[The cementless Duraloc acetabular component: 100 cases assessed after a minimum five year follow-up]. / Evaluation au recul de 5 ans de 100 cupules impactées sans ciment de type Duraloc.

PURPOSE OF THE STUDY: The longevity of an acetabular implant depends in part on its resistance to mechanical stress. Long-term stability of an uncemented cup requires stable primary fixation. This can be achieved with press-fit components. MATERIAL AND METHODS: One hundred forty-nine Duroloc press-fit acetabular implants were studied after a minimum follow-up of 60 months. Among these 149 cups, 100 were analyzed with a mean follow-up of 60 months. Twenty-two patients were lost to follow-up, 19 were contacted by telephone, and eight had died. Clinical and radiological criteria were used to assess outcome. Digitalized x-rays were processed with Imagika (View Tec, Saint-Maurice, France) to determine the position of the implant in two-dimensional space, inclinaison, anteversion, polyethylene wear, bone-implant contact, and presence of ossifications. Seventy percent of the patients underwent arthroplasty for degenerative hip disease. RESULTS: The cohort included 40 women and 60 men. Mean age at surgery was 59.4 years, range 30-80 years. The Postel-Merle-d'Aubigne score improved from 10 to 16. Mean polyethylene wear was 0.5 mm with an annual rate of 0.087 mm/yr. Among the 57 cup-bone spaces present postoperatively, 41 had filled at last follow-up (78%). There were no cases of osteolysis. Peri-prosthetic ossifications were observed in 50 patients (16 stage I, 12 stage II, 19 stage II, and 3 stage IV). Medial displacement of the cup > 4 mm was observed in one patient and ascension > 4 mm in four patients who had no other sign of loosening. Complications were: dislocation (n=15), phlebitis (n=2), sciatalgia (n=1) and infection (n=1). DISCUSSION: This retrospective series revealed an unacceptable dislocation rate with no correlation with implant positioning error in comparison with the biomechanical position of the healthy hip. The non-hemispheric shape of the implant and the beveled edge of the polyethylene insert could be implicated, particularly since none of the implants had a polyethylene overhang. The mean annual wear (0.087 mm) was relatively high compared with cemented cups. Age was the only factor correlated with wear. Migrations were difficult to interpret. Medialization or ascension of the implant was not associated with any clinical sign suggestive of loosening. The poor reproducibility of the x-rays cannot explain these findings. Secondary repositioning of the implant might be involved. CONCLUSION: The high rate of dislocation and the frequency of excessive wear have led us to abandon this implant for more hemispheric cups.

[Uretero-acetabular fistula after removal of a septic total hip prosthesis]. / Fistule urétéro-cotyloïdienne après ablation d'une prothése totale de hanche septique.

The authors report a case of an uretero-acetabular fistula after a Girdlestone procedure. The reason of ablation was an infected hip prosthesis. The urinary fistula was treated with an uretero-ileoplasty and hip infection with a two stages procedure. There was no recurrence of infection at two years follow-up. Different causes of this urinary complication are discussed.

[Treatment of fresh humeral diaphysis fractures by Seidel intramedullary locked nailing. A study of 23 initial cases after 2.5 years with rotator cuff evaluation]. / Traitemet des fractures récentes de la diaphyse humérale par enclouage centro-médullaire verrouillé selon Seidel. Révision des 23 premiers cas à 2.5 ans avec étude de la coiffe des rotateurs.

PURPOSE OF THE STUDY: The Seidel intramedullary locking nail is one of the alternative methods for operative treatment of humeral shaft fractures. Short follow-up demonstrated persistent pain and stiffness at the shoulder joint. The aims of this retrospective study were first to evaluate results with attention to operative technique, consolidation rate and postoperative complications. Second we studied rotator cuff healing in our first patients. MATERIAL AND METHODS: Twenty-five acute diaphyseal fractures were treated between May 91 and Dec 94. We reviewed personally 23 patients with a mean follow-up of 33 months (range 22-66). The dominant fracture type according to AO was type A. Clinical shoulder assessment was carried out using the Constant score. Isometric strength was recorded in both shoulders with a hand-held dynamometer in abduction, external and internal rotation. Sonographic evaluation of the rotator cuff was performed using a 7.5 MHz linear array transducer in all 23 patients. RESULTS: All but one fracture healed at an average of two months. Impingement was observed in three patients but pain relief and normal shoulder motion have been reached after nail removal. Infection occurred in one patient but final result was good. Constant score averaged 78.7 (range 51-94.2) classifying the result in all but two patients as excellent or good. Compared with the external and internal rotations, strength was significantly reduced in abduction but reached 83.5 per cent of the opposite shoulder. No statistical differences were found in relation with age, gender and side. Compared with the contralateral shoulder, rotator cuff evaluation with sonography was considered as normal in 18 patients. Calcium deposits of the cuff were noticed in the infected patient. In three cases sonography detected hyperechoic line considered as scar in the supraspinatus tendon without any partial or full-thickness tear. DISCUSSION AND CONCLUSION: A median starting point avoids the avascular area and gives a straight access to the medullary canal. This study demonstrates that using this entry portal and a reliable technique antegrade nailing of the humerus does not compromise rotator cuff healing and shoulder function. Technical errors lead to poor or fair results but despite this learning curve, Seidel nail when operative treatment is indicated, is a good choice. Attention must be paid to patients with clinical history of impingement or rotator cuff tendinopathy.