Cementless revision femoral stems application of press-fit principles and clinical outcomes

International audienceBACKGROUND:Cementless femoral stems are currently used in revision total hip arthroplasty (THA) with the surgeon choosing between various fixation modes. The outcomes are good in the medium term; however, some failures have been attributed to technical errors during implantation. When the decision has been made to use a press-fit implant, the impact of the surgeon's technique on the functional outcomes have not been explored in-depth. This led us to carry out a retrospective study on a large population of total hip arthroplasty patients which aims were achieved press-fit to (1) determine the impact of the type of primary fixation (with and without press-fit) on the functional outcomes; (2) specify the effect of stem length on the functional scores when diaphyseal press-fit is achieved and (3) analyse the main reasons why a true press-fit effect was not achieved (three-point fixation).HYPOTHESIS:There is a relationship between the primary fixation method by press-fit of a revision femoral stem and the functional outcomes.PATIENTS AND METHODS:We performed a retrospective analysis of a continuous cohort of 244 THA revision cases with a mean follow-up of 6.1 ± 3.5 years (range, 2-18). The femoral area in which close contact was achieved (shared interface between the bone and implant) was used to define various types of press-fit fixation. The functional outcomes were determined using the Harris Hip Score (HHS) and the Merle d'AubignéPostel score (MAP score) out of 12 points (pain and walking items).RESULTS:The post-operative HHS averaged 90.83 ± 7.51 for proximal press-fit and 80.14 ± 14.93 with no press-fit (p = 0.01). The MAP averaged 10.83 ± 1.03 for proximal press-fit and 9.75 ± 2.09 with no press-fit (p = 0.09). The MAP score was worse for long diaphyseal press-fit than for short press-fit (p = 0.02). Use of a long stem with an endofemoral route or an overly small femoral window in patients with a curved femur is the main reason that three-point fixation occurred instead of press-fit.CONCLUSIONS:While press-fit is an effective concept, it is a demanding one that requires the surgeon to choose the correct surgical strategy for the patient's anatomy. A meticulous surgical technique is required to achieve proximal press-fit or at a minimum, short diaphyseal press-fit

Global radiological score for femoral cementless revision stem

International audiencePURPOSE:The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) revision with cementless stems using a numeric global radiological score (GRxS) that summarizes two previously validated scores: secondary bone stock (SBS) and osseointegration-secondary stability (O-SS).METHOD:One hundred fifty cases of THA were evaluated at a mean follow-up of 6.5 ± 3.7 years. The GRxS combines the SBS, which evaluated cortical bone thickness, bone density and bone defects in each Gruen zone and the O-SS, which evaluated the location and extent of a single radiolucent line. To calculate the GRxS, the SBS and O-SS were each expressed on a 10-point scale and given equal weighing. The final result was a number out of 20. The GRxS was used to assign a radiological grade to each THA case: very good (20), good (18-15), average (13-12), or poor (≤ 10). The numerical mean (Nm) was calculated for each grade. The inter- and intra-observer reproducibility was evaluated.RESULTS:The inter-observer reproducibility was good (0.8) and the intra-observer reproducibility was very good (0.9). The GRxS was considered very good in 46 cases (Nm 20), good in 57 cases (Nm 16.6), average in 25 cases and poor in 22 cases. There was a significant relationship between the GRxS and the Harris Hip and Postel Merle d'Aubigné scores (p < 0.0001), and the initial bone stock (p = 0.0001).CONCLUSIONS:The GRxS is reliable and reproducible. This information can be used by surgeons to adapt the surgical technique to bone characteristics (especially during revision cases) and to compare the outcomes of different implant designs

Bone stock in revision femoral arthroplasty: a new evaluation

International audiencePURPOSE:The purpose of this study was to finalize a method allowing a qualitative and numerical evaluation of the bone stock and to confirm its reproducibility, to verify the relationship between the secondary bone stock value and the functional results, and to determine the main factors influencing the value of the bone stock.METHODS:A clinical and radiological evaluation was performed in a group of 150 revisions of total hip replacements according to a new method taking into account cortical bone thickness, bone density and bone defects.RESULTS:Interobserver reproducibility was evaluated at an average of 0.6 and intra-observer reproducibility was considered good at 0.8. Between the initial bone stock and at the last follow-up, no significant difference was noticed. For secondary bone stock considered as "very good or good", the gain was +38.1 points versus +29.9 points for patients evaluated as "average or poor" (p < 0.0001). Between the initial bone stock assessment and at last follow-up, a significant relation was found in numerical values for the global type of primary fixation and in the presence of osteopenia (p < 0.0001).CONCLUSIONS:Deficient secondary bone stock can result in less favourable functional results. The numerical scores confirm the importance of strategic choices during surgery in order to manage bone stock preservation

Les parlementaires de la Seine sous la Troisième République. Vol. 1

Ce volume sur les parlementaires de la Seine est publié dans le cadre de l’enquête sur le personnel parlementaire de la Troisième République, entreprise par le Centre d’Histoire du xixe siècle (Universités Paris I et Paris IV) associé au CNRS. Parallèlement au dictionnaire de ces parlementaires, un ensemble de contributions veulent éclairer le monde des élus, à la Chambre et au Sénat, du département de la Seine : Paris et sa proche banlieue. Origines et formation, activités professionnelles et associations, fortune, vie familiale, orientations spirituelles et philosophiques, itinéraires politiques, ce sont quelques-unes des interrogations qui s’efforcent de discerner l’originalité de ce personnel. Ce livre témoigne de l’intérêt de la démarche prosopographique et constitue un apport à l’histoire sociale et politique de la Seine et de la France de la Troisième République

Associations et champ politique

La loi de 1901 est née des débats consécutifs à l’Affaire Dreyfus. Le vote de cette loi de liberté restait bloqué depuis les années 1880, de crainte de légaliser des congrégations hostiles à la République. Après l’Affaire, le Parti républicain tranche pour un système à deux vitesses, restrictif pour les congrégations et libéral pour les associations laïques. Pour ces dernières, la loi entérine le régime de tolérance en vigueur. Des historiens, des juristes et des politologues reviennent ici sur le « moment 1901 ». Ce moment voit aussi l’émergence des partis modernes. Mais les partis n’ont pas tous utilisé la possibilité que leur offrait la loi de « se déclarer », On se « déclare » plus souvent à droite qu’à gauche, et le mode des relations que l’on entretient avec les associations amies varie d’un bord à l’autre de l’échiquier politique. Inversement, des associations se placent dans le champ politique, revendiquent une légitimité propre et entrent en concurrence avec les partis. Les légitimités participative et représentative sont-elles antagoniques par essence ? Peut-on au contraire les penser comme complémentaires ? Le mouvement associatif constitue-til un relais lors des périodes de perte de représentativité du système partisan ? Cette enquête pluridisciplinaire porte un nouveau regard sur les acteurs et les ressorts de la démocratie