Utjecaj centra rotacije na opterećenje nakon. displazije svaki se milimetar računa

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1 Utjecaj centra rotacije na opterećenje nakon ugradnjetotalne endoproteze kuka kod displazije svaki se milimetar računa Goran Bićanić Klinika za ortopediju Medicinskog fakulteta Sveučilišta u Zagrebu i Kliničkog ičk bolničkog centra Zagreb gbic@mef.hr

2 DISPLAZIJA KUKA (prirođeno razvojno iščašenje kuka) ( ) 2 4 djeteta na sto živorođene djece u Hrvatskoj genetski čimbenici hormonski čimbenici čimbenici okoline... Pećina M. Ortopedija. Naklada Ljevak, Zagreb 2004.

3 Liječenje Konzervativno Operativno Sekundarna artroza kuka

4 Problemi kasnog operacijskog liječenja Malen i plitak pravi acetabulum Kranijalno postavljen neoacetabulum Manja koštana masa acetabula Velika anteverzija glave femura Veliko skraćenje nogu Mlađa životna dob (u prosjeku 52 g. od 24...)...

6 Čimbenici koji određuju položaj endoproteze Primarna stabilnost Natkrivenost Nagib acetabuluma Centar rotacije Anteverzija Dovoljno velik acetabulum...

7 Klasifikacije Crowe Hartofilakidis Eftekhar.. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia yp of the hip. J Bone Joint Surg Am, 61(1): 15 23, Eftekhar NS. Congenital dysplasia and dislocation. In Total Hip Arthroplasty. Edited by Eftekhar, N. S., St. Louis, C. V. Mosby, Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am May;78(5):

8 Klasifikacija prema Crowe u Crowe 1 Crowe 2 *Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979;61 1:15 23.

9 Klasifikacija prema Crowe u Crowe 3 Crowe 4 *Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979;61 1:15 23.

10 Određivanje centra rotacije Ranawat a at Perka Pierchon Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am Oct;62(7): Perka C, Fischer U, Taylor WR, Matziolis G. Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am Feb;86 A(2): Pierchon F, Migaud H, Duquennoy A, Fontaine C. [Radiologic evaluation of the rotation center of the hip]. Revue de chirurgie orthopedique et reparatrice de l'appareil moteur. 1993;79(4):281 4.

11 Ranawat Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am Oct;62(7):

12 Perka Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am Oct;62(7): Perka C, Fischer U, Taylor WR, Matziolis G. Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am Feb;86 A(2):312 9.

13 Pierchon Pierchon F, Migaud H, Duquennoy A, Fontaine C. [Radiologic evaluation of the rotation center of the hip]. Revue de chirurgie orthopedique et reparatrice de l'appareil moteur. 1993;79(4):281 4.

15 Čimbenici Primarna stabilnost Natkrivenost Medijalno, proksimalno, kotiloplastika, graftovi Nagib acetabuluma 1 >45⁰ =0.096mm/god <45⁰ =0.084mm/god 084 Centar rotacije Poremećaj hoda 2 Vol.trošenje mm 3 /god idealni COR, mm 3 /god proksimalni COR, mm 3 /god medijalni COR Snaga abduktora pada kod proksimalnog COR (13 35mm), a lateralni COR (5 25mm) tenzor fascie l. ne funkcionira kao abd. 4 Odnos sila 1 Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23: Rosler J, Perka C. The effect of anatomical positional relationships on kinetic parameters after total hip replacement. Int Orthop. 2000;24: Heller MO, Schröder JH, Matziolis G, Sharenkov A, Taylor WR, Perka C, Duda GN. Musculoskeletal load analysis. A biomechanical explanation for clinical results and more?. Orthopade 2007;36:188, Jerosch J, Steinbeck J, Stechmann J, Guth V. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg 1997;116:

17 Cilj Kako se mijenja opterećenje na kuk nakon ugradnje totalne endoproteze kuka k u bolesnika s displazijom, a ovisno o različitim položajima postoperativnog centra rotacije (i odnos sila prema silama u idealnom centru rotacije) Brinckmann P, Frobin W, Hierholzer E. Stress on the articular surface of the hip joint in healthy adults and persons with idiopathic osteoarthrosis of the hip joint. J Biomech 1981;14: Noble PC, Sugano N, Johnston JD, Thompson MT, Conditt MA, Engh CA Sr, Mathis KB. Computer simulation: how can it help the surgeon optimize implant position? Clin Orthop Relat Res 2003;417: The B, Hosman A, Kootstra J, Kralj Iglic V, Flivik G, Verdonschot N, Diercks R. Association between contact hip stress and RSA measured wear rates in total hip arthroplasties of 31 patients. J Biomech 2008;41: Zupanc O, Antolic V, Iglic A, Jaklic A, Kralj Iglic V, Stare J, Vengust R. The assessment of contact stress in the hip joint after operative treatment for severe slipped capital femoral epiphysis. Int Orthop 2001;25:9 12 Erceg M. The influence of femoral head shift on hip biomechanics: additional parameters accounted. Int Orthop. 2009;33:

18 Kako 49 pac., 57 kukova Sekundarna artroza, žene

19 Poslijeoperacijsko opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

20 Poslijeoperacijsko opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

21 Poslijeoperacijsko opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

22 Poslijeoperacijsko opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

24 Mnemotehnika 1 mm lateralno = 0.7% opterećenje 1 mm proksimalno = 0.1% opterećenje 1 mm lateralni lt liofset = 08% 0.8% opterećenje ć 1 mm dužina vrata = 1% opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

25 Primjer 1 Postoperacijski centar u odnosu na idealni 17 mm lateralno 25 mm proksimalno Opterećenje=17*0.7%+25*0.1%=14.4% Matematički opterećenje=16.6%

26 Primjer 2 Postoperacijski centar u odnosu na idealni 4 mm medijalno 15 mm proksimalno Opterećenje=4*( 0.7)%+15*0.1%= 1.5% Matematički opterećenje= 1.3%

27 Čimbenici Primarna stabilnost Natkrivenost Medijalno, proksimalno, kotiloplastika, graftovi Nagib acetabuluma 1 >45⁰ =0.096mm/god <45⁰ =0.084mm/god 084 Centar rotacije Poremećaj hoda 2 Vol.trošenje mm 3 /god idealni COR, mm 3 /god proksimalni COR, mm 3 /god medijalni COR Snaga abduktora pada kod proksimalnog COR (13 35mm), a lateralni COR (5 25mm) tenzor fascie l. ne funkcionira kao abd. 4 Odnos sila 1 Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23: Rosler J, Perka C. The effect of anatomical positional relationships on kinetic parameters after total hip replacement. Int Orthop. 2000;24: Heller MO, Schröder JH, Matziolis G, Sharenkov A, Taylor WR, Perka C, Duda GN. Musculoskeletal load analysis. A biomechanical explanation for clinical results and more?. Orthopade 2007;36:188, Jerosch J, Steinbeck J, Stechmann J, Guth V. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg 1997;116:

28 Mnemotehnika 1 mm lateralno = 0.7% opterećenje 1 mm proksimalno = 0.1% opterećenje 1 mm lateralni lt liofset = 08% 0.8% opterećenje ć 1 mm dužina vrata = 1% opterećenje Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009;33:

Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia

DOI 10.1007/s00264-008-0683-z ORIGINAL PAPER Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia Goran Bicanic & Domagoj Delimar & Marko Delimar & Marko Pecina Received: