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The purpose of this study is to review our experience with Kerboull reinforcement device combined with bulk allograft for management of severe acetabular defects.We investigated the results of revision total hip arthroplasty (THA) in 65 hips of 59 patients (10 male, 49 female) with Paprosky type 3A or 3B acetabular bone defects. Functional outcome was assessed using the Merle d'Aubigne hip score. Post-operative radiographs were examined for evidence of cup loosening. The mean age at revision THA was 59.1 years (23-85) and mean follow-up duration was 11.2 years (2-15).The Merle d'Aubigne hip score improved from 10.6 points (5-15) before surgery to 17.1 points (15-18) (P.05) at the time of last investigation. In this series, mean coverage of the bone graft was 83.0% (34.6-100) of the loading portion in the horizontal plane on radiography immediately after revision. However, consolidation of the bone graft was completed within 12 months for all cases. There were 4 radiological failures due to acetabular aseptic loosening at a mean of 10.8 years (8-13) after index surgery; all 4 cases demonstrated massive bone loss that no part of the rounded plate could be placed on the host bone. Kaplan-Meier analysis showed that the 15.2-year survival rate was 85.1% (95% confidence interval 71-99) with re-revision surgery for any reason as the end point.Despite massive bone defects, we achieved favorable results for revision THA using bulk allograft and the Kerboull reinforcement device.

We report here the study of a personal series of 129 consecutive femoral impaction grafting during hip revision replacement performed between January 1991 and December 2005. The indication for the revision of the femoral component was aseptic loosening in 127 hips and septic loosening in two. The precise locations of the segmental defects and osteolytic areas were determined and classified, with use of the Endo-Klinik System, as follows: grade 2 in 75 hips, grade 3 in 43, and grade 4 in 11. Removal of the components, debris and cement was done with special care to achieve a complete resection of fibrous tissue in the medullary canal to ensure a direct contact between the graft and the host bone. Before impaction grafting, femoral segmental bone defects or windows were reconstructed and reinforced with strut allograft and cerclage wires. We used in all hips a special revision set of instruments specially designed for impaction grafting. All the acetabular cups were also revised. Clinical and radiologic evaluation was performed at six weeks, three months, six months and one year. Then, patients were reviewed every year for the first five postoperative years and every two years thereafter. A survivorship analysis was performed to determine the overall success of the procedure. Failure was defined as an implant that had been revised or that was radiologically loosened at the time of follow-up. The survival curve was derived from the cumulative survival rate over time, as calculated from the actuarial life table. At the last follow-up evaluation, seven patients (seven hips) had died and two (two hips) were lost to follow-up. The follow-up of these nine patients ranged from two to ten years. One hundred and twenty patients (120 hips) were reviewed with a mean follow-up of 8.2 years (range, two to 16 years). The average follow-up of the whole series was 8.4 years (range, two to 16 years). At the time of the final review 1 of the 129 hips had migration of the stem’s cement mantle relative to the bone (5 mm) with lucent lines at the graft-host interface in three Gruen zones. Another one had migration within the cement (8 mm) with lucent line at the distal graft-host interface and a distal fracture of the cement mantle. These two stems were considered as definitely loosed according to the criteria of Johnston et al. but none of them was revised. The remaining 127 hips showed no radiological changes at the latest examination concerning stem migration and radiolucent lines. One acetabular definite loosening occurred at ten years and was revised at 11 years postoperatively. In this respect, of the 129 hips, only one hip was revised at 11 years’ follow-up (0.7%). The survivorship analysis, with radiologic loosening as the endpoint, yielded a 98% cumulative survival rate for the femoral component and for the acetabular component, 99% at eleven years follow-up. The survival rate with revision for any reason as the endpoint was 99.4% at eleven years follow-up. The results observed in this series, regarding the need for a repeat revision for any reason, are in agreement with the excellent outcome reported by other authors using similar technique. Nevertheless two main differences must be emphasized when comparing the results of this study with the others. The first one is the low rate of subsidence and the second is the absence of postoperative femoral fracture. The quality of bone grafting and the use of a Kerboull stem, double tapered and polish, were associated with the very low rate of distal migration. The unconditional reconstruction of distal bone deficiency or weakness with bone graft strut appeared efficient to prevent the occurrence of femoral fracture, despite the unique use or standard stems.

Once routinely used, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. Many variations of the osteotomy and many various techniques for the trochanter reattachment have been described. Our specific surgical technique is presented as well as its advantages and drawbacks. Primary total hip arthroplasty procedures requiring the enhanced exposure provided by trochanteric osteotomy is needed in patients with hip ankylosis or fusion, protrusio acetabuli, proximal femoral deformities, developmental dysplasia, or abductor muscle laxity. Trochanteric osteotomy, in revision arthroplasties, facilitates the removal of well-fixed femoral components and enhance acetabular exposure. In all cases trochanteric osteotomy remains useful to preserve the periarticular muscles and restore the geometry of the artificial hip which are the best ways to prevent dislocation.

The purpose of this retrospective study was to report the minimum 10-year follow-up results of a consecutive series of 122 cemented low-friction total hip arthroplasties performed for osteonecrosis. Revision was performed for high polyethylene wear associated with periprosthetic osteolysis and socket loosening in 6 hips, and for deep sepsis in 1. The survival rate at 15 years, using revision for any reason as the end point, was 88.5%. Among the variables studied in this series, the only factor associated with a higher risk of revision was a socket wear rate greater than 0.1 mm/y. This series indicated that cemented low-friction total hip arthroplasty performed for avascular necrosis could grant satisfactory long-term results, provided that polyethylene socket wear remained below 0.1 mm/y.

Resume Le but de cette etude prospective ouverte etait d’evaluer les resultats a 2 ans minimum de recul d’une serie consecutive d’arthroplasties totales de hanche utilisant le couple de frottement zircone-polyethylene. Entre janvier 1997 et juin 1999, 55 arthroplasties totales de hanche utilisant ce couple ont ete realisees chez 51 patients. L’âge moyen etait de 52,2 ± 12 ans. La tete femorale en zircone de 22,2 mm de diametre etait fixee a la piece femorale via l’utilisation d’un cone Morse. Tous les implants etaient de type Charnley-Kerboull. Les resultats cliniques ont ete evalues selon la cotation de Merle d’Aubigne. L’usure de la cupule et l’osteolyse periprothetique ont ete mesurees sur des cliches successifs du bassin de face. Le recul moyen de la serie etait de 32 mois (24 a 48). Aucun patient n’a ete perdu de vue. Le score fonctionnel moyen au dernier recul etait de 17,8 ± 0,2. Aucun implant n’avait migre sur le versant femoral ni acetabulaire. L’usure de la cupule n’etait pas mesurable. En revanche, une lesion osteolytique de type de geode endostee au niveau du Merkel mesurant moins de 1 cm 2 a ete observee sur 19 des 55 hanches, soient 34,5 %. Ces lesions osteolytiques sont apparues entre la premiere et la deuxieme annee postoperatoire. L’osteolyse precoce du calcar observee dans cette etude peut etre liee soit a un phenomene de rodage soit aux premices d’une osteolyse extensive. Les auteurs ont decide de suspendre l’utilisation de la ceramique de zircone.

BACKGROUND: The purpose of this retrospective study was to analyze the utility of a trochanteric claw plate in the treatment of an ununited greater trochanter following total hip arthroplasty. METHODS: From 1986 through 1999, seventy-two consecutive procedures to reattach an ununited greater trochanter were performed in seventy-one patients. The average age at the time of the index arthroplasty was 66.2 years. The arthroplasty that resulted in the nonunion of the greater trochanter was primary in fifty-four hips, a first revision in sixteen hips, and a second and third revision in one hip each. The mean duration between the hip replacement and the treatment of the nonunion was 8.1 months. The greater trochanter was fixed with the trochanteric plate alone in forty-eight hips and with the plate in conjunction with vertical wires in the remaining twenty-four hips. The average duration of followup was 5.1 years. RESULTS: Osseous union occurred in fifty-one of the seventy-two hips. There was a persistent nonunion in twelve hips and fibrous consolidation in the remaining nine hips. The mean time to osseous consolidation was 3.7 ± 2.1 months (range, two to twelve months). The mean Merle d'Aubigne hip score was 16.1 ± 2.4 points at the time of the latest follow-up. A highly significant improvement in function was achieved only in the group with osseous consolidation (p < 0.0001). The highest rate of osseous union was achieved when vertical wires had been used in conjunction with the claw plate. Union occurred in twenty-one of the twenty-four hips in that group (p = 0.025). CONCLUSIONS: Nonunion of the greater trochanter following total hip arthroplasty can be successfully treated with a trochanteric claw plate. The use of adjunctive vertical wires results in better osseous contact and union.

Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In the case of major bone loss where less than 50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring in association with a cemented component and allograft bone should be used. Herein we describe the technical details of the use of the Kerboull acetabular reinforcement device and the GAP cup. Both these devices have a hook that has to be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of these devices are their help in restoring the normal hip center of rotation, guiding the reconstruction, and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies.

Since its introduction, Bernese periacetabular osteotomy with a modified Smith-Petersen approach has become a successful strategy for the treatment of insufficient femoral head coverage in developmental dysplasia of the hip. Additionally, femoro-acetabular impingement secondary to acetabular retroversion has been effectively treated by this technique. Although the vascularity of the osteotomized acetabular fragement has not been a problem with the modified Smith-Petersen approach for the Bernese periacetabular osteotomy, little information is available on the vascularity of the periacetabular bone after an osteotomy through a posterolateral approach. Such an approach would allow for improved treatment of certain intraarticular pathologies while simultaneously providing the option of performing an acetabular osteotomy. This study was designed to determine the vascularity of the external periacetabular bone with a colored latex injection technique into the common iliac artery in 16 fresh cadavers. Additionally, in 7 injected cadavers, a periacetabular osteotomy was performed with a posterolateral approach. Our dissections demonstrated the technical feasibility of a juxta-acetabular osteotomy performed through a posterolateral approach. These dissections further demonstrated the importance of identifying and protecting the constant acetabular branch of the superior gluteal artery (present in 23 of 23 cases), which is necessary for preservation of the superior acetabular blood supply. The integrity of both the superior gluteal branch and the acetabular branch of the obturator artery were maintained in all 7 osteotomy cases. Thus, in indicated cases, a juxta-acetabular osteotomy can be safely executed and combined with a capsulotomy, femoral head dislocation, and femoral head/neck shaping procedure through a posterolateral approach.

Sixty consecutive revision total hip arthroplasties were performed with bulk allograft bone supported by the Kerboull reinforcement acetabular device in 53 patients from 1980 to 1987. The average age of the patients at the time of hip revision was 57.7 years. Acetabular bone loss according to the American Academy of Orthopaedic Surgeons grading system was Type III for 48 hips in 41 patients and Type IV for 12 hips in 12 patients. Three failures, defined as radiologic loosening of the socket, revised or not, were reported in this series at a mean 8-year followup. Eight patients died of unrelated causes at a mean of 5 years. No patient was lost to followup. The mean followup of the series was 10 years +/- 3 years. The mean preoperative Merle d'Aubigné hip functional score was 11.7 +/- 2.4 versus 17.4 +/- 0.6 at the latest followup. Consolidation of the graft was considered completed in all 60 hips and occurred by 12 months. Remodeling of the graft proceeded for 3 to 4 years. The survival rate at 13 years was 92.1% +/- 5% using loosening of the acetabular component as the end point. This study indicated that acetabular allograft reconstructions reinforced by the Kerboull acetabular device were able to provide satisfactory long-term clinical and radiologic results.

A retrospective study has been carried out to assess the effectiveness of indomethacin in preventing heterotopic ossification after total hip arthroplasty, and the effect of using it for different periods of time. One hundred and sixty-eight hips operated on in 1983 were not given indomethacin and acted as a control. One hundred and fifty hips operated on in 1988 were given indomethacin and divided into 3 groups: 42 received indomethacin for 5 days, 49 for 11 days and 59 for 45 days. The results indicate that ossification is significantly reduced in those patients receiving indomethacin for 5 and 11 days, but there was no additional reduction when it was given for 45 days. Treatment should begin on the night of operation and continued for 11 days while the patient remains in hospital.

We have evaluated the in vivo migration patterns of 164 primary consecutive Charnley-Kerboull total hip replacements which were undertaken in 155 patients. The femoral preparation included removal of diaphyseal cancellous bone to obtain primary rotational stability of the stem before line-to-line cementing. We used the Ein Bild Roentgen Analyse femoral component method to assess the subsidence of the femoral component. At a mean of 17.3 years (15.1 to 18.3) 73 patients were still alive and had not been revised, eight had been revised, 66 had died and eight had been lost to follow-up. The mean subsidence of the entire series was 0.63 mm (0.0 to 1.94). When using a 1.5 mm threshold, only four stems were considered to have subsided. Our study showed that, in most cases, a highly polished double-tapered stem cemented line-to-line does not subside at least up to 18 years after implantation.

The optimal surface finish for a cemented THA stem is still debated. We hypothesized surface finish would influence survival of Kerboull cemented hip arthroplasties and a matte finish would have lower survival. We reviewed survival of 433 total hip arthroplasties in 395 patients: 284 consecutive patients (310 hips) were enrolled in a prospective, randomized study of polished (165 hips) or matte finish stems (145 hips) and compared to a historical series of satin stems (123 hips) in 111 patients. The satin and matte finish implants had similar geometry but the polished was quadrangular rather than oval. Finish roughnesses were: polished (radius, 0.04 μm), satin (radius, 0.9 μm), and matte (radius, 1.7 μm). The mean age of the patients at the time of the index arthroplasty was 63.6 years. The survival rate at 13 years, using radiographic loosening as the end point, was 97.3% ± 2.6% for polished stems, 97.1% ± 2.1% for satin stems, and 78.9% ± 5.8% for matte stems. The data suggest survival of Kerboull stems was higher with a polished or satin surface finish than with a matte finish. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

A consecutive series of 118 total hip arthroplasties was performed for Crowe type IV developmental hip dysplasia in 89 patients. The mean age of the patients was 52 years. All procedures were carried out through a transtrochanteric approach by the same surgeon. In all cases, the acetabular component was placed at the level of the true acetabulum. The mean lengthening of the operated limb was 3.8 cm. The average follow-up of the whole series was 16.9 years. At the last follow-up evaluation, 41 patients (48 hips) had died and 7 patients (9 hips) were lost to followup. Forty patients (61 hips) were still alive at a mean follow-up of 22 years. At the time of last follow-up, the mean Merle d’Aubigne hip score was 17 compared with 10.6 preoperatively. The survival rate, with revision for any reason as the endpoint, was 75% at 25-year follow-up.

Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3–16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability. Level of evidence: Therapeutic study, level III (retrospective comparative study).

Background: Pigmented villonodular synovitis of the hip is a rare disease. Synovectomy is generally accepted as the only surgical treatment for the disorder, but there have been few studies with a sufficient sample size and duration of follow-up to allow the evaluation of long-term outcomes. The aim of this study was to determine the long-term outcome of the treatment in sixteen patients. Methods: Sixteen patients (nine men and seven women), with a mean age of 35.5 years at the time of surgery, were treated between 1970 and 1996. Complete synovectomy was performed in all patients; in addition, three had a cup arthroplasty, four had a total hip arthroplasty, and one had a monopolar arthroplasty. Clinical and radiographic outcomes were evaluated retrospectively at a mean of 16.7 years postoperatively. Only one patient was followed for less than eight years. Results: Nine patients needed repeat surgery, but only one had recurrent synovitis, as detected with pathological examination fourteen years after treatment with synovectomy and cup arthroplasty. Secondary osteoarthritis developed in all eight patients who had been treated with synovectomy alone, and four of them required a total hip arthroplasty within the follow-up period. Conclusions: These results support earlier data indicating that osteoarthritis consistently develops in patients with pigmented villonodular synovitis of the hip. Complete synovectomy seems to be effective in preventing recurrence of the synovitis, but it does not appear to prevent the development of secondary osteoarthritis. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

The purpose of this retrospective study was to report the minimum 10-year follow-up results of a consecutive series of 122 cemented low-friction total hip arthroplasties performed for osteonecrosis. Revision was performed for high polyethylene wear associated with periprosthetic osteolysis and socket loosening in 6 hips, and for deep sepsis in 1. The survival rate at 15 years, using revision for any reason as the end point, was 88.5%. Among the variables studied in this series, the only factor associated with a higher risk of revision was a socket wear rate greater than 0.1 mm/y. This series indicated that cemented low-friction total hip arthroplasty performed for avascular necrosis could grant satisfactory long-term results, provided that polyethylene socket wear remained below 0.1 mm/y.

Two hundred eighty-seven Charnley-Kerboull low friction total hip arthroplasties were done between 1975 and 1990 in 222 patients younger than 50 years. The average age of the patients at the time of the index procedure was 40.1 years. The mean followup of the entire series was 14.5 +/- 5.1 years with a median of 13.9 years. Forty-five patients (52 hips) had a followup greater than 20 years. The mean preoperative Merle d'Aubigne hip functional score was 9.6 +/- 2.5 points versus 17.2 +/- 0.8 points at the latest followup. Twenty-five revisions were documented in this series; 17 were done for aseptic loosening. The mean wear rate was 0.12 +/- 0.21 mm per year. Considering 0.1 mm per year as the threshold for a normal wear rate, 196 hips had a normal or below normal wear rate (mean, 0.02 mm per year), whereas the remaining 91 hips had an abnormally high wear rate (mean, 0.28 mm per year). The overall survival rate at 20 years was 85.4% +/- 5% using revision of either component as the end point. The only predictive factor of loosening was a wear rate higher than 0.1 mm per year.

The purpose of this retrospective study was to analyze the utility of a trochanteric claw plate in the treatment of an ununited greater trochanter following total hip arthroplasty.From 1986 through 1999, seventy-two consecutive procedures to reattach an ununited greater trochanter were performed in seventy-one patients. The average age at the time of the index arthroplasty was 66.2 years. The arthroplasty that resulted in the nonunion of the greater trochanter was primary in fifty-four hips, a first revision in sixteen hips, and a second and third revision in one hip each. The mean duration between the hip replacement and the treatment of the nonunion was 8.1 months. The greater trochanter was fixed with the trochanteric plate alone in forty-eight hips and with the plate in conjunction with vertical wires in the remaining twenty-four hips. The average duration of follow-up was 5.1 years.Osseous union occurred in fifty-one of the seventy-two hips. There was a persistent nonunion in twelve hips and fibrous consolidation in the remaining nine hips. The mean time to osseous consolidation was 3.7 +/- 2.1 months (range, two to twelve months). The mean Merle d'Aubigné hip score was 16.1 +/- 2.4 points at the time of the latest follow-up. A highly significant improvement in function was achieved only in the group with osseous consolidation (p0.0001). The highest rate of osseous union was achieved when vertical wires had been used in conjunction with the claw plate. Union occurred in twenty-one of the twenty-four hips in that group (p = 0.025).Nonunion of the greater trochanter following total hip arthroplasty can be successfully treated with a trochanteric claw plate. The use of adjunctive vertical wires results in better osseous contact and union.

Failure of the femoral component with progressive bone loss is an important long-term complication of total hip arthroplasty. Among the different methods that have been advocated for dealing with massive femoral structural defects, bone-grafting is the only currently available procedure for restoring bone stock1-7. At the institution of the senior one of us (M.K.), a method to deal with deficient proximal femoral cortical bone was developed in 1987 and has been in use since that time8. This technique consists of impaction of a proximal femoral structural allograft into the host femur. A femoral component of standard length then is cemented only into the allograft. The clinical and radiographic results have been satisfactory, with one revision among twenty-seven procedures after a mean of five years of follow-up8. However, the underlying process of incorporation of a massive allograft remains unknown. To the best of our knowledge, there are no reports in the literature of the long-term results of histological evaluation of a massive allograft following revision total hip arthroplasty. The aim of this report is to address the issue of long-term incorporation and remodeling of a femoral structural allograft. A sixty-nine-year-old woman with an initial diagnosis of hip dysplasia was referred to our department in 1989 because of intractable pain in the groin related to a loose total hip prosthesis. She had had multiple procedures about the hip, including a revision total hip arthroplasty performed in 1982, which had resulted in 7 cm of shortening. At the seven-year follow-up evaluation, the functional outcome, based upon the findings of the clinical examination9, was poor. Both components were loose, and there was extensive bone loss on the femoral side (Fig. 1-A). Laboratory tests (C-reactive protein level and sedimentation rate) and a hip-joint aspiration showed …

A consecutive series of 118 total hip arthroplasties was performed for Crowe type IV developmental hip dysplasia in 89 patients. The mean age of the patients was 52 years. All procedures were carried out through a transtrochanteric approach by the same surgeon. In all cases, the acetabular component was placed at the level of the true acetabulum. The mean lengthening of the operated limb was 3.8 cm. The average follow-up of the whole series was 12.8 years. At the last follow-up evaluation, 29 patients (35 hips) had died or were lost to follow-up at a mean of 11 years. Sixty patients (83 hips) were still alive at a mean follow-up of 16 years. At the time of last follow-up, the mean Merle d'Aubigne hip score was 17.4 compared with 10.6 preoperatively. The survival rate, with revision for any reason as the endpoint, was 78% at 20-year follow-up.

Background: The purpose of the present retrospective study was to report the long-term results of total hip arthroplasty following a hip fusion. Special attention was paid to the resulting function of both the involved joint and the neighboring joints, as pain in the lower back or knee was the usual indication for conversion. The factors that were likely to influence the functional outcome were analyzed. Methods: Forty-five consecutive total hip arthroplasties were performed in forty-five patients from 1969 through 1993. The mean age of the patients at the time of the operation was 55.8 years (range, twenty-eight to eighty years). Ankylosis of the hip had been spontaneous in twenty patients and postoperative in twenty-five patients. The mean duration of the ankylosis had been thirty-six years (range, three to sixty-five years). The mean duration of follow-up was 8.5 years (range, five to twenty-one years). No patient was lost to follow-up. Results: The mean hip score, according to the scale of Merle d’Aubigne, was 16.5 1.5 points at the latest follow-up evaluation. Hip function was considered to be satisfactory for forty-one (91%) of the forty-five patients. The definitive score for walking ability was not achieved by the one-year evaluation; it improved notably for two to three years and then it remained stable. At the time of the latest follow-up, the mean arc of flexion was 88° (range, 30° to 130°). Forty-three (96%) of the forty-five patients had no pain in the involved joint. The only factor that was predictive of the final functional result with regard to walking ability was the intraoperative status of the gluteal muscles. Most patients had effective pain relief in the neighboring joints. The cumulative survival rate at eight years, with revision as the end point, was 96.7% (95% confidence interval, 90.2% to 100%). Conclusions: The long-term effectiveness of total hip arthroplasty for the treatment of an ankylosed hip was clearly demonstrated in both the involved and the neighboring joints in the present study. However, the preoperative and intraoperative status of the gluteal muscles should be carefully evaluated when this procedure is being considered, as this was the only factor that was predictive of the final walking ability.

La reprise avec changement en un temps des protheses totales de hanches infectees est notre attitude therapeutique habituelle. Cette methode implique l'eradication de l'infection, grâce a un nettoyage chirurgical complet et un traitement antibiotique adapte. Dans ce contexte, nous avons utilise des allogreffes osseuses pour reconstruire les pertes de substance cotyloidiennes ou femorales souvent importantes. Le changement prothetique en un temps n'est pas une attitude nouvelle, mais reste discute par rapport au traitement en deux temps; l'usage d'allogreffes dans ce contexte initialement septique est en revanche inhabituel, voire formellement deconseille par certains auteurs. Nous avons revu une serie consecutive de 90 reprises faites avant 1988 et parmi lesquelles 46 allogreffes cotyloidiennes et/ou femorales avaient ete implantees. Nous denombrons globalement 17 echecs (19%), lies a 1 deces post-operatoire, 8 recidives certaines de l'infection (9%), 1 evolution douteuse au plan septique sans descellement, et 7 descellements femoraux sans contexte septique (parmi ces descellements femoraux, 3 ont une explication mecanique plausible, mais 4 sont inexpliques, laissant craindre une persistance de l'infection a bas bruit). Le pronostic a ete significativement conditionne par la nature du germe (role pejoratif du Staphylocoque dore et du Pseudomonas), alors que l'etat pre-operatoire clinique, biologique et radiologique, ou l'utilisation d'allogreffe (3 echecs septiques sur les 46 hanches qui ont recu une allogreffe cotyloidienne et/ou femorale, 5 echecs parmi les 44 hanches qui n'en ont pas recu) n'ont pas modifie le pronostic vis a vis de la guerison de l'infection. Les tetes femorales de banque se sont averees fiables pour les reconstructions cotyloidiennes et les petites pertes de substance femorales, toutefois lorsque la perte de substance femorale est plus importante nous preferons les allogreffes massives cortico-spongieuses irradiees. La qualite de la reconstruction obtenue explique probablement les bons resultats fonctionnels enregistres dans 79% des cas, et nous parait etre le garant de la perennite mecanique de l'arthroplastie. L'implantation de ces allogreffes en milieu initialement septique ne se concoit qu'a la condition d'avoir obtenu un nettoyage chirurgical complet des lesions septiques, associe a un traitement antibiotique adapte. Il s'agit la des criteres qui president a l'indication du changement de prothese en un temps, qu'une allogreffe soit utilisee ou non.

Background Human herpesviruses (HHVs) 6 and 7 are recently discovered betaherpesviruses. Although HHV-6 has been associated with disordered hematopoiesis in bone marrow transplant recipients, little information is available on the presence of both viruses in the bone marrow from healthy subjects. Methods We detected HHV-6 and HHV-7 DNA by means of polymerase chain reaction in bone marrow and peripheral blood samples from 18 healthy subjects who underwent total hip arthroplasty. Results Genomic HHV-6 and HHV-7 DNA were detected in 11% and 67% of the blood samples, respectively, and in 28% and 50% of the bone marrow samples, respectively. Conclusions Both viruses may be present in the bone marrow without hematopoiesis disorder and can be transmitted through bone marrow infusion. Therefore, the causative role of these two viruses in some bone marrow diseases cannot be inferred simply from the detection of their genome in bone marrow by means of polymerase chain reaction.

Introduction Le but de cette etude etait d’evaluer les resultats a 10 ans de recul minimum d’une serie prospective randomisee et d’une serie historique d’arthroplasties totales de hanche cimentees basse friction en fonction de l’etat de surface de la piece femorale. Materiels et Methodes La serie prospective randomisee comportait 284 patients (310 hanches) âges en moyenne de 64,1 ans. Parmi ces 310 hanches, la piece femorale etait hautement polie (Ra = 0,04 microns, MKIII, Stryker) pour 165 hanches et mattes pour 145 (Ra = 1,7 microns, CMK3, Vector Orthopedique). La serie historique operee par les memes operateurs selon la meme technique comportait 111 patients (123 hanches) pour lesquels la piece femorale etait satinees (Ra = 0,9 microns, CMK2, Sanortho). L’evaluation des resultats cliniques a ete realisee selon la cotation de Merle d’Aubigne. L’evaluation radiologique de la migration des implants a ete realisee a l’aide des reperes classiques sur des radiographies du bassin de face. Enfin une analyse de survie a ete effectuee selon la methode actuarielle. Resultats Lors de l’evaluation a 10 ans minimum de recul, 43 patients (48 hanches) etait en perdus de vue (0,3 a 8,7 ans), 80 patients (83 hanches) etaient decedes (0,1 a 13,6 ans), 26 patients (26 hanches) avaient ete repris sur le versant acetabulaire et/ou femoral (0,9 a 15,9 ans) et 246 patients (276 hanches) n’avait pas subi de reprise au recul moyen de 12,3 ± 1,9 ans (10 a 16 ans). Parmi les 26 hanches reprises, 2 appartenaient au groupe pieces femorales polies (une seule piece descellee), 12 au groupe satinees (trois pieces femorales descellees), et 12 au groupe mattes (9 pieces femorales descellees). Un descellement radiologique etait note pour une des 165 pieces femorales polies (0,6 %), quatre des 123 pieces femorales satinees (3,3 %), et 15 des 145 pieces femorales mattes (10,3 %). Il n’existait pas de difference significative entre les trois groupes pour aucun des parametres du score de Merle d’Aubigne ni pour le score global. Le taux de survie cumulee de la piece femorale a 13 ans, en definissant l’echec comme le descellement, etait de 97,3 % ± 2,6 % pour les pieces femorales polies, 97,1 % ± 2,1 % pour les pieces satinees, et 78,9 % ± 5,8 % pour les pieces mattes (Logrank, p Discussion et Conclusion Les resultats de cette etude ainsi qu’une revue de la litterature indiquent que la rugosite d’une piece femorale cimentee doit etre inferieur a 1 micron.

During recent years the acetabular labrum has gained increased interest because its degeneration frequently is found in association with early osteoarthritis of the hip. To determine spatial distribution of labral degeneration in the aged hip and to identify the pathologic features triggering this event, an anatomic postmortem and an intraoperative in vivo study were done in 30 cadavers (range, 60-90 years) and in 18 elderly patients (range, 69-97 years) who had hemiarthroplasty for displaced femoral neck fractures. In both groups, no gross anatomic or radiographic abnormalities suggesting advanced osteoarthritis were present. All cadaveric acetabuli (30 of 30) revealed labrum and cartilage damage. Labrum damage (17 of 18) and cartilage lesions (16 of 18) occurred less frequently and were smaller in the elderly patients. Peripheral joint degeneration was most frequent at the superior acetabular rim close to the anterior inferior iliac spine. More centrally localized cartilage lesions were present in 47% of cadavers and in 28% of patients. The majority of femurs (cadavers) (80%) showed reduced narrowing at the anteromedial femoral head-neck junction causing impingement against the corresponding acetabular rim or squeezing of this area into the joint during flexion, whereas the femoral head cartilage appeared normal in all but one hip. Acetabular rim degeneration is a constant finding in the aged hip, which seems to be triggered by femoroacetabular impingement.