Total Hip Resurfacing (Double Cup) Replacement

The operation is to cover and reconstruct the articular surface that has been destroyed by the acetabular cap of the ultra-high molecular polyethylene and the metal femoral head cup to restore the joint function. This procedure is characterized by the fact that the femoral head and neck are not removed too much and the trauma is small, which is suitable for cases of younger age and only joint surface destruction. However, surface replacement has its shortcomings: the prosthesis is easy to loosen and dislocate, especially the femoral head and neck are more easily loosened due to ischemic necrosis and absorption. Due to the removal of part of the femoral neck bone, it can also cause a femoral neck fracture. However, because the femoral head and neck are not removed, there is still a chance to switch to total hip arthroplasty after failure, which is a good transition for relatively young cases. Treatment of diseases: congenital dislocation of the hip in adults with congenital dislocation of the hip Indication 1. The adult osteoarthritis of the hip has only articular surface destruction, severe pain, dysfunction, and affects the daily life. 2. Avascular necrosis of the femoral head, neck damage is not much. 3. Rheumatoid arthritis, tonic pain, multiple joint involvement. Contraindications 1. Hip joint purulent infection. 2. Femoral head, neck or ankle defect or excessive destruction. 3. Extensive necrosis of the femoral head or severe loose bone. 4. Obviously, the two lower limbs should be treated with caution. Preoperative preparation 1. Comprehensive physical examination, understanding the heart, lung, liver and kidney function, and appropriate treatment to adapt to surgery. 2. Patients with femoral neck fractures should be treated with preoperative skin traction or tibial tuberosity. The upward displacement of the distal end of the fracture and the contraction of the muscles around the hip should be corrected to reduce intraoperative and reduce postoperative complications. 3. Antibiotics are routinely given 1 to 3 days before surgery, and contraindications are given to the affected area to prevent infection. 4. Regular skin preparation for 3 days; night enema before surgery, fasting 12 hours before surgery. 5. Select artificial femoral heads of similar size and place x-ray films on the same plane as the hips. According to this, select and prepare suitable artificial femoral heads and spare ones for each of the larger and smaller ones. 6. Special equipment for medullary cavity, artificial femoral head hammer, femoral head extractor, femoral head grasper, bone cement, etc. Surgical procedure 1. Incision, exposure: see the way the hip joint is exposed. 2. Treatment of acetabulum: There are sciatic nerve, femoral artery, vein and femoral nerve in the soft tissue around the hip joint. To avoid injury, apply a pointed or toothed hook, and the tines hook on the bone outside the acetabular rim. Tilting outwards pulls away the surrounding soft tissue, which prevents slippage and satisfactorily reveals the acetabulum. Excision of the labrum, round ligament, all intraorbital soft tissue and cartilage surface. If the bone is very hard, you can use a round chisel to remove a layer of subchondral bone. If there are too many callus on the acetabular rim, it should be properly removed. If the head is fused, it should be scored with a flat chisel between the head and the head. The acetabular chisel cuts the head and forms a false twist. Use the acetabular size suitable for artificial acetabulos to deepen the acetabulum until it can fully accommodate the artificial acetabulum, and then expand it properly. Because the artificial acetabular rim can not exceed 0.5cm of the original iliac crest, the filling bone must be left. The space of cement. When using the acetabulum, attention should be paid to the direction, that is, the camber is 40° to 50°, and the flash is 10° to 15° for the placement of the artificial acetabulum. At the same time, note that the bone at the top of the outer edge of the acetabulum can not be removed too much, in order to maintain the stability of the artificial acetabulum after surgery, and the inner wall of the sputum is thin, so be careful not to penetrate when sputum, especially for patients with osteoporosis. Then, a bone hole of 0.8 cm in diameter and 1 cm deep is scraped on the sputum, shame, and isch bone to fill the bone cement to strengthen the cementing strength of the bone cement. Finally, rinse with saline to remove all blood, clots and bone chips, use dry gauze to compress, completely stop bleeding, if necessary, use electrocoagulation, hydrogen peroxide or hemostatic fibers to stop bleeding, and then keep the dry gauze pressed until the bone cement is applied. 3. Disposal of the femoral head: This article only introduces the amstutz method. A guide pin was inserted into the central axis of the femoral neck under the guidance of the introducer and confirmed by a ring tester. The annular reamer with the same inner diameter as the metal cup is placed, and the cartilage surface on the side of the femoral head is removed, and the damaged bone and the proliferating margin are removed. Take care to avoid eccentricity or off-axis of the guide pin and incorrect reaming. Then, replace the cup high indicator ring, remove the dome of the residual head, and grind the head with the femoral head to just fit into the metal cup. Do not wear too much to avoid postoperative femoral neck fracture. Drill 3 to 4 bone holes with a diameter of 3 mm and a depth of 0.5 cm on the femoral head. Fill the tuned cement into the metal cup and the skull hole, and quickly place the cup on the femoral head with a cup holder. Above, the center of the metal cup and the axis of the femoral neck must be the same. The metal cup is pressed against the metal cup to make the metal cup closely adhere to the bone; the cement that overflows from the periphery of the metal cup and the top hole is scraped off. . The pressurizer is removed after the cement is cured. 4. Reset: The affected limb is towed and externally rotated. When the femoral head is close to the acetabulum, the metal cup is pressed with a finger while abducting and internal rotation of the affected limb can be reset. 5. Stitching: Soaking with 1:1000 Xinjieer, then flushing with normal saline, completely stop bleeding, put a negative pressure drainage tube around the joint, and take out the skin through a small incision on the skin outside the incision. Finally, the wound was sutured in layers and pressure bandaged.