Cementless hip Cementless hip Dr. Clemens Menapace Dr. Clemens Menapace FA für Orthopädie und...

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Cementless hipCementless hipCementless hipCementless hip

Dr. Clemens Dr. Clemens

MenapaceMenapace

FA für Orthopädie und orthop. ChirurgieFA für Orthopädie und orthop. Chirurgie

Ritter v. Schwarzstr. 8, 5400 - Hallein Ritter v. Schwarzstr. 8, 5400 - Hallein

Dr. Clemens Dr. Clemens

MenapaceMenapace

FA für Orthopädie und orthop. ChirurgieFA für Orthopädie und orthop. Chirurgie

Ritter v. Schwarzstr. 8, 5400 - Hallein Ritter v. Schwarzstr. 8, 5400 - Hallein

www.menapace.comwww.menapace.com

Cementless hip Cementless hip Cementless hip Cementless hip

Dr. Clemens MenapaceDr. Clemens Menapace

Departement for orthopedic and endoskopicDepartement for orthopedic and endoskopic

joint surgeryjoint surgery

www.menapace.comwww.menapace.com

Director of Director of the Departement for the Departement for

orthopedic and endoskopic orthopedic and endoskopic joint surgeryjoint surgery

Ritter v. Schwarzstr. 8 Ritter v. Schwarzstr. 8 5440-Hallein5440-Hallein

Guggenbichlerstr, 20Guggenbichlerstr, 205020-Salzburg5020-Salzburg

www.menapace.com

M.D. Orthopedy and M.D. Orthopedy and orthopedic surgeryorthopedic surgery

ClemensClemensMENAPACEMENAPACE

Director of Director of the Departement for the Departement for

orthopedic and endoskopic orthopedic and endoskopic joint surgeryjoint surgery

Ritter v. Schwarzstr. 8 Ritter v. Schwarzstr. 8 5440-Hallein5440-Hallein

Guggenbichlerstr, 20Guggenbichlerstr, 205020-Salzburg5020-Salzburg

www.menapace.com

M.D. Orthopedy and M.D. Orthopedy and orthopedic surgeryorthopedic surgery

ClemensClemensMENAPACEMENAPACE

Cementless hipCementless hip

Orthopedic surgery is getting more and more technically demandingOrthopedic surgery is getting more and more technically demanding

Modern Modern cementlesscementlesship implant hip implant designdesign

NEW YORK - 1940: Chrom-Kobalt-Molybdän-Endoprotheses

PARIS - 1950: Judet-brothers

VIENNA - 1948: Endler-Stadler, Kunstharzprothese (300) Total-Endoprotheses

in the 1970s Zementless Implants, Titanium

1926 1949 2000

19501950 19701970 19851985

aktiv aktiv

passivpassiv

interfaceinterface

Contact area between biological Contact area between biological and non- and non-

biological material = biological material = interfaceinterface

cement

titanium alloys

cobalt-chrome alloys

design surface type of material

ceramics

f i x a t i o nf i x a t i o n

Advantage of cement-fixationAdvantage of cement-fixation: :

Instant stability Instant stability

congruency of minor importance congruency of minor importance

less requiremnts as to materilal less requiremnts as to materilal and design of the implantand design of the implant

less expensive less expensive

Advantage of cementless-fixation Advantage of cementless-fixation (titanium-alloy)(titanium-alloy)

One interface (metal-bone)One interface (metal-bone)

excellent biocompatibilty (actual excellent biocompatibilty (actual bony ingrowth)bony ingrowth)

excellent metallurgical excellent metallurgical properties properties

line of retreat open during line of retreat open during surgery and later (revision)surgery and later (revision)

Problems with cement-fixationProblems with cement-fixation

Two interfacess: metal- cement-boneTwo interfacess: metal- cement-bone

No line of retreatNo line of retreat

Toxic charcteristicsToxic charcteristics

Aging of cement (mechanically, Aging of cement (mechanically, chemically)chemically)

Problems with cementless-fixationProblems with cementless-fixation

More challinging surgical tecnique More challinging surgical tecnique (longer learning curve)(longer learning curve)

Expensive implant Expensive implant (double the price) (double the price)

What we want

different stem sizes

different neck lengths

different neck angels

different materials of femoral haed

diffent cup designs

different acetabular desing

different acetabular material

Cementless hip: Cementless hip: stemstem

Rectangular

custom made

Stem-designStem-design

rectangular designrectangular designThe stem is wedged into the oval femur The stem is wedged into the oval femur after exact reamingafter exact reaming

Other Other stemstemdesignsdesigns

roundedleft-rigt-design

Cementless hip: Cementless hip: neckneck

Choice of varus and anteversion

Choice of overlap

Cementless Hip: Cementless Hip: stemstem

custom madecustom made

What you wish is not always what you get

Cementless Hip: Cementless Hip: stemstemMaterialsMaterials

Titanium based alloysTitanium based alloys

Cobalt based alloysCobalt based alloys

Resistent to corrosion, highly inert excellent fatigue, sufficent elasticity exellent bony integration

high friction coefficent, diffucult to maschine, expensive

except low friction coefficent and lower price

All properties mentioned less then titanium,

Cementless Hip: Cementless Hip: stemstemsurfacesurface

Porous coatedPorous coated

CERAMICSCERAMICS

RoughRough

SmoothSmoothMETALMETAL

Designed surfaceDesigned surface

Cementless Hip: Cementless Hip: materialmaterial

1= Titanium alloy

2= trabecular bone

Cementless Hip: Cementless Hip: cupcupCup - bone interface: designCup - bone interface: design

smoothsmooth press fit screw fixations

screw-typescrew-type

smoothsmooth press fit screw fixations

screw-typescrew-type

Cementless Hip: Cementless Hip: cupcup

Tintanium based alloysTintanium based alloys

CeramicsCeramics

Cobalt based alloysCobalt based alloys

Polymethylenmeth-Polymethylenmeth-axcrylateaxcrylate

Cup - bone interface: materialsCup - bone interface: materials

Ceramic coatedCeramic coated

Cementless Hip: Cementless Hip: cupcupAcetabular materialAcetabular material

PMMAPMMA

CeramicsCeramics

MetalMetal

Cementless Hip: Cementless Hip: cupcupAcetabular desginAcetabular desgin

Be sure PMMA never gets in contact with boneBe sure PMMA never gets in contact with bone

Cementless Hip: Cementless Hip: femoral headfemoral head

materialmaterial

Cobalt alloyCobalt alloy

ceramicsceramics

designdesign

NecklengthNecklength

28/32 mm28/32 mm

Surgical room with highest class of sterilitySurgical room with highest class of sterility

Only Only people people involvedinvolvedenterenter

No No fooling fooling aroundaround

Cementless Hip: Cementless Hip: sterilitysterility

Perioperative antibíotic prophylaxis

Postop blood recovery

2 drains removed day after surgery

Mobilisation 2 days aftger surgery

Initial full weight bearing if bone quality is OK

Hospitalized for 2-3 weeks, or rehabilitation clinic

Checks 3 month and 1 year postop

Cementless Hip: Cementless Hip: that is the truththat is the truth

Sometimes helpful, not necessary, but nice to haveSometimes helpful, not necessary, but nice to have

Preop construction drawingPreop construction drawing

3D-CT Scanner 3D-CT Scanner

Cementless HipCementless Hip

Cementless Hip: Cementless Hip: case studycase study

IncisionIncision

Femoral neck before resectionFemoral neck before resection

Resection of femoral head with jig-saw

Destroyed surface of femoral headDestroyed surface of femoral head

Acetabulum with rest-cartilageAcetabulum with rest-cartilage

reaming of acetabulumacetabulum

acetabulum before implantationacetabulum before implantation

titanium cuptitanium cup inlay inlay

trial cuptrial cup

reaming the femurreaming the femur

femur ready to accept implantfemur ready to accept implant

checking length of neck checking length of neck with trial femoral headwith trial femoral head

femoral implantfemoral implant cup implantcup implant

definitedefinite implant after reductionimplant after reduction

Cementless Hip:Cementless Hip:

Navigation-systemsNavigation-systems

Planning of Cup and StemPlanning of Cup and Stem

Accurate Positioning of ComponentsAccurate Positioning of Components

Cup PlacementCup Placement

Reduce complications by correct placement of the cup

What is it ?

How does it work ?

Applications ?

Surgical NavigationSurgical Navigation

Combination of Medical Image

and Surgical Action

What is it ?What is it ?

Action

NavigationConceptConcept

Basic Basic principleprinciple

Instument trackingInstument tracking

• Image Transfer

• Tracking

• Referencing

• Matching

How does it work ?How does it work ?

Medivision Station

DAT/ Net

Radiology: CT, MRI

Medical images are loaded into the computerMedical images are loaded into the computer

Multiscanning - 3D - CamMultiscanning - 3D - Cam Data-Processor (Cam/CT)Data-Processor (Cam/CT)

Tool Set Hip ProstheticsTool Set Hip Prosthetics

Execution PhaseExecution Phase

OR SetupOR Setup

Cup PlanningCup Planning

optimal implantoptimal placement

Execution PhaseExecution Phase

The RoboDoc SystemThe RoboDoc SystemSome steps along the surgical procecdure are Some steps along the surgical procecdure are

physically performed by a computer. physically performed by a computer.

More precise?Very expensive Very expensive

Complicated handlingComplicated handling

TimeconsumingTimeconsuming

More invasiveMore invasive

Higher bloodlossHigher bloodloss

Infectionrate?Infectionrate?

Surgical managability Surgical managability

Excuse me Doc, can I see your diploma?

Managable for the average orthopedic surgeon

DurabilityDurability

AffordabilityAffordability

Discussion welcomedDiscussion welcomed

you will be answeredyou will be answered

Cementless hipCementless hip www.menapace.comwww.menapace.com

Cementless hip Cementless hip Dr. Clemens Menapace Dr. Clemens Menapace FA für Orthopädie und...

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