Beschreibung
In the last 10 years, total prosthetic replacement has become the hip oper ation for many but not all surgeons. In our clinic the increasing frequency of TP has been paralleled by a reduction in the frequency of 10 and HA. For the experienced orthopaedic surgeon and hip surgeon, hip disease has so many facets that it could not possibly be tackled with one operation alone. Thus, HA seems recently to have won renewed recognition. It has once more become the procedure of choice in specific cases, possibly because of certain disadvantages and complications associated with TP which have somewhat tempered the original optimism. Currently, the risk of infection or loosening of the pros thesis is such that the operation cannot justifiably be recommended for patients under 55-60 years of age. In contrast with HA, in the majority of cases the results of TP or 10 are not fully predictable. The loss of joint motion is offset by two important advantages: -complete freedom from pain - full weight bearing is possible on the arthrodesed hip. On following up our HA operations from 1961 to 1971, we examined the development of the operative procedures in our clinic. We found that the range of indications had narrowed as stricter criteria were applied in choosing patients for operation. Adequate and precise operative tech niques were developed. We studied the biomechanics of the hip joint exten sively (effect of arthrodesis on the statics and dynamics of the hip joint and neighbouring joints).
Autorenporträt
InhaltsangabeI: General Aspects.- List of Abbreviations.- I. Historical Review.- II. Anatomy of the Hip Joint.- III. Biomechanics of Hip Arthrodesis and Internal Fixation: Kinetics and Elastometry.- 1 Introduction.- 2 Statics.- 2.1 Hip Joint and Lower Limb Skeleton.- 2.1.1 Standing on Both Legs.- 2.1.2 Standing on One Leg.- 2.2 Knee Joint.- 3 Kinetics.- 3.1 Introduction.- 3.2 Hip Joint and Lower Limb Skeleton.- 3.3 Pelvis and Lumbar Spine.- 3.3.1 Normal Conditions.- 3.3.2 Differences in the Coronal Plane.- 3.3.3 Differences in the Sagittal Plane.- 3.3.4 Knee Joint.- 3.3.5 The Contralateral Hip.- 4 Biomechanics of Individual Hip Arthrodeses.- 4.1 Introduction.- 4.2 Arthrodesis by Resection of the Joint Surfaces.- 4.3 Extra-articular Hip Arthrodeses.- 4.4 Hip Arthrodeses with Central Dislocation.- 4.5 Hip Arthrodesis with Pelvic Osteotomy.- 5 Biomechanics and Technique of Internal Fixation in Hip Arthrodesis.- 5.1 Introduction.- 5.2 Type I Hip Arthrodesis.- 5.2.1 Screw Fixation of the Iliofemoral Bridge Graft.- 5.2.2 Screw Fixation of the Proximal End of the Femur to the Pelvis.- 5.3 Type II Hip Arthrodesis.- 5.3.1 Buttress Plate.- 5.3.2 Compression Plate.- 5.4 Type III Hip Arthrodesis.- 5.5 Type IV Hip Arthrodesis.- 5.5.1 Correct Technique.- 5.5.2 Incorrect Technique.- 5.6 Hip Arthrodesis in the Presence of Infection.- 6 Elastometry.- 6.1 Introduction.- 6.2 Experimental Method.- 6.3 Results.- 6.3.1 Effects of Medial Displacement.- 6.3.2 Effects of Pretensioning of the Plate.- 6.3.3 Influence of Length of the Distal Screw.- 6.3.4 Hip Arthrodesis with Central Dislocation (Charnley).- 6.4 Evaluation of Experimental Results.- 6.5 Summary.- 7 Summary.- IV. General Indications for Hip Arthrodesis.- 1 Introduction.- 2 Diagnoses Leading to Hip Arthrodesis.- 3 General Considerations.- 3.1 Age.- 3.2 General Condition of Patient.- 3.3 Somatic Type.- 3.4 Sex.- 3.5 State of Joints Adjacent to the Arthrodesis.- 3.5.1 Lumbar Spine and Sacroiliac Joint.- 3.5.2 Ipsilateral Knee Joint.- 3.5.3 Contralateral Hip Joint.- 3.6 Occupation.- 3.7 Social Circumstances.- 3.8 Sport.- 3.9 Psychological Factors.- 4 Contraindications to Hip Arthrodesis.- 4.1 Relative Contraindications.- 4.2 Absolute Contraindications.- 5 Choice of Operation.- 6 Summary.- V. Operative Technique.- 1 Introduction.- 2 Preoperative Work-Up.- 2.1 Medical Examination.- 2.2 Radiological Examination.- 2.3 Orthopedic Investigation.- 3 Preparation for Operation.- 3.1 Anaesthesia.- 3.2 Positioning of the Patient.- 3.3 Draping.- 4 Operative Technique.- 4.1 Usual Operative Approach.- 4.2 Pelvic Osteotomy.- 4.3 Intertrochanteric Osteotomy.- 4.4 Wound Closure.- 5 Operative Technique: Particular Features of Different Arthrodesis Types.- 5.1 Type I Hip Arthrodesis.- 5.2 Type II Hip Arthrodesis.- 5.3 Type III Hip Arthrodesis.- 5.4 Type IV Hip Arthrodesis.- 5.5 Atypical Hip Arthrodeses.- 5.5.1 Hip Arthrodesis in the Presence of Infection.- 5.5.2 Arthrodesis of Girdlestone Hips or Similar Conditions.- 5.5.3 Arthrodesis of a High Dislocated Femoral Head.- 5.5.4 Hip Arthrodesis in Cases of Incomplete Painful Ankylosis of the Hip (Intertrochanteric Valgus Osteotomy).- 6 Corrective Osteotomies.- 6.1 Intertrochanteric Corrective Osteotomy.- 6.2 Supracondylar Corrective Osteotomy.- 6.2.1 Correction in Cases of Valgus Deformity.- 6.2.2 Correction in Cases of Varus Deformity.- 7 Summary.- VI. Summary of Part I (General Aspects).- II: Specific Problems and Case Material.- I. Evaluation of Case Material.- 1 Methods.- 2 Characteristics of Case Material.- 2.1 Sex.- 2.2 Age.- 2.3 Etiology.- 3 Types of Operation.- 3.1 Postoperative Course.- 3.1.1 Duration of Hospital Stay.- 3.1.2 Postoperative Cast Fixation.- 3.2 Intraoperative and Postoperative Complications.- 3.2.1 General Complications.- 3.2.2 Local Complications.- 3.2.3 Localised Operative Failures.- a) Pseudarthrosis.- b) Malposition.- c) Difference in Leg Length.- d) Nerve Damage.- e) Fatigue Fractures.- 3.3 Sociomedical Problems.- 3.3.1 Postoperative Fitness for Wor
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