joint replacement surgery : how far have we reached joint... · senior knee and hip replacement...
TRANSCRIPT
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Joint Replacement Surgery :
How far have we reached
Dr. (Prof.) Anil Arora
MS (Ortho) DNB (Ortho) Dip SIROT (USA)
FAPOA (Korea), FIGOF (Germany), FJOA (Japan)
Commonwealth Fellow Joint Replacement
(Royal National Orthopaedic Hospital, London, UK)
Senior Knee and Hip Replacement Surgeon
Associate Director
Department of Orthopaedics and Joint Replacement
Max Superspeciality Hospital, Patparganj, Delhi (India)
E-mail : [email protected]
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1966 2008
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5 yr post op 15 yr post op 42 yr post op
Proximal Femoral Replacement
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Total Joint Replacement surgery
is considered
“the most successful orthopaedic surgery”
of the last century,
as it can give
predictable positive results provided……
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Mr Rajesh, 40 years male
Childhood T. B. Hip
Totally disorganised joint
No socket to put Acetabulam
6 cm shortening
Difficult walk
Patient still wanted mobile, stable, painless hip !!!!
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Severely destroyed head and socket of hip joint
Chances of damage to nerve in such cases
are very high if we try to lengthen the leg
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Proper preoperative planning and workup with CT scan
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Total hip replacement done
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Able to do his daily activityPatient is very happy with result
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CAN DO ACTIVE LEG RAISING NOW
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He walked on his own after 17 years without support
His leg is 4 cm long now and no damage to nerve occurred
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Message
• Old neglected problems of hip aredifficult to manage
• Careful planning and expertise insuch surgeries can give good results
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New Bearings
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Surface Replacement
Bone-conserving
alternative to
conventional
Total Hip Replacement (THR).
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Surface Replacement
• Sacrifices only the diseased bone and
preserves normal bone
• Less risk of dislocation
• No leg length alteration
• Allows a normal range of movement and
sporting activities after operation
• Allows the patient to squat and sit on the
floor safely
• Easy to revise if needed
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KNEE
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Results – ROM - Movies
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Tricompartmental
Replacement
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Mrs S. B,
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PREOP AP
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POSTOP XRAY
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Selective
Compartment
Replacements
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Revision Joints
Wedges and Stems
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Revision Knee -
Aseptic Loosening
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Revision Knee
Septic
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Revision Hips
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50 YEAR : 18 YEAR FU: L
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A P
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79 YR : ? PELVIC DISCONTINUITY
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Massive Replacements
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Massive Reconstruction of hip in a case of aggressive cancer of bone
• Mr Dharampal, 38/m.
• Moderate pain Lt- hip 1year
• Inability to sleep because of pain
• Investigations : CHONDROSARCOMA of
acetabulum
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Radiograph showed destruction of socket of hip
Chondrosarcoma is a dangerous cancer of bonethat spreads rapidally if not treated in time
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CT-SCAN
Measurement of cancer done to properly plan the surgery And put the prosthesis of appropriate size
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We measured all possible dimensions of cancer
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MRI was done to see any involvement of adjoining muscles
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BONE SCAN done to rule out other area envolvement
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BIOPSY
chondrosarcoma
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We did
• Wide resection of tumor through abdomenand buttock
• Surgery last for 14-hours
• Oncosurgeon was also envolved with us
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SURGICAL INCISION
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Reconstruction of hip with Acetabular cage, Bone graft and Uncemented hip replacement
marginal biopsy - no activity
HERNIA MESH WAS USED TO HOLD GRAFT IN PLACE
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At 6 weeks bone graft is well incorporated
At this stage he is able to sit. Able to walk non weight bearing
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Message
• Although treating tumor in such places is difficult but not impossible
• Well planned surgery and extensive properative planning is needed to treat such cases
• Restoration of function of individual is the aim but only after complete removal of tumor
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Some Innovative Replacements
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77 Yr
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CUSTOM MADE
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Minimally Invasive Surgery
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Thank You