Médecine

Paramédical

Autres domaines


S'abonner

Does using a polyethylene RM press-fit cup modify the preparation of the acetabulum and acetabular offset in primary hip arthroplasty? - 18/08/17

Doi : 10.1016/j.otsr.2017.03.026 
R. Erivan a, , S. Aubret b, G. Villatte a, A. Mulliez c, S. Descamps a, S. Boisgard a
a CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France 
b Université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France 
c Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France 

Corresponding author. Orthopedic and trauma surgery department, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand, France.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Abstract

Introduction

When performing total hip arthroplasty (THA), it is important to maintain the femoral and acetabular offsets to ensure good joint stability and to restore the function of the hip abductor muscles. In our practice, we mainly use a lateralized stem and hollow out the acetabulum to the quadrilateral plate to accommodate a press-fit polyethylene cup. However, the repercussions of this preparation method, which is driven by the cup's design, are not known. We carried out a retrospective study to assess: (1) the changes in the femoral and acetabular offset; (2) the height of the center of rotation; and (3) the repercussions on wear.

Hypothesis

We hypothesized there would be no significant differences between the preoperative and postoperative femoral and acetabular offsets.

Patients and methods

We reviewed 88 primary THA cases performed with the RM Pressfit™ cup that had a minimum of 5 years’ follow-up. A lateralized self-locking Muller-type cemented femoral stem was used in 92.0% of cases and a standard stem in 8.0%. Measurements were done on plain radiographs with MHP™ and Mesurim Pro™ software. The average follow-up was 6.5 years (5–8).

Results

On average, the acetabular offset was reduced by 2.75mm±5.9 mm (range: –17.5 to +10.6 mm) (P<0.001) and the femoral offset was increased by 0.01mm±5.5 mm (range: –17.8 to +11.0 mm) (P=0.99). In terms of total offset, medialization of 2.74mm±7 mm (range: –17.7 to +18.2mm) was found (P=0.001). The acetabular center of rotation was on average 4.77mm±5.1 mm higher (P<0.001). The mean annual wear at the more recent follow-up (min.: 5 years) was 0.068mm (range: 0.01 to 0.25mm) per year. The wear was not impacted by having more than 5mm change in offset.

Discussion

Measurements of acetabular offset revealed statistically significant medialization due to the type of implant used and the surgical technique. The anatomical technique consists of positioning the cup in subchondral bone without contacting the quadrilateral plate. This preserves bone stock, which may be useful later on if the cup is revised, particularly in younger patients. Conversely, the femoral offset did not change significantly, despite the use of lateralized stems in 92.0% of cases. We measured an annual wear rate of 0.068mm per year, which is lower than in other published studies, possibly because our patient population was older.

Level of evidence

IV, retrospective study.

Le texte complet de cet article est disponible en PDF.

Keywords : Acetabular offset, Femoral offset, Wear, Total offset, Press-fit polyethylene, RM cup, Total hip arthroplasty


Plan


© 2017  Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 103 - N° 5

P. 669-674 - septembre 2017 Retour au numéro
Article précédent Article précédent
  • What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips
  • M.H. Fessy, S. Putman, A. Viste, R. Isida, N. Ramdane, A. Ferreira, A. Leglise, B. Rubens-Duval, N. Bonin, F. Bonnomet, A. Combes, S. Boisgard, D. Mainard, S. Leclercq, H. Migaud, SFHG 1
| Article suivant Article suivant
  • High-impact sport after hip resurfacing: The Ironman triathlon
  • J. Girard, A. Lons, T. Pommepuy, R. Isida, K. Benad, S. Putman

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement ou un achat à l’unité.

Déjà abonné à cette revue ?

;

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.