Advanced Primary Total Hip Arthroplasty

The hip and knee are intricate joints pivotal for weight-bearing and mobility, enabling daily activities and physical engagement. Comprising articulating bones supported by ligaments, tendons, muscles, and cartilage, they ensure optimal function. However, congenital deformities, complex fractures, and injuries often necessitate individualized treatment approaches, including accurate diagnosis and tailored intervention plans. Reconstructive procedures, classified as complex hip and knee surgeries, aim to rectify joint issues, alleviate pain, and restore stability and function. Moreover, they encompass surgeries for bone reconstruction following partial bone removal due to conditions like bone cancer.

Complex Hip and Knee Reconstruction

Complex hip and knee reconstruction encompasses various surgical techniques, including:
  • Open and Closed Reduction: These methods primarily address complex fractures. Open reduction involves surgical incisions to insert internal fixators like screws, pins, or plates either anteriorly or posteriorly to stabilize the pelvis. In contrast, closed reduction involves placing external fixators such as pins or screws into the fractured bone without incisions, forming an external frame for stability and healing.
  • Ilizarov Method: This minimally invasive approach corrects deformities using a circular ring fixator. The procedure entails three phases:
       - Operative Phase: K-wires are passed through bones proximal and distal to the deformity and fixed to Ilizarov rings using wire fixation bolts. Rings are connected by hinges and threaded rods.
       - Distraction Phase: Twists or pressure applied stimulate new bone growth at a rate of 3 mm/day until deformity correction is achieved.
       - Consolidation Phase: Following solid bone formation, the Ilizarov ring fixations are removed, and a plaster of Paris cast is applied for protection. Partial weight bearing is initially allowed, progressing to full weight bearing.
  • Metal Rod Placement: Bone metastases involving the lower hip often require metal rod placement down the femoral canal to stabilize the bone.
  • Bone Implantation: In cases where fragmented or lost bone cannot be repaired using other methods, healthy bone from one body part is transplanted to the affected area, sometimes sourced from a cadaver.
  • ACL Reconstruction: Commonly injured in knee trauma, the anterior cruciate ligament (ACL) provides rotational stability to the knee joint. Arthroscopic ACL reconstruction involves using autografts or allografts to reconstruct the ligament, often addressing accompanying cartilage, meniscus, or ligament damage
  • ;Acetabular and Femoral Osteotomy: Periacetabular osteotomy corrects hip dysplasia by repositioning the acetabulum using screws for optimal femoral head fit. Femoral osteotomy, a separate procedure, may involve cutting and repositioning the femoral head.
    In summary, advanced primary total hip arthroplasty encompasses a spectrum of techniques aimed at restoring joint integrity, function, and mobility in patients with complex hip and knee conditions. These interventions represent a multidimensional approach to address diverse structural challenges and optimize patient outcomes.
Scroll to Top