Total Hip replacement: C stem AMT/Elite (Depuy) cemented hip (femur first) surgical technique
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A cemented total hip replacement should be considered in the elderly population. It is forgiving to the ageing skeleton, there is a lower risk of fracture on both the acetabular and femoral bone when compared to uncemented designs. I favour the C-Stem AMT/Elite as it has a modular broaching system. This allows for intra-operative changes in neck size (high offset verses standard) without the need to change the broach. Furthermore, it allows the femur to be prepared first. I find that preparing the femur first speeds up the operation, by decreasing the number of steps required and allowing scrub staff to bring the required stem into the operating room when they go for the acetabular component.
The Elite cup has excellent revision rates on the National Joint Registry of England, Wales and Northern Ireland 2017 at ten years in combination with both the Exeter (Stryker) and C-Stem AMT (Depuy) stems. I favour the C-stem AMT due to its modular neck options. A ceramic head is favoured as it has slightly lower revision rates compared to metal heads in this construct (NJR 2017) and where possible a 32mm head is favoured to reduce dislocation rates (a 43mm Elite cup requires a 28mm head).
Author: Mr Richard Baker MD, MSc, MB.ChB, FRCS (Tr & Orth)
Institution: The Avon Orthopaedic Centre, Bristol, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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