Total hip replacement after intertrochanteric osteotomy.

From 1980 to 1993 we inserted 216 total prostheses into hips which had been treated by varus and valgus-extension intertrochanteric osteotomy. The technique of the operation was more difficult than in hips operated on for the first time because of anatomical changes produced by the osteotomy in the surrounding structures. We have had complications which taught us how to prevent and deal with these problems.

Teicoplanin versus cefamandole in the prevention of infection in total hip replacement.

In a prospective, controlled, single-blind study the efficacy of teicoplanin versus cefamandole in preventing infections in total hip replacement was investigated in 496 consecutive patients. A single intravenous dose of teicoplanin (400 mg) was as effective as two intravenous doses of cefamandole (2 g before and 1 g after surgery). No major complications were observed in either group.

[Loosening of total hip prosthesis].

The problem of total hip prosthesis is an immediate and long-term stability. An insufficient bone anchorage of the prosthesis produces a tissue reaction around the implant that causes a loosening. The hight incidence of loosening of cemented total prosthesis has spurred the research into uncemented implants.

Valgus-extension osteotomy for osteoarthritis of the hip. Indications and long-term results.

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigné scale.

Cementless R.M. isoelastic total hip prosthesis in revision surgery for loose prostheses.

Forty-three patients with aseptic mobilization of hip prostheses were submitted to revision surgery using cementless R.M. isoelastic total hip prostheses.

The isoelastic, noncemented total hip arthroplasty. Preliminary experience with 400 cases.

The first 400 patients having cementless isoelastic total hip arthroplasties with a polyacetyl femoral component stem were assessed by independent observers with a minimum review time of two years. Six percent of the patients had died at the time of review; these were mainly elderly patients with subcapital fractures. Ninety-seven percent of the surviving patients appeared for a complete clinical and radiological review.

The inclination of the weight bearing surface in the hip joint. The clinical significance of abnormal force.

The mechanical basis responsible for the development of secondary osteoarthritis in adults and slipped capital femoral epiphysis in adolescents is discussed, with the role of the oblique weight-bearing surface in generating abnormal shearing forces in these two conditions emphasized. The same biomechanical principles have been found to apply to the acetabular component in total hip implants. A vertical cup position will lead to abnormal stress concentration in the outer edge of the bone implant interface with an increase in shearing forces.