Risk of sex after thr. Physical Therapy after a Hip Replacement.



Risk of sex after thr

Risk of sex after thr

Medical uses[ edit ] Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis , avascular necrosis , traumatic arthritis , protrusio acetabuli , certain hip fractures , benign and malignant bone tumors , arthritis associated with Paget's disease , ankylosing spondylitis and juvenile rheumatoid arthritis.

The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.

Main components of a hip prosthesis [2] A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup The modern artificial joint owes much to the work of Sir John Charnley at Wrightington Hospital. His work in the field of tribology resulted in a design that almost completely replaced the other designs by the s.

Charnley's design consisted of three parts: Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation.

This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component.

Charnley's other major contribution was to use polymethylmethacrylate PMMA bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants. The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device.

Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions. Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement.

In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place.

That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem.

It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone.

Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking AML stem design.

With time, other forms of stem surface treatment and stem geometry have been developed and improved. Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece.

Using an independent head allows the surgeon to adjust leg length some heads seat more or less onto the stem and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.

To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed.

At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices.

All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery. When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems.

No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion.

Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. This is rarely seen with cemented stems. Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett , and the 8-time Major-winning American golfer Tom Watson , who shot a 67 in the opening round of the Masters Tournament in the year following his operation.

Techniques[ edit ] There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior Moore , lateral Hardinge or Liverpool , [4] antero-lateral Watson-Jones , [5] anterior Smith-Petersen [6] and greater trochanter osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral Watson-Jones or posterior approach.

This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed.

Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.

Lateral approach[ edit ] The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors gluteus medius and gluteus minimus to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires as per Charnley ,[ citation needed ] or may be divided at their tendinous portion, or through the functional tendon as per Hardinge and repaired using sutures.

Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.

Antero-lateral approach[ edit ] The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius.

The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior front for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.

Anterior approach[ edit ] The anterior approach uses an interval between the sartorius muscle and tensor fasciae latae. Joel Matta and Dr.

Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach.

With modern implant designs, dislocation rates are similar between the anterior and posterior approaches. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a "minimally invasive" approach compared to traditional approaches which were quite large comparatively.

Computer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.

The prosthetic implant used in hip replacement consists of three parts: Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: Acetabular cup[ edit ] The acetabular cup is the component which is placed into the acetabulum hip socket.

Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular.

One-piece monobloc shells are either UHMWPE ultra-high-molecular-weight polyethylene or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner.

Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.

Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed.

April Learn how and when to remove this template message The femoral component is the component that fits in the femur thigh bone. Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head ball. There are two types of fixation: Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone.

Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials titanium, cobalt chromium, stainless steel, and polymer composites and they can be monolithic or modular.

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Risk of sex after thr

Medical uses[ edit ] Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis , avascular necrosis , traumatic arthritis , protrusio acetabuli , certain hip fractures , benign and malignant bone tumors , arthritis associated with Paget's disease , ankylosing spondylitis and juvenile rheumatoid arthritis. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.

Main components of a hip prosthesis [2] A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup The modern artificial joint owes much to the work of Sir John Charnley at Wrightington Hospital.

His work in the field of tribology resulted in a design that almost completely replaced the other designs by the s. Charnley's design consisted of three parts: Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs.

The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component.

Charnley's other major contribution was to use polymethylmethacrylate PMMA bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants. The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device.

Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions. Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants.

The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone.

Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking AML stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.

Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length some heads seat more or less onto the stem and to select from various materials from which the head is formed.

A modern acetabulum component is also made up of two parts: First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.

To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved.

The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.

When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion.

Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. This is rarely seen with cemented stems. Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett , and the 8-time Major-winning American golfer Tom Watson , who shot a 67 in the opening round of the Masters Tournament in the year following his operation.

Techniques[ edit ] There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior Moore , lateral Hardinge or Liverpool , [4] antero-lateral Watson-Jones , [5] anterior Smith-Petersen [6] and greater trochanter osteotomy.

There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral Watson-Jones or posterior approach.

This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.

Lateral approach[ edit ] The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors gluteus medius and gluteus minimus to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires as per Charnley ,[ citation needed ] or may be divided at their tendinous portion, or through the functional tendon as per Hardinge and repaired using sutures.

Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.

Antero-lateral approach[ edit ] The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior front for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint. Anterior approach[ edit ] The anterior approach uses an interval between the sartorius muscle and tensor fasciae latae.

Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller.

This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a "minimally invasive" approach compared to traditional approaches which were quite large comparatively. Computer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy.

Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant.

Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw. The prosthetic implant used in hip replacement consists of three parts: Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: Acetabular cup[ edit ] The acetabular cup is the component which is placed into the acetabulum hip socket. Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement.

Some acetabular cups are one piece, while others are modular. One-piece monobloc shells are either UHMWPE ultra-high-molecular-weight polyethylene or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place.

A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner.

Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.

Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. April Learn how and when to remove this template message The femoral component is the component that fits in the femur thigh bone.

Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head ball. There are two types of fixation: Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant.

Stems are made of multiple materials titanium, cobalt chromium, stainless steel, and polymer composites and they can be monolithic or modular.

Risk of sex after thr

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