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Papers by jean louis PRUDHON

Research paper thumbnail of Liste des auteurs

Research paper thumbnail of Comparative Retrospective Study of 320 Primary Charnley Total Hip Arthroplasty with a Minimum of Ten Years' Follow-Up to Assess Whether Dual Mobility Cup Has a Decreased Dislocation

Orthopaedic Proceedings, Feb 21, 2018

Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional... more Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However dislocation still remains an unsolved problem. Dislocation may occur all along the patient and implant life. The aim of this study is to answer the question: does Dual Mobility Cup (DMC) decrease the dislocation risk? Method: We report comparative results at ten years of follow-up of 2 groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n=215) and the other one with a DMC (group 2, n=105). Results: In group 1, twenty-six dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by close reduction, without any recurrence. This difference was statistically significant (p=0.0018). In group 1, reason for revision was recurrent dislocation in twenty one cases. Five patients have been revised for other reasons. The global revision rate was 12.9%. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1%. This difference was statistically significant (p=0.0054). The goal was reached for the patients of group 2 who had more risks factors of dislocation (age, aetiology, ASA and Devane scores) than those of group 1. When using a DMC, we observed a low rate of dislocation in primary THA (0.9%). This surgical choice seems to be a secure and effective technique in Charnley-type THA, especially in a high risk population.

Research paper thumbnail of The SFA system for assessing articular cartilage lesions at arthroscopy of the knee

Arthroscopy, Feb 1, 1994

We proposed to establish a system of assessing severity of chondropathy taking into account local... more We proposed to establish a system of assessing severity of chondropathy taking into account localization, size, and depth of cartilage lesions. The design of the study was prospective and multicenter. The subjects were 755 patients who had undergone arthroscopy of the knee. Criteria for assessment of severity of chondropathy were as follows: (a) Physician's overall assessment using a 100-mm-long Visual Analogue Scale, and (b) size, grade, and localization of cartilage lesions recorded on a diagram. We used multivariate parametric and nonparametric analyses. The analyses resulted in two systems of assessing severity of chondropathy: SFA scoring for the three compartments of the knee, which is a continuous variable, and SFA grading, which is a semiquantitative variable. These systems seem to be of clinical relevance. However, more studies are required to further validate them and their capacity to detect changes in severity of chondropathy.

Research paper thumbnail of Dual Mobility Cup in the Treatment of Upper Femoral Fractures: Prospective Study at One Year of Follow-Up

Orthopaedic Proceedings, Feb 21, 2018

Introduction Upper femoral fractures include intra and extra-capsular fracture (ECF). For intra-c... more Introduction Upper femoral fractures include intra and extra-capsular fracture (ECF). For intra-capsular fracture (ICF), hemi-arthroplasty (HA) is the most commonly used treatment. Interest in total hip arthroplasty (THA) is growing because THA yields less revision (4% versus 7%) associated to better functional results despite higher dislocation rate (9% versus 3%). Regarding ECF, internal fixation is the reference treatment. THA could represent a relevant alternative. This study evaluates the efficiency of THA using dual mobility cup (THA-DMC) as treatment of these fractures specially in elderly patients. Material and method 70 patients were operated on for upper femoral fractures with Quattro THA-DMC between May 2012 and October 2013. Minimum follow-up is one year. Seven surgeons in 4 institutions were involved. Data collected were: age, gender, type of fracture, surgical approach, mortality, revision rate and dislocation rate. Results Seventy patients were included. 83.3 % were women. Mean age was 82.8 (51–99). 43% were ECF and 57% ICF. Postero-lateral approach represented 51% of cases, trans-trochanteric 43% and Hardinge 6%. Mortality rate was 10%. One dislocation (1.4%) occurred at one month postoperative treated by closed reduction. No revision was performed. Discussion Even though THA is widely used to treat ICF, two recent meta-analyses concluded that THAs bring better survivorship as well as better functional results despite a higher dislocation rates. THA-DMC is a way to decrease dislocation risk as confirmed by our study. There is a lack of studies published on the treatment of ECF, precluding a proper assessment. Conclusion Given the studies identified, the gold standard in the treatment of ICF is moving toward THA. THA-DMC could overcome the higher dislocation rate observed with standard THA.

Research paper thumbnail of 23 Dix ans d’expérience de prothèses totales de genou à plateau fixe

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Sep 1, 2004

Research paper thumbnail of Prothèse totale du genou bilatérale simultanée : une étude de faisabilité multicentrique

Revue de Chirurgie Orthopédique et Traumatologique, Apr 1, 2013

Acceptation définitive le : 11 janvier 2013 MOTS CLÉS Genou ; Prothèse totale simultanée bilatéra... more Acceptation définitive le : 11 janvier 2013 MOTS CLÉS Genou ; Prothèse totale simultanée bilatérale ; Résultats ; Complications Résumé Introduction.-Il existe une controverse sur l'intérêt et l'innocuité de traiter les patients porteurs d'une gonarthrose bilatérale par prothèse totale du genou (PTG) bilatérale simultanée. Hypothèses.-Le risque de complication d'une PTG bilatérale simultanée est majoré par rapport à celui publié dans la littérature pour les PTG unilatérales, et les résultats cliniques et fonctionnels sont inférieurs à ce groupe de référence. Patients et méthodes.-Cent-vingt-trois patients opérés d'une PTG bilatérale simultanée entre 2005 et 2011 dans cinq centres spécialisés ont été recensés. Les dossiers ont été étudiés de façon rétrospective avec un recul moyen de 33 mois.

Research paper thumbnail of Prothèse totale de hanche bilatérale en un temps : résultats fonctionnels et complications sur une série de 112 patients

Revue de Chirurgie Orthopédique et Traumatologique, Oct 1, 2012

ABSTRACT Introduction Le remplacement prothétique bilatéral de hanche en une session opératoire o... more ABSTRACT Introduction Le remplacement prothétique bilatéral de hanche en une session opératoire offre les avantages d’un seul séjour hospitalier, d’une rééducation raccourcie et d’une diminution du coût de prise en charge par patient. Cependant, la crainte d’un taux plus élevé de complications périopératoires a jusqu’alors freiné cette stratégie. Les objectifs de cette étude étaient d’évaluer la morbi-mortalité et le bénéfice fonctionnel de cette stratégie. Hypothèse Le taux de complication des arthroplasties totales de hanche bilatérales en une séance est voisin de celui des arthroplasties de hanche unilatérales. Patients et méthodes Un protocole d’analyse rétrospectif observationnel de patients opérés de prothèses totales de hanches bilatérales en une session opératoire (PTH Bi) a été soumis à quatre centres chirurgicaux français. Cent douze patients ont été inclus, dont 55 femmes, l’âge moyen était de 59 ans (22 à 84), le recul clinique de 30 mois (six à 103). Résultats La durée moyenne de séjour (DMS) hospitalier était de 10,8 jours (six à 27), la durée opératoire de 162 minutes (95 à 270). Le taux d’hémoglobine était de 14,3 g/L en préopératoire et de 10,1 g/L en postopératoire. Il n’a été enregistré aucun décès périopératoire. Huit patients ont présenté une phlébite (7,5 %) et 6 une embolie pulmonaire (5,5 %). Le score de Merle d’Aubigné passait de 9,25 ± 2,9 (3 à 16) en préopératoire à 17,5 ± 1 (14 à 18) au recul. Tous les patients sauf 3 referaient l’intervention (97 %) et 102/112 (90 %) la conseilleraient à un proche. Discussion/Conclusion Cette série multicentrique indique que le remplacement prothétique bilatéral de hanche en une session opératoire représente une alternative au remplacement bilatéral en deux sessions pour les patients ASA 1 et 2 avec un taux d’hémoglobine préopératoire à 14 g/dl. Le taux de complications majeures de 7,5 % est un peu plus élevé que celui de prothèses unilatérales et les complications principales sont les phlébites et les embolies pulmonaires. Type d’étude Rétrospective multicentrique observationnelle, niveau d’évidence IV.

Research paper thumbnail of Letter to the editor on “Catastrophic failure of a dual mobility bearing in a revision total hip arthroplasty”

Arthroplasty today, Jun 1, 2019

Research paper thumbnail of Pourquoi révise-t-on les prothèses double mobilité ?

Research paper thumbnail of Comparative Retrospective Study of 320 Primary Charnley Total Hip Arthroplasty with a Minimum of Ten Years' Follow-Up to Assess Whether Dual Mobility Cup Has a Decreased Dislocation

Journal of Bone and Joint Surgery-british Volume, 2016

Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional... more Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However dislocation still remains an unsolved problem. Dislocation may occur all along the patient and implant life. The aim of this study is to answer the question: does Dual Mobility Cup (DMC) decrease the dislocation risk? Method: We report comparative results at ten years of follow-up of 2 groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n=215) and the other one with a DMC (group 2, n=105). Results: In group 1, twenty-six dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by close reduction, without any recurrence. This difference was statistically significant (p=0.0018). In group 1, reason for revision was recurrent dislocation in twenty one cases. Five patients have been revised for other reasons. The global revision...

Research paper thumbnail of 132 Prothèse totale de genou rotatoire New Wave : expérience clinique

Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004

nouvel implant parfaitement stabilisé, au sein d'un fémur solide et bien axé. L'intervention est ... more nouvel implant parfaitement stabilisé, au sein d'un fémur solide et bien axé. L'intervention est prévue par planification pour éviter le maximum d'imprévus. La tige Intégra modulaire est adaptée à la fémorotomie. Stable dans les trois plans de l'espace, elle peut exceptionnellement être verrouillée. Nous enlevons l'implant par fémorotomie pour éviter fractures et fausses routes. Une plaque souple permet de stabiliser le volet même s'il est fracturé. Si nécessaire, des apports osseux ou un recalibrage augmentent le stock osseux ou adaptent le fémur autour de l'implant. L'analyse de la pose de 100 tiges de reprise Intégra posées à partir de 1999, confirme les qualités de l'association tige-plaque qui permettent d'avoir, en fin d'intervention, un implant et un volet toujours parfaitement stables. Les interventions de reprise sont ainsi sécurisées. L'ablation de l'implant par voie transfémorale diminue la durée de l'intervention, évite les complications des techniques classiques et n'entraîne pas de complications iatrogènes majeures : pas de pseudarthrose ou de nécrose du volet, une seule ablation de plaque pour intolérance. Des gestes complémentaires (apports osseux ou recalibrage) ont été nécessaires dans plus de 60 % des cas. Les résultats à distance sont très satisfaisants sur la douleur et sur la mobilité. Les résultats sur la stabilité de la hanche dépendent de l'état articulaire et musculaire initial ; en aucun cas ils n'ont été aggravés par l'intervention. Le concept Intégra planifie efficacement le changement de tige fémorale. La planification et l'utilisation d'implants adaptés sécurisent l'intervention. Des gestes chirurgicaux complémentaires permettent de normaliser l'aspect du fémur. Le concept Intégra permet d'obtenir en fin d'intervention le résultat initialement prévu.

Research paper thumbnail of Is Wear of Dual Mobility Cup Lower or Upper Than Conventional Cup? Results Analysis of an in Vitro Standard Test

Orthopaedic Proceedings, Feb 21, 2018

Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, le... more Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, leading to osteolysis and decreasing survivorship rates. Dual mobility cups (DMC) are widely used to prevent or treat THA instability. However some studies have pointed PE wear risk as a “dual wear” risk. Hip wear simulation is usually used to understand factors influencing wear and to differentiate design, PE types and materials performances. To date, few works have been published studying dual mobility insert wear. Objectives Our objective was to evaluate wear of DMC with comparison with a fixed single articulating hip design and to measure wear under same conditions (loading cycle, temperature, sterilization, material and surface roughness). Methods The test bench includes one station for a control sample and one for dynamic test. Those are driven independently one from the other. Two electrical actuators applied the forces and two forces sensors putted on the fixing plate of the acetabular part gave the corresponding values. On the dynamic station, the angular movements are generated by an electric motor. Sleeves are installed on the bowls containing the testing liquid and on the supports of acetabular parts, in order to get a tight volume that excludes contaminant particles. Wear is measured by a gravimetric method. The simulator is stopped and implants have been removed from the simulators in order to achieve weighting and observations at 0.5, 1, 2, 3, 4 and 5 millions cycles. At the end, the sample PE insert and the control one are removed from their cup in the aim to measure the mass loss. Results Under same conditions the gravimetric wear and the linear penetration of the head are perfectly comparable between a conventional and a dual mobility cup. Conclusion In vitro, DMC wear is equal or less important than a standard single fixed cup and volumetric wear is lower than published data. Wear of the two joints of a DMC is not increased thanks to the recruitment phenomenon and the freedom induced by the concept.

Research paper thumbnail of Analyse des facteurs influençant le saignement dans l’arthroplastie du genou sur une série prospective de 117 patients

Revue de Chirurgie Orthopédique et Traumatologique, Nov 1, 2016

Research paper thumbnail of 104 Echecs précoces de cupules sans ciment avec couple métal-métal

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Oct 1, 2004

L'auteur rapporte une série d'échecs précoces de cupules Acora en titane sablé avec utilisation d... more L'auteur rapporte une série d'échecs précoces de cupules Acora en titane sablé avec utilisation d'un couple métal-métal. Trois cent soixante-dix cupules Acora sans ciment (Protek Cedior) ont été implantées par l'auteur entre 1996 et 2003. Le pivot fémoral était toujours un pivot cimenté (type Charnley Acora) modulaire avec soit un couple métal-polyéthylène à tête de 22,2 (190 cas) soit un couple métal-métal à tête de 28 mm (Protek Cedior) (180 cas). Aucun échec n'est noté dans la série métal/PE alors que 9 révisions ont été effectuées dans la série métal métal. L'analyse des échecs fait apparaître une absence de fixation avec des douleurs inguinales et boiterie, voire une bascule complète de la cupule entre 6 et 24 mois après l'implantation. Le seul facteur déterminant dans la survenue de ces échecs était l'utilisation du couple métal-métal alors que tous les autres facteurs ne semblaient pas influencer la capacité de fixation de l'implant. Il semble que le couple métal-métal augmente les contraintes au niveau de la fixation osseuse du métal-back, que celui-ci soit fixé avec ou sans vis. Cette expérience négative nous a imposé un arrêt de l'utilisation de ce type de cupule. Une expérience plus limitée (36 cas) avec utilisation d'une cupule sans ciment recouverte d'HAP et un couple métal-métal ne révèle actuellement aucun échec. En conclusion, nous pensons que l'utilisation d'une cupule sans ciment en titane sablé augmente de façon significative le risque d'échec lors de l'utilisation du couple métal-métal.

Research paper thumbnail of Dual-mobility cups could yield lesser infections than conventional cups: a meta-analysis of comparative studies

International Orthopaedics, Sep 19, 2020

Introduction Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dis... more Introduction Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dislocation following total hip arthroplasty (THA). Currently, indication for DMC use extends beyond patients with high risk of dislocation or revision THA cases. Many authors reported DMC outcomes in primary THA for all aetiologies. However, some reports claimed that the use of DMC is accompanied with higher rates of infection compared with conventional cups (CC) in both primary and revision THA. Research question Does the use of DMC generate higher rates of infection when compared with conventional cups? Objectives The aim of this meta-analysis was to look for significant difference in the rate of post-operative infection between DMC cups and conventional cups. Methodology MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched since inception. Only studies with comparative design reporting the outcome infection rate were included. Results Seventeen retrospective comparative studies were located comprising 248,541 patients: 16,020 in the DMC group and 232,521 in the CC group. The mean follow-up period was 37.5 ± 42 and 50.2 ± 48.7 months for the DMC and CC groups, respectively. The meta-analytical results indicated the following: (a) significantly lesser infections following DMC compared with CC in revision THA (odds ratio (OR) = 0.75 (95% CI = 0.653 to 0.874, P = 0.0002, I 2 = 25%); (b) for primary THA and for large-sampled registries, significance was found using only the fixed-effects model estimate; and (c) no significant difference was found for the subgroup of cohort studies. Conclusion Our results clearly refute the claim that DMC would yield higher rates of infection. On the contrary, the findings demonstrated that the use of DMC reduces the risk of post-operative infection in revision THA and a similar lower infection trend for primary THA when compared with the standard cups.

Research paper thumbnail of Letter to the editor on “Early intraprosthetic dislocation in dual-mobility implants: a systematic review”

Arthroplasty today, Mar 1, 2018

Research paper thumbnail of Equivalent wear performance of dual mobility bearing compared with standard bearing in total hip arthroplasty: in vitro study

International Orthopaedics, Nov 22, 2016

Purpose Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the ... more Purpose Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the survival of the prosthesis. Dual mobility in THAs, which is claimed to reduce dislocation risk, has very good long-term clinical results. However, little is known about how the liner wears in this design, compared to the standard single mobility model. Methods A comparative study looking at wear of a conventional ultra-high-molecular-weight polyethylene liner, using gravimetric measurement, between dual mobility implants and standard implants, was performed on a simulator in accordance with a normed protocol based on the same dimensions, environmental conditions and stresses. A linear regression test was employed. Results Under the same conditions (loading, cycles, sterilization, material and surface roughness), the gravimetric wear (for conventional polyethylene) is comparable between a standard and a dual mobility cup. This correlates to ten year follow-up results of dual mobility cup. Discussion-Conclusion This in vitro equivalent wear serves to confirm the very good long-term clinical results observed with dual mobility bearing, whose use should not be restricted by concerns about increased polyethylene wear.

Research paper thumbnail of Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study

Orthopaedics & traumatology: surgery & research, Apr 1, 2013

Introduction: The value and risk of simultaneous total knee arthroplasty (TKA) in patients with b... more Introduction: The value and risk of simultaneous total knee arthroplasty (TKA) in patients with bilateral knee arthritis is a subject of debate. Hypotheses: The risk of complications following simultaneous bilateral TKA will be increased compared to the rates published in the literature for unilateral TKA, and the clinical and functional outcomes will be poorer in this particular group. Materials and methods: One hundred and twenty-three patients who underwent simultaneous bilateral TKA between 2005 and 2011 in five specialized, high volume centers were evaluated. The files were analyzed retrospectively after a mean 33 months of follow-up. Results: The mean hospital stay was 11 days. Mean blood loss was 4.1 g/dL. A postoperative transfusion was performed in 68 patients (55%), with a mean 3.1 units of blood. The mean global IKS score increased from 90 to 150 points. Eighty patients would agree to undergo simultaneous bilateral TKA again (65%), and 70 would recommend this procedure to others (57%). Discussion: The hypothesis was not confirmed: the risk of complications was not increased compared to the generally accepted risk of a unilateral procedure. The risk of complications in this study was very similar to that published in the literature for the same therapeutic strategy. Therefore, there is no solid medical evidence to prevent recommending this strategy.

Research paper thumbnail of Causes for Revision of Primary Dual Mobility Total Hip Arthroplasty: A Prospective Multicentric Study Series of 251 Implants Compared with 1856 Fixed Socket Total Hip Arthroplasties

Orthopaedic Proceedings, Feb 21, 2018

Introduction The causes for revision of primary total hip arthroplasty (THA) are various and quit... more Introduction The causes for revision of primary total hip arthroplasty (THA) are various and quite well known. The developing use of dual-mobility THA (DM-THA) seems a relevant option to decrease the risk of instability. Due to lack of long-term follow-up, this innovative retentive concept is suspected to increase the risk of polyethylene (PE) wear. The aim of the study was to analyse the causes for DM-THA revision and assess whether or not its occurrence is different from that of fixed-standard (FS) THA, particularly for aseptic loosening or wear and/or osteolysis. Materials and methods The SoFCOT group conducted an observational prospective multicentre study from 1 January 2010 to 31 December 2011. Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs. After excluding complications linked to patient factors (infection and periprosthetic fractures), we performed a matched case–control study (matching ratio 1:1) comparing two groups of 133 THAs. Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA (58.7 %) as in FS-THA (57.1 %) (p 0.32); 7.5 % of DM-THAwere revised for dislocation versus 19.5 % of FS-THA (p 0.007). Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA; revision for dislocation was less frequent in DM-THA. This confirms the efficiency of the DM concept regarding the risk of dislocation. Causes for revision were different between groups, and revisions for dislocation were less frequent in DM-THA. Only prospective comparative studies could provide reliable information that may support broader use of the DM concept.

Research paper thumbnail of Is Wear of Dual Mobility Cup Lower or Upper Than Conventional Cup? Results Analysis of an in Vitro Standard Test

Orthopaedic Proceedings, Feb 21, 2018

Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, le... more Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, leading to osteolysis and decreasing survivorship rates. Dual mobility cups (DMC) are widely used to prevent or treat THA instability. However some studies have pointed PE wear risk as a “dual wear” risk. Hip wear simulation is usually used to understand factors influencing wear and to differentiate design, PE types and materials performances. To date, few works have been published studying dual mobility insert wear. Objectives Our objective was to evaluate wear of DMC with comparison with a fixed single articulating hip design and to measure wear under same conditions (loading cycle, temperature, sterilization, material and surface roughness). Methods The test bench includes one station for a control sample and one for dynamic test. Those are driven independently one from the other. Two electrical actuators applied the forces and two forces sensors putted on the fixing plate of the acetabular part gave the corresponding values. On the dynamic station, the angular movements are generated by an electric motor. Sleeves are installed on the bowls containing the testing liquid and on the supports of acetabular parts, in order to get a tight volume that excludes contaminant particles. Wear is measured by a gravimetric method. The simulator is stopped and implants have been removed from the simulators in order to achieve weighting and observations at 0.5, 1, 2, 3, 4 and 5 millions cycles. At the end, the sample PE insert and the control one are removed from their cup in the aim to measure the mass loss. Results Under same conditions the gravimetric wear and the linear penetration of the head are perfectly comparable between a conventional and a dual mobility cup. Conclusion In vitro, DMC wear is equal or less important than a standard single fixed cup and volumetric wear is lower than published data. Wear of the two joints of a DMC is not increased thanks to the recruitment phenomenon and the freedom induced by the concept.

Research paper thumbnail of Liste des auteurs

Research paper thumbnail of Comparative Retrospective Study of 320 Primary Charnley Total Hip Arthroplasty with a Minimum of Ten Years' Follow-Up to Assess Whether Dual Mobility Cup Has a Decreased Dislocation

Orthopaedic Proceedings, Feb 21, 2018

Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional... more Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However dislocation still remains an unsolved problem. Dislocation may occur all along the patient and implant life. The aim of this study is to answer the question: does Dual Mobility Cup (DMC) decrease the dislocation risk? Method: We report comparative results at ten years of follow-up of 2 groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n=215) and the other one with a DMC (group 2, n=105). Results: In group 1, twenty-six dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by close reduction, without any recurrence. This difference was statistically significant (p=0.0018). In group 1, reason for revision was recurrent dislocation in twenty one cases. Five patients have been revised for other reasons. The global revision rate was 12.9%. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1%. This difference was statistically significant (p=0.0054). The goal was reached for the patients of group 2 who had more risks factors of dislocation (age, aetiology, ASA and Devane scores) than those of group 1. When using a DMC, we observed a low rate of dislocation in primary THA (0.9%). This surgical choice seems to be a secure and effective technique in Charnley-type THA, especially in a high risk population.

Research paper thumbnail of The SFA system for assessing articular cartilage lesions at arthroscopy of the knee

Arthroscopy, Feb 1, 1994

We proposed to establish a system of assessing severity of chondropathy taking into account local... more We proposed to establish a system of assessing severity of chondropathy taking into account localization, size, and depth of cartilage lesions. The design of the study was prospective and multicenter. The subjects were 755 patients who had undergone arthroscopy of the knee. Criteria for assessment of severity of chondropathy were as follows: (a) Physician's overall assessment using a 100-mm-long Visual Analogue Scale, and (b) size, grade, and localization of cartilage lesions recorded on a diagram. We used multivariate parametric and nonparametric analyses. The analyses resulted in two systems of assessing severity of chondropathy: SFA scoring for the three compartments of the knee, which is a continuous variable, and SFA grading, which is a semiquantitative variable. These systems seem to be of clinical relevance. However, more studies are required to further validate them and their capacity to detect changes in severity of chondropathy.

Research paper thumbnail of Dual Mobility Cup in the Treatment of Upper Femoral Fractures: Prospective Study at One Year of Follow-Up

Orthopaedic Proceedings, Feb 21, 2018

Introduction Upper femoral fractures include intra and extra-capsular fracture (ECF). For intra-c... more Introduction Upper femoral fractures include intra and extra-capsular fracture (ECF). For intra-capsular fracture (ICF), hemi-arthroplasty (HA) is the most commonly used treatment. Interest in total hip arthroplasty (THA) is growing because THA yields less revision (4% versus 7%) associated to better functional results despite higher dislocation rate (9% versus 3%). Regarding ECF, internal fixation is the reference treatment. THA could represent a relevant alternative. This study evaluates the efficiency of THA using dual mobility cup (THA-DMC) as treatment of these fractures specially in elderly patients. Material and method 70 patients were operated on for upper femoral fractures with Quattro THA-DMC between May 2012 and October 2013. Minimum follow-up is one year. Seven surgeons in 4 institutions were involved. Data collected were: age, gender, type of fracture, surgical approach, mortality, revision rate and dislocation rate. Results Seventy patients were included. 83.3 % were women. Mean age was 82.8 (51–99). 43% were ECF and 57% ICF. Postero-lateral approach represented 51% of cases, trans-trochanteric 43% and Hardinge 6%. Mortality rate was 10%. One dislocation (1.4%) occurred at one month postoperative treated by closed reduction. No revision was performed. Discussion Even though THA is widely used to treat ICF, two recent meta-analyses concluded that THAs bring better survivorship as well as better functional results despite a higher dislocation rates. THA-DMC is a way to decrease dislocation risk as confirmed by our study. There is a lack of studies published on the treatment of ECF, precluding a proper assessment. Conclusion Given the studies identified, the gold standard in the treatment of ICF is moving toward THA. THA-DMC could overcome the higher dislocation rate observed with standard THA.

Research paper thumbnail of 23 Dix ans d’expérience de prothèses totales de genou à plateau fixe

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Sep 1, 2004

Research paper thumbnail of Prothèse totale du genou bilatérale simultanée : une étude de faisabilité multicentrique

Revue de Chirurgie Orthopédique et Traumatologique, Apr 1, 2013

Acceptation définitive le : 11 janvier 2013 MOTS CLÉS Genou ; Prothèse totale simultanée bilatéra... more Acceptation définitive le : 11 janvier 2013 MOTS CLÉS Genou ; Prothèse totale simultanée bilatérale ; Résultats ; Complications Résumé Introduction.-Il existe une controverse sur l'intérêt et l'innocuité de traiter les patients porteurs d'une gonarthrose bilatérale par prothèse totale du genou (PTG) bilatérale simultanée. Hypothèses.-Le risque de complication d'une PTG bilatérale simultanée est majoré par rapport à celui publié dans la littérature pour les PTG unilatérales, et les résultats cliniques et fonctionnels sont inférieurs à ce groupe de référence. Patients et méthodes.-Cent-vingt-trois patients opérés d'une PTG bilatérale simultanée entre 2005 et 2011 dans cinq centres spécialisés ont été recensés. Les dossiers ont été étudiés de façon rétrospective avec un recul moyen de 33 mois.

Research paper thumbnail of Prothèse totale de hanche bilatérale en un temps : résultats fonctionnels et complications sur une série de 112 patients

Revue de Chirurgie Orthopédique et Traumatologique, Oct 1, 2012

ABSTRACT Introduction Le remplacement prothétique bilatéral de hanche en une session opératoire o... more ABSTRACT Introduction Le remplacement prothétique bilatéral de hanche en une session opératoire offre les avantages d’un seul séjour hospitalier, d’une rééducation raccourcie et d’une diminution du coût de prise en charge par patient. Cependant, la crainte d’un taux plus élevé de complications périopératoires a jusqu’alors freiné cette stratégie. Les objectifs de cette étude étaient d’évaluer la morbi-mortalité et le bénéfice fonctionnel de cette stratégie. Hypothèse Le taux de complication des arthroplasties totales de hanche bilatérales en une séance est voisin de celui des arthroplasties de hanche unilatérales. Patients et méthodes Un protocole d’analyse rétrospectif observationnel de patients opérés de prothèses totales de hanches bilatérales en une session opératoire (PTH Bi) a été soumis à quatre centres chirurgicaux français. Cent douze patients ont été inclus, dont 55 femmes, l’âge moyen était de 59 ans (22 à 84), le recul clinique de 30 mois (six à 103). Résultats La durée moyenne de séjour (DMS) hospitalier était de 10,8 jours (six à 27), la durée opératoire de 162 minutes (95 à 270). Le taux d’hémoglobine était de 14,3 g/L en préopératoire et de 10,1 g/L en postopératoire. Il n’a été enregistré aucun décès périopératoire. Huit patients ont présenté une phlébite (7,5 %) et 6 une embolie pulmonaire (5,5 %). Le score de Merle d’Aubigné passait de 9,25 ± 2,9 (3 à 16) en préopératoire à 17,5 ± 1 (14 à 18) au recul. Tous les patients sauf 3 referaient l’intervention (97 %) et 102/112 (90 %) la conseilleraient à un proche. Discussion/Conclusion Cette série multicentrique indique que le remplacement prothétique bilatéral de hanche en une session opératoire représente une alternative au remplacement bilatéral en deux sessions pour les patients ASA 1 et 2 avec un taux d’hémoglobine préopératoire à 14 g/dl. Le taux de complications majeures de 7,5 % est un peu plus élevé que celui de prothèses unilatérales et les complications principales sont les phlébites et les embolies pulmonaires. Type d’étude Rétrospective multicentrique observationnelle, niveau d’évidence IV.

Research paper thumbnail of Letter to the editor on “Catastrophic failure of a dual mobility bearing in a revision total hip arthroplasty”

Arthroplasty today, Jun 1, 2019

Research paper thumbnail of Pourquoi révise-t-on les prothèses double mobilité ?

Research paper thumbnail of Comparative Retrospective Study of 320 Primary Charnley Total Hip Arthroplasty with a Minimum of Ten Years' Follow-Up to Assess Whether Dual Mobility Cup Has a Decreased Dislocation

Journal of Bone and Joint Surgery-british Volume, 2016

Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional... more Mid and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However dislocation still remains an unsolved problem. Dislocation may occur all along the patient and implant life. The aim of this study is to answer the question: does Dual Mobility Cup (DMC) decrease the dislocation risk? Method: We report comparative results at ten years of follow-up of 2 groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n=215) and the other one with a DMC (group 2, n=105). Results: In group 1, twenty-six dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by close reduction, without any recurrence. This difference was statistically significant (p=0.0018). In group 1, reason for revision was recurrent dislocation in twenty one cases. Five patients have been revised for other reasons. The global revision...

Research paper thumbnail of 132 Prothèse totale de genou rotatoire New Wave : expérience clinique

Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004

nouvel implant parfaitement stabilisé, au sein d'un fémur solide et bien axé. L'intervention est ... more nouvel implant parfaitement stabilisé, au sein d'un fémur solide et bien axé. L'intervention est prévue par planification pour éviter le maximum d'imprévus. La tige Intégra modulaire est adaptée à la fémorotomie. Stable dans les trois plans de l'espace, elle peut exceptionnellement être verrouillée. Nous enlevons l'implant par fémorotomie pour éviter fractures et fausses routes. Une plaque souple permet de stabiliser le volet même s'il est fracturé. Si nécessaire, des apports osseux ou un recalibrage augmentent le stock osseux ou adaptent le fémur autour de l'implant. L'analyse de la pose de 100 tiges de reprise Intégra posées à partir de 1999, confirme les qualités de l'association tige-plaque qui permettent d'avoir, en fin d'intervention, un implant et un volet toujours parfaitement stables. Les interventions de reprise sont ainsi sécurisées. L'ablation de l'implant par voie transfémorale diminue la durée de l'intervention, évite les complications des techniques classiques et n'entraîne pas de complications iatrogènes majeures : pas de pseudarthrose ou de nécrose du volet, une seule ablation de plaque pour intolérance. Des gestes complémentaires (apports osseux ou recalibrage) ont été nécessaires dans plus de 60 % des cas. Les résultats à distance sont très satisfaisants sur la douleur et sur la mobilité. Les résultats sur la stabilité de la hanche dépendent de l'état articulaire et musculaire initial ; en aucun cas ils n'ont été aggravés par l'intervention. Le concept Intégra planifie efficacement le changement de tige fémorale. La planification et l'utilisation d'implants adaptés sécurisent l'intervention. Des gestes chirurgicaux complémentaires permettent de normaliser l'aspect du fémur. Le concept Intégra permet d'obtenir en fin d'intervention le résultat initialement prévu.

Research paper thumbnail of Is Wear of Dual Mobility Cup Lower or Upper Than Conventional Cup? Results Analysis of an in Vitro Standard Test

Orthopaedic Proceedings, Feb 21, 2018

Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, le... more Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, leading to osteolysis and decreasing survivorship rates. Dual mobility cups (DMC) are widely used to prevent or treat THA instability. However some studies have pointed PE wear risk as a “dual wear” risk. Hip wear simulation is usually used to understand factors influencing wear and to differentiate design, PE types and materials performances. To date, few works have been published studying dual mobility insert wear. Objectives Our objective was to evaluate wear of DMC with comparison with a fixed single articulating hip design and to measure wear under same conditions (loading cycle, temperature, sterilization, material and surface roughness). Methods The test bench includes one station for a control sample and one for dynamic test. Those are driven independently one from the other. Two electrical actuators applied the forces and two forces sensors putted on the fixing plate of the acetabular part gave the corresponding values. On the dynamic station, the angular movements are generated by an electric motor. Sleeves are installed on the bowls containing the testing liquid and on the supports of acetabular parts, in order to get a tight volume that excludes contaminant particles. Wear is measured by a gravimetric method. The simulator is stopped and implants have been removed from the simulators in order to achieve weighting and observations at 0.5, 1, 2, 3, 4 and 5 millions cycles. At the end, the sample PE insert and the control one are removed from their cup in the aim to measure the mass loss. Results Under same conditions the gravimetric wear and the linear penetration of the head are perfectly comparable between a conventional and a dual mobility cup. Conclusion In vitro, DMC wear is equal or less important than a standard single fixed cup and volumetric wear is lower than published data. Wear of the two joints of a DMC is not increased thanks to the recruitment phenomenon and the freedom induced by the concept.

Research paper thumbnail of Analyse des facteurs influençant le saignement dans l’arthroplastie du genou sur une série prospective de 117 patients

Revue de Chirurgie Orthopédique et Traumatologique, Nov 1, 2016

Research paper thumbnail of 104 Echecs précoces de cupules sans ciment avec couple métal-métal

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Oct 1, 2004

L'auteur rapporte une série d'échecs précoces de cupules Acora en titane sablé avec utilisation d... more L'auteur rapporte une série d'échecs précoces de cupules Acora en titane sablé avec utilisation d'un couple métal-métal. Trois cent soixante-dix cupules Acora sans ciment (Protek Cedior) ont été implantées par l'auteur entre 1996 et 2003. Le pivot fémoral était toujours un pivot cimenté (type Charnley Acora) modulaire avec soit un couple métal-polyéthylène à tête de 22,2 (190 cas) soit un couple métal-métal à tête de 28 mm (Protek Cedior) (180 cas). Aucun échec n'est noté dans la série métal/PE alors que 9 révisions ont été effectuées dans la série métal métal. L'analyse des échecs fait apparaître une absence de fixation avec des douleurs inguinales et boiterie, voire une bascule complète de la cupule entre 6 et 24 mois après l'implantation. Le seul facteur déterminant dans la survenue de ces échecs était l'utilisation du couple métal-métal alors que tous les autres facteurs ne semblaient pas influencer la capacité de fixation de l'implant. Il semble que le couple métal-métal augmente les contraintes au niveau de la fixation osseuse du métal-back, que celui-ci soit fixé avec ou sans vis. Cette expérience négative nous a imposé un arrêt de l'utilisation de ce type de cupule. Une expérience plus limitée (36 cas) avec utilisation d'une cupule sans ciment recouverte d'HAP et un couple métal-métal ne révèle actuellement aucun échec. En conclusion, nous pensons que l'utilisation d'une cupule sans ciment en titane sablé augmente de façon significative le risque d'échec lors de l'utilisation du couple métal-métal.

Research paper thumbnail of Dual-mobility cups could yield lesser infections than conventional cups: a meta-analysis of comparative studies

International Orthopaedics, Sep 19, 2020

Introduction Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dis... more Introduction Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dislocation following total hip arthroplasty (THA). Currently, indication for DMC use extends beyond patients with high risk of dislocation or revision THA cases. Many authors reported DMC outcomes in primary THA for all aetiologies. However, some reports claimed that the use of DMC is accompanied with higher rates of infection compared with conventional cups (CC) in both primary and revision THA. Research question Does the use of DMC generate higher rates of infection when compared with conventional cups? Objectives The aim of this meta-analysis was to look for significant difference in the rate of post-operative infection between DMC cups and conventional cups. Methodology MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched since inception. Only studies with comparative design reporting the outcome infection rate were included. Results Seventeen retrospective comparative studies were located comprising 248,541 patients: 16,020 in the DMC group and 232,521 in the CC group. The mean follow-up period was 37.5 ± 42 and 50.2 ± 48.7 months for the DMC and CC groups, respectively. The meta-analytical results indicated the following: (a) significantly lesser infections following DMC compared with CC in revision THA (odds ratio (OR) = 0.75 (95% CI = 0.653 to 0.874, P = 0.0002, I 2 = 25%); (b) for primary THA and for large-sampled registries, significance was found using only the fixed-effects model estimate; and (c) no significant difference was found for the subgroup of cohort studies. Conclusion Our results clearly refute the claim that DMC would yield higher rates of infection. On the contrary, the findings demonstrated that the use of DMC reduces the risk of post-operative infection in revision THA and a similar lower infection trend for primary THA when compared with the standard cups.

Research paper thumbnail of Letter to the editor on “Early intraprosthetic dislocation in dual-mobility implants: a systematic review”

Arthroplasty today, Mar 1, 2018

Research paper thumbnail of Equivalent wear performance of dual mobility bearing compared with standard bearing in total hip arthroplasty: in vitro study

International Orthopaedics, Nov 22, 2016

Purpose Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the ... more Purpose Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the survival of the prosthesis. Dual mobility in THAs, which is claimed to reduce dislocation risk, has very good long-term clinical results. However, little is known about how the liner wears in this design, compared to the standard single mobility model. Methods A comparative study looking at wear of a conventional ultra-high-molecular-weight polyethylene liner, using gravimetric measurement, between dual mobility implants and standard implants, was performed on a simulator in accordance with a normed protocol based on the same dimensions, environmental conditions and stresses. A linear regression test was employed. Results Under the same conditions (loading, cycles, sterilization, material and surface roughness), the gravimetric wear (for conventional polyethylene) is comparable between a standard and a dual mobility cup. This correlates to ten year follow-up results of dual mobility cup. Discussion-Conclusion This in vitro equivalent wear serves to confirm the very good long-term clinical results observed with dual mobility bearing, whose use should not be restricted by concerns about increased polyethylene wear.

Research paper thumbnail of Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study

Orthopaedics & traumatology: surgery & research, Apr 1, 2013

Introduction: The value and risk of simultaneous total knee arthroplasty (TKA) in patients with b... more Introduction: The value and risk of simultaneous total knee arthroplasty (TKA) in patients with bilateral knee arthritis is a subject of debate. Hypotheses: The risk of complications following simultaneous bilateral TKA will be increased compared to the rates published in the literature for unilateral TKA, and the clinical and functional outcomes will be poorer in this particular group. Materials and methods: One hundred and twenty-three patients who underwent simultaneous bilateral TKA between 2005 and 2011 in five specialized, high volume centers were evaluated. The files were analyzed retrospectively after a mean 33 months of follow-up. Results: The mean hospital stay was 11 days. Mean blood loss was 4.1 g/dL. A postoperative transfusion was performed in 68 patients (55%), with a mean 3.1 units of blood. The mean global IKS score increased from 90 to 150 points. Eighty patients would agree to undergo simultaneous bilateral TKA again (65%), and 70 would recommend this procedure to others (57%). Discussion: The hypothesis was not confirmed: the risk of complications was not increased compared to the generally accepted risk of a unilateral procedure. The risk of complications in this study was very similar to that published in the literature for the same therapeutic strategy. Therefore, there is no solid medical evidence to prevent recommending this strategy.

Research paper thumbnail of Causes for Revision of Primary Dual Mobility Total Hip Arthroplasty: A Prospective Multicentric Study Series of 251 Implants Compared with 1856 Fixed Socket Total Hip Arthroplasties

Orthopaedic Proceedings, Feb 21, 2018

Introduction The causes for revision of primary total hip arthroplasty (THA) are various and quit... more Introduction The causes for revision of primary total hip arthroplasty (THA) are various and quite well known. The developing use of dual-mobility THA (DM-THA) seems a relevant option to decrease the risk of instability. Due to lack of long-term follow-up, this innovative retentive concept is suspected to increase the risk of polyethylene (PE) wear. The aim of the study was to analyse the causes for DM-THA revision and assess whether or not its occurrence is different from that of fixed-standard (FS) THA, particularly for aseptic loosening or wear and/or osteolysis. Materials and methods The SoFCOT group conducted an observational prospective multicentre study from 1 January 2010 to 31 December 2011. Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs. After excluding complications linked to patient factors (infection and periprosthetic fractures), we performed a matched case–control study (matching ratio 1:1) comparing two groups of 133 THAs. Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA (58.7 %) as in FS-THA (57.1 %) (p 0.32); 7.5 % of DM-THAwere revised for dislocation versus 19.5 % of FS-THA (p 0.007). Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA; revision for dislocation was less frequent in DM-THA. This confirms the efficiency of the DM concept regarding the risk of dislocation. Causes for revision were different between groups, and revisions for dislocation were less frequent in DM-THA. Only prospective comparative studies could provide reliable information that may support broader use of the DM concept.

Research paper thumbnail of Is Wear of Dual Mobility Cup Lower or Upper Than Conventional Cup? Results Analysis of an in Vitro Standard Test

Orthopaedic Proceedings, Feb 21, 2018

Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, le... more Introduction Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, leading to osteolysis and decreasing survivorship rates. Dual mobility cups (DMC) are widely used to prevent or treat THA instability. However some studies have pointed PE wear risk as a “dual wear” risk. Hip wear simulation is usually used to understand factors influencing wear and to differentiate design, PE types and materials performances. To date, few works have been published studying dual mobility insert wear. Objectives Our objective was to evaluate wear of DMC with comparison with a fixed single articulating hip design and to measure wear under same conditions (loading cycle, temperature, sterilization, material and surface roughness). Methods The test bench includes one station for a control sample and one for dynamic test. Those are driven independently one from the other. Two electrical actuators applied the forces and two forces sensors putted on the fixing plate of the acetabular part gave the corresponding values. On the dynamic station, the angular movements are generated by an electric motor. Sleeves are installed on the bowls containing the testing liquid and on the supports of acetabular parts, in order to get a tight volume that excludes contaminant particles. Wear is measured by a gravimetric method. The simulator is stopped and implants have been removed from the simulators in order to achieve weighting and observations at 0.5, 1, 2, 3, 4 and 5 millions cycles. At the end, the sample PE insert and the control one are removed from their cup in the aim to measure the mass loss. Results Under same conditions the gravimetric wear and the linear penetration of the head are perfectly comparable between a conventional and a dual mobility cup. Conclusion In vitro, DMC wear is equal or less important than a standard single fixed cup and volumetric wear is lower than published data. Wear of the two joints of a DMC is not increased thanks to the recruitment phenomenon and the freedom induced by the concept.