hip resurfacing in young athletes - service...
TRANSCRIPT
GIRARD Julien,
Service d’orthopédie C,
CHRU Lille
HIP RESURFACING IN YOUNG ATHLETES
Professeur Julien GirardCHRU Lille (France)
The author claims to have participated in clinical trials, scientific research, consultancy, conferences, seminars for companies Smith and Nephew, Wright Medical Technology, Zimmer, DePuy.
Repeated loading traumatism: wear- Wear if hard on soft bearing (PE+++)
- Fracture risk if CoC
- Risk of aseptic loosening if repeated loading
High traumatism:
- Dislocation: pb for dangerous sports (ski, hikking, trekking…)
- Femoral fracture if femoral stem
- Implant fracture
RISKS for SPORTS with THA
SSMKS Chambéry 2005
Recommandations
Healy W (Am J Sport Med 1999)
Members of Hip Society
Klein G (J of arthroplasty 2007)
Members of HS and AAHKS
Exclusion for high impact sports (tennis, running, snowboard…)
Evolution of recommandations according to new hard on hard bearings
THA and SPORT
In 2013, what is the best hip arthroplasty for a young and active patient???
We can « play » with:
1. Bearing
2. Stem (yes or no) and design
3. Head diameter
1. Bearing
Bearing: minimize the wear
If hard on soft bearing (PE) then choose a soft sport activity:
- no loading impact
- no impact (jump, running…)
- choose a soft sport with gentle RoM without loading
- no impact sport (vélo, natation)
SSMKS Chambéry 2005
Bearings
Adaptation de la prothèse à l’activité sportive :
MoMWear resistantNo osteolysisChrome/Cobalt Wear 0,001 à 0,003 mm/year
PE/Mele plus ancien mais activité augmente usure25 à 35 ans de reculDébris PE / ostéolyse Usure 0,1 à 0,3 mm/an.
CoCWear resistantNo osteolysisFracture de la céramique (1/5000)Wear 0,001 à 0,005 mm/an
Ceramic : problems
FractureFRACTURE :
Less and less with tribological advancesRisk difficult to assess: 1/1000 to 1/10000
Ceramic : problem
- Risk of fracture if high impact (See et al. JoA 2003, Koo et al. JBJS Br 2008…)
- Risque de « chipping » par effet came (Stewert et al. JoA 2009)
- - Risque de squeaking 1 à 10%
Pour bcp d’auteurs : CI aux sports à impact avec CoC…
Badminton PTH 3 ans 38 ans
DISLOCATION….
Impossible to obtain anatomical head diameter (40 mm max) except with MoM …But femoral head diameter is 52mm for male and 47 for female
52mm 32mm
DISLOCATION
Whatever the rate (1-5%) after THA, it will be too great…
Correlation between dislocation rate and sport activity (Naal et al. CORR 2008)
BFH = 0% of dislocation and great RoM … (Amstutz, JOA 2007; Girard, RCO 2007; Vendittoli, Hip 2008; Mont, JoA 2008)
2. Stem (yes or no)
What is the main pb with a femoral stem?
Risk of femoral fracture with THA
SSMKS Chambéry 2005
What is the main pb with a femoral stem?
Risk of implant fracture
SSMKS Chambéry 2005
SSMKS Chambéry 2005
- No wear : no PE and hard on hard bearing (CoC or moM)
- No head fracture: pas de CoC
- No dislocation: BFH
- No stem fracture: very short stem or no stem
- Preservation of hip proprioception: preserve femoral neck (proprioceptors)
Ideal hip arthroplasty
RESURFACING
ADVANTAGES
- Femoral bone stock preservation
- Biomechanical preservation
- Optimization of stress transfert
- Stability
- BFH
LITTERATURE
SPORT AND RSA
Return to sport and THA
N age recul % préop % postop
Chatterji (2004) 235 67.8 18 m 80% 53%
Huch (2005) 420 60.5 5 ans 56% 32%
Dubs (1983) 110 55 3 ans 78% 36%
71% 40%
SPORT and RSA
Return to sport and RSA
N Age Recul % préop % postop
Banerjee (1) 152 52.6 23.4 m 98% 98%
Naal (2) 112 46.4 24 m 95% 98%
Amstutz (3) 350 41.2 5.5 y 31.5% 51.1%
Daniel (4) 446 43.8 8.2 y 60% 87%
(1) Banerjee M. Am J Sport Med 2010 71% 83%(2) Naal F. Am J Sport Med 2010(3) Amstutz H. Clin Orthop 2007(4) Daniel J. J Bone Joint Surg Br 2004
TENNIS and RSA
58 tennis players (75 hips)
Mean age: 50 years (38-58 ans)
Return to tennis: 6 months after procedure
Mean practice 3x/week
Same tennis practice level +++
96% survivorship at 8 years of FU (95 à 98% in non active population)
Mont et al. 1999. Am J Sports Med.
RSA and HIGH IMPACT SPORT
Personnal series (Girard et al. Inter Orthop 2013)
55 RSA (50 patients)
All impact sport (more 4) during preop period
Running, Foot, Rugby, Tennis, Ski, Hockey
Mean age 45.5 ans
Mean FU 4 ans
Return to sport 98% +++
No surgical revision +++
RSA and RUNNINGGirard et al. Am J Sport Med 2012
43 RSA
Running more than 3h/week
Mean FU 3 ans
No revision +++
All patients Before 50 years old After 50 years old
Before After p value Before After p value Before After p value
Time
(hours) 5.2 5.1 0.536 5.2 5.1 0.317 5.1 5.1 1
Mileage
(km) 48.9 48.4 0.009 50.7 52.1 0.25 48.1 46.5 0.009
RSA and RUNNING Girard et al. Am J Sport Med 2012
Return to competition:
Same level than preopNo significant différence for compétition
22 21
10
7
2
12
7
1 2 2
0
5
10
15
20
25
nu m be r of h ips
None 10 km Half-marathon
marathon triathlon
lev e l in c o m p e titio n
before
after
RCT: THA vs RSA Girard et al, OTSR 2008
p = 0.022
5
26
28
7
4
12
38
15
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
THA SRA
Activity level one year after surgery
high impact
moderate impact
light impact
no physicalactivity
RETURN TO SPORTS…Girard et al, Am J Sport Med 2009
p=0.00772%
39%
5%
22%34%
50% 49%
20%12% 8%
0%
20%
40%
60%
80%
100%
Heavy/sport Moderate/recreational Mild/w alking Sedentary
THA
SRA
IONS and SPORT
De Smet et al. JBJS Br 2007 :
Triathlète with MoM RSABefore Cr = 0,5 Co = 0,7After Ironman (12h35) Cr = 0,7 Co = 1,1 NSD2 Cr = 0,6 Co= 0,7 NS
Experience personnelle : (Girard et al. JBJS Am in press)
31 runners during half marathon with MoM RSA
Before race Co = 0,7 Cr = 0,92 h after Co = 1 Cr = 1,2 NSD1 Co = 0,8 Cr = 0,8 NS
Conclusion
L’arthroplastie conventionnelle moderne est compatible avec des activités d’impact faible (+/- intermédiaire) mais pas plus….
Conclusion
Absence de luxation et absence d’usure
RTH implant idéal pour des patients pratiquant des sports d’impact élevé.
Aucune contre indication +++
Course à pied possible même en compétition +++