Cemented Hemiarthroplasty

1. Patient in Lateral Position

2. Incision centering the GT around 7 cm above and below
3. Incise fascia lata along the line of incision and extend towards Gluteus
Maximus
4. Incise Gluteus medius along the line superiorly and curve it anteriorly in the
attachment sparing the Vastus lateralis. The posterior to 1/3 of Gluteus
medius is left intact
5. Slowly externally rotate the hip and subperiosteally elevate the anterior
attachment of Gluteus medius and minimus.
6. Incise the capsule along the neck
7. Deliver the NOF and Keep the limb in externally rotated and in Figure of 4
position
8. Cut the neck at 1 cm proximal to LT. Oblique cut
9. Deliver the head using skid or head extractor and measure the head size.
Head size is the size just less to the one where it passes freely
10.Use Box chisel to chisel out the cancellous bone in the GT. Chisel to be
positioned pointing at the direction of neck remnant
11.Use rasp to make path for the prosthesis passing it flush with the lateral
cortex
12.Insert the prosthesis and do a trial reduction.
13.Reduction: Traction till the head is at the level of acetabulum. Hold the
superior labrum with kocher and then internally rotate.
14.Asses the reduction
15.Use a bone hook to redislocate
16.Check for loose fragments inside the acetabulum
17.Insert a bone plug into the canal
18.Mix cement
19.Put a suction canula inside the medullary cavity and connect to suction
device
20.Insert cement when it reaches the desired consistency (doesnt stick to
gloves)
21.Insert the prosthesis and reduce
22.Put drain
23.Repair the Gluteus medius, Fascia lata, Sub cut and skin