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State of the art Hüftendoprothetik Das Team  der Abteilung für Orthopädie  und orthopädische Chirurgie LKH Klagenfurt Matthias Honl
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
Ziel der hüftendoprothetischen Versorgung Schmerzlinderung!!! Wiederherstellung von Beweglichkeit und Funktion Problemlösung bis an das Lebensende
Anatomy—Hip
Implantate
Implantatwahl: zementiert
Implantatwahl: zementiert
Verfahren
Verfahren
Verfahren
Verfahren
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
Geschichte Anfang 1960er
Wiles  1938 Geschichte: erste Endoprothesen Ring  1964  McKee Farrar
Historie: Gleitpaarungen
- Historie -
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
EVIDENZ
EVIDENZ
EVIDENZ
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
Implantatversagen früh (<10%) Luxation Infektion Implantatversagen spät (> 5 Jahre post op) Verschleiss Osteolyse Lockerung Periprosthetische Fractur
Dislokation/Instabilität
Infektion
Verschleiß
Osteolysen
Große Knochendefekte
Aseptische/Mechanische Lockerung
Artificial Hip Joints:
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
Tribologie  ist die Wissenschaft und Technik von aufeinander einwirkenden Oberflächen in Relativbewegung. Sie umfasst das Gesamtgebiet von  Reibung und Verschleiß , einschließlich  Schmierung , und schließt entsprechende Grenzflächenwechselwirkungen sowohl zwischen Festkörpern als auch zwischen Festkörpern und Flüssigkeiten oder Gasen ein.  - Tribologie -
BIOLOGIE - Tribologie -
Simulator testing: MTS Wear Studies: Methodology
Comparison of Wear Rates - Tribologie -
insgesamt betrachtet versagten die  Metall-Metall Prothesen der 1. Generation  WARUM? Material, Design, Verankerung, Herstellungs- und Implantationsprobleme -Tribologie am Beispiel Metall-Metall
- Tribologie -
Schmierung ist die Hypothese
Durchmesser Oberflächenrauhigkeit Legierung Rundheit Spiel (Passung) = λ Schmierfilmdicke  Oberflächenrauhigkeit  -MoM - Effective Schmierfilmdicke
“ God made materials but surfaces were the work of the Devil.” Pauli -MoM -
Erhöhung der effektiven Schmierfilmdicke: Geschwindigkeitserhöhung? Nicht moeglich Lastreduzierung?    Nicht moeglich   Viskositätserhöhung?    Nicht moeglich   Verringerung Kontaktspannung?  ->  Geometrie -MoM -
Geometrie Durchmesserhöhung erzeugt: Erhöhung Kontaktfläche  Verringerung Kontaktspannung  Geschwindigkeitserhöhung  -MoM - r T
Geometrie Durchmesserhöhung:  Erhöhung Kontaktfläche   Verringerung Kontaktspannung   Geschwindigkeitserhöhung   Erhöhung Kontaktfläche   Spielverringerung:  -MoM -
MoM der 3. Generation -MoM 3. Generation - ACCIS Finsbury Int. Orthopaedics Bio-surf Wright BHR
- jede Paarung produziert Partikel - jeder Partikel kann Reaktionen erzeugen, Unterschiede: ·  Anzahl ·  Form ·  Material ·  Oberfläche ·  Lokation ·  Toxizität ·  Abbau ·  ….. -Tribologischer Imput -
Abriebpartikel Metall: - ca. 10 6  Metallpartikel / pro Schritt - Nebenwirkungen:   Lmphozytische Reaktion    Hypersensitivität    in ca. 0,05 – 0,5% der Patienten   (Willert / Park / Schmalzried/Jacobs) - Ionenkonzentration Blut / Serum - jede Paarung produziert Partikel - jeder Partikel kann Reaktionen erzeugen
- gross  - rund  - hart - geschmiert - passgenau - perfekt ausgerichtet Für Metall Metall: TAKE HOME
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
WAS tun- für unsere Patienten???
 
 
Survivorship – global results
Australian Orthopaedic Association National Joint Replacement Registry 2006 Report “ Unlike conventional total hips, the younger the resurfacing patient the lower the revision rate”
 
2J 3J
Finite Elemente: Southampton - Andrew New:
Prosthese Knochen Methode Coordinate Systems:
 
CT0501 – Current Study Centre Status Centre Number Investigator Study Site No.  / Approval Status 2 Dr J Sullivan Sydney Adventist Hospital, Australia 19 3 Dr C Waller Randwick Orthosports Clinic, Australia 10 4 Mr M Maheson Llandough Hospital, Wales  0 5 Prof N Pace Ospedali Riuniti di Jesi, Italy Approvals in progress 6 Prof E Masterson Midwestern Regional Orthopaedic Hospital, Ireland Approvals in progress 7 Dr R Verheul Royal Newcastle Hospital, Australia 4 9 Prof A Kurth Universitatsklinik Friedrichscheim, Germany Approvals in progress 10 Prof P Piriou Hôpital Raymond-Poincar é , France   9
 
 
 
Reinigung des Knochenbetts Ohne Pulse-Lavage Mit Pulse-Lavage Breusch, 2000
 
 
Pulse lavage Keine Puls Lavage Breusch, 2000
Aufsammeln unter Vakuum   Vacuum Stop vacuum Vacuum mixing Collection without vacuum vacuum Collection with vacuum Wang et al. Acta Orthop Scand. 1993, 64:143-6 vacuum Collection with vacuum
Gliederung Ziel und Verfahren des Hüftgelenkersatzes Historie Evidenz Versagensmechanismen Tribologie Prothesendesigns Das altersadaptierte Konzept  im LKH Klagenfurt
Ziel der hüftendoprothetischen Versorgung Schmerzlinderung!!! Wiederherstellung von Beweglichkeit und Funktion Problemlösung bis an das Lebensende
Unser  Lebensalter adaptiertes Therapiekonzept LKH Orthopädie: Wir verantworten Bewegung ! EVIDENZ?
Das Team sagt Danke:

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Matthias Honl Fachkonzept

Hinweis der Redaktion

  1. In fact thin film lubrication depends on head diameter, surface finish, surface roundness, clearance and the material itself. The Depuy product will be better than all the competitors in all these...
  2. But there are limitations on this approach. Firstly of all, roughness depends on the manufacturing capabilities, bearing materials, and operating conditions, and may be difficult to control and is not easy to characterize. Secondly, the meaning of Ra is not very precise. Different surface roughness profiles may give the same Ra value.
  3. There are many ways which can be used to increase the lubricant film thickness. For example, to increase the contact area between the two bearing surfaces, which can generally lead to the increase in the lubricant film thickness. This can be achieved through modification of the geometries of the bearing surfaces. It is also possible to increase the elasticity of the bearing surfaces, through considerations of both the materials and the structural supports. It is also possible to alter the loading pattern to increase the squeeze-film action, or to inject an artificial lubricant with high viscosities, but these may not be easy to achieve. So the most widely adopted strategy is to modify the geometries of the bearings surfaces to increase the lubricant film thickness.
  4. There are two main parameters which governing the geometry of the bearing surfaces. The femoral head and the clearance The increase in the femoral head radius can increase the lubricant film thickness, since both the contact area and the sliding speed can be increased. But we should also realize that the sliding distance is also increased, which may not be a problem if the two surfaces are completely separated. The decrease in clearance also increases the contact area and hence lubrication. But we must be careful that the increase in the contact radius does not adversely affect lubrication, for example equatorial contact and blockage of lubricant entry.
  5. There are two main parameters which governing the geometry of the bearing surfaces. The femoral head and the clearance The increase in the femoral head radius can increase the lubricant film thickness, since both the contact area and the sliding speed can be increased. But we should also realize that the sliding distance is also increased, which may not be a problem if the two surfaces are completely separated. The decrease in clearance also increases the contact area and hence lubrication. But we must be careful that the increase in the contact radius does not adversely affect lubrication, for example equatorial contact and blockage of lubricant entry.