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1.
Orthop Traumatol Surg Res ; 109(7): 103684, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37704103

RESUMEN

BACKGROUND: When performing total hip arthroplasty in patients with severe developmental dysplasia, shortening the femur facilitates reduction while also preventing sciatic or crural nerve injury and excessive length of the operated limb. No consensus exists about the optimal type of implant and best internal fixation procedure, two parameters that directly govern the risk of the most common intraoperative and postoperative complications (diaphyseal fractures, dislocation, non-union). To minimise these risks, we developed a technique combining a transverse subtrochanteric shortening osteotomy, a long ovoid-profiled, cementless stem anchored in the metaphysis, and double tension-band wiring for internal fixation. The primary objective of this study was to evaluate the outcomes of this technique with emphasis on (i) complications and femoral implant survival, (ii) clinical outcomes (functional scores and lower-limb length inequality [LLLI]), and time to healing. HYPOTHESIS: Our technique is associated with low rates of intraoperative and postoperative complications. MATERIAL AND METHODS: This single-centre retrospective cohort study included patients who underwent THA with a transverse subtrochanteric shortening osteotomy and fixation using double tension-band wiring to treat severe (Crowe III or IV) developmental hip dysplasia. The femoral implant was a long, ovoid, cementless stem fully coated with hydroxyapatite. We collected the intraoperative and postoperative complications, survival, LLLI, functional scores (Harris Hip Score [HHS] and Forgotten Joint Score [FJS]), patient satisfaction, and radiographic outcomes. RESULTS: The study included 31 hips in 25 patients. Two patients (2/31 hips, 6.5%) were lost to follow-up, leaving 29 hips for the analysis of postoperative outcomes. Mean follow-up was 13.7±4.2 years (range, 5.8-18.3 years). The four intraoperative complications (4/31, 12.9%) consisted fracture of the diaphysis (2/31, 6.5%), fracture of the greater trochanter (1/31, 3.2%), and sciatic nerve injury followed by a full recovery (1/29, 3.4%). The 8 (8/29, 27.5%) postoperative complications consisted of dislocation (2/29, 6.9%), stem subsidence (2/29, 6.9%), and non-union (4/29, 13.8%). Femoral implant survival at last follow-up was 87.1% (95% CI, 76.1-99.7). The mean HHS increased from 39.6±12.0 (range, 14-61) before surgery to 81.7±13.2 (range, 48-100) at last follow-up (p<0.01). The FJS at last follow-up indicated that the joint was forgotten in 14/29 (48.2%) cases and caused only acceptable symptoms in 9/29 (31.0%) of cases. Clinically significant (≥ 1cm) LLLI was present in 8/29 (27.6%) patients postoperatively compared to 19/29 (65.5%) preoperatively. The mean LLLI decreased from 20.8±19.7mm (range, 0-60mm) to 5.0±7.3mm (range, 0-30mm). Mean time to healing was 4.3±2.4 months (range, 2-11 months). CONCLUSION: Regarding these complex procedures, this technique was associated with low rates of intraoperative fractures and early postoperative complications. However, femoral stem survival was shorter than in earlier studies and the non-union rate was high, despite satisfactory functional and clinical outcomes.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación Congénita de la Cadera , Luxaciones Articulares , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/complicaciones , Estudios Retrospectivos , Fémur/cirugía , Complicaciones Posoperatorias/cirugía , Luxaciones Articulares/cirugía , Osteotomía/métodos , Extremidad Inferior/cirugía , Complicaciones Intraoperatorias , Estudios de Seguimiento
2.
Orthop Traumatol Surg Res ; 108(2): 103029, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34343696

RESUMEN

INTRODUCTION: Reconstruction of extensive proximal femoral bone loss is a major challenge during total hip arthroplasty (THA). Proximal femoral replacement (PFR), initially used for bone tumors, is an alternative to allograft-prosthetic composite reconstruction. However, PFRs present a high complication rate, particularly related to dislocation. Moreover, dual mobility cups (DMCs) are effective in preventing dislocation, and no study has yet assessed their association with PFRs. Therefore, the aim of this study was to assess the dislocation and complication rates in THA using PFRs with DMCs. HYPOTHESIS: The use of a DMC decreases the dislocation rate associated with PFRs in nontumoral indications. METHODS: From 2008 to 2017, 66 PFRs associated with a DMC (40 women, mean age=71 years [26-94]) were included in our total joint registry and retrospectively reviewed. The main indications were complex periprosthetic and pertrochanteric fractures (26 THAs, 40%), aseptic loosening (22 THAs, 33%) and periprosthetic joint infections (18 THAs, 27%). A single design of PFR implant was used (Global Modular Replacement System (GMRS), Stryker, Mahwah, NJ, USA) with an uncemented stem in 54 THAs (82%). RESULTS: Eighteen complications (27%) were reported at a mean follow-up of 4.6 years [2-10]: 5 dislocations (7.5%), 9 periprosthetic joint infections (13.6%), 2 aseptic loosening (3%) and 2 femur fractures (3%). Overall survivorship at 5 years was 72% (95% CI: 58-82). Survivorship free from dislocation was 94% (95% CI: 85-98) at 1 year. The mean Harris Hip Score was 70±16.4 [26-100] at latest follow-up. CONCLUSION: The use of DMCs limits the risk of PFR dislocation, in comparison to other series in the literature that used large femoral heads, without compromising implant survivorship. In addition, DMCs make it possible to overcome the potential risks of mechanical failure associated with constrained acetabular components. LEVEL OF EVIDENCE: IV; retrospective cohort.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación de la Cadera , Prótesis de Cadera , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Fémur/cirugía , Luxación de la Cadera/etiología , Luxación de la Cadera/prevención & control , Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Diseño de Prótesis , Falla de Prótesis , Reoperación/efectos adversos , Estudios Retrospectivos
4.
Clin Orthop Relat Res ; 478(2): 279-287, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31794492

RESUMEN

BACKGROUND: Intraprosthetic dislocation is a specific complication of dual mobility cups, although it occurs less frequently with the latest generations of implants. Intraprosthetic dislocation is related to long-term polyethylene wear of the mobile component chamfer and retentive area, leading to a snap-out of the femoral head. With the increased use of dual mobility cups, even in younger and active patients, the management of intraprosthetic dislocation should be defined according to its type. However, no previous studies, except for case reports, have described the strategy to manage long-term wear-related intraprosthetic dislocation, particularly when a dual mobility cup is not loose. QUESTIONS/PURPOSES: This study aimed to (1) determine the prevalence of intraprosthetic dislocation in this patient population and the macroscopic findings at the time of surgical revision and (2) evaluate whether isolated mobile component exchange could be an option to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. METHODS: From January 1991 to December 2009, a continuous series of 5274 THAs with dual mobility cups (4546 patients; 2773 women; mean [range] age 58 years [22-87]; bilateral THA = 728) were prospectively enrolled in our institutional total joint registry. A cementless, hemispherical dual mobility cup was systematically implanted, regardless of the patient's age or indication for THA. At the latest follow-up examination, the registry was queried to isolate each occurrence of intraprosthetic dislocation, which was retrospectively analyzed regarding the patient's demographics, indication for THA, radiographs, intraoperative findings (polyethylene wear and lesion patterns on the mobile component, periarticular metallosis, and implant damage because of intraprosthetic impingement of the femoral neck), management of intraprosthetic dislocation (isolated exchange of the mobile component or revision of the dual mobility cup), and outcome. RESULTS: At a mean (range) follow-up duration of 14 years (3-26), 3% of intraprosthetic dislocations (169 of 5274) were reported, with a mean (range) time from THA of 18 years (13-22). Intraprosthetic dislocation occurred predominantly in younger men (mean [range] age at THA, 42 years [22-64] versus 61 years [46-87]; p < 0.001, and sex ratio (male to female, 1:32 [96 male and 73 female] versus 0.62 [1677 male and 2700 female]; p < 0.001) in patients with intraprosthetic dislocation and those without, respectively, but was not influenced by the indication for THA (105 patients with intraprosthetic dislocation who underwent THA for primary hip osteoarthritis and 64 with other diagnoses versus 3146 patients without who underwent THA for primary hip osteoarthritis and 1959 for other diagnoses (p = 0.9)). In all patients with intraprosthetic dislocation, a macroscopic analysis of the explanted mobile component revealed circumferential polyethylene wear and damage to the chamfer and retentive area, with subsequent loss of retaining power for the femoral head. Nine percent of intraprosthetic dislocations (16 of 169 patients with intraprosthetic dislocations) were associated with aseptic loosening of the dual mobility cup and were managed with acetabular revision without recurrence at a mean (range) follow-up duration of 7.5 years (5-11). Ninety-one percent of intraprosthetic dislocations (153 of 169) were pure, related to wear of the mobile component chamfer and retentive area without aseptic loosening of the dual mobility cup, and managed with isolated mobile component exchange. Intraprosthetic dislocation recurred in 6% (nine of 153) at a mean (range) follow-up interval of 3 years (2-4.5). Additionally, severe premature polyethylene wear of the mobile component with loosening of the dual mobility cup occurred in 12% of patients (19 of 153) at a mean (range) follow-up duration of 1.5 years (0.5-3). CONCLUSIONS: A failure rate of 18% (28 of 153 patients undergoing isolated mobile component exchange) was reported within 5 years after isolated mobile component exchange to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. The two modes of failure were early recurrence of intraprosthetic dislocation or severe premature metallosis-related polyethylene wear of the mobile component with loosening of the dual mobility cup. Acetabular revision with synovectomy should remain the standard procedure to manage intraprosthetic dislocation, particularly if periarticular metallosis is present. The exception is intraprosthetic dislocation occurring in elderly or frail patients, for whom a conventional acetabular revision procedure would be associated with an unjustified surgical or anesthetic risk. LEVEL OF EVIDENCE: Level II, prognostic study.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Luxación de la Cadera/cirugía , Articulación de la Cadera/cirugía , Prótesis de Cadera , Falla de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/etiología , Luxación de la Cadera/fisiopatología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Sistema de Registros , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
5.
Ann Transl Med ; 7(5): 92, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31019942

RESUMEN

BACKGROUND: Modular stems have been widely studied as they allow intraoperative adjustments (offset, anteversion, limb length) to better restore hip biomechanics. Many authors reported outcomes of revision total hip arthroplasty (THA) using modular stems with metaphyseal-diaphyseal junctions, however, little is known about modular neck femoral stems (MNFS) with metaphyseal-epiphyseal junctions. We therefore aimed to report outcomes and implant survival of a MNFS in a consecutive series of revision THA at a minimum follow-up of 5 years. METHODS: We reviewed a consecutive series of 28 revision THAs performed between February 2010 and March 2012 using an uncemented MNFS. The final study cohort included 25 patients living with their original components, at a mean follow-up of 68.4±7.4 months and aged 67.7±11.6 years at index operation. RESULTS: The Harris Hip Score (HHS) improved from 39.1±19.2 pre-operatively to 78.1±18.3 post-operatively, and the Postel Merle d'Aubigné score (PMA) improved from 9.8±3.0 pre-operatively to 14.8±2.8 post-operatively. The postoperative limb length discrepancy (LLD) was >10 mm in 18% of the hips. There were no significant differences of femoral offset and neck shaft angle (NSA) between operated and contralateral hips. Two hips (8.0%) showed new periprosthetic radiolucent lines. Periprosthetic fractures (PPF) occurred in 3 hips (12%). No subluxations, dislocations or implant breakages were reported. One revision (3.6%) was performed with retrieval of the revision stem for infection. The Kaplan-Meier (KM) survival at 5 years, using stem revision as endpoint, was 96.0%. CONCLUSIONS: The Optimal® MNFS provided a satisfactory survival and clinical outcomes at 5 years, with no noticeable adverse effects resulting from the additional modular junction.

6.
Orthop Traumatol Surg Res ; 104(7): 1069-1072, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30114514

RESUMEN

Tricortical cortico-cancellous bone allografts from the anterior iliac crest are routinely used in revision arthroplasty and to treat non-union. Trans-iliac herniation (TIH) has been reported as an exceptional complication after extensive graft harvesting. The various reconstruction techniques include isolated parietal reconstruction and combined parietal and bone reconstruction using allografts or a spacer to reconstruct the bone defect. No previous study has evaluated a combined reconstruction technique involving both bone reconstruction with a titanium plate and abdominal wall reconstruction with a parietal reinforcement prosthesis. This technical note describes the evaluation of an original combined reconstruction technique used after failure of isolated parietal reconstruction to treat TIH. Through a direct approach to the anterior iliac crest, the bone defect was repaired using a flexible titanium cranio-facial reconstruction plate and the abdominal wall defect using a polypropylene/poliglecaprone parietal reinforcement prosthesis. This original technique was demonstrated to be effective for treating TIH, with no recurrence after 2.5 years of follow-up. In addition, this technique involves no added morbidity related, for instance, to allograft using or spacer migration.


Asunto(s)
Pared Abdominal/cirugía , Herniorrafia/métodos , Ilion/cirugía , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Placas Óseas , Trasplante Óseo , Hernia/etiología , Herniorrafia/instrumentación , Humanos , Ilion/trasplante , Persona de Mediana Edad , Prótesis e Implantes
7.
J Arthroplasty ; 33(8): 2546-2555, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29656965

RESUMEN

BACKGROUND: Periacetabular metastatic disease requires complex acetabular reconstruction. The complication rate for these frail patients is high. Various cement-rebar reinforced techniques allowing cemented total hip arthroplasty (THA) have been described. The optimal procedure has not yet been identified. METHODS: A continuous series of 131 THAs performed in 126 patients with periacetabular metastatic disease was prospectively included in this study. After bone metastasis curettage and cementation, an original technique of acetabular reconstruction was performed using a dual mobility cup cemented into an acetabular reinforcement device (ie, Kerboull cross-plate or Burch-Schneider antiprotrusio cage) according to the Harrington classification. Functional outcome for independent ambulation in the community, pain relief, and occurrence of dislocation or mechanical failure of the acetabular reconstruction were assessed. RESULTS: At a mean follow-up of 33 ± 17 months, the improvement in the preoperative to postoperative functional outcome and pain relief was significant (P < .001). The dislocation rate was 2%. Two of the 3 cases of dislocation occurred in acetabular reconstructions associated with a proximal femoral arthroplasty. No mechanical failure or aseptic loosening of the acetabular reconstruction was observed. CONCLUSION: This study emphasized that our original technique combining bone metastasis curettage and cementation, acetabular reinforcement device and cemented dual mobility cup was effective to restore a painless functional independence and ensure a durable acetabular reconstruction able to face to adjuvant radiation therapy and mechanical solicitations for long survivors. In addition, dual mobility cup limited the risk of dislocation in patients undergoing THA for periacetabular metastatic disease.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Neoplasias Óseas/cirugía , Carcinoma/cirugía , Recuperación de la Función , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Cementos para Huesos , Neoplasias Óseas/secundario , Placas Óseas , Carcinoma/secundario , Cementación , Femenino , Prótesis de Cadera , Humanos , Luxaciones Articulares/etiología , Masculino , Persona de Mediana Edad , Dolor/cirugía , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Rango del Movimiento Articular
8.
Int Orthop ; 42(10): 2329-2334, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29468265

RESUMEN

PURPOSE: Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study. Therefore, this anatomic study aimed to evaluate the relationship between the intra- and extramedullary PF parameters using tridimensional CT scan reconstructions. METHODS: One hundred fifty-one CT scans of adult healthy hips were obtained from 151 male Caucasian patients (mean age = 66 ± 11 years) undergoing lower limb CT scan arteriography. Tridimensional PF reconstructions and parameter measurements were performed using a corrected PF coronal plane-defined by the femoral neck and diaphyseal canal longitudinal axes-to avoid influence of PF helitorsion and femoral neck version on extramedullary PF parameters. RESULTS: Independently of the femoral neck-shaft angle, the PFMV was significantly and positively correlated with the FO, FNL, and FHH (r = 0.407 to 0.420; p < 0.0001). CONCLUSION: This study emphasized that the tridimensional PF geometry measurement in the corrected coronal plane of the femoral neck can be useful to determine and optimize the design of a non-modular cementless femoral stem. Particularly, continuous homothetic size progression of the intra- and extramedullary PF parameters should be achieved to assure stem fixation and restore anatomic hip biomechanics.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Fémur/diagnóstico por imagen , Prótesis de Cadera/estadística & datos numéricos , Imagenología Tridimensional/métodos , Diseño de Prótesis/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Fémur/cirugía , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
Int Orthop ; 42(5): 1051-1060, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-28889222

RESUMEN

PURPOSE: The decision to resurface the patella during total knee arthroplasty (TKA) remains controversial. This prospective cohort study aimed to evaluate the outcome and survivorship of the native patella in computer-assisted TKA (CAS TKA) implanted for primary knee osteoarthritis, and to determine the predictive factors of secondary patellar resurfacing (SPR). METHODS: A prospective cohort of 273 cementless ultra-congruent mobile-bearing CAS TKA implanted without patellar resurfacing was included in our total joint registry. Patients were evaluated with the International Knee Society (IKS) and Hospital for Special Surgery Patellar (HSSP) scores. Radiographic evaluation was focused on the patellofemoral (PF) compartment to assess: the patellar dysplasia (Wiberg classification), PF osteoarthritis (Iwano classification), femoral trochlear dysplasia (femoral sulcus angle), patellar maltracking (patellar tilt and lateralization), and patella height (Blackburne-Peel ratio). RESULTS: At a six-year median follow-up, the CAS TKA survivorship using SPR as end-point was 95% (range, 91-99%). The IKS and HSSP improved significantly after SPR (p = 0.001 and 0.004, respectively). No significant difference in the IKS and HSSP was detected between TKA with native patella and SPR-TKA at latest follow-up. Importantly, four pre-operative radiographic PF parameters were significantly associated with SPR: higher stages of patellar dysplasia and PF osteoarthritis, and higher sulcus angle and patellar lateralization (hazard ratios = 5.1 to 11.6, p = 0.009 to 0.04). CONCLUSION: When preserving the native patella, surgeons should be aware of pre-operative PF radiographic parameters that could influence the outcome and survivorship of CAS TKA leading to SPR. Particularly, evidence of PF dysplasia, osteoarthritis and maltracking should be determined pre-operatively to resurface the patella at the time of TKA. LEVEL OF EVIDENCE: Therapeutic Level II (prospective cohort study).


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Rótula/cirugía , Cirugía Asistida por Computador/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Cirugía Asistida por Computador/efectos adversos , Análisis de Supervivencia , Supervivencia , Resultado del Tratamiento
10.
J Exp Orthop ; 4(1): 32, 2017 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-28975538

RESUMEN

BACKGROUND: Even if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks. METHODS: Computed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size). RESULTS: Univariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance. CONCLUSION: We found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted ('standard' or 'varus') and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for 'varus' stem models than for 'standard' stem models.

11.
Int Orthop ; 41(3): 507-512, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27837329

RESUMEN

PURPOSE: Dual mobility cup (DMC) consists of a cobalt-chromium (CoCr) alloy cup articulated with a polyethylene (PE) mobile component capturing the femoral head in force using a snap-fit technique. This biomechanical study was the first to evaluate and compare the generation of cracks in the retentive area of DMC mobile components made of highly crosslinked PE (XLPE) or conventional ultra-high molecular weight PE (UHMWPE). METHODS: Eighty mobile components designed for a 52-mm diameter Symbol® DMC (Dedienne Santé, Mauguio, France) and a 28-mm diameter femoral head were analyzed. Four groups of 20 mobile components were constituted according to the PE material: raw UHMWPE, sterilized UHMWPE, annealed XLPE and remelted XLPE. Ten mobile components in each group were impacted with a 28-mm diameter CoCr femoral head using a snap-fit technique. The occurrence, location and area of the cracks in the retentive area were investigated using micro-CT (Skyscan 1176®, Bruker, Aarsellar, Belgium) with a 35 µm nominal isotropic voxel size by two observers blinded to the PE material and impaction or not of the mobile components. RESULTS: Compared to conventional UHMWPE, the femoral head snap-fit did not generate more or wider cracks in the retentive area of annealed or remelted XLPE mobile components. CONCLUSION: This biomechanical study suggests that XLPE in DMC could be a safe alternative to conventional UHMWPE regarding the generation of cracks in the retentive area related to the femoral head snap-fit.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Polietilenos/uso terapéutico , Diseño de Prótesis , Fenómenos Biomecánicos , Cabeza Femoral/cirugía , Humanos , Ensayo de Materiales , Polietilenos/efectos adversos , Falla de Prótesis , Factores de Tiempo
12.
Knee Surg Sports Traumatol Arthrosc ; 24(11): 3448-3456, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27056689

RESUMEN

PURPOSE: Computer-assisted surgery (CAS) has been proposed to improve the performance of total knee arthroplasty (TKA) by reducing implant mal-position and mechanical axis mal-alignment. However, no clinical study has been performed to evaluate whether CAS improves survivorship of cementless TKA at long-term follow-up. This prospective and comparative study evaluated the outcome and survivorship of a cementless rotating mobile-bearing TKA performed with or without CAS at a minimum 10-year follow-up. METHODS: A continuous series of 138 TKA (SCORE®, Amplitude, Valence, France) comparing 87 CAS TKA versus 51 conventional mechanical technique (MECA) TKA was prospectively included in our total joint registry. RESULTS: At 10.5 years after implantation, 95 TKA (59 CAS and 36 MECA TKA) were evaluated. No significant difference was detected in the clinical outcome and mechanical axis between the two groups. The overall 10-year survivorship using revision for any reason as end-point was 91 ± 5 % without significant difference detected between the two groups [86 ± 10 % in the MECA group and 94 ± 5 % in the CAS group (n.s.)]. Using aseptic loosening as end-point, the 10-year survivorship was 100 % in both groups. Using secondary patellar resurfacing as end-point, the 10-year survivorship was significantly higher in the CAS than in MECA group (100 and 85 ± 15 %, respectively; p = 0.0039). CONCLUSION: With no implant aseptic loosening or mechanical failure at 10.5 years after implantation, the cementless rotating mobile-bearing SCORE® TKA demonstrated favourable survivorship without influence of CAS. However, CAS might influence TKA survivorship by limiting secondary patellar resurfacing. LEVEL OF EVIDENCE: Therapeutic, Level II.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Cirugía Asistida por Computador , Tasa de Supervivencia , Anciano , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Rótula/cirugía , Estudios Prospectivos , Sistema de Registros , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento
13.
J Arthroplasty ; 30(4): 631-40, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25443363

RESUMEN

UNLABELLED: The outcome of a single design of dual mobility cup was prospectively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation (IPD). At a 7.3-year mean follow-up, the dislocation rate was 1.5% and the IPD rate was 0.2%. The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer. Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors. In addition, IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio. LEVEL OF EVIDENCE: Therapeutic study-Level IV.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Luxación de la Cadera/prevención & control , Prótesis de Cadera , Reoperación/métodos , Acetábulo/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Luxación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Polietileno , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Rango del Movimiento Articular , Factores de Tiempo , Resultado del Tratamiento
14.
J Arthroplasty ; 29(2): 432-7, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23849510

RESUMEN

The current study aimed to evaluate the outcome of a continuous and prospective series of 61 revision THAs with AAOS grade III and IV acetabular bone defect reconstruction using a Kerboull cross-plate, structural allograft and cemented dual mobility cup (Saturne, Amplitude, Valence, France). At a 7.5-year mean follow-up, no instability was reported after revision. In addition, no failure of the acetabular reconstruction was observed in 98% of the patients with complete allograft osseointegration and no evidence of mechanical rupture of the Kerboull cross-plate and/or loosening of the cemented dual mobility cup. In conclusion, such reconstruction technique demonstrated excellent results at mid-term follow-up in terms of prevention of instability after revision, restoration of the acetabular bone stock, and stable cemented fixation of the dual mobility cup.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Trasplante Óseo , Prótesis de Cadera , Inestabilidad de la Articulación/prevención & control , Anciano , Aloinjertos , Placas Óseas , Cementación , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis/etiología , Reoperación
15.
J Arthroplasty ; 27(6): 1008-13, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22425297

RESUMEN

The aim of the study was to analyze the incidence of squeaking with ceramic-on-ceramic total hip arthroplasty (THA) after 10 years of follow-up and the potential complications that could occur related to this phenomenon. One hundred THAs implanted between November 1999 and December 2000 were evaluated. Incidence of squeaking was investigated clinically with a questionnaire. Implant positioning was analyzed on x-rays and computer tomography. Of the 100 THAs, 5 patients presented with squeaking. All of them were active, sporty, and heavy men. Functional scores were comparable with nonsqueaking patients. There was no malpositioning on the x-ray analysis, no wear, and no loosening. We could not demonstrate any relation between squeaking and ceramic fracture. Squeaking noise appeared at a mean of 66 months postsurgery. It appears to be an isolated phenomenon without any consequences at 10-year follow-up.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Cerámica , Articulación de la Cadera/cirugía , Prótesis de Cadera , Ruido , Osteoartritis de la Cadera/cirugía , Adulto , Desviación Ósea/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Falla de Prótesis , Estudios Retrospectivos , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
16.
Int Orthop ; 35(11): 1599-604, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21174208

RESUMEN

The aim of this study was to evaluate the first 100 cementless ceramic-on-ceramic total hip arthroplasty (THA) performed at our institution with more than nine years of follow-up. Clinical evaluation was performed using Harris hip score. Radiological evaluation was performed by two surgeons. Four patients were lost to follow-up. Harris hip score significantly improved at latest follow-up. Radiological analysis showed calcar osteolysis for 75 patients and one cup loosening. One patient required a revision five years postoperatively for cup loosening. Based on these results and the routine use of a navigation system to optimise positioning of the implants, we advocate the use of uncemented hydroxyapatite coated ceramic-on-ceramic THA in young and active patients in our current practice.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Cerámica , Prótesis de Cadera , Diseño de Prótesis , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Materiales Biocompatibles , Cementación/métodos , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Estado de Salud , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Falla de Prótesis , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto Joven
17.
Int Orthop ; 34(8): 1103-9, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19669762

RESUMEN

Paget's disease of bone (PDB) is a localised chronic osteopathy leading to bone deformities, bone hypervascularity, structural weakness and altered joint biomechanics. The pelvis and upper femur are frequently involved, resulting in disabling hip disease, and total hip arthroplasty (THA) may be required. We performed a retrospective study on the management and the outcome of 39 uncemented hydroxyapatite fully-coated THA in patients with PDB of the hip. The follow-up averaged 79.4 months (range 24-194). Functional scores improved significantly and, using the Harris hip score, 84% of patients had an excellent clinical outcome at the latest follow-up. Despite one case of an uncemented acetabular component with probable loosening, no implant revision had been required at our latest follow-up. Signs of implant loosening were found to be significantly more frequent in patients with active disease. For this reason, we advocate the use of pre-operative medication with bisphosphonates to reduce disease activity. Another benefit of this treatment is the significant decrease of intra-operative blood loss. Provided the control of disease activity in the pre-operative period with bisphosphonates is achieved, good outcome of cementless THAs can be expected. Bisphosphonates reduced the risk of implant loosening and excessive intra-operative blood loss.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Articulación de la Cadera/cirugía , Osteítis Deformante/cirugía , Complicaciones Posoperatorias , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/rehabilitación , Conservadores de la Densidad Ósea/uso terapéutico , Cementación , Difosfonatos/uso terapéutico , Durapatita , Femenino , Indicadores de Salud , Articulación de la Cadera/fisiopatología , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Falla de Prótesis/efectos de los fármacos , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento
18.
Clin Orthop Relat Res ; 467(2): 465-72, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18780135

RESUMEN

UNLABELLED: Unconstrained tripolar hip implants provide an additional bearing using a mobile polyethylene component between the prosthetic head and the outer metal shell. Such a design increases the effective head diameter and therefore is an attractive option in challenging situations of unstable total hip arthroplasties. We report our experience with 54 patients treated using this dual mobility implant in such situations. We ascertained its ability to restore and maintain stability, and examined component loosening and component failure. At a minimum followup of 2.2 years (mean, 4 years; range, 2.2-6.8 years), one hip had redislocated 2 months postoperatively and was managed successfully without reoperation by closed reduction with no additional dislocation. Two patients required revision of the implant because of dislocation at the inner bearing. Technical errors were responsible for these failures. Three patients had reoperations for deep infections. The postoperative radiographs at latest followup showed very satisfactory osseointegration of the acetabular component because no radiolucent line or osteolysis was reported. Use of this unconstrained tripolar design was successful in restoring and maintaining hip stability. We observed encouraging results at short-term followup regarding potential for loosening or mechanical failures. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Asunto(s)
Prótesis de Cadera , Diseño de Prótesis , Artroplastia de Reemplazo de Cadera , Articulación de la Cadera , Humanos , Inestabilidad de la Articulación/prevención & control , Osteoartritis de la Cadera/cirugía , Reoperación , Estudios Retrospectivos
19.
J Arthroplasty ; 22(6): 849-58, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17826276

RESUMEN

We performed a retrospective study on 167 primary total hip arthroplasty (THA) procedures in 163 patients at high risk for instability to assess the reliability of unconstrained tripolar implants (press-fit outer metal shell articulating a bipolar polyethylene component) in preventing dislocations. Eighty-four percent of the patients had at least 2 risk factors for dislocation. The mean follow-up length was 40.2 months. No dislocation was observed. Harris hip scores improved significantly. Six hips were revised, and no aseptic loosening of the cup was observed. The tripolar implant was extremely successful in achieving stability. However, because of the current lack of data documenting polyethylene wear at additional bearing, the routine use of tripolar implants in primary THA is discouraged and should be considered at the present time only for selected patients at high risk for dislocation and with limited activities.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis e Implantes , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Luxación de la Cadera/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Falla de Prótesis , Estudios Retrospectivos , Factores de Riesgo
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