Video Journal of Orthopaedics

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Primary Total Hip Arthroplasty – Clinical Perspectives: Part II

Lester S. Borden, MD

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Often patients that have undergone total hip arthroplasty develop a persistent limp postoperatively. This can be attributed to the improper exposure and reattachment of the various primary and secondary anatomical structures that control the hip function. This causative factor, affecting muscle/tendon resting length, dramatically influences the normal kinematics of the hip and subsequently is responsible for the patient's persistent limp.

In this segment, Dr. Borden, Department Head, Section of Joint Replacement and Arthritis Surgery at the Cleveland Clinic focuses on the proper technique for incising the hip utilizing a midlateral approach.

In addition, one of the primary factors for femoral stem loosening and subsequent failure with modern ingrowth systems is the improper undersizing of the femoral implant. Dr. Borden graphically demonstrates the proper technique for interface needed to maximize ingrowth results.

    References

  1. Andriacci TP, Galante JO, Belytschko TB, Hampton S A Stress Analysis of the Femoral Stem in Total Hip Prostheses J Bone Joint Surg 58-A:618-24, Jul 1976
  2. Bobyn JD, Pilliar RM, Cameron HU, Weatherly GC The Optimum Pore Size for the Fixation of Porous Surfaced Metal Implants by Bone Ingrowth Clin Orthop 150:263, 1980
  3. Crowninshield RD, Brand RA, Johnston RC, Milroy JC An Analysis of Femoral Component Stem Design in Total Hip Arthroplasty J Bone Joint Surg 62-A:68-78, Jan 1980
  4. Crowninshield RD, Brand RA, Johnston RC, Pederson DR An Analysis of Collar Function and the Use of Titanium in Femoral Prostheses Clin Orthop 158:270-77, 1981
  5. Galante JO Acetabular Fixation: Clinical Problems and Possible Solutions Hip 187-98, 1985
  6. Gruen TA, McNeice GM, Amstutz HC Modes of Failure of Cemented Stem-type Femoral Components. A Radiographic Analysis of Loosening Clin Orthop 141:17-27, 1979
  7. Hedley AK, Gruen TA, Borden LS, Hungerford DS, et al. Two-Year Follow-UP of the PCA Noncemented Total Hip Replacement Hip 225-50, 1987
  8. Hungerford DS Clinical Experience with an Acetabular Cup for Cementless Use Hip 250-60, 1985
  9. Jacob HAC, Huggler AH An Investigation into Biochemical Causes of Prosthesis Stem Loosening Within the Proximal End of the Human Femur J Biomech 13:159-73, 1980
  10. Johnston RC, Brand RA, Crowninshield RD Reconstruction of the Hip. A Mathematical Approach to Determine Optimum Geometric Relationships J Bone Joint Surg 61A:639-52, Jul 1979
  11. Lewis JL, Askew MJ, Wixson RL, Kramer GM, Tarr RR The Influence of Prosthetic Stern Stiffness and of a Calcar Collar on Stresses in the Proximal End of the Femur with a Cemented Femoral Component J Bone Joint Surg 66-A:280-86, Feb 1984
  12. McNeice GM, Amstutz HC Finite Element Studies in Hip Reconstruction In: Komi PV [ed] Biomechanics Baltimore, University Park Press Vol V-A:399-405, 1976
  13. Markoff KL, Amstutz HC, Hirschowitz DL The Effect of Calcar Contact on Femoral Component Micromovement. A Mechanical Study J Bone Joint Surg 62-A:1315-23, Dec 1980
  14. Oh I, Harris WH Proximal Strain Distribution in the Loaded Femur. An In Vitro Comparison of the Distributions in the Intact Femur and After Insertion of Different Hip Replacement Femoral Components J Bone Joint Surg 60-A:75-85, Jan 1987

Specifications

  • Total Run Time: 22:50 minutes
  • Catalog Number: 4003
  • VJO Publication Date: April, 1988