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Charnley-Kerboull THA for AVN: A minimal 10-year follow-up study

Charnley-Kerboull THA for AVN: A minimal 10-year follow-up study. C. Nich, J.P. Courpied, M. Kerboull M. Postel, M. Hamadouche Service A de Chirurgie Orthopédique et Reconstructrice Université R. Descartes, Hôpital Cochin. Introduction.

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Charnley-Kerboull THA for AVN: A minimal 10-year follow-up study

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  1. Charnley-Kerboull THA for AVN:A minimal 10-year follow-up study C. Nich, J.P. Courpied, M. Kerboull M. Postel, M. Hamadouche Service A de Chirurgie Orthopédique et Reconstructrice Université R. Descartes, Hôpital Cochin

  2. Introduction • THA for AVN- Higher risk of complication (dislocation) - High mechanical failure rate • AVN risk factor itself for failure Chandler et al., J Bone Joint Surg Am, 1981 Collis et al., J Bone Joint Surg Am, 1984 Cornel et al., Orthop Clin North Am, 1985 Dorr el al., J Bone Joint Surg Am, 1983 Ortiguera et al., J Arthroplasty, 1999 Ranawat et al., J Bone Joint Surg Am, 1984

  3. Aim: Clinical and Radiographic outcome of Charnley-Kerboull THA in AVN Minimum 10-year follow-up Predictive factors

  4. Materials and Methods • 122 consecutive THAs for AVN (1980 – 1990) • 96 patients: 70 men, 26 females • Mean age: 50.8 ± 13.3 years (21 to 85) • 3 senior surgeons • Underlying disease:idiopathic 40.6 % Ethanol 16.7 % Steroids 19.8 % Post-traumatic 11.5 % Others 12.2 %

  5. Materials and Methods • Ficat and Arlet grading: 66 % grade III, 34 % grade IV • Extent of necrosis (Kerboull et al., JBJS-Br, 1974): 187° ± 70° • 13 hips previous surgery:- 10 fracture fixation - 2 core decompression - 1 Vernon Luck cup

  6. Trans-trochnateric approach • Single THA design: Charnley-Kerboull monobloc 316L SS, polished (Ra = 0.04 mm) 22.2 mm head all-polyethylene cup cemented with CMW 1

  7. Evaluation • Clinical results: Merle d’Aubigné hip score • AP view of the pelvis:-loosening(Harris et al. JBJS-A, 1982 )-osteolysis (Maloney et al. JBJS-A, 1990 )- wear (Livermore et al. JBJS-A, 1990 ) • Survival analysis:- actuarial method - log rank

  8. RESULTS • 13 patients (16 hips) LTFU3.4 years (0.8 to 6.5) • 19 patients (24 hips) deceased4.3 years (0 to 11,8) • 5 patients (7 hips) revised10.5 years (1.7 to 12) • 59 patients (75 hips) not revised- mean FU 12.8 ± 2.6 years (10 to 20.8)

  9. Complications • Medical (myocardial, cerebral infarction) 2 • Dislocation: 4 including 3 single episode 1 recurrent • Greater trochanter nonunion: 1 • Brooker class III: 1 (HO removal) • Deep infection: 1

  10. Revisions • 7 hips (5 patients): 9.6 ± 3.6 years • 1 hip: septic loosening • 6 hips: aseptic looseninghigh polyethylene wear and osteolysis no loosened femoral component acetabular reconstruction (Kerboull device)

  11. Bilat THA 1983 Bilat OH AVN (53 years) Wear and osteolysis 1993 Bilateral revision

  12. Results • Clinical results:- 10.8 ± 2.5 pre-op to 17.4 ± 0.6 last FUp < 0.001 (Wilcoxon)- age, underlying disease: NS- 94.6% rated excellent to good • Radiographic results • Mean wear:0.06 ± 0.08 mm/year unrevised hips 0.33 ± 0.06 mm/year revised hips Incplete RL No RL Cplete RL Acetabular Side 63 10 2 p = 0.008 Mann-Whitney Femoral Side 69 5 1

  13. Survivorship analysis @ 15 years • Revision for any reason: 88.5 ± 4.3 % (95% CI, 80.2 to 96.9%) • Revision for aseptic loosening:89.8 ± 4.1 % (95% CI, 81.7 to 97.9%)

  14. 100 98.6% 85.6% 80 60 Acetabular components Survival rate (%) 40 Femoral components 20 0 0 5 10 15 Follow-up (years) Survivorship analysis @ 15 years End-point = Radiographic loosening

  15. Predictive factors of radiographic loosening (Log rank) Age at index THA Gender Ficat and Arlet Stage Underlying disease Kerboull Necrotic Angle NS

  16. 100 94.4% 80 60 56.2% Wear rate ≤ 0.1 mm/year (n=100) Survival rate (%) 40 Wear rate > 0.1 mm/year (n=22) 20 0 0 5 10 15 Follow-up (years) Survivorship analysis @ 15 years End-point = Radiographic loosening p = 0.04 Log rank

  17. Discussion • Controversial published results • Cemented implants: Poor results / osteoarthritis Chandler et al., J Bone Joint Surg Am, 1981 Collis et al., J Bone Joint Surg Am, 1984 Cornel et al., Orthop Clin North Am, 1985 Dorr el al., J Bone Joint Surg Am, 1983 Ortiguera et al., J Arthroplasty, 1999 Ranawat et al., J Bone Joint Surg Am, 1984 Cementing technique Ritter et al, Clin Orthop, 1997

  18. Discussion • Cementless implants (early generation):- high incidence of thigh pain- failure up to 20.5% @ 9-year FU • Hartley et al., JBJS A, 2000- 10 different stems, 3 cup designs- 79.7 ± 13% @ 10-year FU Katz et al., Clin Orthop 1992 Lins et al., Clin Orthop 1993 Kim et al., Clin Orthop 1995 Stulberg et al., Clin Orthop 1997 Wear and osteolysis

  19. Discussion • Cementless Vs Cemented stems (prospective studies)- Katz et al., Clin Orthop 1992- Kim et al., J Bone Joint Surg A, 2003 NS • Berry et al., J Bone Joint Surg A, 2002- Mayo Hip Register, Charnley THA- 103 AVN (25-year FU)- Multivariate analysis: AVN ( odds ratio 0.9, p = .645)

  20. Conclusion • Current study- single implant, single technique- min 10-year FU • Low friction = GOLD STANDARD- wear < 0.1 mm/year- highly cross-linked PE ? 21-year FU

  21. Thank You !

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