[Bipolar endoprosthesis in fractures of the femoral neck. Apropos of 201 cases, 116 after a 6-year follow-up]. / La prothèse intermédiaire dans les fractures du col du fémur. A propos de 201 cas dont 116 avec un recul médian de 6 ans.

We report our experience with 201 SEM bipolar prostheses used to treat femoral neck fractures in patients with a mean age of 70 years and a mean follow-up of 57 months (median 75 months). Clinical outcome was favorable with 94 per cent satisfactory results (very good and good). Femoral complications requiring reoperation (conversion to total hip replacement) occurred in 2.2 per cent of cases. Among the 163 patients for whom roentgenographic data were available, 5 (3.6 per cent) developed evidence of acetabular wear but remained symptom-free and did not require reoperation. As compared with Moore's prosthesis, the SEM bipolar prosthesis seems to provide substantially better clinical and roentgenographic results. For the treatment of femoral neck fractures, total hip replacement seems to provide results comparable to those reported here but requires a more sophisticated operative technique and carries a greater risk of subsequent dislocation. Two factors prevent the widespread use of the bipolar prosthesis at present: the need for femoral grouting which carries a well-documented risk of hemodynamic complications, and the higher cost of the device.

[Osteonecrosis of the femur head in patients with renal transplant. Apropos of 82 surgically treated hips]. / L'ostéonécrose de la tête fémorale chez le transplanté rénal. A propos de 82 hanches opérées.

Fifty-six renal transplanted patients having an average age of 33 years have been operated on for necrosis of the femoral head from 1973 to 1988. They totalise 85 cephalic necrosis due to the therapeutic peaks of corticotherapy. The femoral condyles were affected by the necrosis in 21 patients, and the humeral head in 16 patients. 82 surgical operations of first intention and 18 resumptions leading to 100 the total number of operations. The 26 drilling gave place to 11 by arthroplasty. The good results of the drillings only concern the infraradiological stages and the MRI allows to detect the non symptomatic stages 0. The 33 intermediate prosthesis did not lead to septic complications but 9 cotiloidal alterations of which 4 important with a resumption by total prosthesis. 36 total prosthesis were realized out of which 13 for resumption. Two early and two late suppurations after septicemia complicated the evolution. If at stage 0 or 1 the drilling seems to remain a reliable indication, the total prosthesis is the only possible solution for invalidating stages IV, the intermediate prosthesis seems to be able to keep a place in the intermediate stages.