Unit 2 - Hip Replacement Flashcards

1
Q

Who designed the first successful hip prosthesis?

A

John Charnley

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2
Q

What features does the Charnley hip have that other prior prostheses didnt?

A

smaller femoral head
bone cement
HDP bearing surface
matching instrumentation

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3
Q

What kind of fit does a cementless hip rely on?

A

interferene (press) fit

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4
Q

Why is it difficult to produce new bone cements?

A

they are classed as drugs by the FDA

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5
Q

What is the general criteria for hip replacements?

A

tolerated in the body with no short term and little long term risk of adverse effects

give pain relief and restore activities of daily living

should exceed the expected life span of the individual without need for revision

insertable by a competent surgeon of average ability

acceptable cost inc. hospital stay and country economy

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6
Q

what is the essential functional movement required at the hip?

A

extend slightly
flex to a minimum of 30 degrees
abduct when weight bearing
rotate when in full extension

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7
Q

Name a computational method of stress analysis

A

finite element analysis

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8
Q

Name a traditional method of stress measurement

A

strain gauge attached to the surface of the bone

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9
Q

Which activity of daily living involving hip movement has the largest resultant force?

A

ascending stairs

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10
Q

Which activity of daily living has the lowest resultant force on the hip?

A

rising from a chair

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11
Q

Why is it difficult to calculate exact loads on the hip joint?

A

there are 7 sets of ligaments and muscles

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12
Q

What is it called when the exact forces in a joint cannot be calculated?

A

indeterminate structure

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13
Q

give two reasons why the loads on the hip joint cannot be determined accurately

A

magnitude of muscle forces cannot be determined accurately

joint load varies according to physical activity being undertaken

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14
Q

What is the equation for compressive stress?

A

Compressive force/area compressed

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15
Q

What design features can prevent the stem sinking distally into the medullary canal?

A

tapering the stem
proximal collar
fixing bone to the stem by ingrowth/adhesion
strong cements to withstand shear

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16
Q

How can interface shear stress be reduced?

A

proximal collar
tapering

(convert shear to compression)

17
Q

How can fracture of the stem be avoided?

A

sufficiently large cross-section

high strength material

18
Q

How can stress shielding be avoided?

A

careful selection of the stem rigidity

19
Q

What is the equation for bending stress>

A

Bending moment * distance from neutral axis/ the second moment of area

20
Q

What design features can be implemented to ensure the stem doesn’t fail under bending load?

A

large enough I

shape design to limit bending moment due to joint force

21
Q

How can stem loosening be avoided from bending stresses?

A

strong bond between bone an stem/cement

good press fit in the medullar canal

22
Q

How can stress shielding of the bone from bending loads be minimised?

A

suitable rigidity of stem

23
Q

What other two stresses are generated under bending load?

A

radial and circumferential

24
Q

What is another word for circumferential stress?

A

hoop stress

25
Q

Where are radial stresses highest?

A

points of bone-stem contact

26
Q

What causes hoop stresses?

A

radial stresses which act in a direction to tend to split the bone

27
Q

What kind of stems cause high radial stresses?

A

short stems

28
Q

how are hoop stresses avoided?

A

long enough stem

ensure good fit i the medullary canal

29
Q

What design factors help to reduce torsional stresses?

A

non-circular stem sections
shear strength of cement
good bone-cement and cement-implant bonding
surface treatments of the stem to improve interface bonding

30
Q

Why are non-circular sections for the stem used?

A

allow some of the torsional stress to be taken as compression

31
Q

Name some important factors in design of acetabular replacement

A

size and conformity of joint surfaces
ways to maintain the integrity of the subchondral bone
thickness of cement layer
use of a backing plate
technique used to fix the cup into the remaining acetabular bone