THE PRIMARY STABILITY OF A CEMENTLESS HIP PROSTHESIS UNDER THE COMPRESSIVE LOADING

The objective of this research is to better understand the problems of primary stability of cementless hip prosthesis. The present study is aimed to develop a finite element model of the coupled system "femur-cementless prosthesis" which represents the implant in its environment particularly under the compressive loading. Its primary stability is investigated by quantifying the migration of the femoral stem in the femur and by analyzing the stress and strains engendered. We have made experimentations on ten fresh human femurs. A good agreement is observed between the experiments and the prediction by our finite element model for the prosthetic head displacement

Etude prospective randomisée de 130 prothèses totales de genou HLS Noetos avec composant fémoral cimenté versus sans ciment (résultats à 1 an)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Genu recurvatum

El genu recurvatum se define como la hiperextensión de la rodilla más allá de 180° o posición cero de referencia. En la mayoría de los casos es bilateral, simétrico, de origen constitucional y asintomático. Puede ser congénito o adquirido (óseo, ligamentoso o mixto) y, en este caso, asimétrico y posiblemente sintomático. Se presenta con diversas manifestaciones clínicas: dolor, inestabilidad femorotibial, inestabilidad femoropatelar, desigualdad de longitud de los miembros inferiores e incluso un perjuicio estético. La exploración física debe ser completa y, sobre todo, bilateral comparativa. La exploración radiológica permite medir el grado del recurvatum, tanto en el aspecto óseo intraarticular o extraarticular como en el aspecto ligamentoso. El recurvatum óseo es distinto al ligamentoso, pero pueden estar asociados. La búsqueda etiológica permite escoger el tratamiento adecuado. En el tratamiento quirúrgico predominan las técnicas de osteotomía de abertura tibial anterior, pero no son las únicas. De forma asociada o aislada también pueden efectuarse procedimientos ligamentosos o conservadores

Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up

Background The type of total knee arthroplasty (TKA) fixation (cemented or uncemented) is still subject to debate. The aim of this study is to assess the survival rate, clinical outcomes, and radiological results of TKA according to the fixation type. Methods A total of 130 patients were randomly assigned to either the cement group (cemented femoral and tibial implants) or the hybrid group (cemented tibial implant, uncemented femoral implant). The inclusion criteria were patients between 50 and 90 years old who underwent primary TKA for osteoarthritis between 2004 and 2005 without a history of open knee surgery. Revisions and complications were reported, as well as clinical scores and radiological signs of loosening. Results One hundred eighteen patients had complete data at 10 years of minimum follow-up (59 in each group). The mean age was 72 years old. The mean follow-up was 13 years. The survival rate was 98% at 13 years in both groups (1 aseptic loosening at 2 years in the cement group, 1 septic loosening in the hybrid group). The complication rate in the cement group was 8.5% (n= 5) vs 12.1% (n= 7) in the hybrid group (P= .8). The clinical results were not significantly different. In the cement group, 25% of patients (n= 15) had radiolucent lines at 10 years. In the hybrid group, 33% of patients had bone transparencies, not evolving or symptomatic. Conclusion At a minimum follow-up of 10 years, there were no significant differences between cemented TKA and hybrid TKA for the survivorship, the complication rate, the clinical scores, or the radiological signs of loosening. Level of Evidence I

A Biomechanical Evaluation of Bicortical Metal Screw Fixation Versus Absorbable Interference Screw Fixation After Coracoid Transfer for Anterior Shoulder Instability

Purpose: The purpose was to evaluate the load to failure of 2 coracoid fixation techniques after transfer of the coracoid to the anterior glenoid neck. Methods: Ten cadavers (mean age, 87 years; range, 74 to 96 years) underwent the Bristow conjoined tendon tenodesis technique as described by Boileau et al. (bioabsorbable interference screw fixation of a coracoid bone plug) in 1 shoulder and the Latarjet-Patte coracoid transfer popularized by Walch (fixation with 2 screws through a larger piece of the coracoid) in the opposite shoulder. The force on the conjoined tendon required to pull the coracoid off of the anterior glenoid was recorded, along with the mode of construct failure. Results: The median ultimate failure load was 110 N (range, 35 to 170 N) in the interference screw group and 202 N (range, 95 to 300 N) in the bicortical screw group (P .002). The mode of failure of the interference screw technique was complete avulsion of the bone plug from the socket in 6 cases (60%) and fracture of the bone plug in 4 (40%). The mode of failure of the bone block technique was a vertical fracture through both screw holes in 7 cases (70%), a horizontal fracture through the distal screw hole in 2 (20%), and an intratendinous rupture of the conjoined tendon in 1 (10%). Conclusions: Fixation of a coracoid bone block to the anterior glenoid neck with 2 bicortical metal screws is stronger than fixation of a coracoid bone plug with an absorbable interference screw. Clinical Relevance: These data may influence surgeons' decisions regarding coracoid fixation as well as postoperative rehabilitation after coracoid transfer

The effect of gender on outcome of unicompartmental knee arthroplasty

No report has specifically addressed the question of the influence of gender on outcome following unicompartmental knee arthroplasty (UKA). To clarify this issue, we studied two groups of 40 patients of each gender, matched by pre-operative clinical and radiological presentation, and with post-operative follow up of at least 2 years. The mean age at operation was 71 years and the mean follow-up was 5.9 years. In both groups, IKS score improved significantly, but without difference based on gender. No difference was found between groups in terms of range of motion, alignment, or radiologic progression of arthritis. These results suggest that when utilizing specific patient selection criteria, gender does not influence outcome following UKA. Unicompartmental knee arthroplasty (UKA) - Gende

Total knee arthroplasty of the stiff knee: three hundred and four cases

PURPOSE: The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ?90° and/or flexion contracture ?20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness. METHODS: Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction. RESULTS: At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17%). Pain and residual stiffness were the most common complications. CONCLUSION: TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit

The influence of femoral cementing on perioperative blood loss in total knee arthroplasty a prospective randomized study

Background: Total knee arthroplasty can involve substantial blood loss. We prospectively studied a consecutive series of patients undergoing primary total knee arthroplasty to assess the influence of femoral cementing on perioperative blood loss. We hypothesized that an uncemented femoral component is a risk factor for bleeding. Methods: A semiconstrained posterior stabilized prosthesis was used in all patients. Preoperatively, 130 patients were randomly assigned to either the cement group (Group 1) or the hybrid group (Group 2). We selected all patients who underwent a knee replacement through a medial parapatellar approach (n = 107). Group 1 consisted of forty-two women and twelve men ranging in age from fifty-six to eighty-five years. Group 2 consisted of thirty-seven women and sixteen men ranging in age from fifty-six to eighty-five years. The hemoglobin and hematocrit levels were recorded preoperatively and five days postoperatively for each patient. The volumes of postoperative suction drainage and the rate of blood transfusion were recorded. Results: No differences between the two groups were identified with regard to hemoglobin and hematocrit levels, total measured blood loss, postoperative drainage amounts, or transfusion rates. The total measured blood loss was 1758.9 mL for Group 1 and 1759 mL for Group 2. Conclusions: Cementing the femoral component during a total knee arthroplasty does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion