Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum: a minimum five-year follow-up study.

Aims: The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods: We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d'Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results: At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d'Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion: These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725-32.

A randomised controlled trial comparing highly cross-linked and contemporary annealed polyethylene after a minimal eight-year follow-up in total hip arthroplasty using cemented acetabular components.

Most published randomised controlled trials which compare the rates of wear of conventional and cross-linked (XL) polyethylene (PE) in total hip arthroplasty (THA) have described their use with a cementless acetabular component. We conducted a prospective randomised study to assess the rates of penetration of two distinct types of PE in otherwise identical cemented all-PE acetabular components. A total of 100 consecutive patients for THA were randomised to receive an acetabular component which had been either highly XL then remelted or moderately XL then annealed. After a minimum of eight years follow-up, 38 hips in the XL group and 30 hips in the annealed group had complete data (mean follow-up of 9.1 years (7.6 to 10.7) and 8.7 years (7.2 to 10.2), respectively). In the XL group, the steady state rate of penetration from one year onwards was -0.0002 mm/year (sd 0.108): in the annealed group it was 0.1382 mm/year (sd 0.129) (Mann-Whitney U test, p < 0.001). No complication specific to either material was recorded. These results show that the yearly linear rate of femoral head penetration can be significantly reduced by using a highly XLPE cemented acetabular component.

A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomised controlled trial.

In this study we randomised 140 patients who were due to undergo primary total knee arthroplasty (TKA) to have the procedure performed using either patient-specific cutting guides (PSCG) or conventional instrumentation (CI). The primary outcome measure was the mechanical axis, as measured at three months on a standing long-leg radiograph by the hip-knee-ankle (HKA) angle. This was undertaken by an independent observer who was blinded to the instrumentation. Secondary outcome measures were component positioning, operating time, Knee Society and Oxford knee scores, blood loss and length of hospital stay. A total of 126 patients (67 in the CI group and 59 in the PSCG group) had complete clinical and radiological data. There were 88 females and 52 males with a mean age of 69.3 years (47 to 84) and a mean BMI of 28.6 kg/m(2) (20.2 to 40.8). The mean HKA angle was 178.9° (172.5 to 183.4) in the CI group and 178.2° (172.4 to 183.4) in the PSCG group (p = 0.34). Outliers were identified in 22 of 67 knees (32.8%) in the CI group and 19 of 59 knees (32.2%) in the PSCG group (p = 0.99). There was no significant difference in the clinical results (p = 0.95 and 0.59, respectively). Operating time, blood loss and length of hospital stay were not significantly reduced (p = 0.09, 0.58 and 0.50, respectively) when using PSCG. The use of PSCG in primary TKA did not reduce the proportion of outliers as measured by post-operative coronal alignment.

An unreported cause of early postoperative dislocation following total hip revision: massive intra-capsular oedema related to inferior vena cava filter thrombosis.

Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism (PE) in patients with an absolute or relative contraindication for anticoagulants, during the peri-operative period of trauma or total joint replacement. No complication specific to the orthopaedic's aspect of this practice has been described. We report the case of a patient who had major femoral head/cup separation mimicking dislocation following revision total hip arthroplasty related to massive intra-capsular oedema produced by IVC filter thrombosis. The patient could be successfully treated non-operatively. Orthopaedic surgeons should identify and refer patients with a complicated IVC filter, to identify any migration or occlusion, and also be aware that removable filters must not be kept in situ, once the high-risk phase of developing PE is past.

Psychometric properties of the OARSI/OMERACT osteoarthritis pain and functional impairment scales: ICOAP, KOOS-PS and HOOS-PS.

OBJECTIVES: To evaluate the psychometric properties of the OARSI-OMERACT questionnaires in comparison to the existing validated scales. METHODS: Consecutive hip or knee osteoarthritis patients consulting in an orthopedic department were enrolled in the study. Data collected were pain using the Intermittent and Constant Osteoarthritis Pain (ICOAP), a Numeric Rating Scale (NRS), the Western Ontario McMaster Universities' Osteoarthritis Index (WOMAC) pain subscale, the Lequesne pain subscale; functional impairment using the Knee disability and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), the Hip disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS), a NRS, the WOMAC function sub-scale, the Lequesne function subscale. Validity was assessed by calculating the Spearman's correlation coefficient between all the scales. Reliability was assessed in out-patients with stable disease comparing the data collected within 2 weeks using the intra-class correlation coefficient (ICC). Responsiveness was assessed on the data from hospitalised patients prior to and 12 weeks after a total joint replacement (TJR) using the standardised response mean. RESULTS: Three hundred patients (mean age=68 years, females=62%, hip OA=57%) were included. There was a moderate to good correlation between ICOAP, KOOS-PS, HOOS-PS and the WOMAC, NRS and Lequesne scales. Reliability of the ICOAP hip OA HOOS-PS and KOOS-PS was good (ICC range 0.80-0.81) whereas it was moderate for knee ICOAP (ICC=0.65). Responsiveness of the ICOAP, KOOS-PS and HOOS-PS 12 weeks after TJR was comparable to responsiveness of other scales (SRM range: 0.54-1.82). CONCLUSIONS: The psychometric properties of the ICOAP, KOOS-PS and HOOS-PS were comparable to those of the WOMAC, Lequesne and NRS.

Is the so-called 'French paradox' a reality?: long-term survival and migration of the Charnley-Kerboull stem cemented line-to-line.

We have evaluated the in vivo migration patterns of 164 primary consecutive Charnley-Kerboull total hip replacements which were undertaken in 155 patients. The femoral preparation included removal of diaphyseal cancellous bone to obtain primary rotational stability of the stem before line-to-line cementing. We used the Ein Bild Roentgen Analyse femoral component method to assess the subsidence of the femoral component. At a mean of 17.3 years (15.1 to 18.3) 73 patients were still alive and had not been revised, eight had been revised, 66 had died and eight had been lost to follow-up. The mean subsidence of the entire series was 0.63 mm (0.0 to 1.94). When using a 1.5 mm threshold, only four stems were considered to have subsided. Our study showed that, in most cases, a highly polished double-tapered stem cemented line-to-line does not subside at least up to 18 years after implantation.

Comparative ultrasound evaluation of human trabecular bone graft properties after treatment with different sterilization procedures.

New sterilization methods for human bone are likely to affect the mechanical properties of human cancellous grafts. These mechanical properties dictate the short- and mid-term results of the orthopedic procedure. The aim of this study was to compare the effects on bone mechanical properties, as assessed by ultrasound velocity, of different sterilization methods used under similar conditions: bleach and sublimation, humid heat, successive baths of physiological saline with osmotic detersion, and CO(2) in the supercritical phase. Alterations in mechanical properties were small with CO(2) (velocity change: -2%) and humid heat (-2.5%). Osmotic detersion had a significant but moderate effect (-4.7%). The -9% change with the protocol involving bleach suggested a greater than 30% decrease in load to failure, based on earlier studies. Gamma irradiation of defatted trabecular allografts, in a dose of 10 or 25 KGy, produced no significant changes in ultrasound velocity. Powerful protein denaturants used in sterilization protocols substantially alter the mechanical resistance of the grafts, which may jeopardize the orthopedic procedure.

Pain after total hip arthroplasty: a psychiatric point of view.

After total hip arthroplasty (THA), many studies report that a small percentage of patients mention painful symptoms, whose origin remains more or less obscure. We investigated 1,000 patients who had undergone a THA at least one year before their inclusion in the survey protocol. Among these 1,000 patients, 64 were complaining of pain in the region of the operated hip. These were later examined and investigated, both clinically (physical and psychiatric examination) and paraclinically (radiography, biology). Those requiring it received adequate treatment and the others were only regularly followed up. We identified the cause of all but one patient's pain. In all cases except one, the symptoms of pain without physical cause had a psychiatric origin. The results of our study show that, if the clinical picture is not perfectly clear, a psychiatric screening before surgery could contribute to decreasing the incidence of pain syndrome after THA.

[Should monobloc cemented stems be systematically revised during revision total hip arthroplasty? A prospective evaluation]. / Faut-il systématiquement changer une pièce fémorale monobloc cimentée lors d'une reprise d'arthroplastie totale ? Evaluation prospective.

PURPOSE OF THE STUDY: The main reason for revision of Charnley type total hip arthroplasty is socket loosening related to high polyethylene wear and periacetabular osteolysis. In these situations, the monobloc cemented stem is frequently not loosened and it is not clear whether the femoral component can be retained during the revision procedure. The aim of this study was to evaluate surface and sphericity damage to the femoral head of a prospective and consecutive series of revision total hip arthroplasties during which the cemented monobloc femoral component has been systematically revised. MATERIALS AND METHODS: We performed 22 revisions of both components of Charnley type cemented total hip arthroplasties. In all cases, the 22.2 mm head of the monobloc femoral component was made of 316 L stainless steel. The international standard for such femoral heads includes an average surface roughness (Ra) of 0.05 microm, a total roughness (Rt) value of 0.5 microm and a sphericity of +/-5 microm. The mean age of the patients at the time of the index arthroplasty was 51.3 years. The average time to revision was 14.8 years (seven to 25 years). The reasons for revision included isolated socket loosening (12), extensive periacetabular osteolysis without socket loosening (two), recurrent dislocation associated with socket loosening (one), sepsis without implant loosening (one), loosening of both components (one), and isolated loosening of the femoral component (five). Hence, 15 of the 22 (68.2%) femoral components could theoretically have been retained. The surface roughness of the femoral heads was evaluated using a contact-type profilometer. For each head, the apex and two zones, either macroscopically scratched or with loss of the mirror finish, were analyzed. Moreover, the sphericity of the heads was measured using a spherometer. RESULTS: The stem explanted after recurrent dislocation was analyzed separately as the femoral head had major scratches. The mean Ra and Rt of the series at the apex was 0.029 and 0.876 microm, respectively. The mean Ra and Rt of the series for the macroscopically damaged areas was 0.05 microm and 1.540 microm, respectively. The mean sphericity of the series was 7.2 microm. Hence among the 22 explanted stems, 10 femoral heads (45.4%) had Ra or Rt apex and 18 (81.8%) Ra or Rt scratched area values beyond ISO standards, respectively. Sphericity was greater than +/-5mm for 13 of the 22 femoral heads (59.1%). With the numbers available, the age at the time of the index arthroplasty, the BMI, the time and the reason for revision were not significantly associated with the degree of femoral head damage for both roughness and sphericity parameters. DISCUSSION: Retaining the femoral component during revision of the total hip arthroplasty including a monobloc femoral component is theoretically an interesting alternative. However, femoral head surface damage occurring in vivo would have lead us to retain severely scratched heads in over 80% of the hips, and heads with abnormal roughness and sphericity values in over 90% of the hips. Bases upon our results, we recommend systematically revising the femoral component during revision THA including a monobloc stem, irrespective of the reason for revision.

A comparison of the penetration rate of two polyethylene acetabular liners of different levels of cross-linking. A prospective randomised trial.

We carried out a prospective randomised study designed to compare the penetration rate of acetabular polyethylene inserts of identical design but different levels of cross-linking at a minimum of four years follow-up. A total of 102 patients (102 hips) were randomised to receive either highly cross-linked Durasul, or contemporary Sulene polyethylene inserts at total hip replacement. A single blinded observer used the Martell system to assess penetration of the femoral head. At a mean follow-up of 4.9 years (4.2 to 6.1) the mean femoral head penetration rate was 0.025 mm/year (SD 0.128) in the Durasul group compared with 0.106 mm/year (SD 0.109) in the Sulene group (Mann-Whitney test, p = 0.0027). The mean volumetric penetration rate was 29.24 mm(3)/year (SD 44.08) in the Durasul group compared with 53.32 mm(3)/year (SD 48.68) in the Sulene group. The yearly volumetric penetration rate was 55% lower in the Durasul group (Mann-Whitney test, p = 0.0058). Longer term results are needed to investigate whether less osteolysis will occur.

[Surveillance of operative site infections in an orthopedic and traumatology surgery department: an example of methodology]. / Proposition d'un protocole de suivi des infections avérées de site opératoire en chirurgie orthopédique et traumatologique.

PURPOSE OF THE STUDY: A program for the prevention of nosocomial infections, including operative site infections (OSI) is a legal obligation in France. According to the CDC, in orthopedic surgery, nosocomial infection is defined as any infection occurring within 30 days of operation, or within one year in the event of material implantation. No surveillance system has been validated and the rate of OSI is unknown in orthopedic surgery. We report the number of OSI observed during a three year period in our unit and describe the characteristic features. MATERIAL AND METHODS: Data were collected from the bacteriology reports on operative site samples with a positive culture. A group of specialists determined the infective nature of the germ and the nosocomial nature of the OSI. Clinical and bacteriological data were noted on a standard datasheet used for prospective follow-up of the number of cases and data processing. During a three-year period (2000, 2001, 2002), among 9397 orthopedic and traumatology operations performed, 86 OSI were identified. Mean patient age was 58 years and mean body mass index was 25.7. The ASA score was >or=II for 72% of patients. RESULTS: The OSI involved an arthroplasty in 23 cases, a traumatology procedure in 21, and tumor treatment in 24. The diagnosis was established within 30 days of operation for 75% and after discharge from hospital in 65.4%. Single-germ infections predominated (n=59). Staphylococcus aureus was isolated in 80.23% of infections. For tumor surgery, the statistically more frequent multiple-germ infections associated coagulase negative Staphylococcus and Gram-negative bacilli. There were six OSI-related deaths. DISCUSSION: Two criticisms can be formulated concerning our surveillance system. First, infections with no identified germ could be missed. The frequency of such infections has been estimated at 2.8 to 19% by different authors. Although patients are automatically recalled for consultation, we were unable to determine the number of patients lost to follow-up at one year. It was thus not possible to determine a precise rate of OSI. Data in the literature have not demonstrated any system providing an exhaustive surveillance, particularly because of the long postoperative period after material implantation. Excepting tumor surgery, Staphylococcus aureus infections predominated. Factors of risk of OSI include the patient's general status, particularly for arthroplasty. We had a mortality rate of 7% for our OSI, corroborating earlier studies and illustrating the severity of such infections. CONCLUSION: Surveillance of OSI in orthopedic surgery requires the development of a system responding to the problem of a long observation period. It would be important to know the precise number of OSI and their characteristic features in order to develop comparison tools.

Effects of gamma irradiation on mechanical properties of defatted trabecular bone allografts assessed by speed-of-sound measurement.

New sterilization methods for human bone allografts may lead to alterations in bone mechanical properties, which strongly influence short- and medium-term outcomes. In many sterilization procedures, bone allografts are subjected to gamma irradiation, usually with 25 KGy, after treatment and packaging. We used speed-of-sound (SOS) measurements to evaluate the effects of gamma irradiation on bone. All bone specimens were subjected to the same microbial inactivation procedure. They were then separated into three groups, of which one was treated and not irradiated and two were exposed to 10 and 25 KGy of gamma radiation, respectively. SOS was measured using high- and low-frequency ultrasound beams in each orthogonal direction. SOS and Young modulus were altered significantly in the three groups, compared to native untreated bone. Exposure to 10 or 25 KGy had no noticeable effect on the study variables. The impact of irradiation was small compared to the effects of physical or chemical defatting. Reducing the radiation dose used in everyday practice failed to improve graft mechanical properties in this study.

[Electromyographic study of stretch reflexes in the normal and prosthetic hip]. / Etude électromyographique des réflexes d'étirement intervenant au niveau de l'articulation coxo-fémorale normale et prothétique.

PURPOSE OF THE STUDY: Several studies have been devoted to the effect of proprioception on joint function. Modifications in feedback control from the cord have been observed in unstable joints due to capsule and ligament laxity. A few studies have examined the effect of knee and hip arthroplasty on proprioception, but none have established whether stretch reflexes affect function of a prosthetic joint. The purpose of the present study was to demonstrate the electromyographic characteristics of stretch reflexes of the normal hip joint and to compare them with those observed in the prosthetic hip. MATERIAL AND METHODS: Two groups of patients were studied. The first included eleven subjects free of neurological disorders whose studied limb was healthy. The second group included ten subjects with a total hip prosthesis who had undergone extensive capsulectomy during the arthroplasty. Voluntary muscle contraction was noted in each subject. In addition, electromyographic recordings were made to note response of the ipsilateral and contralateral quadriceps crural and tensor of the fascia lata during changes in joint position. Recordings were made with the subject in the supine position, the limb suspended, hip flexed at 45 degrees and knee extended. Three series of ten recordings were made in random order to measure the latency of muscle response to free fall of the limb, accelerated fall of the relaxed limb, and accelerated fall associated with calibrated contraction of the quadriceps. Mean latency of muscle response was calculated for each trial. RESULTS: In the conditions of this study, there was no statistically significant difference (p = 0.05) in the reflex time course between natural and prosthetic hips. DISCUSSION: Changes due to joint replacement and capsulectomy do not appear to affect the stretch reflexes of the hip joint.

[Early femoral osteolysis following Charnley-Kerboull total hip arthroplasty combining a 22-mm zirconia head on polyethylene]. / Ostéolyse fémorale précoce après arthroplastie totale de hanche Charnley-Kerboull a tête zircone 22 sur polyéthylène.

PURPOSE OF THE STUDY: New bearings have been developed to reduce polyethylene wear. Zirconia ceramic is one proposal with attractive tribologic properties. The purpose of this prospective study was to evaluate the clinical and radiological results at least two years after implantation in a continuous series of total hip arthroplasties combining a zirconia head with polyethylene socket. MATERIAL AND METHODS: The series included 56total hip arthroplasties performed in 51 patients (30 females and 21 males), mean age 52.2 +/- 12 years (25-76 years). Prostheses were implanted for primary degenerative disease (43%) and dysplasia (27%). The femoral component was a stainless steel stem with a Morse cone measuring 11degrees 25' for 27 hips and 5 degrees 40' for 28 hips. A 22-mm stabilized yttrium tetragonal polycrystalline zirconia head (Y-TZP) was used. The transtrochanteric approach was used for all arthroplaties with implantation of a cemented Charnley-Kerboull prosthesis. Clinical outcome was assessed with the Postel-Merle-d'Aubligné (PMA) score. Acetabular cup wear and periprosthetic osteolysis were measured on successive AP x-rays of the pelvis. RESULTS: Mean follow-up was 32 months (24-48). None of the patients were lost to follow-up. Mean function score at last follow-up was 17.8 +/- 0.2 (16-18) versus 12.2 +/- 2.6 preoperatively (Wilcoxon, p < 0.0001). There were no cases of implant migration (femoral or acetabular). An endosteal defect by femoral osteolysis in the calcar femoral was observed in 19 of 55 cases. It appeared early between first and second post-operative year and did not progress later. Its surface remained less than 1 cm2 in all cases. We were unable to identify any factor predictive of these osteolytic lesions. DISCUSSION: The short-term clinical results with this type of arthroplasty was comparable with earlier results described with classical Charnely-Kerboull implants using a metal-polyethylene bearing. The Merkel osteolysis observed in this series occurred early for one-third of the hips with no measurable polyethylene wear. We suggest surgeons should be cautious about using the zirconia head. We are continuing our surveillance of these patients.

[Variables influencing bleeding during total hip arthroplasty]. / Variables influençant le saignement lors d'une arthroplastie totale de hanche.

PURPOSE OF THE STUDY: The purpose of this retrospective analysis was to study the parameters having an effect on blood loss during or after total hip arthroplasty. We examined a series of 350 procedures for primary degenerative hip disease with a normal course (n = 100), rapidly destructive degenerative disease (n = 100), and secondary joint degeneration due to atraumatic osteonecrosis of the femoral head (n = 100) or rheumatoid disease (n = 50). MATERIAL AND METHODS: All arthroplasties were performed via the transtrochanteric approach using Charnley-Kerboull implants. The volume of blood loss was calculated by noting compensated blood loss (transfusion during the procedure and shortly thereafter), and estimated non-compensated loss using the Nadler and Mercuriali and Inghilleri formula. We examined the influence of age, gender, obesity, and surgeon experience. Data were analyzed with the Student-Fisher reduced deviation method was used for quantitative and qualitative variables and the coefficient of correlation for quantitative variables. RESULTS: Blood loss, calculated in ml packed red blood cells (hematocrit 100%), was 573 ml for arthroplasties with a normal course, 713 for arthroplasties secondary to osteonecrosis of the femoral head, and 950 ml for rapidly destructive degenerative disease and finally 609 ml for patients with rheumatoid arthritis. Considering 35% as normal for hematocrit, total estimated blood loss was 1,640, 2,040, 2,710, and 1,740 ml respectively in the different groups. Compared with the group of patients who had a normal course, total blood loss was significantly higher when arthroplasty was performed for osteonecrosis and rapidly destructive degenerative disease (p < 0.001). Age, obesity, and duration of the intervention had no effect on blood loss. Female gender and operator experience had a favorable influence in the group of patients who underwent hip surgery for primary degenerative disease. Blood loss occurring during or shortly after total hip arthroplasty was greater in men, when the procedure was performed for osteonecrosis, and most importantly for rapidly destructive diseases. DISCUSSION: In clinical practice, the influence of gender is not significant enough to require specific preoperative transfusion plans. Conversely, certain etiologies of the joint disease impose transfusion in all such patients, using a blood volume which usually exceeds the possibilities of auto-transfusions.

[Prevention of heterotopic ossifications in hip arthroplasty: effectiveness of selective Cox-2 inhibitors (celecoxib) versus ketoprofen]. / Comparaison célécoxib versus kétoprofène pour la prévention des ossifications péri-prothétiques de hanche.

PURPOSE OF THE STUDY: Peri-prosthetic ossifications are a frequent complication of total hip arthroplasty, which, if effective preventive measures are not taken, occur in 60% of patients. Numerous classic antiinflammatory agents have shown their preventive efficacy. New selective Cox-2 inhibitors offer the possibility of reducing the adverse effects of antiinflammatory drugs but remain to be proven effective in this indication. The purpose of this pilot study was to compare the efficacy of celecoxib versus ketoprofen. MATERIAL AND METHODS: In order to obtain sufficient statistical power to have a 70% chance of detecting a 25% difference between the two treatments with a 5% risk of error, we evaluated the incidence of peri-prosthetic ossifications of the hip in a prospective monocentric series of 52 patients receiving 400 mg celecoxib a day during a week. It was compared with the incidence in a control series of 52 matched patients (same age, gender, diagnosis, operator experience) given 200 mg ketoprofen iv for 48 hr then 300 mg po for 5 days as preventive treatment. Ossifications were studied on the plain AP view of the pelvis at a mean follow-up of more than 11 months (11.4 vs 11.9). The Brooker classification was determined. RESULTS: The percent of patients presenting peri-prosthetic ossifications was equivalent. For the celecoxib group, 60% of the patients were free of ossifications; 28.9% presented stage 1 ossification and 11.1% stage 2 ossification; none of the hip exhibited a higher stage. In the ketoprofen control group, 53.2% of patients were free of ossification, 38.2% had stage 1 ossification, 6.4% stage 2, and 2.1% stage 3; there was no patient with stage 4. Fisher's exact test did not demonstrate a significant difference between the groups (p<0.51). Compared with an older series of patients who were not given preventive treatment, there was a significant reduction in incidence of peri-prosthetic ossification (p=0.014). DISCUSSION: The two study groups were not significantly different for age, gender, or underlying disease. There were an equivalent number of cases of intolerance to treatment in the two groups. CONCLUSION: These findings appear to indicate an equivalent efficacy for celecoxib and ketoprofen for the reduction of peri-prosthetic ossifications. Based on these results, a randomized prospective comparative study can be undertaken without risk of losing effective prevention in one group. This prospective study should enable a more precise evaluation of treatment equivalence and quantify any potential gain in morbidity obtained with celecoxib.

Effect of different sterilization processing methods on the mechanical properties of human cancellous bone allografts.

Use of new sterilization methods applied to human bone is likely to affect both the mechanical and biological properties of human cancellous grafts. The mechanical properties of the transplanted bone inevitably determine the short- and mid-term results of the orthopedic procedure performed. The aim of this study was to compare, under similar conditions, the mechanical effects of gamma irradiation, lipid extraction, and treatment with 6M urea on trabecular bone samples, through conventional mechanical tests and measurement of the ultrasound wave propagation rate. Deteriorations measured for gamma irradiation and lipid extraction were low: 2.4% and 2.5%, respectively, for ultrasound propagation wave measurements. They were clearly significant for protocol including 6M urea, corresponding to a loss of 30% in values measured in the control sample for the stress to failure, inciting prudence when grafted bone is used for support in orthopedic assembly. High consistency in the results obtained between travel time of the ultrasound wave, easily done, and measurement of stress to failure through conventional tests, favor the use of ultrasound protocol, described as a quality test performed on bone grafts in the tissue bank before distribution and implantation.

[Outcome after total hip arthroplasty performed for rapidly progressive hip destruction]. / Résultat des arthroplasties totales de hanche réalisées pour coxarthrose destructrice rapide.

PURPOSE OF THE STUDY: Rapidly progressive destruction of the hip joint occurs in approximately 5 to 10% of patients with degenerative hip disease. The cause and natural history remain unclear, but total hip arthroplasty is almost always necessary. We performed a retrospective analysis to determine the particular clinical and radiological features of this condition and to assess long-term outcome after total hip arthroplasty. MATERIAL AND METHODS: One hundred total hip arthroplasties were performed between 1984 and 1988 in patients with rapidly progressive hip destruction (67 women and 11 men, mean age 71 years). The transtorchanteric approach was used in all cases to implant cemented Charnley-Kerboull prostheses. Mean follow-up was 7 years 10 months. RESULTS: There were seven complications: two nonunions of the trochanter, three extensive periprosthetic ossifications, one case of recurrent dislocation, and one late hematogenous infection. At last follow-up, the Merle d'Aubigné classification showed an excellent or very good functional result in 95 hips. Stable fixation was observed for 94 acetabular implants and 97 femoral implants. Six acetabular implants showed signs of loosening: certain=1, probable=4, potential=1. Three femoral implants showed signs of loosening: certain=1, potential=2. All the femoral loosenings were associated with acetabular loosening. Four hips required revision surgery: one for nonunion of the trochanter, one for septic loosening, two for aseptic loosening. DISCUSSION: This series confirmed the radiological and clinical definitions of rapidly progressive hip destruction and demonstrated the reliability of pathological examination of the femoral head and joint capsule. Among the different hypotheses put forward to explain this condition, neither overloading nor use of antiinflammatory drugs would appear to be operating in this series. We were unable to confirm or infirm the micro-crystalline or vascular origin of this condition. Nevertheless, the vascular phenomena observed in the femoral head could be compared with those observed in ischemic joint disease. Arthroplasty led to major blood loss (2706 ml, hematocrit 35). This appears to be higher than observed for arthroplasty performed with the same technique in patients with the usual form of degenerative hip disease. Excepting this fact, the complications observed and the clinical results as well as the longevity of these implants suggest that arthroplasties performed for rapidly degenerative hips are not substantially different from those performed for common degenerative hip disease.

[Osteoarticular disease in adults in France. A survey of 2000 persons]. / Pathologie ostéo-articulaire de l'adulte en France. Enquête auprès d'un énchantillon de 2000 personnes.

PURPOSE OF THE STUDY: Seeking for a global epidemiology data on bone and joint disease in adults in France, we analyzed the problems related to bone and joint disease in a sample population to determine healthcare needs. We also examined patient referral and demand for surgical care for bone and joint disease and the degree of patient satisfaction. MATERIAL AND METHODS: A telephone interview was conducted in a randomly sampled population of adults living in France to determine their demographic characteristics and bone and joint conditions and surgical care reported by the interviewees. Before standardizing, the sample population in the 60-year and older group was increased in order to obtain more precise information concerning degenerative joint disease. The sample included 1000 persons aged under 60 years and another 1000 persons aged over 60 years. The sample populations were matched to the French population for sex and age distribution. One hundred personal face-to-face interviews were also conducted with 100 persons residing in a nursing home. The two surveys were conducted in June and July 1999. RESULTS: Extrapolation of the data obtained to the French population yielded a total of 12 million adults affected by a bone and joint condition during the year preceding the survey. Considering both study samples, the most frequent localizations concerned the spine and the knees. The distribution of the other localizations was age and sex dependent. The percentage of trauma-induced conditions was 31%, predominantly in men under the age of 60 years and in institutionalized individuals. Extrapolation yielded a total of 5.4 million persons who had (or expected to have) a surgical intervention due to a bone and joint condition. The percentage of surgical treatment was highest for fractures (41%) and extravertebral osteoarthritis (18%). Extrapolation to the French population yielded 0.55 million persons aged over 60 years with a hip prosthesis and 0.27 million with a knee prosthesis. Seventy-six percent of the individuals who had undergone surgery for a conditions unrelated to trauma felt their quality of life had been improved. For those who had surgery for a trauma-induced condition, 85% considered they had minimal or no sequelae. Information provided by the surgeon concerning surgical care was thought to be insufficient by 23% of the operated individuals and 43% of those who had a joint prosthesis stated they had not been informed that their implant might be changed. Management of postoperative pain was thought to be insufficient by 36% of the operated individuals. DISCUSSION: Due to the wide field of investigation and the methodology used to collect these data, our findings cannot be easily compared with other epidemiological data. They must be considered with caution due to the sampling bias of a telephone interview and also to the bias introduced by the simplified nosology scheme used for the questionnaire and the fact that no medical validation was performed. These data do however show that a large number of adults are concerned, notwithstanding conditions occurring before the age of 18 years with the frequency of accidents during childhood and adolescence. The data collected confirm the priorities set within the framework of the Bone and Joint Decade 2000-2010.