Limb length disparity is a frequent complication after hip surgery inducing many surgeon-patients conflicts. To date no study has been able to precisely quantify such limb length disparity. EOS® system, currently validated to measure lower limb parameters, allows from two bi-dimensional numerical orthogonal radiographies in standing position to obtain a tri-dimensional reconstruction of lower limbs. A computerized system achieves the parameters calculation. The aim of this study is to precisely measure the limb length disparities and the other hip parameters following total hip arthroplasty surgical procedure, by using a standard X-rays and using EOS® three-dimensional reconstructions. Twenty-eight patients programmed for total hip arthroplasty have been included (i.e. thirty lower limbs). Two independent performers have carried out twice the measures either on standard X-rays and using three-dimensional reconstructions of the lower limb disparities prior and after the surgical procedure. The inter and intra-observer reproducibility for the measure of the lower limb disparities have been of the EOS® measures have been respectively of 0.854 and 0.865 and for the standard X-rays of 0.717 and 0.726. Mean length disparity observed was before Total Hip Arthroplasty of −0.328 cm (0.705; −1.266/0.530) and was of 0.088 mm (1.326; −1.635/0.632) after. We are able to decrease the lower limbs disparity in 69.1% and for the average of 0,416cm. Using EOS® system has allowed assessing with greater precision the possibility to restore equal lower limb length. This assessment has permitted introducing a new planning procedure including EOS® imaging associated to the fusion of the prosthetic tri-dimensional image in order to achieve adequate lower limb length.
Hard-on-hard bearing surface have been accepted as a valuable alternative for young and active patients needing a hip replacement because these combinations are resistant to wear. Initial development of alumina-on-alumina bearings faced complications such as fractures, and socket loosening. But, with the increasing number of prostheses implanted, noise occurrence appeared as a new complication. The primary aim of the present survey was to quantify the prevalence of having noise in a population receiving alumina-on-alumina hip arthroplasty. Two hundred and eighty-four ceramic-on-ceramic hips were performed in 238 patients (126 males and 112 females) from January 2003 to December 2004. The average age at the index operation was 52.4 ± 13.4 years (range, 13 to 74 years). We used the same type of prosthesis for all patients manufactured in all cases by Ceraver-Osteal®. Clearance between femoral and insert was between 20 and 50 microns in order to achieve minimal wear. The survey was conducted by an independent surgeon who did not participated in patients care during the last 6 months of 2007. He interviewed the patients by phone with a standardized questionnaire (appendix) that aimed to assess if noise was present and the characteristics of this noise if present. No suggestion was done on how they could describe the noise and they felt free to use the word that they considered to be the most adapted. Satisfaction was evaluated asking if the patient was very satisfied, satisfied or dissatisfied with its prosthesis. When the noise was present, the X-ray was independently evaluated to assess if sign of component fracture was present. Four patients (six hips) died of unrelated cause during the follow-up. Three patients (three hips) lived outside France and could not be followed (1.3%). Nine patients (ten hips) could not be traced and are considered lost to follow-up (3.8%). Two hundred and twenty-two patients with 265 hips were therefore surveyed. Among these 265 hips, 28 experienced noise generation (10.6%). It was defined as a snap for 6 patients, as a cracking sound by 6, as rustling by 6 patients, as a squeaking by 7 patients (2.6%), a tinkling by 2 patients, one patient was unable to define the sound she felt. No factor related to the patient influenced the occurrence of noise. Twelve patients were dissatisfied with the result of the hip prosthesis, 5 of them experienced noise (41.7%); 210 were satisfied or very satisfied 23 of them experienced noise (11%); this difference was significant (p=0.002). No patients required revision for noise. The origins of noise occurrence are unknown but several hypotheses can be suggested. Squeaking may be due to absence of sufficient lubrication. Other types of noise can be due to microseparation, occult dislocation, impingement between the femoral neck and the acetabular rim but demonstration remain an issue.
To date, no technique has proved to be reliable and reproducible in order to precisely calculate radiological lower limb parameters. EOS® system allows from two bi-dimensional orthogonal radiographies in standing position to obtain a tridimensional reconstruction. A computerized system achieves the parameters calculation. The aim of the study was first to evaluate the inter and intraobserver reproducibility of the EOS® system, secondly to compare EOS® measures with X-ray orthoroentgenograms. Twenty-five patients about to receive total hip arthroplasty were included (fifty lower limbs). Two independent performers have carried out twice the measures either on standard X-rays and using three-dimensional reconstructions (femoral parameters (length, offset, collo-diaphy-seal angle, neck length, and head diameter), tibiae length, limb length, HKA, HKS). The reproducibility was estimated by intraclass correlation coefficients. The inter and intraobserver reproducibility of the EOS® measures have been respectively of 0.881 and 0.916 and more specifically of 0,997 and 0,997 for femoral length, of 0.996 and 0.997 for tibiae, of 0.999 and 0.999 for limb length, of 0.893 and 0.890 for HKS, of 0.993 and 0.994 for HKA, of 0.892 and 0.914 for femoral offset, of 0.765 and 0.850 for collo-diaphyseal angle. The inter and intraobserver reproducibility using orthoroentgenograms reached 0.854 and 0.902.
Its use prior to the decision of surgery and during surgery planning for lower limb arthroplasty is for us essential for adjusting surgical procedure accordingly.
From 1979 to 2002, 131 total hip replacement were performed consecutively in patients less than 30 years of age (13 to 30,7 mean 24;2) in 75 patients (44 in males and 31 in females. Seventy six in 57 patients could have more than 2 years follow-up and will presented hereby. Regarding the type of prosthesis, 59 stem were cemented and 16 cementless. Five different socket were implanted: 6 screw-in metal back: 8 bulky cemented, 23 bulky cementless, 13 metalback press fit with titanium mesh and 26 HA covered. Underlying diseases were Avascular necrosis in 46, 8 inflammatory disease, 6 after infected articulation, epiphysiolysis in 4 and acetabular fracture in 3. 48 were done primarily, 28 were a revision procedure and 10 had some past history of infection. Mean follow up was 7,84 years (range 1,13-22,9). One patient (two hips deceased at 1,1 year. One hips was lost to follow-up. 73 had complete clinical and radiological evaluation. Nine hips were revised from 2,97-18,64 years after the index procedure (mean 8,53). In 7 only the socket was revised, in two both components. Two of these were infected (secondary infection in one). Of the remaining: 45 had no pain, 18 slight uncommon pain, 10 were classified 5 and 8 had some limp. Radiological evaluation: 56 had no lucent lines nor subsidence, 4 had some radiolucent line none progressive and 1 had a complete lucent line: and is considered as impending failure. In no case osteosysis was documented. With the exception of socket loosening due to non optimal design of the initial system (bulky alumina cemented or cementless) the overall results are in favor of theis material in young and active patients.
In order to avoid the consequences of polyethylene wear in a high-risk population, 128 alumina-alumina total hip arthroplasty were implanted in 116 consecutive patients of 40 years old or less. Osteonecrosis and sequellae of congenital hip dislocation were the main etiologies representing 71% of the hips. The same titanium alloy cemented stem was implanted in all hips. Four alumina acetabular component fixations were used: cemented plain alumina socket (41 hips), screw-in ring with an alumina insert (22 hips), a press-fit plain alumina socket (32 hips) and a press-fit titanium metal back with an alumina insert (33 hips). Eight patients (11 hips) died during the follow-up period. Sixteen revisions were documented, 12 for ace-tabular aseptic loosening, 3 for bipolar loosening (2 were septic), and 1 for unexplained pain. Eighty-nine hips were followed radiologically for two to twenty years. No femoral nor acetabular osteolysis were observed with an average follow-up of 8.4 years. Wear was unmeasurable. Four additional sockets showed definite migration. The respective survival rate at 7 years were 91.4% for the cemented cup, 88.8% for the screw-in ring, 95.1% for cementless press-fit plain alumina socket and 94.3% for the metal-back press-fit component. The ten-year survival rate was 88.0% for the cemented socket and 88.8% for the screw-in ring. The fifteen-year survival rate was 76.7% for the cemented socket. The occurrence of a graft was the only prognostic factor with a 62.6% survival rate at ten years for the grafted hips and a 90.1% for the non-grafted hips (p=0.004). The alumina-alumina bearing surfaces for young patients appeared as a valuable alternative to standard metal-polyethylene system. There is a need to improve socket fixation if we want to have a survival of the arthroplasty as long as the life expectancy of this increasing and demanding population. The last design with a fully coated HA titanium shell and an alumina liner seems to fulfill the requirements.