Introduction: The aim of this study was to evaluate the in vivo migration patterns using EBRA-FCA of a consecutive series of polished femoral components cemented line-toline.

Materials and Methods: Between January 1988 and December 1989, 164 primary total hip arthroplasties were performed in 155 patients. The mean age at the time of the index arthroplasty was 63.8 ± 11.6 years. A single design prosthesis was used combining an all-polyethylene socket and a 22.2 mm femoral head. The mono-block double tapered (5.2°) femoral component made of 316-L stainless steel had a highly polished surface (Ra = 0.04 μm) and a quadrangular section(Kerboull^® 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. For each patients, all available AP radiographs of the pelvis were digitized (Vidar Sierra Plus, Vidar System Corporation, Herdon, Virginia) and linked to an IMB-compatible computer. The EBRAFCA software is a validated method designed to assess migration of a femoral component through comparable pairs of radiographs.

Results: At the minimum 15-year follow-up, 73 patients (77 hips) were still alive and had not been revised at a mean of 17.3 ± 0.8 years (15–18 years), 8 patients (8 hips) had been revised for high polyethylene wear associated with periacetabular osteolysis, 66 patients (69 hips) were deceased, and 8 patients (10 hips) were lost to follow-up. Among the 8 revision procedures, the femoral component was loose in 3 hips. A total of 1689 radiographs (mean 10.3 per hip) were digitized. At the last follow-up, the mean subsidence of the entire series was 0.63 ± 0.49 mm (median of 0.61 mm; range 0 to 1.94 mm). When using a 1.5 mm threshold (accuracy of the EBRAFCA method) for subsidence, 4 of the 142 stems with adequate EBRA-FCA data were considered to have migrated. Using a threshold of 2 mm for subsidence, none of the 142 stems were considered to have migrated. The patterns of migration were calculated every 2 years giving 9 intervals. The evolution of mean subsidence during the whole follow-up period remained below 1.5 mm.

Discussion: Mean subsidence of this quadrangular highly polished femoral component remained below the accuracy of the method (± 1.5 mm) throughout the entire follow-up period. Of the 142 hips analyzed, only four (2.8%) had subsided of more than 1.5 mm and none more than 2 mm. This study demonstrates that contrary to other cemented femoral components that have provided excellent survival in the long term frequently associated with stem subsidence, a highly polished cemented double tapered femoral component with a quadrangular cross-section cemented line to line does not subside up to 18-year follow-up.

Introduction: The purpose of this study was to report on the minimal 10-year followup results of a prospective randomized and a historical series of low friction cemented hip arthroplasties according to the surface finish of the femoral implant.

Patients and Methods: The prospective randomized series included 284 patients (310 hips) with a mean age of 64.1 years. Among these 310 hips, the femoral component had a highly polished surface (Ra = 0.04 micron, MKIII, Stryker) in 165 hips, and a matte surface finish (Ra = 1.7 microns, CMK3, Vector Orthopedique) in the remaining 145 hips. The historical series that was operated by the sames surgeons according to the same surgical technique included 111 patients (123 hips) with a satin finish femoral component (Ra = 0.9 micron, CMK2, Sanortho). Clinical results were rated according to the Merle d’Aubigne hip score. Radiologic analysis was performed according to the criteria of Barrack et al. for the definition of loosening. Moreover, a survival analysis according to the actuarial method was conducted.

Results: At the minimum 10-year follow-up evaluation, 43 patients (48 hips) were lost to follow-up (0.3 to 8.7 years), 80 patients (83 hips) were deceased (0.1 to 13.6 years), 26 patients had revision of either or both components (0.9 to 15.9 years), and 246 patients (276 hips) were alive and had not been revised after a mean 12.3 ± 1.9 years (10 to 16 years). Radiologic loosening of the femoral component, including revision, occured in one, four, and 15 hips for the polished, stain, and matte groups, respectively. The survival rate at 13 years of the femoral component, using loosening as the end point, was 97.3 ± 2.6% (95% CI, 92.2 to 100%), 97.1 ± 2.1% (95% CI, 93 to 100%), and 78.9 ± 5.8% (95% CI, 67.6 to 90.3%) for polished, satin, and matte stems, respectively.

Discussion: This study demonstrated that cement fixation of a femoral component was more reliable in the long term with a polished or satin surface finish. Based upon our results and the review of the literature, we recommend abondoning the use of cemented stems with a surface roughness greater than 1 micron.

Purpose: Certain authors have indicated that the primum movens of loosening of cemented femoral stems is related to the decohesion of the cement implant interface. Under such conditions, improvement in this interface was attempted with the development of a rough surface for the femoral piece. The purpose of this retrospective analysis was to evaluate results a minimum ten years follow-up in a consecutive series of total hip arthroplasties comparing types of femoral implant surfaces.

Material and methods: Between January 1988 and December 1989, 311 THA were implanted in 286 patients aged 63.6±11.8 years (26–91). All implantations were performed via the transtrochanteric approach by two senior surgeons. Two types of femoral implant were used: 166 non-polished pieces with a round section Ra = 3 mm (CMK3, Vector Orthopédique) and 145 polished pieces with a quadrangular section Ra = 0.4 mm (MKIII, Stryker Howmedica). The preoperative data were comparable for the two groups. Functional results were assessed with the Postel Merle d’Aubigné score (PMA). Actuarial survival curves were plotted.

Results: At minimum ten years follow-up, 187 patients (204 hips) were living and had not required revision at mean follow-up of 11.7±2.5 years (10–14), 15 patients (15 hips) had revision of the acetabular and/or femoral element, 54 patients (58 hips) had died, and 30 patients (34 hips) were lost to follow-up. The mean preoperative function score was 11.2±2.5 (4–16) versus 17.5±0.5 (10–18) at last follow-up (Wilcoxon rank test, p< 0.001). Cumulative survival at 13 years, taking radiographic loosening of the femoral piece as the endpoint, was 78.9±5.8% (95%CI 67.6–90.3%) for unpolished implants versus 97.3±2.6 (95%CI 92.2–100) for polished implants. The difference was significantly different (p< 0.001).

Discussion: The results of this analysis indicate that radiographic survival of unpolished cemented femoral pieces is significant inferior compared with polished pieces. The increased adherence of the femoral cement is probably the cause of increased shear stress at the bone-cement interface. The respective influence of section and surface remain to be determined.

Aims: The purpose of this prospective randomized study was to report on the minimal 10-year follow-up results of a consecutive series of cemented total hip arthroplasty according to the surface finish of the femoral implant. Methods: Between January 1988 and December 1989, 311 total hip arthroplasties were performed in 286 patients. Implants were of Charnley Kerboull design combining a 22.2-mm femoral head and an all-polyethylene socket. The cemented femoral implant was available in two configurations: polished (Ra = 0.4 μm) and matte (Ra = 3 μm). The polished stem (MK III, Stryker Howmedica) was implanted in 166 hips, and the matte stem (CMK 3, Vecteur Orthopedic) in the remaining 145. The mean age of the patients was 63.6 years. Results: At the minimum 10-year follow-up evaluation, 187 patients (204 hips) were still alive and had not been revised at a mean of 11.7 years (10–14 years), 15 patients (15 hips) had been revised, 54 patients (58 hips) had died from unrelated causes, and 30 patients (34 hips) were lost to follow-up. The mean d’Aubigné hip score was 17.7 ± 0.3 at the latest follow-up. The survival rate at 13 years, using radiologic loosening as the end-point, was 97.3 ± 2.6% (95% confidence interval, 92.2 to 100%) for polished stems, versus 78.9 ± 5.8% (95% confidence interval, 67.6 to 90.3%) for matte stems (log-rank test, p = 0.0001). Conclusions: This study demonstrated that cemented fixation of femoral stems was significantly more reliable in the long-term with a polished surface.

Purpose: Surgical prosthetic treatment of excentred degeneration of the shoulder joint has long been limited to simple humeral prostheses. Inverted total shoulder arthroplasty (ITSA) using the Grammont system appears to provide real improvement. What is the comparative outcome? Does the Grammont prosthesis give constant results? Is the simple humeral prosthesis still indicated for selected cases? In order to respond to these questions, we reviewed 84 patients who had undergone surgery between 1986 and 2000 for implantation of 52 simple humeral prostheses (mean follow-up 7.1 years) and 32 ITSA (mean follow-up 4.3 years).

Material and methods: Between 1986 and 1995, all patients with excentred degeneration of the shoulder joint were treated with a simple humeral prosthesis (36 cases). Between 1995 and 2000, either ITSA or simple humeral prosthesis (16 cases) was used. For the ITSA, indications were limited to excentred degeneration in patients aged over 70 years with a painful pseudoparalytic shoulder or contraindication for a simple prosthesis (alteration of the acromiocorocoid vault or the subscapular area). Simple prostheses were used either when an ITSA could not be implanted (patient too young, overly deteriorated glenoid, deltoid insufficiency) or when there was a preferential indication (excentred degeneration in young patients < 65 years, preservation of active motion, Favard type 1 or 2 glenoid…).

Results: For the simple humeral prosthesis series (1986–1995): the Constant score improved from 16.4 preoperatively to 489.6 postoperatively; radiographically there were one humeral loosening, three superior migrations, and three glenoid degenerations; three revision procedures were required. For the ITSA: the Constant score improved from 14.2 preoperatively to 61.6 postoperatively; radiographically there was one humeral loosening; 32% glenoid alterations in Nérot grades 3 and 4; one revision procedure was required. For the later simple humeral protheses (1995–2000): the Constant score improved from 18.2 preoperatively to 56.4 postoperatively (60.2 excluding cases with a simple prosthesis due to contraindication of an ITSA); radiologically there were one superior migration and two glenoid deteriorations.

Discussion: For a given indication, the results with the ITSA were better than with the simple prosthesis (p < 0.001). However, excluding salvage procedures where the ITSA could not be used, simple prostheses inserted for precise indications provided results nearly equivalent to the ITSA (p < 0.05) with less uncertainty concerning the future. For us, the inverted total shoulder prosthesis and the simple humeral prosthesis share indications for surgical repair of excentred degeneration of the shoulder joint.

Purpose: The hand-to-forehead test is a new subjective and objective test for anterior shoulder instability. This test is performed preoperatively under general anaesthesia and involves a quantifiable patient-controlled apprehension test and an objective quantitative test of anterior stability.

Material and methods: Between January 1998 and April 2000, 135 patients (97 men and 38 women), mean age 25 years, age range 16–40 years, candidates for surgery for anterior instability of the shoulder (115 Latarget, 14 Bankart, 6 capsular shift) were tested. A control group of 300 candidates free of any shoulder disorder for other surgery were also tested.

Results: the Apprehension test was positive in 95 of the operated patients and negative in 40. Mean angle was 160° (90–180°). The test was always negative in patients with an underlying hyperlaxity (18 patients). The test was positive in 20 controls and negative in 270. Test sensitivity was 72%, specificity 92.5%, positive predictive value 42%, (prevalence 1.5%) and negative predictive value 86%. Reproducibility was 80%. The objective test was positive in 125 of the operated patients and negative in 10. The value was 2++ in 55% of the cases. In the control group, the objective test was positive in 28 and negative in 272. The sensitivity of the objective test was 95%, specificity 90%, positive predictive value 55% and negative predictive value 95%. Reproducibility was 92%.

Discussion: The purpose of the hand-to-forehead test is to express the instability as perceived by the patient and to exteriorise anterior laxity without reproducing true anterior displacement. Excepting cases with underlying hyperlaxity, this test does not appear to be inflenced by different injuries subsequent to recurrent anterior dislocation. (no significant difference between glenoid bone lesions, Broca lesions or Malgaigne notches).

Conclusion: This new test provides a reliable objective assessment of anterior instability of the shoulder using a quantifiable combination of classical apprehension and laxity tests. It is a supplementary diagnostic tool for difficult cases and a useful aid for pre- and postoperative evaluation of these patients.