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Planning for successThe high value hip

Justin Cobb

Chair of Orthopaedics

Imperial College LondonVijay Kannan, Wael Dandachli, Hardik Patel, Peter Darcy

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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

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Resurfacing has a new level of compromise – Best Bone interface

• On head, or neck?

Plan your compromises

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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

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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

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Ct based system

Freeware for training and planning – www.acrobot.co.uk

• Low dose protocol• Segmentation and orientation by radiographer

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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:

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Precise resurfacing

For the high value hip– Navigation

• Should become ‘standard of care’

– Preop planning • Will make it quicker

and safer