then brought back to aneutral position. This is repeated as

many times as possible, working up tothirty repetitions.2. The operated leg is elevated to the

side about forty degrees and returnedto neutral. This, likewise, is repeated

and the number of repetitions is

increased to thirty.

3. The same sequence is repeatedlifting the leg backwards twenty to

thirty degrees.


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Materials used for manufacture and fixation of totalhip prostheses are:

Metals: not pure metal, but from metal alloys. Cobalt-Chrome alloys Titanium alloys

Stainless Steel alloys.

Polyethylene: kind of plastic.Ceramics: composed of pure crystals of aluminum

or zirconium oxides.Bone cement: a compound consisting of 90 % ofpolymethylmetacrylate, (PMM), the rest are mainlycrystals of barium sulfate or Zirconium oxide

Materials for theprosthesis


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in 1826 john rhea bartonii was the first person to

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