Twenty-year results of the cementless Corail stem

The concept of an extensive hydroxyapatite (HA) coating for the fixation of a tapered femoral stem (Corail®) was introduced 25 years ago in the hope that we could achieve durable biological fixation while preserving normal periprosthetic bone activity. The value of uncemented fixation using HA-coated implants is now widely admitted. However, the characteristics of implant coating and more specifically its extent still remain a subject of debate or even controversy. This prospective study conducted over a 20-year period has greatly contributed to demonstrating the reliability of the Corail® prosthesis, in terms of functional abilities, radiographic evidence and global survivorship. A full HA coating applied on a straight and proximally flared stem induces substantial short-, mid- and long-term benefits without any deleterious effects reported. Modifications of the bone pattern have been strictly limited: slight resorption at the calcar level, absence of cortical hypertrophy and alleged stress shielding. The radiological “silence” is one of the paramount facts clearly demonstrated

Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint: Comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis

Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface’s of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint