Joint Replacement Surgery :

How far have we reached

Dr. (Prof.) Anil Arora

MS (Ortho) DNB (Ortho) Dip SIROT (USA)

FAPOA (Korea), FIGOF (Germany), FJOA (Japan)

Commonwealth Fellow Joint Replacement

(Royal National Orthopaedic Hospital, London, UK)

Senior Knee and Hip Replacement Surgeon

Associate Director

Department of Orthopaedics and Joint Replacement

Max Superspeciality Hospital, Patparganj, Delhi (India)

E-mail : anilarora@delhiorthojournal.com

1966 2008

5 yr post op 15 yr post op 42 yr post op

Proximal Femoral Replacement

Total Joint Replacement surgery

is considered

“the most successful orthopaedic surgery”

of the last century,

as it can give

predictable positive results provided……

Mr Rajesh, 40 years male

Childhood T. B. Hip

Totally disorganised joint

No socket to put Acetabulam

6 cm shortening

Difficult walk

Patient still wanted mobile, stable, painless hip !!!!

Severely destroyed head and socket of hip joint

Chances of damage to nerve in such cases

are very high if we try to lengthen the leg

Proper preoperative planning and workup with CT scan

Total hip replacement done

Able to do his daily activityPatient is very happy with result

CAN DO ACTIVE LEG RAISING NOW

He walked on his own after 17 years without support

His leg is 4 cm long now and no damage to nerve occurred

Message

• Old neglected problems of hip aredifficult to manage

• Careful planning and expertise insuch surgeries can give good results

New Bearings

Surface Replacement

Bone-conserving

alternative to

conventional

Total Hip Replacement (THR).

Surface Replacement

• Sacrifices only the diseased bone and

preserves normal bone

• Less risk of dislocation

• No leg length alteration

• Allows a normal range of movement and

sporting activities after operation

• Allows the patient to squat and sit on the

floor safely

• Easy to revise if needed

KNEE

Results – ROM - Movies

Tricompartmental

Replacement

Mrs S. B,

PREOP AP

POSTOP XRAY

Selective

Compartment

Replacements

Revision Joints

Wedges and Stems

Revision Knee -

Aseptic Loosening

Revision Knee

Septic

Revision Hips

50 YEAR : 18 YEAR FU: L

A P

79 YR : ? PELVIC DISCONTINUITY

Massive Replacements

Massive Reconstruction of hip in a case of aggressive cancer of bone

• Mr Dharampal, 38/m.

• Moderate pain Lt- hip 1year

• Inability to sleep because of pain

• Investigations : CHONDROSARCOMA of

acetabulum

Radiograph showed destruction of socket of hip

Chondrosarcoma is a dangerous cancer of bonethat spreads rapidally if not treated in time

CT-SCAN

Measurement of cancer done to properly plan the surgery And put the prosthesis of appropriate size

We measured all possible dimensions of cancer

MRI was done to see any involvement of adjoining muscles

BONE SCAN done to rule out other area envolvement

BIOPSY

chondrosarcoma

We did

• Wide resection of tumor through abdomenand buttock

• Surgery last for 14-hours

• Oncosurgeon was also envolved with us

SURGICAL INCISION

Reconstruction of hip with Acetabular cage, Bone graft and Uncemented hip replacement

marginal biopsy - no activity

HERNIA MESH WAS USED TO HOLD GRAFT IN PLACE

At 6 weeks bone graft is well incorporated

At this stage he is able to sit. Able to walk non weight bearing

Message

• Although treating tumor in such places is difficult but not impossible

• Well planned surgery and extensive properative planning is needed to treat such cases

• Restoration of function of individual is the aim but only after complete removal of tumor

Some Innovative Replacements

77 Yr

CUSTOM MADE

Minimally Invasive Surgery

Thank You