Excellent long-term survival rates associated with the absence of stem subsidence have been achieved with total hip arthroplasty (THA) using femoral components cemented line-to-line (“French Paradox”). Recently, short stems have been introduced in order to preserve diaphyseal bone and to accommodate to minimal invasive THA and a variety of clinical situations. The aim of the current study was to quantify the rotational and tilting stability of a Kerboull stem of varying length after line-to-line cementation using a validated in-vitro model. The femoral component made of M30NW stainless steel was derived from the original Kerboull stem. It had a double taper, a highly polished surface, and a quadrangular cross-section. Four stem lengths were designed from the original length with a distal reduction of 6, 12, 17 and 22%, whereas the proximal body geometry of the implant remained unaffected. For each stem length, five specimens were implanted into a non-canal synthetic femoral model. The femoral preparation was performed in order to obtain rotational and tilting stability of the stem prior to the line-to-line cementation. Spatial micro-motions of the specimens were investigated using a validated rotational measuring set-up. In addition, in a second separate step, the specimens were exposed to a ventro-dorsal moment to mimic varus-valgus moment. Statistical analysis was performed using ANOVA with Fisher PLSD.Introduction
Materials & methods
The purpose of this study was to evaluate the in vivo migration patterns of a polished femoral component cemented line-to-line using EBRA –FCA. The series included 164 primary consecutive THAs performed in 155 patients with a mean age of 63.8 years. A single prosthesis was used combining an all-polyethylene socket and a 22.2 mm femoral head. The monoblock double tapered femoral component made of 316-L stainless steel had a highly polished surface (Ra 0.04 micron) and a quadrangular section (Kerboull(r) MKIII, Stryker). The femoral preparation included removal of diaphyseal cancellous bone to obtain primary rotational stability of the stem prior to the line-to-line cementation. Stem subsidence was evaluated using EBRA-FCA software which accuracy is better than ± 1.5 mm (95% percentile), with a specificity of 100% and a sensitivity of 78% for detection of migration of more than 1.0 mm, using RSA as the gold standard.Introduction
Methods
We present a new technique for TKA implantation which utilizes patient-specific femoral and tibial positioning guides developed from MRI to offer an individualized approach to total knee replacement. This is a prospective non controlled study which aims to analyse the precision of this technique, its advantages and inconvenients in comparison with the conventional instrumented technique. The MRI provides a consistent three-dimensional data set of the patient's anatomy which allows for 3D axis identification. The ideal position and sizing is performed by the surgeon on this 3D model and the patient specific guides are manufactured in advance in order to reproduce the bone cuts corresponding to this positioning and implant size. There are no intramedullary nor extramedullary instruments during the surgery. We compared 20 patients operated with this technique with 20 patients operated with the conventional technique. The hypothesis was a difference < 2° between the 2 techniques The measured parameters were: HKS, HKA, tibial slope, femoral rotation on CT Duration, bleeding, pain on VAS and morphine consumption, active flexion, KSS, Oxford score, recovery of independant walking and delay of return to home. Both groups were identical for gender, age, BMI, etiology, comorbidities, pain and rehabilitation protocols.Material
Method
