Results of the Evora dual-mobility socket after a minimum follow-up of five years.

PURPOSE OF THE STUDY: Dislocation is a well-known complication of total hip arthroplasty. The risk can be reduced to one or two cases per thousand using a dual-mobility cup. The survival rate achieved with the Bousquet implant is 95% at 10 years. The complications with this implant are early mobilization and inguinal pain. An overly-large cup and insufficient primary and secondary fixation can be implicated. The design of the original implant was later modified to limit these early complications. The purpose of this study was to check the validity of these design changes. PATIENTS AND METHODS: The chromium-cobalt moulded cementless cup was used. The outer surface of this cup presents large geometric striations and is coated with hydroxyapatite. The cup has the shape of a 180 degrees half sphere and a posterior wall prolongation measuring 6.5mm. Three mechanisms were used for the primary fixation: an asymmetrical growth ring, four anchorage stems and a superior screw. Two hundred cementless cups were implanted in 194 patients. The femoral piece was a Charnley stainless-steel implant (n=139), a titanium SEM implant (n=59) or another implant (n=12). Cement was used for femoral fixation in 193 implantations. The series included 97 women and 103 men with osteoarthritis (n=180), necrosis (n=16) and surgery for fracture and primary arthroplasty (n=9). The Harris and Postel-Merle-d'Aubigné scores were noted. Eight radiographic criteria were analyzed to assess the position of the cup and the radiological course of the interface. RESULTS: The mean follow-up was six years and the minimum was five years. The mean age at surgery was 70 years (range, 32 to 91). At last follow-up, 17 patients had died, eight were lost to follow-up and five were bedridden. Three patients underwent revision surgery. Thus, this analysis included 170 prostheses followed for more than five years (mean, six years; range, five to seven years). The Harris score improved from 48 to 92 and the Postel-Merle-d'Aubigné score from 2/5/4 to 5.8/5.9/5.5 (range, 4 to 6/5 to 6/1 to 6). None of the patients complained of anterior pain during active hip flexion in supine position (related to ilio-psoas irritation). Cup inclination was 46 degrees on average (range, 62 to 22 degrees ). Medialization, lateralization or ascension greater than 10mm from the center of rotation was not observed on the postoperative films. At the last follow-up, no measurable mobilization or migration could be identified on plain X-rays. Radiolucent lines, condensations and bony defects around the cup, when visible postoperatively, were not found on the last follow-up X-rays. There were two cemented femoral pieces that developed a radiolucent line in the nonspecific metaphyseal area. There were no cases of granuloma and no cam effect. Three patients underwent revision for femoral loosening, fracture of the femur below the prosthesis and hematogenous infection. There were no cases of dislocation. DISCUSSION: Changing the design of the implant to modify its volume, material and primary fixation has eliminated the early mobilizations and inguinal pain described for the original Bousquet cup. These options have not had any deleterious effect on prosthesis stability. The question of long-term wear remains an important problem and requires optimization: a neck as thin as possible, optimized surfacing, elimination of laser marks, extraction leads and head skirts.

[Results of the Evora dual mobility socket: five years follow-up]. / Résultat à cinq ans de la cupule à double mobilité Evora.

PURPOSE OF THE STUDY: Dislocation is a well-known complication of total hip arthroplasty. The risk can be reduced to one or two cases per thousand using a double mobility cup. The survival rate achieved with the Bousquet implant is 95% at 10 years. The complications with this implant are early mobilization and inguinal pain. An overly large cup and insufficient primary and secondary fixation can be implicated. The design of the original implant was later modified to limit these early complications. The purpose of this work was to check the validity of the changes made. PATIENTS AND METHODS: The chromium-cobalt moulded cup was used. The outer surface of this cup presents large geometric striations and is coated with hydroxyapatite. The cup has the shape of a half sphere of 180 degrees and a posterior wall prolongation measuring 6.5mm. Three mechanisms were used for the primary fixation: an asymmetrical growth ring, four anchorage stems, and a superior screw. Two hundred cups were implanted in 194 patients. The femoral piece was a Charnley stainless steel implant (n=139), a titanium SEM implant (n=59) or another implant (n=12). Cement was used for 193 implantations. The series included 97 women and 103 men with osteoarthritis (n=180), necrosis (n=16), surgery for fracture and primary arthroplasty (n=9). The Harris and Postel-Merle-d'Aubigné scores were noted. Eight radiographic criteria were analyzed to assess the position of the cup and the radiological course of the interface. RESULTS: Mean time to surgery was six years. Mean age at surgery was 70 years (range: 32-91) and varied depending on the operators from 67 to 73 years. At last follow-up: 17 patients had died, eight were lost to follow-up and five were bedridden. Three patients underwent revision surgery. Thus, this analysis included 170 prostheses followed for more than five years (mean: six years, range: 5-7 years). The Harris score improved from 48 to 92 and the Postel-Merle-d'Aubigné score from 2/5/4 to 5.8/5.9/5.5 (range: 4-6/5-6/1-6). None of the patients complained of anterior pain during hip flexion against resistance. Cup inclination was 46 degrees on average (range: 62-22 degrees ). Medialization, lateralization or ascension greater than 10mm of the centre of rotation was not observed on the postoperative films. At last follow-up, no measurable mobilization or migration could be identified on plain X-rays. Lucent lines, condensations and bony defects around the cup, when visible postoperatively, were not found on the last follow-up X-rays. There were two cemented femoral pieces, which developed a lucent line in the nonspecific metaphyseal area. There were no cases of granuloma and no cam effect. Three patients underwent revision for femoral loosening, fracture of the femur below the prosthesis, and hematogenous infection. There were no cases of dislocation. DISCUSSION: Changing the design of the implant to modify its volume, material and primary fixation has eliminated the early mobilizations and inguinal pain described for the original Bousquet cup. These options have not had any deleterious effect on prosthesis stability. The question of long-term wear remains an important problem and requires optimization: a neck as thin as possible, optimized surfacing, elimination of laser marks, extraction leads, head skirts.

[Distal metastases of bronchial cancers. Bone and soft tissue metastases]. / Métastases distales des cancers bronchiques. Métastase osseuse et métastase des tissus mous.

Distal metastases are classically situated below the knee or elbow. However, metastases of the extremities: wrist and hand, or ankle and foot, have etiological and histological characteristics. We report one case of bone metastasis and one case of soft tissue metastasis. The distal bone metastases are often solitary. Bronchial cancers represent the most frequent cause of distal metastases (20% of all cases). They are responsible for 50% of distal metastases of the upper limb and more often occurs as a squamous cancer. Their localization may sometimes reveal a bronchial cancer, and so allow curative surgery. The metastases of soft tissue are exceptional. In the literature, only 2 cases of soft tissue metastasis of bronchopulmonary cancer are described. Clinically, it is a painful swelling preserving the under lying bone. The prognosis is always one of bronchial metastasis cancer with an average survival of 3-6 months.