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Dr. M. GRIMALDI Clinique universitaire de chirurgie et traumatologie du sport

Dr. M. GRIMALDI Clinique universitaire de chirurgie et traumatologie du sport Service du Pr Saragaglia , Hôpital SUD, CHU Grenoble. Introduction. Etiologies. Les pertes de substance osseuse (PSO). Les pertes de substance osseuse. Et la navigation…. La série.

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Dr. M. GRIMALDI Clinique universitaire de chirurgie et traumatologie du sport

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  1. Dr. M. GRIMALDI Clinique universitaire de chirurgie et traumatologie du sport Service du Pr Saragaglia, Hôpital SUD, CHU Grenoble

  2. Introduction

  3. Etiologies

  4. Les pertes de substance osseuse (PSO)

  5. Les pertes de substance osseuse

  6. Et la navigation…

  7. La série Série rétrospective homogène 75 révisions de PTG entre 01/93 et 03/07 Délai intervention-révision: 83 mois +/-48.6 (6-213) Recul moyen: 50 mois +/- 31 (24-146)

  8. Evaluation fonctionnelle:score IKS

  9. Résultats cliniques • Subjectifs (n=65/75) • 57 patients (89%) • Score IKS • F: 70.3 points • G: 85.2 points • Flexion: 101° • Indolence:52%

  10. Révisions septiques Résultats fonctionnels comparables

  11. rPTG septique Taux de guérison: 53 à 100% Insall et al. JBJS AM 1983 , Insall et al. JBJS Am 2002, Rand et al. JBJS Am 2002, Freeman et al. JBJS Br 1985, Buechel et al. Am J Orthop 2004 1temps vs. 2 temps: pas de consensus 1 temps: Bentson et al. Acta orth Scand 1991, Bauer et Lortat Jacob. RCOT 2006 2 temps: Cuklers et al.J Arthroplasty 2005, Hanssen et al. J. Arthroplasty 2002 Score inferieurs (IKS f) Hanssen et al. J. Arthroplasty 2002 Bauer et al. RCOT 2006

  12. Résultats radiologiques H aMF K aMT • HKA moyen:180.6+/-2.7° (174-188 • aMF: 90,2 +/- 1,7° (86-94°) • aMT: 90,2 +/- 2,1° (85-96°) • Outliers: • 81% axe HKA à180°+/-3 (n=61/75) • 93.3% axe HKA à180°+/-4 (n=70/75) A

  13. Series globales • Comparaison séries rPTG • Résultats • Bonnin M, Deschamps G, Neyret P, Chambat P. [Revision in non-infected total knee arthroplasty: an analysis of 69 consecutive cases]. Rev Chir Orthop Reparatrice Appar Mot 2000 • IKS G 72.5 (85.2) • IKS F 59.3 (70.2) • Pas de revisions pour douleur inexpliquée • IKS G:35 !!! • IKS F: 52 • Comparaisons séries PTG • Moins bons Ethgen et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004

  14. paramètres non influents

  15. Paramètres influents

  16. ANALYSE DE LA SURVIE • Survie à 5 et 10 ans: • 92.2% (84-99) (93.8%) • 70.5% (41-100) (85.2%)

  17. Conclusion

  18. CONCLUSION Kurtz et al. J Bone Joint Surg Am. 2007 Apr;89(4):780-5. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673%to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall Total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030.

  19. merci pour votre attention

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