Médecine

Paramédical

Autres domaines


Suscribirse

Long-term results of alumina-on-alumina total hip arthroplasty - 06/05/08

Doi : RCOE-12-2004-90-8-0035-1040-101019-200516362 

M.A. Rousseua [1],

S. Le Mouel [1],

D. Goutalier [1],

S. Van Driessche [1]

Ver las filiaciones

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.

Conéctese para beneficiarse!

Abstract

Purpose of the study

Mechanical failure in total hip arthroplasty is usually related to aseptic loosening, itself related to wear particles as seen with polyethylene bearings. Alumina has been proposed to avoid wear problems. In vitro and mid-term clinical studies have shown tribological advantages but early acetabular fixation remains an issue. Since alumina-on-alumina bearings are currently used with new fixation techniques, updated evaluations of older series are informative regarding the long-term tolerance of alumina in vivo.

Material and methods

We investigated 104 consecutive alumina-on-alumina cemented total hip arthroàplasties (Cervaer-Osteal, Roissy, France) implanted 20 years ago in 81 patients (from 1979 to 1983) A 32-mm alumina femoral head was used. The alumina acetabular socket and the titanium femoral stem were cemented. The Postel-Merle-d'Aubigné score was used for clinical evaluation. Radiological wear and development of osteolysis or loosening were noted for establishing actuarial curves. When accessible, histological samples from revision procedures were analyzed.

Results

Six infected cases were not taken into account for data analysis. The average follow-up was 11 years, reaching 18 years in 38 cases. Twenty-five hips were revised for changing 23 acetabular sockets, 12 femoral heads, and one femoral stem. We noted one femoral head fracture, 24 definite acetabular loosenings, 12 probably acetabular loosenings, and 3 definite femoral loosenings. Radiological acetabular osteolysis was present in 4 cases, always limited to the DeLee zone 1, and associated with loosening. Radiological wear was below eye detection. Periprosthetic tissue showed non-specific histological reactions to cement particles. Survival rate at 20 years was 62.8% (49.3-76.2%) in terms of revision and 57.1% (42.571.7%) and 95.2% (89.9-100%) in terms of definite acetabular and femoral loosening.

Discussion

Besides the high rate of cemented fixation failure of the socket, loosened and non-loosened cases showed an excellent long-term tolerance of the alumina-on-alumina bearing with normal wear and osteolysis. This may also have protected the femoral component from complications. This study conrirms in vivo the long-term tribological benefit of the alumina-on-alumina bearing in total hip arthroplasty and suggests that acetabular fixation should be improved to achieve full benefit.

Keywords: Total hip arthroplasty , alumina , aseptic loosening , actuarial survival curve , long-term follow-up


Esquema



© 2004 Elsevier Masson SAS. Tous droits réservés.
Añadir a mi biblioteca Eliminar de mi biblioteca Imprimir
Exportación

    Exportación citas

  • Fichero

  • Contenido

Vol 90 - N° 8

P. 741-748 - décembre 2004 Regresar al número

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción o una compra individual.

¿Ya suscrito a @@106933@@ revista ?

;

Mi cuenta


Declaración CNIL

EM-CONSULTE.COM se declara a la CNIL, la declaración N º 1286925.

En virtud de la Ley N º 78-17 del 6 de enero de 1978, relativa a las computadoras, archivos y libertades, usted tiene el derecho de oposición (art.26 de la ley), el acceso (art.34 a 38 Ley), y correcta (artículo 36 de la ley) los datos que le conciernen. Por lo tanto, usted puede pedir que se corrija, complementado, clarificado, actualizado o suprimido información sobre usted que son inexactos, incompletos, engañosos, obsoletos o cuya recogida o de conservación o uso está prohibido.
La información personal sobre los visitantes de nuestro sitio, incluyendo su identidad, son confidenciales.
El jefe del sitio en el honor se compromete a respetar la confidencialidad de los requisitos legales aplicables en Francia y no de revelar dicha información a terceros.