Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes.

INTRODUCTION: Double-button devices for endoscopic management of acute acromioclavicular joint dislocation (ACJD) provide satisfactory short-term functional and radiological results. However, little exists in the literature regarding the long- and medium-term results of these implants, especially regarding the evolution of the acromioclavicular joint (ACJ). HYPOTHESIS: Satisfactory and steady long- and medium-term outcomes can be achieved in patients with acute ACJD undergoing endoscopically assisted ACJ repair using a single double-button device. MATERIAL AND METHOD: A retrospective single-center study was conducted in patients with acute Rockwood III and IV ACJD treated endoscopically with a single double-button device from October 2008 to October 2010, allowing a minimum 5-year follow-up. Functional evaluation used Constant and Quick-DASH scores. Clinical evidence of dislocation recurrence was combined with bilateral Zanca views to assess coracoclavicular distance. Acromioclavicular osteoarthritis was evaluated on the Paxinos test and Zanca views. RESULTS: Nineteen of the 25 operated patients were seen at a mean 76.9±8.5 months' follow-up. Mean age was 34.4±8.3 years. Mean Constant and Quick-DASH scores were 96.2±5.1 and 0.9±1.6 points, respectively. Four patients had a recurrence of their initial dislocation, 3 of whom had positive Paxinos test, whereas the 15 patients without recurrence had a negative test (p=0.004). Five patients had radiological evidence of ACJ osteoarthritis: all 4 patients with recurrence and 1 without (p=0.001). CONCLUSION: Long- and medium-term radioclinical outcome of endoscopically assisted management of acute ACJD using a single double-button device seems to be satisfactory and steady over time. Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. LEVEL OF EVIDENCE: Therapeutic type IV-Retrospective case series.

A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations.

PURPOSE: To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations. METHODS: A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope® system, whereas last series (DB group) was treated with the Dog Bone® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction. RESULTS: Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively. CONCLUSIONS: Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone® device, we would prefer the TightRope® device in acute acromioclavicular dislocations. LEVEL OF EVIDENCE: IV: Therapeutic study-cases series.

Tunnel positioning assessment after anterior cruciate ligament reconstruction at 12months: Comparison between 3D CT and 3D MRI. A pilot study.

BACKGROUND: Tunnel positioning assessment is a major issue after anterior cruciate ligament (ACL) reconstruction surgery. Historically, it used plain X-ray and, more recently, CT with 3D reconstruction. MRI is a reliable method of assessing ACL graft integrity and postoperative complications. To our knowledge, there have been no studies of efficacy in tunnel positioning assessment. The aim of this study was to assess the efficacy of 3D MRI in assessing femoral and tibial tunnel positioning after ACL reconstruction. The hypothesis was that 3D MRI sequences with reconstruction are as accurate as 3D CT for tunnel positioning assessment in ACL reconstruction. METHODS: Twenty-two patients who underwent an arthroscopic ACL reconstruction using hamstring graft were included in a prospective study. All patients were examined on 3D CT and 3D MRI at 12months post-surgery. Tunnel positioning was assessed on both imaging systems by a musculoskeletal radiologist and an orthopedic surgeon specialized in knee arthroscopy, both blind to all clinical data. RESULTS: No statistically significant difference was found between 3D CT and 3D MRI on coronal and sagittal reconstructions. For coronal assessment of tibial tunnel orifice, sagittal assessment of tibial tunnel orifice and sagittal assessment of femoral tunnel orifice, P-values ranged from 0.37 to 0.99, 0.051 to 0.64 and 0.19 to 0.59, respectively. For tibial and femoral tunnel angulation, P-values were respectively 0.52 and 0.29. CONCLUSION: 3D MRI is a reliable method to assess femoral and tibia tunnel positioning in ACL reconstruction, compared to 3D CT as gold standard. Indeed, in our opinion 3D MRI could in the future replace CT for ACL reconstruction assessment, concerning not only the meniscus and ligaments but also tunnel position. LEVEL OF EVIDENCE: Level 3; comparative prospective study.

MRI in patients with chronic pubalgia: Is precise useful information provided to the surgeon? A case-control study.

BACKGROUND: Recent studies described that MRI is a good examination to assess damage in chronic athletic pubalgia (AP). However, to our knowledge, no studies focus on systematic correlation of precise tendon or parietal lesion in MRI with surgery and histological assessment. Therefore, we performed a case-control study to determine if MRI can precisely assess Adductor longus (AL) tendinopathy and parietal lesion, compared with surgery and histology. HYPOTHESIS: MRI can determine if AP comes from pubis symphysis, musculotendinous or inguinal orifice structures. MATERIALS/METHODS: Eighteen consecutive patients were enrolled from November 2011 to April 2013 for chronic AP. To constitute a control group, we also enrolled 18 asymptomatic men. All MRI were reviewed in consensus by 2 skeletal radiologists for pubic symphysis, musculotendinous, abdominal wall assessment and compared to surgery and histology findings. RESULTS: Regarding pubis symphysis, we found 4 symmetric bone marrow oedema (14%), 2 secondary cleft (7%) and 2 superior ligaments lesions (7%). For AL tendon, we mainly found 13 asymmetric bone marrow oedema (46%), 15 hyperaemia (54%). Regarding abdominal wall, the deep inguinal orifice size in the group of symptomatic athletes and the control group was respectively 27.3±6.4mm and 23.8±6.3mm. The correlation between MRI and surgery/histology was low: 20% for the AL tendon and 9% for the abdominal wall. If we chose the criteria "affected versus unaffected", this correlation became higher: 100% for AL tendon and 73% for the abdominal wall. CONCLUSION: MRI chronic athletic pubalgia concerns preferentially AL tendinopathy and deep inguinal canal dehiscence with high correlation to surgery/histology when only considering the item "affected versus unaffected" despite low correlation when we try to precisely grade these lesions. LEVEL OF EVIDENCE: III: case-control study.

Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: Clinical and MRI results.

INTRODUCTION: Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome. MATERIAL: Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device. METHODS: Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results. RESULTS: Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07). CONCLUSION: Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These satisfactory anatomic results correlated with good clinical outcome encourage continuing with this technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Initial disc structural preservation in type A1 and A3 thoracolumbar fractures.

PURPOSE: Despite a sizable amount of literature, the optimal management of thoracolumbar fractures remains controversial and many authors assume the existence of disc lesions in Magerl type A fractures. The purpose of the study was to assess the intervertebral discs in these fractures at the time of trauma. The hypothesis was that there was no change in shape and signal intensity of the discs initially. METHODS: Fifty-one patients diagnosed with 87 types A1 and A3 thoracolumbar fractures were enrolled in a prospective study. MRI analysis involved evaluation of disc signal, height and morphological modifications according to Oner's classification. RESULTS: No signal intensity modification was identified on MRI. Disc morphology was either normal or altered with creeping of discal tissue in the vertebral endplate depression. Overall, 98% of the discs were either type 1 or type 3. Mean disc height on MRI was 1.03 ± 0.36 initially. CONCLUSIONS: In this study, MRI showed that no loss of height occurred in discs adjacent to fractured vertebra and that there was no major alteration of the disc in terms of signal intensity and morphology. Therefore, the intervertebral disc should not be removed in Magerl type A fractures. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Iliac Crest Avulsion Fracture in a Young Sprinter.

Avulsion fracture of the iliac crest is an uncommon pathology. It usually occurs in teenagers during sport activities, more common in boys. We report a case of 16-year-old male competitive sprinter, who had an avulsion of a part of the iliac crest and the anterior-superior iliac spine during a competition. The traumatism occurred during the period of acceleration phase out of the blocks which corresponds to the maximum traction phase on the tendons. Then a total loss of function of the lower limb appears forcing him to stop the run. X-ray and CT scan confirmed the rare diagnosis of avulsion of the quasitotality of the iliac crest apophysis, corresponding to Salter 2 fracture. We performed an open reduction and internal fixation with two screws, allowing a return to sport after 3 months and his personal best record in the 100 meters at the 6th postoperative month.

Management of recent first-time anterior shoulder dislocations.

The management of a first episode of anterior shoulder dislocation starts with an analysis of the causative mechanism and a physical examination to establish the diagnosis. Based on the findings, the case can be classified as simple or accompanied with complications, most notably vascular or nerve injuries. Two radiographs perpendicular to each other should be obtained to confirm the diagnosis then repeated after the reduction manoeuvres. Additional imaging studies may be needed to assess concomitant bony lesions (impaction lesions or fractures). External reduction should always be attempted after premedication appropriate for the severity of the pain. General anaesthesia may be necessary. There is no consensus regarding the optimal reduction technique, although the need for gentle manoeuvres that do not cause pain is universally recognised. Immobilisation currently involves keeping the elbow by the side with the arm internally rotated for 3-6weeks depending on patient age. Vessel and nerve injuries are rare but can cause major functional impairments. Follow-up evaluations are in order to check the recovery of normal function, which may be more difficult to achieve in patients with concomitant lesions; and to detect recurrent shoulder instability and rotator cuff lesions. At the acute phase, surgery is indicated only in patients with complications or after failure of the reduction manoeuvres. Shoulder immobilisation with the arm externally rotated and surgical treatment of the first episode are controversial strategies that are discussed herein.

Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures.

INTRODUCTION: Intramedullary nailing in distal tibial fracture is controversial because of a lack of stability. The present study sought to assess radiological and clinical results for a new "angular-stable" locking system in difficult indications for intramedullary nailing. MATERIAL AND METHOD: A prospective study recruited 41 patients (41 tibias) with distal tibial fracture consecutively managed using angular-stable locked intramedullary nails. Radiologic assessment comprised AP and lateral lower-limb views, taken postoperatively and through to last follow-up. The mean distance was measured between fracture and joint line. Fusion, with or without malunion, primary reduction defect, non-union and secondary displacement were recorded, as were all complications. RESULTS: Mean follow-up was 18 ± 5 months; 3 patients were lost to follow-up. Mean fracture distance from the joint line was 63 ± 25 mm. Fusion was achieved within 3 months in 29 cases (76%); delayed fusion in 7 patients (18%) required secondary dynamization at a mean 3 months, with favorable evolution. Revision surgery was required in 2 cases: 1 for secondary displacement exceeding 10°, and 1 for non-union at 7 months. Other complications mainly comprised 4 malunions of less than 10° due to primary reduction defect. CONCLUSION: Angular-stable locked lower-limb intramedullary nailing provided a very satisfactory fusion rate, with few complications. It is, however, a demanding procedure, especially as regards fracture reduction and nail positioning in the distal fragment. PROSPECTIVE COHORT STUDY: level IV.

Current state of anterior cruciate ligament registers.

PURPOSE: The purpose of this work was to report the main characteristics and results of all active anterior cruciate ligament (ACL) reconstruction registers along with the differences between them. METHODS: We systematically searched on Google and Medline via PubMed to identify ACL registers. National or regional registers were included if they were active and took into account ACL reconstructions. The main results and characteristics, namely the number of inclusions, exhaustivity, data collection methods and results dissemination methods were determined. The collected information was then submitted to each register for validation. RESULTS: Four registers (3 national, 1 regional) were identified that routinely included every ACL reconstruction procedure. Register data were collected either through dedicated websites or on paper forms. All the registers used the same two outcome measures, namely the revision rate and a subjective patient score (KOOS score). Register results were made available through scientific publications or annual reports. The main differences between registers were in the graft choice and presence of associated meniscus and cartilage injuries. CONCLUSIONS: Although there are only a few ACL reconstruction-specific registers, their scientific contribution is undeniable thanks to the quality of the collected data and the organization and collaboration between registers. Their impact on health care and science should grow in the future.

[Treatment of Kienböck's disease using a pyrocarbon implant: case report]. / Le traitement de la maladie de Kienböck par un implant en pyrocarbone: fait clinique.

We report on two patients with advanced Kienböck's disease (Lichtman IIIa and IIIb) who underwent surgical treatment in which the lunate was replaced by a pyrocarbon implant. At a mean follow-up of 3 years, the average VAS pain score was 1 and the average DASH was 11.5. There were no changes in range of motion after surgery and the average grip strength was 76.5% of the contralateral side. X-rays showed no disease progression. These encouraging preliminary results have led us to suggest replacing the lunate with a pyrocarbon implant in a greater number of patients with advanced Kienböck's disease.

The surgical treatment of children with congenital convex foot (vertical talus): evaluation of midtarsal surgical release and open reduction.

In this study we evaluated the results of midtarsal release and open reduction for the treatment of children with convex congenital foot (CCF) (vertical talus) and compared them with the published results of peritalar release. Between 1977 and 2009, a total of 22 children (31 feet) underwent this procedure. In 15 children (48%) the CCF was isolated and in the remainder it was not (seven with arthrogryposis, two with spinal dysraphism, one with a polymalformative syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to 175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°). The procedure included talonavicular and calcaneocuboid joint capsulotomies, lengthening of tendons of tibialis anterior and the extensors of the toes, allowing reduction of the midtarsal joints. Lengthening of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed by the Adelaar score, were good in 24 feet (77.4%), fair in six (19.3%) and poor in one foot (3.3%), with no difference between those with isolated CCF and those without. The mean American Orthopaedic Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8 (36 to 93) for those with isolated CCF and those without, respectively. At the final follow-up, the mean tibiotalar (120°; 90 to 152) and calcaneal pitch angles (4°; -13 to 22) had improved significantly (p < 0.0001). Dislocation of the talonavicular and calcaneocuboid joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet, respectively. Three children (five feet) underwent further surgery at a mean of 8.5 years post-operatively, three with pes planovalgus and two in whom the deformity had been undercorrected. No child developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory procedure, which may provide better results than peritalar release. Complications include the development of pes planovalgus and persistent dorsal subluxation of the talonavicular joint.

[Induced astigmatism after corneal suture removal after cataract surgery]. / Évolution de l'astigmatisme après ablation d'une suture cornéenne pour chirurgie de la cataracte.

PURPOSE: To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery. METHODS: A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured. RESULTS: Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks. CONCLUSION: Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.

Efficacy of second intra-tendinous platelet-rich-plasma injection in case of incomplete response of the first injection: three-year follow up experience.

PURPOSE: Tendinopathy is a frequent and ubiquitous disease developing early disorganized collagen fibers with neo-angiogenesis on histology. Peritendinous injection of corticosteroid is the commonly accepted strategy despite the absence of inflammation in tendinopathy. Platelet-rich plasma (PRP) might be a useful strategy to rapidly accelerate healing of the tendinopathy but there is a lack ok knowledge about the amount of PRP to be injected and the opportunity of a second injection in case of partial pain relief. The aim of our study was to assess the potential therapeutic effect of early second PRP intra-tendinous to treat persistent painful tendon tear and tendinosis in a long-term follow-up by ultrasonography (US) and clinical data in case of incomplete efficiency of first PRP treatment injection. MATERIALS AND METHODS: Twenty-four consecutive patients referred for US treatment of tendon tear or tendinosis (T+) were included retrospectively. All had previously received a single intra-tendinous injection of PRP under US guidance (PRPT+) and benefited of a second PRP injection (PRPT2+) under US guidance in order to treat persistent painful. US and clinical data were collected for each anatomic compartment for upper and lower limbs before treatment (D0), 6 weeks (W6) after first treatment, 6 weeks (W12) after second treatment and until 32-month follow-up. We used Mac Nemar test and regression model to compare US and clinical data. RESULTS: The residual US size of lesions was not significantly lower at W12 after PRPT2+ as compared to W6 (P=0.86 in upper and P=NS in lower member) independently of age (P=0.22), gender (P=0.97) and kind of tendinopathy (P=NS). Quick dash test values and WOMAC values were not significantly lower in PRPT+ at W12 (average: 21.5 months) as compared to W6 (P>0.66) and long-term follow-up (P>0.75) independently of age (P=0.39), gender (P=0.63) and kind of tendinopathy (P=NS). Nevertheless, comparison between D0 and long-term follow-up (LTF) functionnal score was statistically significant (p<0.001 in upper and lower member). CONCLUSION: Our study suggests that second early intra-tendinous PRP injection under US guidance does not permit rapid decrease of tendinopathy area in US, nor does it quickly improve clinical pain and functional data in case of incomplete efficiency of first PRP injection. However, in long-term follow-up, patients improved their ability to mobilize pathologic tendons.

Choroidal and adnexal extranodal marginal zone B-cell lymphoma: presentation, imaging findings, and therapeutic management in a series of nine cases.

PURPOSE: To describe the clinical and imaging presentation, pitfalls in the diagnosis of choroidal extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), as well as the therapeutic management and prognosis. METHODS: A retrospective case review of nine choroidal MALT lymphomas was performed. Initial clinical presentation and imaging findings of these histologically confirmed cases of lymphoma were analyzed. Treatment methods, time to diagnosis, systemic work-up, and treatment prognosis were assessed. RESULTS: Initial presentation was essentially blurred vision. The features described on examination were: anterior and posterior scleritis, iridocyclitis, choroidal infiltration, and exudative retinal detachment. Fluorescein and indocyanine green angiography as well as ultrasonography and optic coherence tomography provided arguments in favor of the diagnosis. Biopsy sites included conjunctiva, Tenon's capsule, deep scleral tissue, episclera, lacrimal gland, and choroid. Treatment mostly consisted of a combination of chemotherapy and radiotherapy. The mean time to diagnosis was 12 months. CONCLUSIONS: Owing to the insidious onset of these tumors and their ability to simulate other conditions, the diagnosis is commonly delayed. The prognosis is generally good and treatment is effective in the case of localized lymphoma.

Is alumina-on-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study.

INTRODUCTION: The alumina-on-alumina bearing couple in total hip replacement seems to be well adapted for young and active patients because of the absence of wear and the rarity of osteolysis. Over the long term, doubts persist as to the cementless cup fixation and on the functioning of this bearing system because of possible acoustic emissions during use. HYPOTHESIS: In young subjects, the ceramic-on-ceramic bearing system limits wear and osteolysis occurrences, without exposing patients to serious side effects. MATERIAL AND MEHTODS: We report the results, with between 7 and 15 years of follow-up, for 32mm-diameter alumina-on-alumina implants in 76 patients younger than 50 years of age (83 hips), combining cementless press-fit hemispheric cups with titanium stems, [either cemented (63 Osteal™ stems) or cementless (20 Multicône™ stems)], with particular attention paid to cup fixation and noise emissions during implant function. First-generation or Cerafit trellis™ acetabular components had a riveted titanium mesh (31 cases), whereas the most recent (Cerafit hydroxyapatite [HA]™) cups had a porous surface coated with hydroxyapatite (52 cases). RESULTS: Three cases of aseptic loosening of the cemented stems were observed as well as late migration of a Cerafit trellis™ cup in the 12th postoperative year. One ceramic insert broke in the eighth postoperative year. With the exception of one case, the patients, questioned retrospectively, reported no audible noise. With aseptic loosening (revised or not), the criterion for failure, the 12-year survival rate was 91±11% for the Cerafit trellis™ acetabular components and 91±16% for the cemented Osteal™ stems. The 9- and 7-year survival rates for the Cerafit HA™ cups and the Multicône™ stems, respectively, were 100%. Including all revisions for any cause, the 10-year survival rate of the entire series was 92%±11%. DISCUSSION: Despite the absence of wear and osteolysis, the long-term survival of these implants in young subjects should be improved. Although longer follow-up is necessary to formulate a definitive opinion, we tend to prefer cementless stem and cup fixation in ceramic-on-ceramic bearing systems. LEVEL OF EVIDENCE: Level 4 retrospective study.