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25 iv 06 Resurfacing has a new level of compromise –Best Bone interface On head, or neck? Plan your compromises
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25 iv 06
Planning for successThe high value hip
Justin CobbChair of Orthopaedics
Imperial College LondonVijay Kannan, Wael Dandachli, Hardik Patel, Peter Darcy
25 iv 06
Objectives of this talk 1 frames of reference
– acetabular and femoral orientation 2 use them to orientate in
– resurfacing arthroplasty• Precise acetabular position• Precise femoral position
– A matched couple
3 look at impact on learning
25 iv 06
Resurfacing has a new level of compromise – Best Bone interface
• On head, or neck?
Plan your compromises
25 iv 06
Resurfacing has compromises 2– Minimise bone resection
• But plain films are inaccurate• 44 looks too small, will notch neck• 48 looks better, but was too big on table
25 iv 06
Resurfacing has compromises 3 Can’t alter:
• Neck angle and neck anteversion Can alter:
• neck length • head on neck angulation and translation• osteochondroplasty often needed
25 iv 06
Ct based system
Freeware for training and planning – www.acrobot.co.uk
• Low dose protocol• Segmentation and orientation by radiographer
25 iv 06
25 iv 06
25 iv 06
What does it cost? Time:
– 2 minutes of fun preop with your patient– Time neutral in theatre
Effort– Organising the system in your hospital
Money– Ct, processing, navigation:
25 iv 06
Precise resurfacing
For the high value hip– Navigation
• Should become ‘standard of care’
– Preop planning • Will make it quicker
and safer