Charnley-Kerboull total hip arthroplasty combining zirconia on polyethylene. A minimum eight-year follow-up prospective study.

PURPOSE: Zirconia was introduced in the 1980s for total hip arthroplasty (THA) with the expectation of lower polyethylene wear. The purpose of this prospective study was to evaluate the results of a continuous series of total hip arthroplasties combining a zirconia head with polyethylene socket at a minimum eight-year follow-up. METHODS: We performed an open prospective clinical trial in 1997. Our study involved 51 consecutive patients (55 hips) with a mean age of 52.5 ± 12 years (range, 25-76 years). All patients had a Charnley-Kerboull all-cemented hip replacement. A 22-mm stabilised yttrium tetragonal polycrystalline zirconia head (Y-TZP) was used in association with moderately cross-linked and annealed polyethylene. Clinical and radiological outcomes were assessed yearly. A survival analysis was performed using revision for any reason as the end-point. RESULTS: At a minimum eight-year follow-up, 12 patients (13 hips) were lost to follow-up (mean 26.8 months), two patients (two hips) had died, and six patients (six hips) were revised. The remaining 31 patients (34 hips) were alive and had not been revised on either the femoral or acetabular side at a mean follow-up of 117.1 months (range, 96-150 months). Mean functional score at last follow-up was 17.7. Mean linear head penetration was 0.23 mm/year. More than 90% of the remaining hips had signs of periprosthetic osteolysis. Five stems were loosened. The survival at eight years was 87.3% (95% IC: 76.7-97.8). CONCLUSION: This study confirms earlier short-terms results, and demonstrates that zirconia should no longer be used in THA.

Intervertebral disc calcification with neurological symptoms in children: report of conservative treatment in two cases.

PURPOSE: Intervertebral calcifications are rare in the paediatric population. Two cases of children with symptomatic intervertebral calcifications responsible for spinal cord compression and neurological compromise are presented. METHODS: The data of two children treated conservatively for a symptomatic intervertebral calcification responsible for spinal cord compression and neurological compromise were retrospectively reviewed. RESULTS: Frontal and lateral radiographs are usually sufficient to determine the presence and extent of the calcified cervical disc protrusion. Conservative treatment with antalgics and bracing was applied in both cases. The two patients were completely free of symptoms 4 weeks after initial treatment. Magnetic resonance imaging screening showed a complete vertebral canal clearance at final follow-up. CONCLUSION: Despite the lack of significance due to the small number of patients, conservative treatment should be considered in children with moderate neurological symptoms due to calcified disc protrusion.

Osteochondritis dissecans of the subtalar articular facet: an unusual diagnosis.

Osteochondritis dissecans of the talus is classically characterized by an abnormality of the articular cartilage of the talar dome. We report a rare case of a lesion of the subtalar facet in a 10-year-old boy. The lesion was responsible for a painful ankle with secondary instability. The diagnosis was made using plain radiographs and CT, which showed a well-circumscribed osteochondral fragment demarcated from the adjacent bone by a radiolucent line. The clinical outcome was favourable after a 6-week period with a non-weight-bearing short-leg cast.

[Postoperative osteitis of the pubis: diagnosis, treatment and results]. / Ostéites du pubis postopératoires: prise en charge diagnostique, thérapeutique et résultats.

OBJECTIVE: Osteomyelitis of the pubis is a possible complication of urological and gynaecological surgery. This article reviews this disease which is still a source of controversy. MATERIAL AND METHODS: Between 1984 and 1997, five patients with osteomyelitis of the pubis, following complementary investigations, underwent resection of the symphysis pubis with histological and bacteriological examination, combined with antibiotic therapy. The follow-up was 1.5 months to 4 years. RESULTS: The time to onset of first symptoms was 2 weeks to 5 years. Pain initially presented inflammatory features during the early postoperative period and subsequently became mechanical as the disease became chronic, with intermittent acute episodes in 3 cases. Radiation of the pain and the abnormalities observed on imaging were predominantly unilateral in all patients. Fever and laboratory signs of inflammation were inconstant. Bacteria were identified in 4 cases in the absence of antibiotics and lesions of chronic osteomyelitis were observed in every case. Antibiotics were administered by intravenous injection for 3 to 7 weeks, then orally for 1.5 to 3 months. Good functional and infectious results were obtained in 4 patients, while the remaining patient presented posterior instability. CONCLUSION: Postoperative pubic osteomyelitis is an infectious disease. Acute osteomyelitis, which can be treated by antibiotics in the absence of a collection and bone sequestrum, is distinguished from chronic osteomyelitis, in which every effort must be made to identify the bacteria responsible. Infected tissues must be widely excised in combination with prolonged antibiotic therapy. Posterior instability is the main complication.