External Cortical Femoral Implant In A T.H.P A Long Term Follow Up Of A Clinical Case

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. Current Trends in Clinical & Medical Sciences Volume 1-Issue 2 Page 2 of 4 Citation: Yves Cirotteau. EXTERNAL CORTICAL FEMORAL IMPLANT IN A T.H.P. A long term follow up of a Clinical Case. Curr Tr Clin & Med Sci. 1(2): 2019. CTCMS.MS.ID.000510. severe coxarthrosis note the good thickness of the femoral cortex before surgery (Figure a, b). Few years later the patient had a hemiplegia. Note the increasing diameter of the femoral medullary canal (Figure c). What would have happened if an intramedullary implant was settle in it? Figure b: Note the Beautiful Reconstruction. Figure B: Left hemiplegia 2 years aftter surgery. Scientific Reasons of this New Concept The choice of this implant’s design was done in the aim of a more physiological respect of the bone structures [3-5]. a) The joint elasticity is mainly due to the cancellous bone of a joint. Most of the intra-medullary canal implants destroy it. In this case the cancellous bone is in the upper femoral metaphyseal neck, more or less in totality (Figure a, b). b) The bone marrow has one of the most important roles in bone physiology: vascularization, cells of bone remodeling, blood cells, proteins and minerals are the major actors of the normal bone life. c) The periosteum is acting all lifelong (even after 100 years) and covers all foreign bodies which are fixed on the shaft, keeping a fixation stronger and stronger by time (Figure c, d). d) The pressure on the calcar is necessary to increase and maintain it thickness. A large crown on the upper part of the implant rests firmly there so that there is no resorption [8-9]. Minimal Resection of the Cancellous Bone To fix in the upper femoral metaphysis the prothesis needs a very few cancellous bone removals as shown on the drawing. It keeps the elasticity of this part of the femur (Figure a, b).