N°266 - August/September 2017
For the 2017 edition of HIP Toulouse, we spoke with Manuel Ribas, who runs the Orthopaedics and Traumatology Unit at the Dexeus University hospital in Barcelona. Manuel is a student of Vilarrubias and has dedicated his career to femoral acetabular surgery.
Article : The history of “coxalgia” By J.-L. Tricoire
“Coxalgia” is not simply a pain in the hip, a catch-all phrase that can be used as a chapter heading in order to introduce and teach all pathologies of the hip joint. The word “coxalgia” is too easily defined as hip pain. This definition ignores an important part of 19th- and 20th-century medical and orthopaedic history. Coxalgia is a tuberculous disorder of the hip joint, also known as white tumour of the hip. The term “white tumour” is used for the knee, ankle, elbow and wrist joints. The term “scapulalgia” refers to the glenohumeral joint, which is rarely affected. Thanks to the BCG vaccine, tuberculosis has almost been eradicated; thus, progressive osteoarticular disorders are rarely seen nowadays, and this could lead to the historical meaning of the term “coxalgia” being abandoned. Sequelae consisting of fracture malunions due to ankylosis in malposition (Fig. 1), or pseudarthroses, are still seen during consultations. These lesions are currently treated by arthroplasty after multidisciplinary team meetings with infectious disease specialists.
The periacetabular osteotomy (PAO), also known as the Ganz or Bernese osteotomy (1), has gained international recognition. It is considered to be a reorientation osteotomy that, when used in hip dysplasia and even some unstable hips with poor acetabular coverage, is able to deliver: - Balanced load distribution on the femoral head. - Improved acetabular coverage in all planes. - Joint congruence with cartilage-on-cartilage contact. - A range of possibilities for correction: this is why pre-operative planning and the learning curve are so significant. A corrective femoral osteotomy should not be excluded in certain cases (head extrusion or deformity). - Satisfactory results in the medium and long term (2).
Article : Standardised preparations of autologous platelet-rich plasma (PRP) and bone marrow cells for orthopaedic therapy By Solange Vischer
Until the 1970s, platelet concentrates were used only in haematology, for patients with a low platelet count and haemorrhaging, and were therefore prepared at blood transfusion centres using a large volume of donor blood. The discovery by Ross et al. (1) that platelet-derived factors can encourage cell growth and therefore that platelets contribute not only to haemostasis but to wound healing too, opened up new possibilities for the use of platelet concentrates. However, it was not until 1998 and 2000 that Robert Marx and his team began using plasma enriched with autologous platelets (PRP) as a source of growth factors to improve bone (2) and soft tissue (3) healing in patients. Since these pivotal clinical studies, the significance of the possible uses of PRP for orthopaedic therapy has expanded steadily, and with it the need to develop medical devices for its safe and effective preparation in the ward, operating theatre or clinic. PRP preparation methods are based on the use of a centrifuge machine to separate the blood into layers. Because bone marrow samples contain a mixture of blood and marrow cells, some of the technologies developed for PRP can also be adapted for the preparation of cell suspensions rich in mesenchymal stem cells (MSC).
Article : Management of limb injuries caused by weapons of war or explosions in an attack By Sylvain Rigal
On 14 November 2015, the front pages of French newspapers did not mince their words. Le Figaro ran a headline saying that “war” had come to the middle of Paris. Sud-Ouest thought that “France was at war”. Since the start of 2016, Europe has seen more than 25 terrorist attacks, five of which involved weapons of war or explosives. These attacks have brought injuries usually associated with warfare to the very heart of European cities.
Article : The Hip: Anatomy and Total Replacements By Philippe Chiron
Total hip replacements are now a reliable procedure. Advances in the materials, forms and surgical techniques have made it possible to improve outcomes and survival and reduce the risk of short- and long-term complications. Orthopaedic surgeons can be proud of having developed one of the most useful surgical procedures of the past fifty years. However, let us take a step back and be humble for a moment! When performing a total hip replacement, should we be trying to replicate the native anatomy? Should we endeavour to preserve the elements that were intact prior to the operation? Can intraoperative anatomical damage create a risk of severe complications that could jeopardise function or even be life threatening for the patient? We do in fact have the answer to all these questions, but it can be useful to consider them all together.