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Adult hip dysplasia: classification, surgical indications, shelf arthroplasty by a minimally invasive approach Ph. Chiron

MO n°213 April 2012

Hip dysplasia due to insufficient coverage of the femoral head is a structural deformity that affects 4% of the Caucasian population and is the cause of 48% of cases of osteoarthritis requiring hip replacement . The option of preventive surgery carries its own risks; meticulous examination of each patient’s individual case is necessary before deciding whether it is indicated. We consider that shelf arthroplasty by a minimally invasive approach is the simplest surgical procedure, has no major complications and has been the best assessed . It does not close the door on good quality primary arthroplasty, nor does it compete with Chiari osteotomy for acetabular enlargement or with triple periacetabular osteotomy, which has its own indications . Varus femoral osteotomywhich deforms the upper extremity of the femur and shortens the leg ... Ph. Chiron

INTRAPROSTHETIC DISLOCATION: A RARE COMPLICATION IN DUAL MOBILITY CUPS M.H. Fessy

MO n°152 March 2006

The main problem with dual mobility cups in the medium term is intraprosthetic dislocation. The head comes out of the polyethylene through wear of the retentive rim. The head then lodges itself in the metalback shell which can be seen by a characteristic view on x.ray. . Alas this type of incident is reported in all the literature on series of dual mobility cups, which is an indicator of this sad reality.We were able to conduct an exhaustive retrospective analysis of all the cases of intraprosthetic dislocation in our departments care between 1991 and 2002. 63 cases were analysed. For each of these 63 cases we had complete medical, surgical and radiological files. Average age at implantation was 51 years. In 30 cases the stem implanted opposite was a PF. This was a screw in stem with a modular monoblock polished stainless steel neck with ... M.H. Fessy

DUAL MOBILITY: A Stéphanois Concept (St Etienne area, France) M.H. Fessy

MO n°152 March 2006

It was Gilles Bousquet who has the merit of having first defined the original concept of dual mobility. The prosthetic head is mobile within a retentive polyethylene which is free to move within a metalback cup . Figure 1 : The principle of dual mobility The first drafts of the project began in the early 1970s. The first implantations started in 1975. The finalisation of the project was due to the meeting of three men. - Gilles Bousquet, Professor in Orthopaedics at the University Hospital of St Etienne - Jean Rieu, Professor of teaching at the Ecole des Mines in St Etienne, and director of the biomaterials department - André Rambert, engineer and Professor in mechanical engineering at the ECAM school in Lyon Gilles Bousquet proposed the concept, Jean Rieu brought his knowledge in biomaterials and especially in surface finishing and ... M.H. Fessy

THE "SARCOPHAGUS" TECHNIQUE FOR CHANGING FEMUR STEMS J.L. Doré

MO n°150 January 2006

The approach and the technique for changing femur stems, whether cemented or not, are not without significant complications: 18% peroperative complications (13% fractures or fissures / 5% false routes). customized stems, because they are frequently inadequate, cause 35 % of fractures. unbridged windows create 24% of fractures. . trochanterotomies cause 20% of cases of non-union of which 55% are upwards . the use of guides for extracting cement limits false routes and fractures to 4%, but their distribution is limited. cement remnants are significant: 17% in cases of metaphysial approach; 13% in cases of trochanterotomy; 11% with isolated windows; 6% with femorotomy sequences; 14% with mechanical cement extractor. simple re-fixing provides poor results, particularly in the case of significant bone deterioration with, at 4 years: 35% ... J.L. Doré

Arthroscopy, shelf, and core decompression: minimal-access conservative hip surgery Ph. Chiron

MO n°123 April 2003

The technique of enlarging the acetabulum by means of an extra-articular bony extension goes back to Koenig , and was first described in the literature by Marcel Lance , in 1925. The shelf consists of a corticocancellous autograft that is fitted on the anterosuperior aspect of the joint capsule in order to provide a larger weightbearing surface and, thus, to reduce the pressure on the cartilage. In the 60s of the last century, a number of authors (among them Castaing, Salmon, Judet, Roy-Camille, Rieunau, Chiari, and Spitzy ) devised modifications of the original technique, in order to improve graft placement and graft fixation. In these modified techniques, the surgical approach initially suggested by Lance – an incision similar to the Smith-Petersen approach – was retained. This route involves wide exposure of the iliac crest. ... Ph. Chiron

APPRAISAL OF SURGICAL TREATMENT REGARDING OSTEONECROSIS OF FEMORAL HEAD Ph. Chiron

MO n°105 June 2001

Although it is desirable to avoid hip replacements in young patients as much as possible, when it comes to choosing a conservative technique the physical and social constraints and the risks incurred by the patient need to be taken into account. The relatively recent progress made in the durability of arthroplasties for young subjects means that the choice of certain surgical techniques whose results are uncertain, preventing a rapid return to social life and sometimes modifying the shape of the upper extremity of the femur with the risk of limiting the chances of success of a subsequent hip replacement, should be avoided.The object of all the surgical techniques is to relieve the often intense and incapacitating pain caused by osteonecrosis. They should also preserve the range of motion, often near to normal preoperatively. All coring techniques ... Ph. Chiron

THE PLACE OF IMAGING IN THE DIAGNOSIS OF IDIOPATHIC OSTEONECROSIS OF THE FEMORAL HEAD. B. Domenech*, J.-J. Railhac*, P. Chiron**, B. Mazieres***

MO n°105 June 2001

In a context of hip pain and suspicion of aseptic osteonecrosis of the femoral head, the role of the imaging device is, on the one hand, to confirm that there is indeed damage to the head and, on the other, to establish a diagnosis of osteonecrosis by eliminating at the same time the two great differential diagnoses which are algodystrophy and epiphyseal stress fracture due to trauma. These days, a virtually certain diagnosis will be based on nuclear magnetic resonance imaging, revealing the existence of a subchondral fracture, key to all the classifications, on the attentive examination of several views of standard radiographs and eventually of CAT scan image slices. Scintigraphy is no longer essential. A technique for earlier detection than the la radiograph or the scanner its sensitivity is high: 85%. However, it is not very specific ... B. Domenech, J.-J. Railhac, P. Chiron, B. Mazieres

The Gamma Nails (Standard, Trochanteric, and Long) Tips And Pitfalls G. Taglang, B. Schenck, C. Averous

MO n°75 June 1998

The Strasbourg Centre of Traumatology and Orthopaedic Surgery (C.T.O.) has a long tradition of closed intramedullary nailing. While the Centre itself was founded at the end of the last century, intramedullary nailing came in, as a major femoral shaft fracture fixation technique, in the late 40s of this century. Gaston Pfister, then a young surgeon at the C.T.O., was the first to use the Küntscher nail for the stabilization of femoral fractures, back in December 1944.Given this long period during which the technique originally devised by Gerhard Küntscher has been in use at our Centre, it is not surprising that it should have been modified and improved over the years. The locking nail, perfected by Grosse and Kempf in the mid-70s, is a good example of the developments and enhancements that have taken place; it is still the gold standard ... G. Taglang, B. Schenck, C. Averous

Reduction and Internal Fixation of Acetabular Fractures through the Kocher-langenbeck Approach. Tips and Tricks. F. Laude

MO n°74 May 1998

The posterior Kocher-Langenbeck approach is probably the best-known and the easiest incision for the management of acetabular fractures. However, the reduction of acetabular fractures through this approach is not altogether straightforward, since the exposure provided is limited, and the proximity of vital structures makes some of the manipulations involved in the reduction dangerous . This article recalls some of the basic principles of the management of acetabular fractures through the Kocher-Langenbeck approach. For acetabular surgery, certain special instruments are required, which greatly facilitate the reduction of the fracture fragments.The joint is deep, and the fragments are, therefore, difficult to mobilize. The ball-spike instrument named “picador” by Emile Letournel is a modified bone awl that allows fragments ... F. Laude

Osteonecrosis of the Femoral Head, at the Pre-prosthetic Stage Ph. Hernigou

MO n°72 March 1998

The chief causes of nontraumatic ONFH are treatment with corticosteroids, sickle cell disease , and chronic alcohol abuse.In patients on long-term steroids, there is a notoriously high incidence of avascular necrosis. Even patients who are given high-dose steroids for short periods of time (e.g. for the management of cerebral oedema) are at increased risk of ON. Also, since the introduction, some years ago, of steroid therapy after the majority of organ transplants, ONFH has frequently been observed in kidney transplant recipients. Of course, the mechanism underlying the ON in patients treated with steroids is complex: it involves changes in the walls of capillaries within the bone, and an accumulation of fat in the reticular cells and the fat cells of the bone marrow.In SCD, the main change in the blood which gives rise to ON is the diminished ... Ph. Hernigou