What is Hip Arthroplasty?

An artificial joint replacement. After more than thirty years of clinical practice, the therapeutic effect of artificial hip replacement has been fully affirmed and has developed into a reliable treatment. The main purpose of artificial joint replacement is to alleviate joint pain, correct deformity, restore and improve joint motor function.

Hip replacement

An artificial joint replacement. After more than thirty years of clinical practice, the therapeutic effect of artificial hip replacement has been fully affirmed and has developed into a reliable treatment. The main purpose of artificial joint replacement is to alleviate joint pain, correct deformity, restore and improve joint motor function.

Basic introduction of hip replacement

After more than thirty years of clinical practice, the therapeutic effect of artificial hip replacement has been fully affirmed and has developed into a reliable treatment. The main purpose of artificial joint replacement is to alleviate joint pain, correct deformity, restore and improve joint motor function. Osteoarthritis is the preferred indication for artificial joint replacement. The others are aseptic bone necrosis (such as femoral head necrosis), some hip fractures (such as femoral neck fractures), rheumatoid arthritis, traumatic Arthritis, benign and malignant bone tumors, ankylosing spondylitis, etc. In short, as long as there are X-ray signs of joint destruction, with moderate to severe persistent joint pain and dysfunction, and diseases that cannot be alleviated through various other non-surgical treatments, there are indications for artificial joint replacement Sign. Obesity is considered a relative contraindication, and local or systemic active infections and other conditions that may increase perioperative serious complications are contraindications for artificial joint replacement.

Artificial joints started abroad in the 1940s, and China gradually developed after the 1960s. Artificial hip and knee replacements are considered to be very effective treatments in artificial joint replacements. Other artificial joints such as artificial elbow joints, artificial shoulder joints, Artificial vertebral bodies and artificial pelvic replacements have been developed to varying degrees. Artificial hip joint replacement refers to a prosthesis similar to human bones and joints made of metal materials with good biocompatibility and mechanical properties. Surgical methods are used to replace artificial joints with articular surfaces damaged by diseases or injuries. It is to remove the lesion, clear the pain, restore the joint activity and original function. Artificial joint replacement has the advantages of better joint movements, early ground movements, and reduction of long-term bed complications in elderly patients.

Hip replacement procedure

Using toothed hooks to reveal acetabulum

Use acetabular file to enlarge and deepen acetabulum

1. Clean up the acetabulum. In the soft tissue around the hip joint, there are sciatic nerves, femoral arteries, veins and femoral nerves. To avoid injury, use pointed or toothed hooks. The sharp teeth are hooked on the bone outside the acetabular margin and outward Tilt can pull away the surrounding soft tissue, which avoids slippage and satisfactorily exposes the acetabulum. The glenoid labrum, round ligament, all soft tissues and cartilage surface in the acetabulum were removed.

Specific methods: If the bone is very hard, a layer of subchondral bone can be removed with a round chisel; if there is too much osteophyte at the acetabular margin, it should be removed appropriately; if the acetabulum is fused, a flat chisel should be used to score the acetabulum Then, the head is removed with an acetabular chisel to form a false acetabulum.

Deepen and enlarge the acetabulum with an acetabular file that is suitable for the size of the artificial acetabulum until it can fully accommodate the artificial acetabulum, and then expand it appropriately. Because many artificial acetabular margins cannot exceed 0.5 cm of the original acetabular margin, it must also leave filling bone Cement room. When using the acetabular file, attention should be paid to the direction, that is, a 40 ° to 50 ° camber and a 10 ° to 15 ° camber to facilitate the placement of the artificial acetabulum. At the same time, pay attention that the bone at the top of the outer edge of the acetabulum cannot be removed too much to maintain the stability of the artificial acetabulum. The inner wall of the acetabulum is thin. Be careful not to penetrate when filing. It is especially necessary for patients with osteoporosis. Then, a 0.8cm diameter and 1cm deep bone hole was scraped on each of the iliac, pubic, and ischial bones and filled with bone cement to strengthen the cement strength of the bone cement.

Afterwards, rinse with normal saline to remove all blood, clots and bone debris, compress and stop bleeding with dry gauze, if necessary, use electrocoagulation, hydrogen peroxide or hemostatic fibers to stop bleeding, and then keep the dry gauze compressed until filling with bone cement.

Strengthening effect of cement fixation with acetabular bony hole

Fingering with bone cement

2. Put the artificial acetabular sacral surgeon to change the gloves. When the assistant mixes the bone cement to the non-stick gloves, the bone cement is evenly filled into the dry acetabulum with the fingers. The three reinforced holes must also be filled. Then place the artificial acetabular pressure on the cement of the acetabular bed. Generally, the acetabular cap is first slanted down against the posterior lower edge of the acetabulum, and then the acetabular positioning pressurizer is pressed forward and upward to make it It is closely and evenly attached to the acetabular bed, and the two arms of the positioner are used to adjust and maintain the artificial acetabulum in an outwardly inclined 45 ° and forward 10 ° to 15 ° positions according to the position; at the same time, the adhesive that overflows around the artificial acetabulum The solid solution scrapes, but the bone cement between the bone and the mortar cap cannot be damaged.

Maintain pressure until the cement has cured before removing the positioner. If the position of the mortar cap is moved after the bone cement begins to harden, it will inevitably pull the bone cement away from the bone or the mortar cap, and it must be avoided. If it is found that the mortar cap is improperly placed, the cap and bone cement should be taken decisively before the bone cement is completely cured, and then placed again.

After flushing, repeat the above steps and squeeze the artificial acetabulum with a pressure device. If the bloody liquid overflows from the bone cement and the bone or acetabular cap, it indicates that the fixation will not be good, and it should be removed and placed. If it is firmly fixed, you can check and remove osteophytes, excess bone cement, and bone fragments scattered in soft tissues.

(a) Squeeze the posterior lower edge of the mortar first

(b) Press forward and upward

(c) Uniform compression to fix the artificial acetabulum

(d) After the cement is solidified, take out the adjustment pressure device

Using the acetabular positioning pressure device to squeeze the artificial acetabulum from the back to the front

3. Rinse the sutures with 1: 1000 Neogel solution and soak for 5 minutes, then rinse the wound with normal saline. To stop bleeding, a negative pressure suction tube is placed near the artificial joint, and a small incision is made on the skin outside the incision to lead out of the skin.