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Reprise des prothèses totales de hanche par implant fémoral personnalisé sans ciment recouvert d'hydroxyapatite dans les descellements sévères

Revision of severe loosening of total hip arthroplasties with a customised femoral stem coated with hydroxyapatite

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Abstract

Twenty total hip arthroplasties with stage III and IV aseptic femoral loosening were revised with a custom cementless hydroxyapatite coated femoral component. A femoral graft was used in 50% of the cases. At an average of two years follow up: - 15 prosthesis remained perfectly stable; - 4 exibited slight early and non progressive subsidence less than 0.5 cm; - finally one case is a failure with progressive migration of 1.5 cm. The bonegrafts seemed to be preferentially incorporated in the endosteal situation. The clinical results were favourable since the average score according to the Merle d'Aubigné hip scale was improved from 8.4 before operation to 14.4 at the last check-up. Two intra operative femoral fractures have not jeopardized the final result. The conception of the computerdesigned custom-made femoral stem seemed to improve the primary stability in very altered femorae and the hydroxyapatite coating has seemed to induce rather quick bony integration. Nervertheless, the quality of these preliminary results cannot prejudge the future and a longer follow up is required for definitive conclusions.

Résumé

Vingt prothèses totales de hanche présentant un descellement fémoral aseptique de stade III ou IV ont été reprises par une tige fémorale sans ciment personnalisée revêtue d'hydroxyapatite. Une greffe fémorale a été associée dans la moitié des cas. A deux ans de recul moyen : - 15 prothèses sont restées parfaitement stables,- 4 ont présenté un enfoncement modéré, inférieur à 0,5 cm ; - 1 cas enfin représente un échec de fixation avec migration évolutive de 1,5 cm. Les greffes osseuses semblent s'être assimilées préférentiellement lorsqu'elles étaient placées en situation endostée. Les résultats cliniques furent favorables puisque le score moyen selon la cotation de Merle d'Aubigné est passé de 8,4 en préopératoire à 14,4 au dernier contrôle. Deux fractures peropératoires du fémur n'ont pas compromis le résultat final. La conception de la tige fémorale personnalisée assistée par ordinateur semble avoir amélioré la stabilité primaire dans des fémurs trés remaniés et le revêtement d'hydroxyapatite a paru induire une ostéo intégration assez rapide. Toutefois, la qualité de ces résultats préliminaires ne saurait préjuger de l'avenir et un recul supérieur est nécessaire pour des conclusions définitives.

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  1. Hôpital Pellegrin Tripode, Place Amélie Raba Léon, F-33076, Bordeaux, France

    X. Pascarel, E. Fleurat, B. Vinciguerra, P. Mangione & J. L. Honton

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  2. E. Fleurat
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Pascarel, X., Fleurat, E., Vinciguerra, B. et al. Reprise des prothèses totales de hanche par implant fémoral personnalisé sans ciment recouvert d'hydroxyapatite dans les descellements sévères. Orthop Traumatol 3, 299–306 (1993). https://doi.org/10.1007/BF01803940

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