Total hip arthroplasty

The next advance in total hip arthroplasty came with the development of various porous surface treatments which allow bone tissue to grow into the metal porous coating on the femoral stem of the hip implant and on the acetabular component of the total joint replacement. These developments arose because of patients who were not able to tolerate cemented implants because of allergies to the cement, methylmethacrylate. More youthflil patients are better served by a press-fit implant as well. Figure 12 shows the difference between textured and beaded surface-treated orthopedic prostheses. 

The acetabular component is as integral to successful total hip arthroplasty as is the femoral hip stem component. The life of the acetabular component depends on proper placement and bone preparation in the acetabular region of the hip girdle, proper use of bone cement, and superior component design. 

The head of the femoral component then articulates with an ion-bombarded, HDPE, high walled, acetabular liner which fits iato a screwed ia, machined, titanium, chromium—cobalt—molybdenum or vanadium—aluminum metallic alloy hydroxyapatite-coated acetabular shell/cup. Each of the separate parts of the modular system for total hip arthroplasty is manufactured ia several different sizes. 

Brief History. B.W., a 75-year-old woman, fell at home and experienced a sudden sharp pain in her left hip. She was unable to walk and was taken to a nearby hospital where x-ray examination showed an impacted fracture of the left hip. The patient was alert and oriented at the time of admission. She had a history of arteriosclerotic cardiovascular disease and diabetes mellitus, but her medical condition was stable. The patient was relatively obese, and a considerable amount of osteoarthritis was present in both hips. Two days after admission, a total hip arthroplasty was performed under general anesthesia. Meperidine (Demerol) was given intramuscularly as a preoperative sedative. General anesthesia was induced by intravenous administration of thiopental (Pentothal) and sustained by inhalation of halothane (Fluothane). The surgery was completed successfully, and physical therapy was initiated at the patient s bedside on the subsequent day. 

Peichl P, Griesmacher A, Kumpan W, et al. Clinical outcome of salmon calcitonin nasal spray treatment in postmenopausal women after total hip arthroplasty. Gerontology. 2005 51 242-252. 

Berkowitz, S.D. Marder, V.J. Kosutic, G. Baughman, R.A. Oral heparin administration with a novel drug delivery agent (SNAC) in healthy volunteers and patients undergoing elective total hip arthroplasty. J. Thromb. Haemost. 2003, 1 (9), 1914-1919. 

A 51-year old woman sustained a fracture of the left femoral neck, later treated by total hip arthroplasty, which was revised several times with the impaction bone grafting technique and insertion of a prosthesis with cement. She developed a persistent weakness of the hip in flexion and abduction. Later the left hip buckled and she fell while walking. X-rays showed a periprosthetic fracture with bending of the femoral component. 

Vogt NH, Bothner U, Kerch G, Lindner KH, Georgieff M. Large-dose administration of 6% hydroxyethyl starch 200/0.5 total hip arthroplasty plasma homeostasis, hemostasis, and renal function compared to use of 5% human albumin. Anesth Analg 1996 83(2) 262-8. 

A 74-year-old man was to receive a combined sciatic nerve and psoas compartment block for a total hip arthroplasty the classic Labat s approach was used and 30 ml of 0.75% ropivacaine was injected over 1.5 minutes, after which he suddenly became unresponsive and developed tonic-clonic movements. Propofol was administered and the seizure resolved, but he developed sinus bradycardia with progressive lengthening of the QRS interval, which converted to nodal bradycardia. A ventricular escape rhythm at 20/minute with T wave inversion was treated with ephedrine 10 mg and adrenahne 0.1 mg, resulting in supraventricular tachycardia with transient atrial fibrillation. 

In a similar case, a 77-year-old woman experienced persistent bleeding after total hip arthroplasty while taking GB therapy (60). This bleeding persisted for 4 weeks, at which time the ginkgo was discontinued. After the GB had been discontinued for 6 weeks, the bleeding stopped. 

Bebbington A, Kulkarni R, Roberts P. Ginkgo biloba. Persistent bleeding after total hip arthroplasty caused by herbal self-medication. J Arthroplasty 2005 20( 1) 125—126. 

Hooker JA, Lachiewicz PF, Kelley SS. Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty. J Bone Joint Surg 1999 81 690-696. 

Prandoni P, Bruchi O, Sabbion P, et al. Prolonged thromboprophylaxis with oral anticoagulants after total hip arthroplasty A prospective, controlled, randomized study. Arch Intern Med 2002 162 1966-1971. 

Functional incontinence is not caused by bladder- or urethra-specific factors. Rather, in patients with conditions such as dementia or cognitive or mobility deficits, the UI is linked to the primary disease process more than any extrinsic or intrinsic deficit of the lower urinary tract. An example of functional incontinence occurs in the postoperative orthopedic surgery patient. Following extensive orthopedic reconstructions such as total hip arthroplasty, patients are often immobile secondary to pain or traction. Therefore the patient may be unable to access toileting facilities in a reasonable period of time and may become incontinent as a result. The treatment of this type of UI may involve only placing a urinal or commode at the bedside that allows for simplified access to toileting. 

Callaghan, J., Albright, J., Goetz, D., Olejniczak, J., and Johnston, R. (2000) Charnley total hip arthroplasty with cement minimum twenty-five year follow-up. J. Bone Joint Surg. Am., 82 (4), 487-497. 

Affato, S. (2014) Perspectives in Total Hip Arthroplasty Advances in Biomaterials and their Tribological Interactions, Wood-head Publishing Series in Biomaterials, vol 84, Elsevier. ISBN 978-1-7824-2031-6. 

Bartolozzi a and Black J (1985) Chromium concentrations in serum blood clot and urine from patients following total hip arthroplasty. Biomaterials 6 2-8. 

Dorr LD, Bloebaum R Emmanual J and Mel-drum R (1990) Histologic biochemical and ion analysis of tissue and fluids retrieved during total hip arthroplasty. Clin Orthop Rel Res 261 82-95. 

Pazaglia UE, Dell orbo C and Wilkinson MJ (1987) The foreign body reaction in total hip arthroplasties. A correlated light- microscopy SEM and TEM study. Arch Orthop Trauma Surg 106 209-219. 

Solomon MI and Sekei R (1992) Total hip arthroplasty complicated by a malignant fibrous histiocytoma. A case report. J Arthroplasty 7 549-550. 

Troop JK, Mallory TH, Eisher DA and Vaughn BK (1990) Malignant fibrous histiocytoma after total hip arthroplasty a case report. Clin Orthop 253 297-300. 

VisuRi X Pukkaia E, Paavoiainen P, Puikkinen P and Riska EB (1996) Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop 3295 280-289. 

Hydroxylapatite plasma sprayed coatings have been used in total hip arthroplasties (Jaffe and Scott 1996), dental implants (Ong and Chan 1999), knee replacements, ankle arthroplasties (Zerahn et al. 2000), orthopaedic screws (Magyar et al. 1997), and spinal implants. The most widely used application is the femoral stem where 11 year clinical results show slightly better performance than cemented prostheses (Ravelin et al. 2000). 

Jaffe WL, Scott DF (1996) Total hip arthroplasty with hydroxylapatite-coated prostheses [A review]. J Bone Joint Surg 78A 1918-1934... 

Eskelinen A et al (2006) Uncemented total hip arthroplasty for primary osteoarthritis in young patients a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop 77(l) 57-70... 

Engh, C.A. and Bobyn, J.D. 1988. Results of porous coated hip replacement using the AML prosthesis. In Non-Cemented Total Hip Arthroplasty, Raven Press, New York. 

Skinner, H.B. 1988. Composite technology for total hip arthroplasty. Clin. Orthop. Rd. Res., 235,224—236. Spector, M., Miller, M., and Beals, N. 1988a. Porous materials. In Encyclopedia of Medical Devices and Instrumentation, J.G. Webster, Ed. John Wiley Sons, New York. 

McKellop, H.A., Campbell, P Park, S.H. et al 1995 The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin. Orthop. 311 3. 

Sarmiento, A., Ebramzadeh, E., Gogan, W.J. et al., 1990. Cup containment and orientation in cemented total hip arthroplasties. /. Bone Joint Surg. 72B 996. 

Jasty, M., Rubash, H.E., Paiemont, G.D. et al. 1992. Porous coated uncemented components in experimental total hip arthroplasty in dogs. Clin. Orthop. Rel. Res. 280 300. 

Perspectives in total hip arthroplasty Advances in biomaterials and their tribological interactions... 

J.J. Callaghan, J.C. Albright, D.D. Goetz, J.P. Olejniczak, R.C. Johnston, Chamley total hip arthroplasty with cement. Minimum twenty-five-year follow-up, J. Bone Joint Srrrg. Am. 82 (2000) 487-497. 

Davidson, J. A., Mishra, A. K., Kovacs R, and Poggie, R.A. New surface-hardened, low-modulus, corrosion resistant Ti-13Nb-13Zr alloy for total hip arthroplasty. Biomed. Mater. Eng., 4,231-243(1994). 

Tarasevicius, S., Tarasevicius, R., Zegunis, V., Smailys, A., Kalesinskas, R.J. Metal type of the femoral stem in total hip arthroplasty. Medicina (Kaunas) 41, 932-935 (2005)... 

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