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

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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

DISPLAZIJA KUKA (prirođeno razvojno iščašenje kuka) (1.5 40 ) 2 4 djeteta na sto živorođene djece u Hrvatskoj genetski čimbenici hormonski čimbenici čimbenici okoline... Pećina M. Ortopedija. Naklada Ljevak, Zagreb 2004.

Liječenje Konzervativno Operativno Sekundarna artroza kuka

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...)...

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

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, 1979. Eftekhar NS. Congenital dysplasia and dislocation. In Total Hip Arthroplasty. Edited by Eftekhar, N. S., St. Louis, C. V. Mosby, 1993. 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. 1996 May;78(5):683 92.

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.

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.

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. 1980 Oct;62(7):1059 65. 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. 2004 Feb;86 A(2):312 9. 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.

Ranawat Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980 Oct;62(7):1059 65.

Perka Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980 Oct;62(7):1059 65. 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. 2004 Feb;86 A(2):312 9.

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.

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 3 0.112 mm 3 /god idealni COR, 0.099 mm 3 /god proksimalni COR, 0.077 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;23:51 56 2 Rosler J, Perka C. The effect of anatomical positional relationships on kinetic parameters after total hip replacement. Int Orthop. 2000;24:23 27 3 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, 190 194 4 Jerosch J, Steinbeck J, Stechmann J, Guth V. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg 1997;116:385 389

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;14:149 156 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;417:242 252 242 252 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;41:100 105 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;33:95 100.

Kako 49 pac., 57 kukova Sekundarna artroza, žene

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;33:397 402.

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;33:397 402.

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;33:397 402.

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;33:397 402.

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;33:397 402.

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%

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%

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 3 0.112 mm 3 /god idealni COR, 0.099 mm 3 /god proksimalni COR, 0.077 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;23:51 56 2 Rosler J, Perka C. The effect of anatomical positional relationships on kinetic parameters after total hip replacement. Int Orthop. 2000;24:23 27 3 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, 190 194 4 Jerosch J, Steinbeck J, Stechmann J, Guth V. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg 1997;116:385 389

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;33:397 402.

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