Total Hip Replacement

Postel, Kerboul, Evrard, Courpied, and their coauthors take a completely objective attitude in describing the progress achieved in total hip replace­ ment with reference to their own experience over the last 20 years. They avoid any triumphant fanfares, but not because of Pascal's dictum: "Do you want people to speak well of you? Don't do it yourself. " Rather, they know that other surgeons, like themselves, are more concerned with effi­ ciency than with laurels, and want that is, new ideas based on sufficiently wide experience and analyzed in a strict and uncompromising manner. In addition, surgeons are particularly anxious for in-depth study of the pr,ob­ lems, complications, and failures encountered as well as for indications as to how these can be avoided and corrected. This book is sure to satisfy sur­ geons on both these counts. It is the exciting and almost incredible prod­ uct of the work and the immense progress that have taken place in the 15 years since I retired. The spirit behind this work has inspired it from the start. It is characterized by a determination to take constant study of the results as the only guide in matters of indications and technique, and the authors insisted on a system of documentation whose purpose (and perhaps merit) was to facilitate comparison both of the preoperative functional state and of the final re­ sult; they have also kept an open mind for interesting new insights from whatever quarter they might arise.

1 Introduction.- 2 Methodology.- 2.1 Statistical Survey Comparing Patients Followed Up with Patients Later Lost to Follow-up.- 2.2 In-depth Research on Patients Lost to Follow-up.- 3 The Development of Total Hip Replacement.- 3.1 The Different Total Hip Prostheses Used at Cochin.- 3.2 The McKee-Merle d’Aubigné Prosthesis.- 3.3 The Low-friction Band Prosthesis.- 3.3.1 Clinical Progress.- 3.3.2 Radiological Development.- 3.3.3 Reasons for Failure.- 3.4 The Charnley Prosthesis.- 3.5 The Charnley-Kerboul Prosthesis.- 3.5.1 Historical Review.- 3.5.2 The Femoral Component of the Charnley Prosthesis.- 3.5.3 A New Series of Prostheses.- 4 The Routine Operation.- 4.1 Indications for Total Hip Replacement and Preparation of the Patient for Surgery.- 4.1.1 Indications.- 4.1.2 Contraindications.- 4.1.3 Preparation of the Patient.- 4.2 The Psychiatrist’s View Point.- 4.3 The Cardiologist and the Candidate for Total Hip Replacement.- 4.3.1 Cardiovascular Risks and Fitness for Surgery.- 4.3.2 Preoperative Diagnosis.- 4.3.3 Cardiovascular Preparation for Surgery.- 4.3.4 In Conclusion.- 4.4 Technical Preparation Prior to Total Hip Arthroplasty ― The Choice of the Prosthesis.- 4.5 Standard Technique for Total Hip Arthroplasty in Uncomplicated Osteoarthritis.- 4.5.1 Positioning of the Patient.- 4.5.2 Approach.- 4.5.3 The Capsule.- 4.5.4 Osteotomy of the Femoral Neck.- 4.5.5 Preparation of the Acetabulum.- 4.5.6 Cementing of the Cup.- 4.5.7 Preparation of the Femur.- 4.5.8 Cementing of the Femoral Component.- 4.5.9 Reduction.- 4.5.10 Reattachment of the Trochanter.- 4.5.11 Closure.- 4.6 Postoperative Management and Follow-up.- 4.6.1 Progression of the Erythrocyte Sedimentation Rate.- 4.6.2 General Health of the Patient in Relation to the Postoperative Course.- 4.6.3 Clinical and Radiological Follow-up.- 5 Results with the Charnley-Kerboul Prosthesis.- 5.1 Introduction.- 5.2 Results in Osteoarthrosis.- 5.2.1 Septic Complications.- 5.2.2 Follow-up.- 5.2.3 Functional Results.- 5.2.4 Radiological Study.- 5.3 Necrosis of the Femoral Head.- 5.4 Total Hip Replacement in Ankylosing Spondylitis.- 5.4.1 The Patients.- 5.4.2 The Operation.- 5.4.3 Complications.- 5.4.4 Results.- 5.5 Total Hip Replacement in Rheumatoid Arthritis.- 5.5.1 Adult Rheumatoid Arthritis.- 5.5.2 Juvenile Rheumatoid Arthritis.- 5.6 Total Hip Replacement in Ankylosis.- 5.6.1 Patients.- 5.6.2 Indications.- 5.6.3 Technique.- 5.6.4 Results.- 5.6.5 Conclusion.- 5.7 Total Hip Replacement for Congenital Dislocation of the Hip.- 5.7.1 The Patients.- 5.7.2 The Condition.- 5.7.3 Preoperative Hip Function.- 5.7.4 Length of Follow-up.- 5.7.5 The Operation.- 5.7.6 Complications.- 5.7.7 Results.- 5.7.8 Analysis.- 5.7.9 Conclusion.- 6 Aseptic Complications Following Total Hip Replacement.- 6.1 Ossification.- 6.1.1 Predisposing Factors.- 6.1.2 Effect on Function.- 6.1.3 Infection.- 6.1.4 Treatment.- 6.1.5 Conclusion.- 6.2 Complications of Trochanterotomy.- 6.2.1 Causes of Nonunion.- 6.2.2 Clinical Significance of Nonunion.- 6.2.3 Conclusions.- 6.3 Dislocation Following Total Hip Replacement.- 6.3.1 Time of Occurrence and Types.- 6.3.2 Predisposing Factors.- 6.3.3 The Mechanism of Dislocation.- 6.3.4 Treatment.- 6.4 Radiological Methods of Assessing the Orientation of the Components.- 6.4.1 Assessment of a Cup with a Metal Ring Around or Parallel to the Equator.- 6.4.2 Assessment of a Cup with a Marker Around the Meridian.- 6.4.3 Measurement of Anteversion of the Neck of the Femoral Prosthesis.- 6.5 Aseptic Loosening Among Charnley-type Prostheses.- 6.5.1 Definitions.- 6.5.2 Radiological Abnormalities Occurring in Our Series.- 7 Revision Surgery for Aseptic Loosening of Total Hip Replacement ― Acetabular Reconstruction.- 7.1 Introduction.- 7.2 Problems Related to the Acetabulum.- 7.2.1 The Lesions.- 7.2.2 Technique and Indications for Acetabular Reconstruction.- 7.3 The Femoral Stage of Total Hip Revision.- 7.3.1 Revision of Cemented Prostheses ― Removal of Cement.- 7.3.2 Diaphyseal Windows.- 7.3.3 False Passages.- 7.3.4 Uncemented Prostheses.- 7.3.5 Broken Prostheses.- 7.3.6 The New Prosthesis.- 7.4 Acetabular Reconstruction by Homograft as a Part of Total Hip Revision.- 7.4.1 The Homograft.- 7.4.2 Radiological Progression.- 7.5 Result of Revision of Aseptic Total Arthroplasty.- 7.5.1 The Operation.- 7.5.2 Functional Results.- 7.5.3 Radiological Results.- 7.6 Conclusions.- 7.6.1 Indications.- 7.6.2 Technical Problems.- 8 Infective Complications of Total Hip Replacement.- 8.1 Introduction.- 8.2 The Patients.- 8.3 Early Infection.- 8.4 Acute Infection of Late Onset.- 8.5 Diagnosis of Chronic Infection.- 8.5.1 Radiological Signs.- 8.5.2 Bacteriology.- 8.6 Histopathology and the Diagnosis of Infection.- 8.6.1 Acute Suppurative Inflammation.- 8.6.2 Chronic Inflammation.- 8.6.3 Rapid Diagnosis of Infection.- 8.7 Methods of Treatment.- 8.7.1 Conservation of the Prosthesis.- 8.7.2 Removal of the Prosthesis.- 8.7.3 Residual Infections.- 8.8 Results of Treatment of Chronic Infection.- 8.9 Development of Treatment of Chronic Infection in Total Hip Replacement ― Present Indications.- 8.10 Prevention of Infection.- 9 The Future of the Polyethylene Cup.- 9.1 Measurement of Wear.- 9.2 Incidence of Wear.- 9.3 Association of Wear with Abnormalities of Fixation.- 9.4 Response of the Femur.- 10 Response of Local Tissue to Total Hip Replacement.- 10.1 Newly Developed Structures Around the Joint.- 10.1.1 Periarticular Changes Caused by Surgery or by the Underlying Joint Pathology.- 10.1.2 Histiocytic Cellular Response.- 10.2 Wear Products and Their Identification.- 10.2.1 Methylmethacrylate.- 10.2.2 Polyethylene.- 10.2.3 Metallic Debris.- 10.2.4 The Quantification of Wear Products.- 10.3 The Bone-cement Interface and Aseptic Loosening.- 10.3.1 Histological Features of Prostheses with Good Fixation.- 10.3.2 Anatomical Appearance of Loose Prostheses.- 10.3.3 Histology and the Different Physiopathological Theories for Bone Resorption.- 11 Conclusions.- 12 Subject Index.