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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
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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
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Cementless hipCementless hipCementless hipCementless hip
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
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Cementless hipCementless hipCementless hipCementless hip
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
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Cementless hipCementless hip
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Cementless hipCementless hip
Orthopedic surgery is getting more and more technically demandingOrthopedic surgery is getting more and more technically demanding
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Cementless hipCementless hip
Modern Modern cementlesscementlesship implant hip implant designdesign
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Cementless hipCementless hip
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
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Cementless hipCementless hip
19501950 19701970 19851985
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Cementless hipCementless hip
19501950 19701970 19851985
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Cementless hipCementless hip
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
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Cementless hipCementless hip
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
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Cementless hipCementless hip
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)
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Cementless hipCementless hip
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)
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Problems with cementless-fixationProblems with cementless-fixation
Cementless hipCementless hip
More challinging surgical tecnique More challinging surgical tecnique (longer learning curve)(longer learning curve)
Expensive implant Expensive implant (double the price) (double the price)
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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 hipCementless hip
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Cementless hip: Cementless hip: stemstem
Rectangular
Other
custom made
Stem-designStem-design
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Cementless hip: Cementless hip: stemstem
rectangular designrectangular designThe stem is wedged into the oval femur The stem is wedged into the oval femur after exact reamingafter exact reaming
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Cementless hip: Cementless hip: stemstem
Other Other stemstemdesignsdesigns
roundedleft-rigt-design
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Cementless hip: Cementless hip: neckneck
Choice of varus and anteversion
Choice of overlap
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Cementless Hip: Cementless Hip: stemstem
custom madecustom made
What you wish is not always what you get
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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,
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Cementless Hip: Cementless Hip: stemstemsurfacesurface
Porous coatedPorous coated
CERAMICSCERAMICS
RoughRough
SmoothSmoothMETALMETAL
Designed surfaceDesigned surface
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Cementless Hip: Cementless Hip: materialmaterial
1= Titanium alloy
2= trabecular bone
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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
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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
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Cementless Hip: Cementless Hip: cupcupAcetabular materialAcetabular material
PMMAPMMA
CeramicsCeramics
MetalMetal
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Cementless Hip: Cementless Hip: cupcupAcetabular desginAcetabular desgin
Be sure PMMA never gets in contact with boneBe sure PMMA never gets in contact with bone
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Cementless Hip: Cementless Hip: femoral headfemoral head
materialmaterial
Cobalt alloyCobalt alloy
ceramicsceramics
designdesign
NecklengthNecklength
28/32 mm28/32 mm
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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
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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
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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
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Cementless Hip: Cementless Hip: case studycase study
IncisionIncision
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Cementless Hip: Cementless Hip: case studycase study
Femoral neck before resectionFemoral neck before resection
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Cementless Hip: Cementless Hip: case studycase study
Resection of femoral head with jig-saw
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Cementless Hip: Cementless Hip: case studycase study
Destroyed surface of femoral headDestroyed surface of femoral head
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Cementless Hip: Cementless Hip: case studycase study
Acetabulum with rest-cartilageAcetabulum with rest-cartilage
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Cementless Hip: Cementless Hip: case studycase study
reaming of acetabulumacetabulum
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Cementless Hip: Cementless Hip: case studycase study
acetabulum before implantationacetabulum before implantation
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Cementless Hip: Cementless Hip: case studycase study
titanium cuptitanium cup inlay inlay
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Cementless Hip: Cementless Hip: case studycase study
trial cuptrial cup
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Cementless Hip: Cementless Hip: case studycase study
reaming the femurreaming the femur
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Cementless Hip: Cementless Hip: case studycase study
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Cementless Hip: Cementless Hip: case studycase study
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Cementless Hip: Cementless Hip: case studycase study
femur ready to accept implantfemur ready to accept implant
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Cementless Hip: Cementless Hip: case studycase study
checking length of neck checking length of neck with trial femoral headwith trial femoral head
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Cementless Hip: Cementless Hip: case studycase study
femoral implantfemoral implant cup implantcup implant
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Cementless Hip: Cementless Hip: case studycase study
definitedefinite implant after reductionimplant after reduction
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Cementless Hip: Cementless Hip: case studycase study
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Cementless hipCementless hip
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Cementless Hip:Cementless Hip:
Navigation-systemsNavigation-systems
Planning of Cup and StemPlanning of Cup and Stem
Accurate Positioning of ComponentsAccurate Positioning of Components
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Cup PlacementCup Placement
Reduce complications by correct placement of the cup
Cementless Hip:Cementless Hip:
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What is it ?
How does it work ?
Applications ?
Surgical NavigationSurgical Navigation
Cementless Hip:Cementless Hip:
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Combination of Medical Image
and Surgical Action
What is it ?What is it ?
Cementless Hip:Cementless Hip:
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Image
Action
NavigationConceptConcept
Cementless Hip:Cementless Hip:
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CT
Basic Basic principleprinciple
Cementless Hip:Cementless Hip:
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Cementless Hip:Cementless Hip:
Instument trackingInstument tracking
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• Image Transfer
• Tracking
• Referencing
• Matching
How does it work ?How does it work ?
Cementless Hip:Cementless Hip:
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Medivision Station
DAT/ Net
Radiology: CT, MRI
Medical images are loaded into the computerMedical images are loaded into the computer
Cementless Hip:Cementless Hip:
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Multiscanning - 3D - CamMultiscanning - 3D - Cam Data-Processor (Cam/CT)Data-Processor (Cam/CT)
Cementless Hip:Cementless Hip:
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Tool Set Hip ProstheticsTool Set Hip Prosthetics
Cementless Hip:Cementless Hip:
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Execution PhaseExecution Phase
Cementless Hip:Cementless Hip:
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OR SetupOR Setup
Cementless Hip:Cementless Hip:
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Cup PlanningCup Planning
optimal implantoptimal placement
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Cementless Hip:Cementless Hip:
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Execution PhaseExecution Phase
Cementless Hip:Cementless Hip:
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Cementless Hip:Cementless Hip:
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?
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Cementless hipCementless hip
Surgical managability Surgical managability
Excuse me Doc, can I see your diploma?
Managable for the average orthopedic surgeon
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Cementless hipCementless hip
DurabilityDurability
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Cementless hipCementless hip
AffordabilityAffordability
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Cementless hipCementless hip
Discussion welcomedDiscussion welcomed
BILIS
you will be answeredyou will be answered
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Cementless hipCementless hip www.menapace.comwww.menapace.com