2017-031
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This document discusses rotating hinge knee arthroplasty indications and results, focusing on patellar complications. Rotating hinge implants connect the femoral and tibial components with a rotating hinge to compensate for ligament deficiencies. Indications include primary TKA for valgus/varus deformity, revision for bone loss or instability. Analysis of 43 patients found 65% had optimal patellar positioning, 28% were tilted, and 7% subluxated/dislocated. Secondary procedures were needed in 5% to address patellar issues. Rotating hinge implants represent 25% of revision TKA indications at the author's hospital, with satisfactory flexion but some patellar complications.
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This document discusses the use of dual mobility cups (DMC) in total hip arthroplasty (THA) for all cases. It summarizes the results of a comparative study of DMC in patients under 55 years old (n=119) over 10 years compared to patients over 55 (n=444). The results show no dislocations or revisions in either group at 10+ years follow up, with excellent survival rates of 98.4% for both groups. The document concludes that DMC is a relevant surgical option for young patients, with no increased risk compared to older patients. It suggests that with modern DMC designs, THA could benefit almost all eligible patients.
2017-028
This document presents a new method for assessing patellar height before and after total knee arthroplasty (TKA).
Previous methods of measurement were inaccurate. The new Caton-Deschamps index measures the ratio of the articular surface to a tibial reference point, eliminating errors from abnormalities. Testing showed good intra- and inter-observer reliability. Results found the patella was lower after TKA in most cases due to femoral and tibial cuts. Moderate lowering did not affect function, but higher positioning or major lowering required further study to understand functional consequences. The new index allows detecting true versus pseudo patella infera to better understand TKA outcomes.
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2017-008
The document discusses different means to prevent dislocation after total hip arthroplasty (THA), including surgical techniques, implant designs, and clinical studies. It describes approaches like anterior or Hardinge to avoid medialization and offset loss. Implant options mentioned are long posterior wall cups, retentive cups, tripolar cups, and double mobility cups. Clinical studies show dislocation rates ranging from 0-2.85% with various dual mobility cup designs at up to 12 years follow-up. The conclusion of one study presented found that dual mobility cups reduce dislocation rates compared to conventional implants for femoral neck fractures.
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- 1. Indications and current résults of rotating hinge arthroplasties. Patellar issues. LUSTIG Sébastien MD, PhD, Prof Albert Trillat Center Lyon North University Hospital LYON - FRANCE
- 2. AIM • CURRENT INDICATIONS OF ROTATING HINGE ARTHROPLASTY • SPECIFIC ASSESSMENT OF PATELLAR COMPLICATIONS
- 3. Principles « … »L’implant fémoral et l’implant tibial sont liés entre eux par un moyen d’union de type charnière palliant la déficience des formations ligamentaires du patient. Cette charnière est fixe ou rotatoire. « … »
- 4. Problems : • Increase bony stress •Long stem is needed More constraints…
- 5. indications ? Avec défaillance ligamentaire Arthroplastie tricompartimentale Sans perte de substance osseuse
- 6. Indications? Arthroplastie tricompartimentale Avec perte de substance osseuse Avec défaillance ligamentaire Avec défaillance ligamentaire
- 7. CHU Lyon Croix Rousse Total UKA TKA RTKA R Hinge 2013 410 19 359 32 12 2014 523 38 444 41 15 2015 633 50 513 70 29 2016 651 54 495 102 43 TOTAL 2217 161 1811 245 96 4% indications
- 8. Indications • Primary TKA: – Valgus (LCM) – Varus (severe +++) / eldearly patient – Desarthrodesis TKA – Polyomyelitis … • Revision : – Bone loss (ligaments ?) – Patella Baja – FT instability – Stiffness ++
- 9. Valgus
- 10. - Seems stable in EXT. - Laxity in flexion (#20-30°) Valgus
- 13. Varus ? ? ?
- 14. Varus
- 15. « Desarthrodesis » TKA
- 18. Indications • Primary TKA: – Valgus (LCM) – Varus (ssevere +++) / eldearly patient – Desarthrodesis TKA – Polyomyelitis … • Revision : – Bone loss (ligaments ?) – Patella Baja – FT instability – Stiffness ++
- 19. Revision for instability ++
- 22. Patella Baja
- 23. infections
- 25. Results
- 26. Patella ?
- 27. CHU Lyon Croix Rousse Total UKA TKA RTKA R Hinge 2013 410 19 359 32 12 2014 523 38 444 41 15 2015 633 50 513 70 29 2016 651 54 495 102 43 TOTAL 2217 161 1811 245 96 4% indications
- 28. Type of R Hinge TKA Simple • Rotax (Groupe Lepine ®) Reconstruction • Noyles (Depuy®) • RHK OSS (Biomet®) n=43 N=29 n = 72
- 29. Patellar analysis • X ray: pattelar view at 30° flexion • 4 groups: – Centered – Tilted – Subdislocated – Dislocated
- 30. Type of R Hinge TKA Simple • Rotax (Groupe Lepine ®) Reconstruction • Noyles (Depuy®) • RHK OSS (Biomet®) 65% 59% 28,1% 6,9%4,6 % 2,3 % 2,3 % 31,8 %
- 31. Type of R Hinge TKA Simple • Rotax (Groupe Lepine ®) Reconstruction • Noyles (Depuy®) • RHK OSS (Biomet®) 65% 59% 28,1% 6,9%4,6 % 2,3 % 2,3 % 31,8 % 93,1% 90,8%
- 32. Type of R Hinge TKA Simple • Rotax (Groupe Lepine ®) Reconstruction • Noyles (Depuy®) • RHK OSS (Biomet®) 65% 59% 28,1% 6,9%4,6 % 2,3 % 2,3 % 31,8 %
- 33. ATT medialisation+ MPFL n = 2
- 34. Conclusion • 25% of our current indications for Revision TKA, • Satisfactory functional results (flexion), • 65% optimal Patellar positioning, • 5% secondary MPFL + ATT medialisation.