Service d'Orthopédie de:
Hôpital Maisonneuve-Rosemont
Service d'orthopédie
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Biomechanical reconstruction of the hip
We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; -2.8 to 11.6) and decreased with SRA (mean -3.3 mm; -8.9 to 8.2). Femoral offset was restored within SD 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (-6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (-7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within SD 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups.
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A prospective randomized clinical trial comparing metal-on-metal total hip arthroplasty and metal-on-metal total hip resurfacing in patients less than 65 years old
ABSTRACT: The purpose of this prospective randomised study is to compare the early clinical results of the metal-on-metal hip resurfacing to metal-on-metal THA. Two hundred and ten hips were randomised between August 2003 and January 2006 (191 subjects). One hundred and two hips were implanted with an uncemented titanium tapered stem, and an uncemented titanium acetabular component and 28 mm metal-on-metal bearing (THA group) and 103 hips received a hybrid metal- on-metal surface replacement arthroplasty (SRA group). No significant difference was found with the WOMAC or Merle d’Aubigné-Postel scales. However, a significantly higher activity level was found in the SRA group (UCLA score 6.3 versus 7.1, p= 0.037) and a greater percentage of the SRA patients returned to heavy or moderate activities at one - year postoperatively (72% versus 39%, p=0.007). No patient in either group presented with thigh pain one year after surgery. Both techniques present similar complication rates (0.15). This study supports the theory of better functional recovery in the short-term favouring the SRA when compared to THA. The clear benefit of surface replacement arthroplasty over THA is proximal femoral bone preservation. However, the long term survivorship of the SRA will determine the real value of the theoretical advantage. (Hip International 2006; 16 (suppl 4): S73-81)
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Randomized Trial Comparing Hip Resurfacing and Total Hip Arthroplasty
Two hundred and nine hips were randomized to receive either a 28-mm total hip athroplasty (THA, 100 hips) or hybrid hip resurfacing (HR, 109 hips). At 1 and 2 years post-operatively, patients with HR achieved statistically significantly better WOMAC functional scores. However, differences in scores were of slight clinical relevance with a difference of 2.2/100 and 3.3/100, at 1 and 2 years respectively (p=0.007). After an average follow-up of 56 months (range 36-72) there were similar re-operation rates 7/100 THA and 6/109 HR (p=0.655) and revision rates 2/100 THA and 4/109 HR (p=0.470). However, the types of complications were different. Higher early aseptic loosening rate was found in HR and long-term survival analysis of both patient cohorts is necessary to determine whether the potential bone preservation advantage offers by HR will overcome its earlier higher failure rate.
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Une chirurgie des plus efficaces avec une longue histoire
L’arthrose de la hanche, ou coxarthrose, constitue la forme de pathologie des articulations la plus fréquente après l’arthrose du genou. Les lésions de l’arthrose comprennent l’amincissement du cartilage, la détérioration de l’os sous le cartilage et les ostéophytes (déformation des rebords de l’os surmené par les contraintes excessives).