Femoral nailing is an attractive option for the treatment of hip fractures. This is a minimally invasive technique only...
Evolution of Hip Prosthesis
Hip prostheses were first developed to treat chronic infections within the hip joint in 1891 using ivory to replace the femoral head. Later designs used glass and stainless steel to replace the femur. The problem with this procedure is that the pelvis side (acetabulum) of the hip joint was left alone, and therefore areas that could be causes arthritic pain were left in place.
It was not until the 1950s that surgeons started replacing the acetabulum as well with a metal cup that articulated with a metal femur prosthesis. With advances in technology the current implants are often ceramic or metal femur prosthesis that articulates with a polyethylene (plastic) cup. In the setting of revision surgery for hip prosthesis or in the setting of trauma to the hip prosthesis, there is associated bone loss. More bone loss requires a larger implant to replace that bone loss.
Eventually the amount of bone loss was significant enough that it resulted in loss of the muscle attachments to the femur. In the 1980s, the proximal femoral replacement (PRF) was created. A PFR is often made of the same material as a standard partial or total hip replacement, however, is much larger in size. It is designed to replace all portions of the femur near the hip joint. This includes the ball portion of the hip joint and the regions where muscles attach.
The reattachment of tendons allows for motion. Additionally, this provides stability to the implant and reduces the risk for postoperative dislocation. This results in a functional hip joint without a patient’s normal bone. A PFR is then cemented into the main shaft of the femur further down the patient’s thigh, creating rigid fixation for the implant. Besides periprosthetic fractures, these implants can also be used in patients with significant bone loss from infections or tumors.
The Stryker Global Modular Replacement System Proximal Femur™ allows the surgeon to recreate the femur part of the hip joint completely with a prosthesis. It has tunnels that allow for the restoration of hip motion with reattachment of the hip flexor, extensor, and abductor muscles, which bring the leg out to the side.
During its assembly, it has the option of building length into the contrast. This allows surgeons to ensure that they have restored a patient’s leg to the correct length. Additionally, it has the option of interfacing a patient’s native acetabulum or with a prosthesis from a total hip replacement.