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Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

Introduction: Since 1996 we have been using cementless fixation with hydroxyapatite (HA) coating. The purpose of this paper is to compare survivorship of a series of 100 cemented Total Knee Arthroplasty (TKA) to a similar series of 100 cementless with a follow up of 11–16 years. Material methods: Both TKA are mobile bearing total knee postero-stabilized. They can be used with cement or without cement. Among 1030 New Wave TKATM implanted from 2002 to 2015 we have identified 100 cemented TKAs and 100 cementless TKAs. All these cases were primary replacement. Differences in survival probability were determined using log-rank test. Results: Survival probabilities at 11 years of follow-up were: Cemented group: 90.2% CI95% [81.9–94.8]; Cementless group: 95.4% CI95% [88.1–98.2]. Comparison between both group showed significant difference, p = 0.32. Discussion: The advantages of cementless TKA are bone stock preservation, cement debris protection and the potential to achieve biologic fixation. Cementless implants rely on a porous or roughened surface to facilitate bone formation. HA has been shown to accelerate bone integration and to decrease micro motion of the components and to increase fixation. With a survival probability of 90.2% (cemented version) and 95.4% (cementless version), this total knee prosthesis performs as intended in primary total knee arthroplasty. No statistical differences could be found between cemented and cementless implants.

Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use routinely for hemiarthroplasty or THA in the cases of unstable ECTF. It reduces complications usually linked to this procedure. Blood loss, operating time, and pain are limited, allowing fast recovery in order to decrease morbidity and mortality.

Introduction: Since the first measurement method of patella height in 1929 (Janssen), more than 16 methods have been described. Most of these measures are not suitable to measure patella height after total knee arthroplasty (TKA). One of us (JC) modified the original Caton Deschamps (oCD), index with a new relative index called modified Caton Deschamps (mCD) index, by using new landmarks. The purpose of this study was to determine how patella height is modified after TKA.Material and Method: Sixty primary TKAs were consecutively prospectively enrolled. One type of implant was used (cementless postero-stabilized TKA, rotating plateau, cemented patella resurfacing). Patient's characteristics, functional and radiological outcomes were recorded pre-operatively and at one year follow-up. Pre-operative and post-operative outcomes were compared by paired t-test. Post-operative outcomes were compared between groups by one-way analysis of variance.Results: Average difference between pre and post-operative mCD was 0.19 in this series. In 81.7% of cases, patella was lowered. Patients were classified in three groups according to patella height lowering. Between these three groups, no significant statistical differences (IKS score knee and function, range of motion) could be identified.Discussion: In TKA, patella assessment in sagittal plane is as important as frontal or horizontal planes. True patella infera (TPI) is mostly due to patella tendon shortening measured by oCD. Pseudo patella infera (PPI) measured by mCD is mostly due to joint line elevation (over femoral cut with an over thickness of the tibial component). In this study a moderate patella lowering (minor than 15%) does not have a significant impact on the functional results (IKS, ROM) nevertheless in 80% patella is lowered. The next step will be to analyze precisely what factors are influencing this lowering and what prevention could be suggested in primary and revision TKA. [ABSTRACT FROM AUTHOR]