Open Access Research Article

External Cortical Femoral Implant in ATHP A Long Term Follow Up of a Clinical Case

Yves Cirotteau*

Neuilly Sur Seine Hospital, France

Corresponding Author

Received Date: July 15, 2019  Published Date: August 22, 2019

Summary

This article will show the clinical and surgical results of a patient who was operated of both hips for a severe coxarthrosis. The follow up is 30 years for the right hip and, and 26 years for the left hip. The woman was treated according to a new concept of the femoral stem. The goal of this concept is to respect-as close as possible-the physiological bone metabolism. The femoral implant, instead of being fixed in the medullary canal, is fixed on the femoral lateral cortex of the shaft to secure a fixation during all the patient’s life, whatever his age.

Abstract

The total Hip Arthroplasty of Sir John Charnley was a revolutionary step in the treatment of hip diseases. Currently, the long-term follow-up of such a prosthesis can be estimated from fifteen to twenty years. The question is: is that delay sufficient to treat young patients with severe hip disease. In a recent publication, Rik Huiskes claims that since Charnley, no so-called innovation has either scientific proof in real efficiency or in terms of longer longevity. This should not be a surprise for all total hip prothesis are placed in the medullary canal, either with or without cement. In fact, the so-called innovations are minimal modifications in the design of the stem. It is obvious that if these modifications are not efficient, one should not follow this line of research. It seems that almost everything has been written on total hip arthroplasty failure. We must therefore work in another direction, with other criteria.

Suppose that it is the bone, with all its specifications, which is the possible reason for that long-term failure. Is the “kuntscher” imperial road, the only highway to deal with the shaft of a long bone? A new concept, a new philosophy to fix a hip stem prosthesis on the femoral shaft becomes apparent. In other words, according to this new scientifically point of view, the mechanical aspect of a stem hip prothesis is no longer of interest. If the stem can be placed inside the medullary canal, why could not it be fixed outside of the shaft, for example on the external part of the diaphyseal cortex, below the periosteal layer? It seems that searcher should work today on bone physiology, instead of working on any mechanical aspect of surgical fixation in the medullary canal. Using the physiological properties of a living bone could be the answer to avoid any failure of the stem all the life’s patient long.

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