Diagnosis
:
radiographies show a pinching of the articular line
space by disappearance of the cartilage: the bone of
the head of the femur is in contact with the cotyle
(pelvis).
Several stages are described according
to the importance of osteoarthritis.
Treatment
:
The treatment must always be medical initially acting
on the pain and the inflammation ; when
the drugs are not enough, physiotherapy (using devices
such the infra-red type or ultrasounds
or laser acting on the pain and the inflammation) can
be carried out.
If all these therapeutic did not generate
improvement, the surgery can be discussed.
Principle
:
To remove injured cartilage surfaces and to replace
them by a prosthesis which is made up:
of a stem introduced into the channel of the femur
after having removed the femoral head ;
of a ball coming to fix itself on the higher end
of the preceding stem ;
of an implant being fixed on the articular slope
of the pelvis, comprising a metal slope with a
natural coating of hydroxyapathite, not requiring
cement and receiving a polyethylene insert which will
be articulated with the ball previously described
:
Sight after the assembly
The size of these implants is defined rigorously according
to the morphology of the articulation of each patient.
Advantages
:
The implants profited from significant technical improvements
these last years:
one of the ways initially surgical makes it possible
to obtain more limited dissections and more reduced
osseous removing, it is about the initially antéro-external
way; immediate rehabilitation and the resumption of
walk with a complete support after the intervention
are possible; the duration of the hospitalization
is shorter of approximately a week and rehabilitation
can be carried out close to the residence ;
their implantation thus is facilitated of it making
it possible to reduce the duration of the intervention;
their implantation is also more precise and is adapted
better to the anatomy of the patient thanks to a more
powerful instrumentation ;
the prostheses of hip comprising a natural coating
(the hydroxyapathite) are today posed without biological
cement and have one longer lifespan, often avoiding
the surgical recoveries for unsealing of the prosthesis,
remotely of the first operation; they have a more
satisfactory anchoring with the bone because this
one is developing itself inside the pores of this
coating around the prosthesis.
Limites
: total ankylosis of the hip; associated neurological
disease ; antecedent of chronic infectious processes…
Demonstration
with a clinical file :
Osteoarthritis of hip with
gaps
on the level of the femoral head
Radiograph hip after implantation
of the prosthesis
A few days after the operation,
the patient found a normal autonomy
Another more complex clinical example, comprising,
in addition to the osteoarthritis of the hip, a deformation
of the femur and pelvis :
The femur is the seat of an after-effect of fracture
and the pelvis comprises a congenital deformity : the
head of the femur left the articulation and is above
the cotyle (congenital sub-dislocation of hip) right
hip on the left of radiography. There it is thus necessary
to find the normal axis of the femur to be able to place
the femoral stem; for that, it is necessary to divide
transversely the old fracture (osteotomy), to deliver
a good axe to the femur and to insert there a longer
femoral stem which will stabilize this zone:
One notes the femoral stem introduced into the femur,
the head of the femur injured having been removed; it
was necessary to rebuild the articular slope of the
pelvis (cotyle) which being non-existent, by the implantation
of a screwed metal ring.
