design

History

First generation (late 70s early 80s) 

Results

Options

1. Always resurface

2. Never resurface

3. Selectively resurface

Decision Making

Controversial

- literature divided on issue

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

Indications

1.  RC arthropathy / > 70 / low functional demand

2.  Revision TSR

3.  Failed Hemiarthoplasty in proximal humerus fracture

Design

Goal

Initial press fit

- implant geometry fits the cortical bone in the proximal femur

- good initial mechanical stability

Biological fixation for success

- good press fit

- minimal micromotion

- bony or fibrous tissue ingrowth or ongrowth

Goals in femoral cementing

Optimize cement-bone interface

Cement mantle free of defects

Minimum 2 mm thickness

Femoral component centred in cement mantle

Survival

Swedish Joint Registry

Reflection All Poly / Spectron 92% 10 year

Indications

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

Acute unreconstructable fracture > 60