Revue de Chirurgie Orthopédique et Traumatologique, 2010
ABSTRACT Le conflit fémoro-acétabulaire a été récemment décrit comme une cause de douleur de hanc... more ABSTRACT Le conflit fémoro-acétabulaire a été récemment décrit comme une cause de douleur de hanche de l’adulte jeune et identifié comme une cause d’arthrose précoce. Ce conflit antérieur correspond à un contact anormal répété entre la zone de jonction tête/col du fémur et le rebord acétabulaire, ayant pour conséquence des lésions cartilagineuses et du labrum. L’anomalie architecturale siège soit sur le versant fémoral, on parlera alors « d’effet came », soit sur le versant acétabulaire, on parlera alors « d’effet pince », ces anomalies étant le plus souvent associées. Certaines pathologies articulaires par leur situation anatomique conduisent à un de ces vices architecturaux, on parlera ainsi de conflit secondaire. Chez ces jeunes patients actifs et souvent sportifs, la chirurgie a pour but de soulager des douleurs invalidantes et prévenir l’évolution arthrosique. L’atteinte cartilagineuse est un facteur pronostique déterminant et la prise en charge thérapeutique.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advanta... more ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true.
Orthopaedics & traumatology, surgery & research : OTSR, 2010
Two hundred and ninety-two patients, aged between 16 and 50 years and presenting with mechanical ... more Two hundred and ninety-two patients, aged between 16 and 50 years and presenting with mechanical hip pathology, were included in a prospective multicenter study. The descriptive study concerned the clinical examination and analysis of three X-ray views (AP pelvic, Lequesne false profile and lateral axial view). The series comprised 62% males, mean age 35 years, with 53% right side and 22% bilateral involvement. Initial trauma was reported in 19% of cases, and direct familial history of hip pathology in 20%. Seventy percent of the patients played sports, 30% were high-level athletes, and 17% played combat sports. The physical impingement sign was present in 18% to 65% of cases depending on the variant studied. On imaging (n=241), 62% of hips showed osteoarthritis, with 25% at the evolved stage. In the series, as a whole, there was a 35% rate of dysplasia, 63% of impingement and 5% of normal X-ray results. The radiologic impingement aspects were 58% cam-type, 19% pincer-type and 23% m...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, sinc... more Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true. A consecutive serie of 68 THA revisions involving replacement of the polyethylene liner was analyzed retrospectively (liner replacement alone for 37 hips and liner replacement plus femoral component revision for 31). The posterolateral approach was used for the revision in all cases. This series was compared with a control series of revisions involving the acetabular component with revision of the femoral component in patients matched for age, sex, and BMI. Operative time and hospital stay were significantly shorter when the revision involved the polyethylene liner alone. In 19 hips, a limited zone of osteolysis was observed around the liner before replacement. At last follow-up, new zones of osteolysis were noted in two hips and aggravation in five, o...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
The anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plan... more The anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plane to guide imageless computer assisted surgery for total hip arthroplasty (THA) because this plane is considered to be globally vertical in the standing position. To our knowledge, no study has evaluated this hypothesis or the potential variations in orientation as a function of gender, position of the subject, or THA insertion. The purpose of this work was to examine these different hypotheses in a radio-clinical study. The orientation of the anterior pelvic plane was measured in relation to the vertical plane on plain lateral x-rays of the pelvis in the standing position. X-rays were studied for 106 patients: 1) 82 patients with a THA (40 with at least one dislocation, 42 with a stable hip selected randomly, 19 with a standing lateral x-ray before and after arthroplasty) and 24 control subjects for whom lateral images were obtained in the supine and standing positions to assess potenti...
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
Purpose of the studyThe anterior pelvic plane, also called the Lewinnek plane, is commonly used a... more Purpose of the studyThe anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plane to guide imageless computer assisted surgery for total hip arthroplasty (THA) because this plane is considered to be globally vertical in the standing position. To our knowledge, no study has evaluated this hypothesis or the potential variations in orientation as a
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2005
We present the first report of transabdominal removal of femoral and acetabular components of a s... more We present the first report of transabdominal removal of femoral and acetabular components of a severely loosened hip prosthesis protruding into the pelvis. In a 73-year-old woman post-operative development of urinary tract complications emphasize importance of careful assessment of the prosthetic relations with the vascular and nervous structures as well as pelvic organs before removal of the hip prosthesis. Angio-computed tomography is the most contributive exploration to assess vascular relations. In patients with particular clinical presentations or with threatened structures in the vicinity of the prosthesis, this examination must be completed by complementary opacifications (urinary and gastrointestinal tracts, joints). Ureteral catheterization may be needed if the structures are close or if there is a suspected modification of the urinary tract (retraction, mass effect). In present case, we did not opacify the urinary tract before laparatomy despite the presence of urinary signs preoperatively. A suspected ureterovaginal fistula was discovered. But they where also a ureteral lesions which can result from difficult dissection in contact with infected tissues. In this patient, urinary complications led to nephrectomy after temporary pyelostomy for urine bypass. At last follow-up, the urinary tract infection was controlled but reimplantation was not attempted because of insulin dependent diabetes mellitus and poor general condition. The spontaneous course of this infection with prosthesis loosening recalls the importance of regular surveillance of total hip replacements.
ABSTRACT In case of severe femoral bone loss, cementless revision hip arthroplasties require a st... more ABSTRACT In case of severe femoral bone loss, cementless revision hip arthroplasties require a stable initial distal fixation that does not compromise a subsequent bone reconstruction. The locking mechanism provides initially reliable fixation, especially if bone loss has spread to the distal femoral isthmus or when an extended trochanteric osteotomy (femorotomy) is indicated. Locking stems can be used in all types of femoral revision, but this type of implant can be especially useful in case of diaphysial damage (beyond the isthmus) which makes fixation of a long cemented or non-cemented stem uncertain; in case of septic revisions which need a careful femoral cleaning; in case of peri-prosthetic fractures or if surgical complications (false route, fracture, perforations) occur that impair fixation of a cemented stem or one that is not of standard length. All approaches may be used, but the need for access to the femur dictates choice of the antero-lateral and especially the postero-lateral route. The choice of diameter is guided by “press-fit” beyond the femorotomy, thus minimizing the stresses that will consequently be exerted on the locking system. The size will be chosen also to optimize the contact between residual bone and prosthetic surface treatment in the metaphysial proximal and diaphysial regions. The stem must be locked depending a few technical requirements. The position of the stem will be chosen regarding limb length (height) and joint stability (anteversion). The quality of femorotomy closure is evaluated by achieving broad contact between the flap and the proximal part of the stem. When the medial part of the femur relative to the flap remains distant from the stem, a “counter-femorotomy” of medial cortical bone made at a different level should be performed to optimize contact. These implants simplify femoral revisions by facilitating femorotomy in complex situations. This method offers constant bone reconstruction without significant bone grafting and durable fixation if locking mechanism is added to an adjusted implant in contact with native bone, limiting short-and long-term stresses on it.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advanta... more ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true.
Revue de Chirurgie Orthopédique et Traumatologique, 2010
ABSTRACT Le conflit fémoro-acétabulaire a été récemment décrit comme une cause de douleur de hanc... more ABSTRACT Le conflit fémoro-acétabulaire a été récemment décrit comme une cause de douleur de hanche de l’adulte jeune et identifié comme une cause d’arthrose précoce. Ce conflit antérieur correspond à un contact anormal répété entre la zone de jonction tête/col du fémur et le rebord acétabulaire, ayant pour conséquence des lésions cartilagineuses et du labrum. L’anomalie architecturale siège soit sur le versant fémoral, on parlera alors « d’effet came », soit sur le versant acétabulaire, on parlera alors « d’effet pince », ces anomalies étant le plus souvent associées. Certaines pathologies articulaires par leur situation anatomique conduisent à un de ces vices architecturaux, on parlera ainsi de conflit secondaire. Chez ces jeunes patients actifs et souvent sportifs, la chirurgie a pour but de soulager des douleurs invalidantes et prévenir l’évolution arthrosique. L’atteinte cartilagineuse est un facteur pronostique déterminant et la prise en charge thérapeutique.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advanta... more ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true.
Orthopaedics & traumatology, surgery & research : OTSR, 2010
Two hundred and ninety-two patients, aged between 16 and 50 years and presenting with mechanical ... more Two hundred and ninety-two patients, aged between 16 and 50 years and presenting with mechanical hip pathology, were included in a prospective multicenter study. The descriptive study concerned the clinical examination and analysis of three X-ray views (AP pelvic, Lequesne false profile and lateral axial view). The series comprised 62% males, mean age 35 years, with 53% right side and 22% bilateral involvement. Initial trauma was reported in 19% of cases, and direct familial history of hip pathology in 20%. Seventy percent of the patients played sports, 30% were high-level athletes, and 17% played combat sports. The physical impingement sign was present in 18% to 65% of cases depending on the variant studied. On imaging (n=241), 62% of hips showed osteoarthritis, with 25% at the evolved stage. In the series, as a whole, there was a 35% rate of dysplasia, 63% of impingement and 5% of normal X-ray results. The radiologic impingement aspects were 58% cam-type, 19% pincer-type and 23% m...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, sinc... more Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true. A consecutive serie of 68 THA revisions involving replacement of the polyethylene liner was analyzed retrospectively (liner replacement alone for 37 hips and liner replacement plus femoral component revision for 31). The posterolateral approach was used for the revision in all cases. This series was compared with a control series of revisions involving the acetabular component with revision of the femoral component in patients matched for age, sex, and BMI. Operative time and hospital stay were significantly shorter when the revision involved the polyethylene liner alone. In 19 hips, a limited zone of osteolysis was observed around the liner before replacement. At last follow-up, new zones of osteolysis were noted in two hips and aggravation in five, o...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
The anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plan... more The anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plane to guide imageless computer assisted surgery for total hip arthroplasty (THA) because this plane is considered to be globally vertical in the standing position. To our knowledge, no study has evaluated this hypothesis or the potential variations in orientation as a function of gender, position of the subject, or THA insertion. The purpose of this work was to examine these different hypotheses in a radio-clinical study. The orientation of the anterior pelvic plane was measured in relation to the vertical plane on plain lateral x-rays of the pelvis in the standing position. X-rays were studied for 106 patients: 1) 82 patients with a THA (40 with at least one dislocation, 42 with a stable hip selected randomly, 19 with a standing lateral x-ray before and after arthroplasty) and 24 control subjects for whom lateral images were obtained in the supine and standing positions to assess potenti...
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
Purpose of the studyThe anterior pelvic plane, also called the Lewinnek plane, is commonly used a... more Purpose of the studyThe anterior pelvic plane, also called the Lewinnek plane, is commonly used as the reference plane to guide imageless computer assisted surgery for total hip arthroplasty (THA) because this plane is considered to be globally vertical in the standing position. To our knowledge, no study has evaluated this hypothesis or the potential variations in orientation as a
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2005
We present the first report of transabdominal removal of femoral and acetabular components of a s... more We present the first report of transabdominal removal of femoral and acetabular components of a severely loosened hip prosthesis protruding into the pelvis. In a 73-year-old woman post-operative development of urinary tract complications emphasize importance of careful assessment of the prosthetic relations with the vascular and nervous structures as well as pelvic organs before removal of the hip prosthesis. Angio-computed tomography is the most contributive exploration to assess vascular relations. In patients with particular clinical presentations or with threatened structures in the vicinity of the prosthesis, this examination must be completed by complementary opacifications (urinary and gastrointestinal tracts, joints). Ureteral catheterization may be needed if the structures are close or if there is a suspected modification of the urinary tract (retraction, mass effect). In present case, we did not opacify the urinary tract before laparatomy despite the presence of urinary signs preoperatively. A suspected ureterovaginal fistula was discovered. But they where also a ureteral lesions which can result from difficult dissection in contact with infected tissues. In this patient, urinary complications led to nephrectomy after temporary pyelostomy for urine bypass. At last follow-up, the urinary tract infection was controlled but reimplantation was not attempted because of insulin dependent diabetes mellitus and poor general condition. The spontaneous course of this infection with prosthesis loosening recalls the importance of regular surveillance of total hip replacements.
ABSTRACT In case of severe femoral bone loss, cementless revision hip arthroplasties require a st... more ABSTRACT In case of severe femoral bone loss, cementless revision hip arthroplasties require a stable initial distal fixation that does not compromise a subsequent bone reconstruction. The locking mechanism provides initially reliable fixation, especially if bone loss has spread to the distal femoral isthmus or when an extended trochanteric osteotomy (femorotomy) is indicated. Locking stems can be used in all types of femoral revision, but this type of implant can be especially useful in case of diaphysial damage (beyond the isthmus) which makes fixation of a long cemented or non-cemented stem uncertain; in case of septic revisions which need a careful femoral cleaning; in case of peri-prosthetic fractures or if surgical complications (false route, fracture, perforations) occur that impair fixation of a cemented stem or one that is not of standard length. All approaches may be used, but the need for access to the femur dictates choice of the antero-lateral and especially the postero-lateral route. The choice of diameter is guided by “press-fit” beyond the femorotomy, thus minimizing the stresses that will consequently be exerted on the locking system. The size will be chosen also to optimize the contact between residual bone and prosthetic surface treatment in the metaphysial proximal and diaphysial regions. The stem must be locked depending a few technical requirements. The position of the stem will be chosen regarding limb length (height) and joint stability (anteversion). The quality of femorotomy closure is evaluated by achieving broad contact between the flap and the proximal part of the stem. When the medial part of the femur relative to the flap remains distant from the stem, a “counter-femorotomy” of medial cortical bone made at a different level should be performed to optimize contact. These implants simplify femoral revisions by facilitating femorotomy in complex situations. This method offers constant bone reconstruction without significant bone grafting and durable fixation if locking mechanism is added to an adjusted implant in contact with native bone, limiting short-and long-term stresses on it.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advanta... more ABSTRACT Purpose of the studyIsolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true.
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