RU2536111C1 - Method for introducing bone cement into femoral canal in hip replacement with cement fixation of hip component - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used in hip replacement surgeries. That is ensured by preparing a silicone tube of a drain system a distal end of which is cut off perpendicularly to a long axis of the tube so that to leave two perforations. This end of the prepared tube is inserted into the prepared intramedullary femoral canal until it stops against the distal bone plug. The perforations are directed into the intramedullary canal cavity. The tube is placed to its inner or outer wall and retained until removed. After placing, the tube us connected to a surgical suction unit, and bone cement mass is tightly implanted into a proximal portion of the intramedullary canal at the phase of modelling. The surgical suction unit is actuated at pressure with a uniform filling of the canal with bone cement mass. A surgeon states the cement visually in the tube and deactivates the surgical suction unit and removes the tube.

EFFECT: method provides generating the uniform cement blanket with minimum foreign matters in the form of bone fragments, blood and air, as well as enables implanting the femoral components of the cement fixation of various configurations without the use of complex expensive devices for introducing the bone cement.

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Description

The invention relates to the field of medicine, namely to traumatology and orthopedics, and can be used for hip replacement surgery, both primary and revision, for implantation of the femoral components of cement fixation of various designs and the absence of defects in the bone marrow canal of the femur.

The technique of introducing bone cement during hip replacement surgery has undergone a number of changes to date.

Modern cement hip arthroplasty dates back to the 60-70s of the last century, when the “gold standard” of prosthetics was proposed by D. Chamley (4). This technique, known as the first-generation cementing technique, has shown good long-term results from numerous publications, however, despite this, after 20-25 years, about 10% of patients underwent revision interventions for aseptic loosening of implants (3). Numerous studies have led to the development of newer methods of introducing bone cement, we are talking about the cement technique of the second, third and fourth generations (1, 2, 6). However, despite the modernization of the implant design, vacuum mixing of cement, antegrade and retrograde introduction of cement mass and the use of special structures (pistols, injectors) to fill the femoral canal, a radical improvement in the results of implantation of cement legs has not yet been achieved (1).

As a result, the modern technique of introducing bone cement, without improving the results of endoprosthetics, has undergone complication and appreciation due to the implementation of technically complex, multicomponent systems.

The prototype of the proposed original method of introducing cement into the canal of the femur was the method of antegrade injection of bone cement, proposed by the founder of modern arthroplasty D. Charnley. Its essence lies in the antegrade implantation of a liquid cement mass into the molding phase in the bone marrow canal of the femur, which has undergone special training (namely, processing the canal with drills and rasps, removing bone fragments and blood, drying), followed by implantation of the component itself. This method has several disadvantages, the main of which is the choice of the model of the implanted femoral component, since the Chamley technique was originally developed specifically for the model of the prosthesis leg of the same name.

A similar, newer way of introducing bone cement, the so-called second and third generation cementing techniques, having undergone a number of modernizations, namely vacuum mixing of cement and the use of special devices - injectors for retrograde introduction of cement mass into the femoral canal, despite the high technology and cost methods, did not radically improve the results of endoprosthetics in relation to the femoral components of cement fixation (5).

The technical result of the invention consists in creating a uniform cement mantle with a minimum amount of impurities in the form of bone fragments, blood and air and the possibility of implanting the femoral components of cement fixation of various designs without the use of complex expensive devices for introducing bone cement.

The result of the invention is achieved due to the fact that the silicone tube from the standard set of drainage system at the distal end is cut perpendicular to the longitudinal axis of the tube so that there are two perforated holes and this end is inserted into the processed bone marrow canal of the femur until it stops in the installed distal bone tube, then Orienting the perforated holes in the cavity of the medullary canal, the tube is set to its inner or outer wall and held until removed, then connected they are removed with surgical suction, then the mass of bone cement in the sculpting phase is manually hermetically implanted into the proximal part of the bone marrow canal and surgical suction is switched on under pressure, after which the remaining blood, bones come out through a specially prepared silicone tube, as a result, the mass of bone cement evenly fills the channel, and then the surgeon visually determines the appearance of cement in the tube, turns off the surgical suction and removes the tube.

The driving force that fills the bone marrow canal of the femur is the pressure difference created by using a surgical suction, a specially prepared silicone tube and hermetically implanted bone cement into the proximal femoral canal in the molding phase.

The figures depict:

Figure 1 - silicone tube from the drainage system;

Figure 2 - specially prepared tube for performing the method;

Figure 3 - the stage of introduction of the tube to the bone tube, where 1 - the tube is adjacent to the channel wall; 2 - perforated holes are oriented into the channel cavity; 3 - transverse hole;

Figure 4 - the stage of introduction of bone mass into the phase of sculpting in the proximal part of the prepared channel and connecting a surgical suction;

Figure 5 - the stage of filling the femoral canal with bone mass under the influence of the pressure difference;

Figure 6 - uniform distribution of cement in the femoral canal and as an indicator of this is the appearance of cement in the tube;

Figure 7 is a schematic representation of an implanted femoral component of cement fixation after completion of the injection of bone cement into the canal of the femur;

Figure 8 is a radiograph of patient A. after implantation of the femoral component according to the proposed method, where 4 is a uniform cement mantle.

The method is as follows: a silicone tube from a standard set of drainage systems, for example Redon (Fig. 1), with perforations along the distal end, is cut perpendicular to the longitudinal axis of the tube so that it leaves two perforated holes 2 (if you leave one hole, then it can be clogged with bone cement during the process, and if there are three holes, the pressure difference will be insufficient). The latter, after preliminary processing of the bone marrow canal of the femur with drills and rasps, installation of the distal bone plug, mechanical removal of bone fragments and dense tamponade of the canal with napkins impregnated with a 3% hydrogen peroxide solution to dry, is inserted with the distal end into the installed bone plug until it stops (Fig. 3) manually or with any auxiliary tool, for example, a long surgical awl, so that the perforated holes 2 are open in the cavity of the channel, and not fit to the bone walls, and connected to a surgical suction. The tube is installed on the inner or outer wall of the medullary canal 1, depending on the preferences of the surgeon and held until removed, then connected to a surgical suction. The transverse hole 3 (appeared as a result of a cut perpendicular to the longitudinal axis of the tube) does not have tight contact with the bone tube due to the spongy structure of the latter and the natural elasticity of the silicone tube. The mass of bone cement (Figure 4) in the molding phase is hermetically implanted in the proximal part of the bone marrow canal of the femur and the suction (Figure 5) is turned on under pressure, for example, from two to three atmospheres, depending on the power of the surgical suction. The latter under the influence of the emerging pressure difference antegrade spreads along the walls of the medullary canal, forming a uniform homogeneous mantle (Fig.6) with a minimum amount of impurities. In the process of filling the bone marrow canal of the femur, impurities are removed as much as possible through the silicone tube under the influence of the forming vacuum. The surgeon visually determines the appearance of cement in the silicone tube at a visible level, which indicates the passage of this mass to the bottom of the channel and, accordingly, its full filling 4. The suction is turned off. After filling the channel with cement mass, removing the tube and pressing the cement, the standard introduction of the femoral component of the cement fixation endoprosthesis of any design follows (Fig 7).

Clinical example: radiographs of a patient A., 67 years old, admitted to the clinic. R.R. Wreden for surgical treatment in the amount of total hip replacement;

a hybrid fixation endoprosthesis was implanted (the acetabular component is cementless and the femoral component of cement fixation); the implantation of the femoral component was performed using the above-described method of introducing bone cement (Fig. 8), which proved to be effective, inexpensive, and easy to reproduce.

BIBLIOGRAPHY

1. Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. JBone Joint Surg Br. 1992; 74: 385-389.

2. Breusch SJ, Norman TL, Schneider U, Reitzel T, Blaha JD, Lukoschek M. Lavage technique in total hip arthroplasty: jet lavage produces better cement penetration than syringe lavage in the proximal femur. J Arthroplasty. 2000; 15: 921-927.

3. Callaghan JJ, Albright JC, Goets DD, Olejniczak JP, Johnston RS. Chhmley total hip arthroplasty with cement. Minimum twenty-five-year follow-up. J Bone Joint Surg Am. 2000; 82: 487-497.

4. Chamley J. Anchorage of the femoral head prothesis to the shaft of the femur. J Bone Joint Surg Br. 1960; 42: 28-30.

5. Shiro Hirose et al., Outcomes of Chamley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques; J Orthop Sci (2012) 17: 118-123

6. Wixson RL. Vacuum mixing of methylmethacrylate bone cement. Trans Orthop Res Soc. 1985; 10: 327.

Claims (1)

The method of introducing bone cement into the canal of the femur during hip replacement surgery with cement fixation of the femoral component, which consists in antegrade cement injection, characterized in that the silicone tube from the set of drainage system at the distal end is cut perpendicular to the longitudinal axis of the tube so that it remains two perforated holes and injected with this end into the processed bone marrow canal of the femur until it stops in the installed distal bone the tube, then, orienting the perforated holes into the cavity of the bone marrow canal, the tube is installed to its inner or outer wall and held until removed, then it is connected to the surgical suction, then the mass of bone cement is manually implanted into the proximal part of the bone marrow canal into the proximal part of the bone marrow and the surgical suction under pressure, as a result of which residues of blood, bones and bone cement mass evenly fill the channel through the prepared silicone tube, and then the surgeon of the visa determines no occurrence of cement in the tube, disconnects and removes the surgical suction tube.

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