Total HIP Replacement with ComputerNavigation :
Femoral component (stem and ball)
The femoral component replaces the femoral head. The femoral component is made of metal. Sometimes, the metal stem is attached to a ceramic ball.
The surgeon begins by making an incision on the side of the thigh to allow access to the hip joint. Once the hip joint is entered, the surgeon dislocates the femoral head from the acetabulum. Then the femoral head is removed by cutting through the femoral neck with a power saw.
Attention is then turned towards the socket. The surgeon uses a power drill and a special reamer (a cutting tool used to enlarge or shape a hole) to remove cartilage from inside the acetabulum. The surgeon shapes the socket into the form of a half-sphere. This is done to make sure the metal shell of the acetabular component will fit perfectly inside. After shaping the acetabulum, the surgeon tests the new component to make sure it fits just right.
HIP Navigation provide surgeons the data they need for cup and stem positioning, leg length determination, correct femoral offset and real time intra-operative assessment of stability and range of motion. It helps the surgeon align and orient the hip implant with more precision than ever before. The surgeon is able to view an interactive display of the lines, angles, and measurements needed to position your hip implant. This combination of computers with wireless cameras and infrared technology is significantly improving medical technology for orthopaedic surgery.
How does computer navigation work?
In the operating room infrared optics and tracking software continually monitor the position and mechanical alignment of the joint replacement components relative to your specific anatomy.
- Minimally invasive smart wireless instruments send data about to the joint movements (kinematics) to a computer.
- The computer analyzes and displays the kinematic data on the screen in the form of charts and graphs.
- These images provide your surgeon with the angles, lines, and measurement needed to best align your hip or knee implant.
What are the potential benefits?
It allows your surgeon to make adjustments to within a fraction of a degree, helping to ensure optimal "fit" for your joint.
- It provides your surgeon with a comprehensive view of your joint mechanics.
- It helps your surgeon correctly position your joint in situations where it is otherwise difficult to get a good view of your anatomy.
- It may lead to improved stability for your joint and optimal range of motion for you.
MIS Hip Replacement
Minimally invasive surgery (MIS) is a general term used to describe a surgical procedure that utilizes a smaller incision(s) than conventional surgery. In some MIS procedures the amount of soft tissue (muscles and tendons, etc.) that are disrupted during surgery may also be reduced.
- The potential benefits may be a smaller scar because of the reduced incision and the potential for a faster recovery because of less tissue disruption as well as the potential for less blood loss.
- The potential risks are the results that may be varied from patient to patient. Not all patients may realize the potential benefits from these relatively new procedures. Also, the risks, which are normally encountered in conventional hip joint replacement, still remain.
The lifespan of the prosthesis
Two major factors affecting the lifespan of the prosthesis are quality of the prosthesis and experience of the surgeon.
Cause of this complication is mostly found in 6 weeks after the operation. The main of cause comes from 2 factors.
- How to patient follow physician suggestion after the operation.
- How to surgeon correctly position your joint.
Length of Leg
During surgery, surgeon has to check the length of legs which must be equal this depends on the surgeon's expertise.
Not recommended for these conditions :
- Young, active patient
- Fat patient. Physician will suggest to loss your weight before operation.
- Patient who has cardiac, lung, kidney problem or risk to get an infection.
Computer Navigation in Hip Replacement Surgery in India Ė a detail view
Some of the latest technology in joint replacement includes not only implant material advances, but also advances in how we place the components during the reconstructive surgery. There are different surgical approaches in hip and knee replacement that can make significant differences in early and late outcomes. Another technology that is attempting to improve early and late outcomes by making implant placement more accurate is computer aided surgery or CAS.
Currently all primary hip and knee replacements in my practice are being done utilizing computer guidance for implant placement. Nearly all patients are candidates for CAS except the very morbidly obese. The technology itself has been available in limited markets for a few years and mainly in knee replacement. Recent software developments have expanded the technology to hip replacement.
The goals for CAS are simple; to improve implant placement, ligament balance and leg length control in an effort to customize each joint replacement with the patientís anatomy, thereby minimizing implantation related complications. The potential complications of interest are ligament imbalance, component malrotation and angular malalignment in knee replacement. In hip replacement the potential complications of interest are angular malalignment, dislocation, leg length discrepancy
Thus far CAS has been very successful in achieving the above goals. In the knee, ligament balance and overall joint motion has been significantly improved by allowing the computer to aid in component size and rotational alignment. In the hip, leg length prediction is very precise decreasing my need for x-ray during the case and avoiding any surprises post operatively.
It is important to understand that CAS is not robotic surgery. The surgeon obtains highly accurate information from the computer, but the surgeon ultimately has complete control and must apply the information correctly. The information obtained is highly precise but could be inaccurate if input information into the computer is incorrect.
There are very few downsides using CAS. Four additional 5mm wounds are made to place pins in the pelvis and femur. There has been very little pain from these wounds reported by patients In my experience, there have only been improvements using CAS. No reconstructions have been adversely affected in my hands with this technology. Again, CAS is an additional tool not the only tool used to properly reconstruct knees and hips.
At this point I have no reason to return to non-navigated replacements. Both in the knee and the hip CAS is another check in an effort to make every joint replacement as close to perfect as possible. Individual patient considerations at times force certain limitations in replacement surgery, but with proper pre-operative planning and additional intra-operative information from technologies such as CAS, surprises during and after surgery can be minimized.
Hip Replacement Surgery with Computer Navigation FAQ
How does computer navigation work?
It is similar to the Global Positioning System (GPS) you might have in your car. For example, computer-assisted knee replacement surgery captures a patientís unique anatomy and translates it to a computer screen, providing the surgeon with an unobstructed view of the patientís knee joint. To accomplish this the surgeon first attaches temporary markers on the bones at strategic locations around the joint. The computer can locate these using an infrared camera. Next comes a ĎteachingĒ procedure. The computer tracks the position of markers while the surgeon guides the joint through a variety of motions. It uses the data it collects to determine where the center of the hip is, where the ankle joints are and where the knee is.
From this information the computer generates a highly detailed and very accurate 3D model of the joint. During the the actual replacement procedure, the surgeon watches the computer screen and sees representations of his tools, the joint replacement and the model of the knee as if he were looking through a window into the actual joint.
What is the advantage of computer navigation for joint replacement surgery?
In nearly 30 years of peer-reviewed orthopedic literature, it is clear that the single most important determinant of long-term survival of a total knee or hip implant in a patient is the alignment of the implant with respect to the whole leg. The more accurate the alignment, the longer the implant will last.
Computer navigation allows us to perform surgical procedures within the joint and to align the implant more reliably and more accurately. Based on past experience, these improvements will translate into longer lasting repairs.
How much more accurate is computer assisted surgery?
Until the advent of computer navigation we were able to align the joint replacement device to within 7 to 9 degrees of optimal alignment. With computer navigation we can be reasonably certain of achieving an alignment within 3 degrees. That is better than a 50 percent improvement.
So how much longer will a computer assisted hip or knee replacement last?
Longevity of a replacement varies from individual to individual. That being said, a standard knee implant without the assistance of computer navigation typically lasts 10 to 15 years. With computer-assisted surgeries, a knee implant is more precisely aligned to minimize joint wear, potentially extending the life of the implant to up to 30 years. We canít say that with absolute certainty yet because we donít have enough data but we will in the years ahead.
Does computer navigation help shorten the recovery period for knee and hip surgery?
There is no conclusive evidence that it does. However, the technology is a perfect complement to minimally invasive surgical
procedures which frequently do result in an easier and faster recovery for the patient. Surgeons can operate through smaller
incisions (4 to 6 inches compared to 10 to 12 in standard, open surgery) This causes less trauma to the surrounding tissue,
which can lead to less post-operative pain, quicker restoration of mobility, and a shorter hospital stay.
Does computer navigation provide similar benefits for hip replacement surgery?
Absolutely. Computer navigation allows us to accurately orient the socket for optimal stability of the ball connection. This, in turn, makes the joint more resistant to dislocation. Another issue that is impacted by orientation of the hip replacement is the length of the leg. Without computer navigation, leg length may vary between a centimeter shorter and a centimeter longer. Computer navigation reduces this variability to within a millimeter. That is a big improvement.
Surface arthroplasty, an emerging technique for hip surgery, also benefits from computer navigation. With this procedure the ball is not removed but resurfaced by putting a specially designed cup over it. The accuracy of cup placement is one of the factors that impacts the longevity of this repair.
Computer navigation eliminates the need for invasive drilling to place alignment hardware in the bone while significantly improving alignment accuracy.
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Total HIP Replacement
A hip that is painful as a result of osteoarthritis (OA) can severely affect your ability to lead a full, active life. HIP replacement surgery (also called hip arthroplasty) is the ultimate solution for advanced hip OA.
The prosthesis is made of two main parts :
Acetabular component (socket)
The acetabular component is made of a metal shell with a plastic inner liner that provides the bearing surface. The plastic used is so tough and slick.