THOUGHTS ON HIP SURGERY

Transcription

1 THOUGHTS ON HIP SURGERY Aymard de Ladoucette Clinique de l Union Toulouse

2 THOUGHTS ON HIP SURGERY PRESERVE PATH PRESERVE AND PATH 3 MORE QUESTIONS CRITERIA OF IMPLANTATION MODULAR NECK EOS

3 PRESERVE

4 PATH

5 PRESERVE AND MIS PRESERVE PATH- MIS

6 PATH AND PRESERVE

7 CRITERIA OF IMPLANTATION LIMB LENGTH FEMORAL OFFSET ACETABULAR OFFSET

8 CRITERIA OF IMPLANTATION ACETABULAR INCLINATION : 30-50

9 CRITERIA OF IMPLANTATION FEMORAL ANTEVERSION: CUP ANTEVERSION:

10 MODULAR NECK

11 MODULAR NECK

12 MODULAR NECK FRACTURE IN MODULAR NECKS JUNCTION COUPLING/ GAP MICROMOVEMENTS FRETTING + CORROSION FRACTURE

13 MODULAR NECK

14 MODULAR NECK FAILURE CONCEPT SURGEON MANUFACTURER

15 MODULAR NECK

16 WRIGHT HIP TECHNOLOGY

17 PLANIFICATION 2 D: X RAY 3D: CT SCAN 3D: EOS

18 2D PLANIFICATION ILIAC TILT LUMBAR DEFORMITY

19 3D PLANIFICATION HIP PLAN

20 CRITERIA OF IMPLANTATION Why studying more?

21 CRITERIA OF IMPLANTATION

22 CRITERIA OF IMPLANTATION

23 EOS CHARPACK: 1992 Nobel Prize. A revolutionary invention: A HIGH ENERGY PARTICLE DETECTOR.

24 EOS

25 EOS

26 EOS

27 EOS 3D RECONSTRUCTION STATISTICAL MODELING BONE SHAPE RECOGNITION DISPLAY OF BONE POSITION, ROTATION AND ORIENTATION

28 PELVIMETRY AUTOMATIC CALCULATION OF MANY TRIDIMENSIONAL CLINICAL PARAMETERS PELVIC INCIDENCE PELVIC TILT SACRAL SLOPE PELVIC AXIAL TORSION PELVIC VERSION

29 RESULTS PELVIC INCIDENCE SACRAL SLOPE PELVIC VERSION PELVIS TILT AXIAL TORSION MEAN MIN MAX

30 EOS PELVIC INCIDENCE SACRAL SLOPE PELVIC VERSION PELVIS TILT AXIAL TORSION SEATED UP

31 EOS Than P, Szuper K, Somoskeoy S, Warta V, Illes T. International Orthopaedics, 2011 Nov 18. Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, et al. European spine journal ; 2011;20 Suppl 5: Lazennec JY, Brusson A, Rousseau MA. European spine journal. 2011;20 Suppl 5: Le Huec JC, Leijssen P, Duarte M, Aunoble S. European spine journal ; 2011;20 Suppl 5: Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM. European spine journal ; 2011;20 Suppl 5: Lazennec JY, Rousseau MA, Rangel A, Gorin M, Belicourt C, Brusson A, Catonné Y. Orthopaedics & traumatology, surgery & research : OTSR. 2011;97(1):

32 PHILIPPOT (OTSR 2009): ANALYSIS OF PELVIC VERSION: VALUES for CUP ORIENTATION STANDING POSITION POSITIONAL CHANGES STANDING UP: INCREASE ANTEVERSION ± 15,4 CONCLUSIONS: DOUBT ABOUT THE RECOMMENDED VALUES FOR CUP ORIENTATION FUNCTIONAL ANTEVERSION: COMPROMISE BETWEEN MAXIMUM STABILITY, MAXIMUM ARTICULAR AMPLITUDE AND ABSENCE OF PROSTHETIC CONFLICT

33 LEGAYE (Int Orthop 2009)

34 E DE THOMASSON (RCO 2004) PSOAS HYPERTONY ENHANCEMENT PELVIS FLEXION WHILE SEATED REDUCTION HIP MUSCULAR STABILIZERS ANTERIOR HIP DISLOCATION REDUCE CUP ANTEVERSION

35 EOS

36 PRE OPERATIVE STRATEGY

37 PRE OPERATIVE STRATEGY

38 PRE OPERATIVE STRATEGY

39 PRE OPERATIVE STRATEGY

40 CRITERIA OF IMPLANTATION PELVIC INCIDENCE SACRAL SLOPE PELVIC VERSION PELVIS TILT AXIAL TORSION MEAN MIN MAX

41 CRITERIA OF IMPLANTATION Why studying more?

42