THR

In 1826 John Rhea Bartonii was the first person to perform a bone
surgery. The operation was a success for the first 3 months, but
several years after the surgery the patient lost all motion in the
joint.

In 1891 the German Professor Themistocles Glück crafted an ivory

hip ball joint with nickel plated hardware.

In 1942 Dr. Austin T. Moore credited a metal prosthetic made from

the metal Vitalliumin.

In 1960, Dr. San Baw used ivory hip pieces to refuse hip bones that
had fractured.

In 1962, Englishman Sir John Charnley was able to successfully

replace an arthritis patient's hip socket with a plastic concave
replacement. He also replaced the
femoral head joint on the same patient with a metal prosthetic. This
 TheHip
The hip joint is where the top of the femur
meets the socket of the pelvic bone.
The top of the femur is ball-shaped and fits
snugly in the socket formed by the socket of the
pelvic bone.
 ?What Causes Hip Pain
o Osteoarthritis:
Osteoarthritis
a disease which affects the tissues that allow
joints to move smoothly.
most common in people over sixty.
- It’s the most common type which causes
THR.

o Rheumatoid arthritis:
the body’s immune system produces a chemical
which targets and then destroys the synovial
lining, the cartilage, and joint surface also
resulting in joint pain and loss of mobility.

o trauma-related arthritis:
Symptoms that might lead you to consider hip
replacement:

o usually begin as pain when bearing weight on the

affected hip.
o You may limp, which is the body’s way of reducing the
forces that the hip has to deal with.
o The degeneration will lead to a reduction in the
range-of-motion of the affected hip.
o Bone spurs will usually develop, which limit
movement of the hip joint.
o Difficulty walking up or down stairs.
o Trouble rising from a seated position.
o Finally, as the condition becomes worse, the pain may
be present all the time and may keep you awake at
night.
 Diagnosis and Tests

• Complete history and physical examination.

X-rays will be taken to determine the extent of
the degenerative process and suggest a cause for the
degeneration.
• If standard x-rays do not indicate hip problems, the
following additional tests are available:
o Aspiration and Arthrograms
oBone Scans
 Technetium Diphosphonaten (TDP).
 Sulfur Colloid Scan.
 A Gallium Scan is ordered if there is concern about
infection.
 Indium-111 Radioisotope Scan: if infection is
suspected.
Not all hip conditions require a hip replacement as
the initial treatment.
The doctor may suggest several alternative
treatments to put off replacing the hip as long as
possible.

•Using a cane may help alleviate some of your

pain and allow you to walk more comfortably.
•Anti-inflammatory medications may reduce
the inflammation from the arthritis and reduce
your pain.
A total hip replacement is a surgical procedure
whereby the diseased cartilage and bone of
the hip joint is surgically replaced with
artificial materials.
The Artificial Hip Joint, called a hip prosthesis, there are two
major types of artificial hip joint:
Cemented Prosthesis: is held in place by a type of epoxy
cement that attaches the metal to the bone.
Un-cemented Prosthesis: has a fine mesh of holes on the
surface area that touches the bone. The mesh allows the bone to
grow into the mesh and "become part of" the bone.

Cemented Un-Cemented

For older patients For younger patients

Each prosthesis is made up of two parts:
1. The acetabular component, or socket
portion, which replaces the acetabulum.

2.The femoral component, or stem portion,

which replaces the femoral head.
The femoral component is made of a
metal stem with a metal ball on the
end.

The acetabular component is a

metal shell with a plastic inner
socket liner that acts like a
bearing.
 The Operation
It begins with making an incision about 8 inches
long over the hip joint.

After the incision is made, the ligaments and

muscles are separated to allow the surgeon
access to the bones of the hip joint.
this part of the surgery that makes the ligaments
and muscles somewhat weak after surgery.
Until they heal, which takes about a month to
six weeks.
Removing the Femoral
Head
Once the hip joint is entered,
the femoral head is
dislocated from the
acetabulum. Then the
femoral head is removed by
cutting through the femoral
neck with a power saw.

Reaming the Acetabulum

The cartilage is removed from
the acetabulum using a power
drill and a special reamer.

Then the new socket is

inserted.
Preparing the Femoral
Canal
Special rasps are used to
shape and hollow out femur to
the exact shape of the metal
stem of the femoral
component.

Inserting the Femoral Stem

The stem is inserted into the
femoral canal.
Attaching the Femoral Head
The metal ball that replaces the
femoral head is attached to the
femoral stem.

Before your incision is closed, an

x-ray is made to make sure
your new prosthesis is in the
correct position.
 The Completed Hip
Replacement

The surgeon will make every effort to maintain the leg

length that you had before surgery, but there is no
guarantee. Once you are up and walking around, you
may find that your leg is now a fraction of an inch
 Complications of Total Hip
Replacement
The most common complications following hip replacement are:

o Thrombophlebitis: the most common complication of hip

replacement surgery.
the blood in the large veins of the leg forms blood
clots within the veins. This may cause the leg to swell and
become warm to the touch and painful.

o Infection in the joint, occur in fewer than 2% of patients.

o Dislocation of the joint

Dislocation is when the ball comes out of the socket.
here is a greater risk of dislocation right after surgery, before
the muscles and tendons around the new joint have healed.

o Loosening of the joint (wearing out).

 Wound Care
Diet
Some loss of appetite is common for several
weeks after surgery. A balanced diet, often
with an iron supplement.
Activity
Exercise particularly during the first few weeks
after surgery. Some discomfort with activity
and at night is common for several weeks.

o Activity program should include:

 A walking program, initially in home and
later outside, to slowly increase your mobility.
 Resuming normal household activities.
Resuming sitting, standing, and walking up
andor
Supportive devices such as walker down stairs.are
crutches
used.
 Exercises
1. Your weight is applied to the un-
operated leg, and the leg that had
surgery is lifted forward about forty
degrees and then brought back to a
neutral position. This is repeated as
many times as possible, working up to
2. The operated leg isthirty
elevated to the
repetitions.
side about forty degrees and returned
to neutral. This, likewise, is repeated
and the number of repetitions is
increased to thirty.

3. The same sequence is repeated

lifting the leg backwards twenty to
thirty degrees.
 Materials for the
prosthesis
Materials used for manufacture and fixation of total
: hip prostheses are
•Metals: not pure metal, but from metal alloys.
 Cobalt-Chrome alloys
 Titanium alloys 
Stainless Steel  alloys.

•Polyethylene: kind of plastic.

•Ceramics: composed of pure crystals of aluminum
or zirconium oxides.
•Bone cement: a compound consisting of 90 % of
polymethylmetacrylate, (PMM), the rest are mainly
crystals of barium sulfate or Zirconium oxide