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Hip, knee, ankle, elbow and shoulder anatomy and joint replacement procedures Quick links, go to: • Hips > • Knees > • Ankles > • Elbows > • Shoulders >

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HIPS Hip anatomy There are two main bones relevant in hip replacement procedures:

• Femur – top of leg (ball) • Acetabulum – part of the pelvis

(socket) NJR Hip replacement procedures:

• Primary Total Prosthetic Replacement using cement • Primary Total Prosthetic Replacement not using cement • Primary Total Prosthetic Replacement not elsewhere classified (eg hybrid) • Primary Resurfacing Arthroplasty of joint • Conversion of Hemi Arthroplasty to Primary Total Hip Replacement • Conversion of Hemi Arthroplasty to Primary Total Hip Replacement

Retaining Femoral Stem Primary Total Prosthetic Replacement Primary total prosthetic replacement procedures require both the acetabulum and femoral sides of the joint to be replaced.

• A cemented procedure is where the femoral stem and acetabular cup or shell requires cement

• A cementless procedure is where the femoral stem and acetabular cup or shell do not use cement

• A hybrid procedure is where the femoral stem OR the acetabular cup or shell use cement

A primary total prosthetic procedure must have 1 of the acetabular options and one of the femoral options

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Acetabular components options for Total Prosthetic Replacements

Monobloc cup Shell and liner Resurfacing shell

Femoral component options for Total Prosthetic Replacements

Monobloc stem Modular stem with modular

head

Proximal and Distal stem

with modular head

Modular stem with modular

neck with modular head

Proximal

Distal

Modular Neck

Modular neck stem

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Resurfacing procedure This type of procedure uses a resurfacing shell and a resurfacing head. No femoral stem is used. The patient’s femoral head is trimmed and the thin resurfacing head forms a cover over the femoral head.

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Conversion of Hemi arthroplasty to Primary Total Hip Replacement A patient may already have a hemiarthroplasty performed. This is where the femoral side only had been replaced. The patient will have a femoral stem and head already implanted. A Primary total hip replacement is the first procedure where both femoral and acetabular sides are replaced. A hemiarthroplasty may be converted to a primary total hip replacement in 2 ways a) where the existing femoral stem remains b) where the existing femoral stem is replaced. In addition, acetabular implants are also used. Initial Hemi Arthroplasty

Conversion to THR retaining femoral stem

Conversion to THR replacing femoral stem

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KNEES Knee anatomy The femur (bone above the knee) and the tibia (bobe below the knee) form the knee joint. A meniscus separates the two bones.

NJR Knee replacement procedures There are 2 distinct types of knee replacement procedures

• Primary Total Prosthetic Replacement (using cement, not using cement, or hybrid)

• Unicompartmental Knee Replacement (Medial, Lateral, Patello-Femoral)

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Primary Total Prosthetic Replacement (using cement, not using cement, or hybrid) This procedure has both condyles on the femur replaced. It is the articulating surface on the femur – tibia that is replaced. The patella may or may not be replaced.

Unicompartmental Knee Replacement There are 3 compartments (medial, lateral, patellofemoral) that can be replaced, either individually or in combination. Medial, Lateral compartments The articulating surface on the femur – tibia is replaced. The lateral is the outside of the knee and the medial condyle is the inside of the knee.

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Patello-Femoral compartment A patello-femoral replacement is where an implant is used to replace the patello-femoral groove and also the patella. The articulating surface that is replaced is therefore between the femur and the patella.

Multiple combinations of compartment replacement are possible. Below are two examples, other combinations are patello-femoral and medial and also all 3 may be replaced.

Medial and lateral compartments

Patella-femoral and lateral compartments

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ANKLES Ankle Anatomy The ankle joint consists of the tibia articulating with the talus. NJR Ankle Relacement procedures A Total Prosthetic replacment procedure may be cemented, cementless or hybrid and comprisies of the tibial and talar articular surfaces being replaced.

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ELBOWS Elbow Anatomy Three main bones make up the elbow:

• Humeral - upper arm • Radius - outside of forearm • Ulna - inside of forearm

This diagram below shows a right arm – Ulna is on the inside of the joint.

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NJR Elbow replacement procedures

• Primary Total Prosthetic Replacement • Primary Radial Head Replacement • Lateral Resurfacing • Distal Humeral Hemi Arthroplasty

Primary Total Prosthetic Replacement Primary total prosthetic replacement includes replacement of the Ulnar and Humeral interfaces. Replacement of the radial interface is optional.

Tornier Latitude with radial head being replaced

Biomet Discovery with no radial head replacement

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Primary Radial Head Replacement Radial only (so it is a hemi-arthroplasty).

Lateral Resurfacing Radial and humeral are replaced.

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Distal Humeral Hemi Arthroplasty (DHH) The humeral articulating surface only is replaced, leaving the ulnar and radius intact.

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SHOULDERS Shoulder anatomy There are two main bones relevant for shoulder replacement procedures:

• Humeral – top of upper arm • Glenoid – cup shaped hollow on the

top corner of the shoulder blade NJR Shoulder Replacement Procedures

• Conventional Total Arthroplasty (Stemmed and Stemless) • Total Reverse Arthroplasty (Stemmed and Stemless) • Resurfacing Total Arthroplasty • Resurfacing Hemi-arthroplasty • Hemi-arthroplasty (Stemmed and Stemless) • Interpositional Arthroplasty (Glenohumeral)

Procedure Humeral

Stem Humeral

Components Glenoid

Components Inter-

positional

Stemmed Conventional Total Arthroplasty Stemless Conventional Total Arthroplasty Stemmed Total Reverse Arthroplasty Stemless Total Reverse Arthroplasty Resurfacing Total Arthroplasty Resurfacing Hemi-arthroplasty Stemmed Hemi-arthroplasty Stemless Hemi-arthroplasty Interpositional Arthroplasty (Glenohumeral)

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Stemmed Conventional Total Arthroplasty In a stemmed shoulder replacement there is the humeral stem, humeral head and glenoid components.

Stemless Conventional Total Arthroplasty In this procedure, there is no humeral stem. Humeral heads are attached implants that do not extend to the diaphysis.

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Stemmed Total Reverse Arthroplasty A Reverse shoulder replacement is so called because the ‘head’ is connected to the glenoid cavity where as in normal shoulder replacement the ‘head’ is connected to the humeral stem.

Stemless Total Reverse Arthroplasty In this procedure, there is no humeral stem. Humeral components are attached implants that do not extend to the diaphysis.

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Resurfacing Total Arthroplasty A Humeral resurfacing head and a glenoid component is used.

Resurfacing Hemi-arthroplasty A Humeral resurfacing head component is used.

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Stemmed Hemi-arthroplasty This is where a humeral stem and humeral head is used but NO glenoid component.

Stemless Hemi-arthroplasty The humeral head is replaced but no humeral stem nor glenoid implants.