Abstract
Introduction
The technology available for replacing/resurfacing the hip is constantly evolving. The surgeon can now choose from a wide array of components to perform a cemented, hybrid, uncemented total hip arthroplasty (THA) or resurfacing arthroplasty (RSA). The aim of our study was to evaluate and compare the restoration of hip biomechanics following the insertion of three different, commonly used constructs.
Methods
We compared the pre and postoperative radiographs from 40 patients who underwent cemented THA, 45 patients who underwent uncemented THA and 40 who underwent RSA. The femoral offset and limb length differences were measured, with reference to the normal contralateral hip.
Results
Resurfacing resulted in a significant reduction in femoral offset, with accurate restoration of limb length. Both cemented and uncemented THA resulted in a significant increase in femoral offset and leg length, uncemented THA’s resulted in the greatest degree of leg lengthening.
Discussion
Restoration of normal hip anatomy optimises biomechanical function and reduces wear of components. The RSA group had the most accurate restoration in comparison to the two other groups. The reduced femoral offset associated with the RSA group may reduce the lever arm of the abductor muscles however this is unlikely to be clinically significant.
Résumé
Introduction
La technologie disponible pour le remplacement/resurfaçage de la hanche est en constante évolution. Le chirurgien peut à présent choisir dans un large éventail de composants pour réaliser une arthroplastie totale de hanche (PTH) cimentée, hybride ou non cimentée ou bien une arthroplastie de resurfaçage (AR). Le but de notre étude a été d’évaluer et de comparer la restauration de la biomécanique de la hanche après l’implantation différents trois montages habituellement utilisés.
Méthodes
Nous avons comparé les radiographies pré- et post-opératoires de 40 patients qui avaient bénéficié de la pose d’une PTH cimentée, de 45 patients ayant bénéficié de la pose d’une PTH non cimentée et de 40 patients qui avaient bénéficié d’une AR. L’excentration (offset) fémorale et la longueur du membre inférieur avaient été mesurées et comparées au côté controlatéral.
Résultats
Le resurfaçage a eu comme conséquence une réduction significative de l’excentration fémorale avec une restauration de la longueur du membre. Les deux PTH cimentées et non cimentées ont eu comme conséquence une augmentation significative de l’excentration fémorale et de la longueur du membre inférieur et ce sont les PTH non cimentées qui ont le plus allongé le membre inférieur.
Discussion
La restauration de l’anatomie normale de la hanche optimise le fonctionnement biomécanique et réduit l’usure des composants prothétiques. Le groupe AR a eu les critères de restauration les plus précis par comparaison avec les deux autres groupes (PTH). La diminution de l’excentration fémorale du groupe AR réduit le bras de levier des muscles abducteurs bien que cela reste cliniquement peu siginficatif.
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Leonard, M., Magill, P., Kiely, P. et al. Radiographic comparison of cemented and uncemented total hip arthroplasty and hip resurfacing. Eur J Orthop Surg Traumatol 17, 583–586 (2007). https://doi.org/10.1007/s00590-007-0228-y
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DOI: https://doi.org/10.1007/s00590-007-0228-y