L’arthroplastie totale de hanche chez l’enfant et l’adolescent

Arthritis Arthritis of the hip in children and adolescent can induce lesions of the articular cartilage and severe handicap. When conservative surgical methods are without benefit, total hip arthroplasty should be an alternative solution.Indications: Chronic pain, abnormal social life and scolarity, stiffness and impossibility for osteotomies are the main criteria to decide and to choose for an arthroplasty.

Two main groups of etiology are as follow

• * group I concerns rhumatologie arthritis. Arthroplasty is decided with pediatricians, physiotherapists… Other joints are often involved and post-operative cares need intensive physiotherapy.

Femoral head necrosis of renal disease and sickle cell disease belong to this group.* group II concerns sequelae of previous femoral osteotomy: septic osteoarthritis, severe stiffness, sequelae of hip dislocation, necrosis of slipped capital epiphysiolysis…Since 1990, Dr J.L. Jouve has operated on 11 hips in patients aged for 14 to 20. Prosthesis used were custom made, Symbios, Switzerland.Results group I: The custom made in this group is interesting because it is obvious to maintain the largest bony pool and to avoid to ream the metaphysis and diaphysis. It is also necessary to thinck in advance for further procedure because these patients are young. Technical surgical approach is without any particularity, no case of fracture was noticed. Post-operative weight-bearing was delayed for 45 days. With a short follow-up of 2 years, results are excellent.Results group II: The custom made is necessery in these cases with an abnormal morphology of the proximal femur and narrow canal following earlier femoral osteotomies. Immediate results are also excellent.Conclusion: Hip arthroplasty with custom made is a nice procedure when other surgical treatments are not possible. But further studies are necessary with a larger follow-up.

Tumors Osteosarcoma and Ewing’s sarcoma needs sometimes wide resections of the proximal femur and reconstruction of the hip joint. In our experience and ISOLS’ series, it seems that following data are favourable:

• - cemented complete prosthesis of the femur resected and no allograft,
• - excellent reconstruction of the muscles of the hip: extensors, abductors and fascia lata, without to try a fixation of these muscles on the prosthesis
• - use of an acetabular mobile cup to preserve further surgery with, for exemple, an acetabular arthroplasty.

Two cases of Ewing’s sarcoma are presented, girls aged 15 and 12.Length of the resection was 23 and 19 cm. Post-operative results are good.     

L’incidence de l’IRCT en 2011

This chapter provides a set of indicators on incident patients with renal replacement therapy. In 2011, in 25 French regions (99% population), 9 248 patients started a treatment by dialysis (incidence of dialysis: 149 per million inhabitants) and 334 patients with a pre-emptive graft without previous dialysis (incidence of pre-emptive graft: 5 per million inhabitants). One patient among two are over 70 years old at renal replacement therapy initiation. As in 2010, incidence rate seems to stabilize.     

Editors’ Comment

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Editors’ Comment     

Authors’ response

McBride TJ, Panrucker S, Clothier JC Hip fractures: public perceptions. Ann R Coll Surg Engl 2011; 93: 67–70 doi: 10.1308/003588411X12851639107034We read with interest the article by McBride et al, which reported that only 4% of 127 patients and relatives in an outpatient clinic post hip replacement following a hip fracture correctly acknowledged one-year mortality for hip fractures to be approximately 30%. Poor knowledge retention of doctor–patient consultations (20-60%)¹ does not explain this figure fully.To investigate further we undertook a retrospective review of case notes for patients presenting with hip fractures during the period July to August 2011, searching for evidence that patients and their relatives were being given information on morbidity and mortality. Written documentation was only found on 10 occasions (28.6%). Although the risks and benefits of surgery are discussed with the patient, it would seem that the severity of the injury itself is not communicated adequately.This might explain why the public grossly underestimates the mortality of sustaining a hip fracture.Discussing such sensitive issues in the acute setting can be very distressing for both the patient and the doctor but it is important to discuss the diagnosis itself to avoid creating unfair and unrealistic expectations of treatment. Perhaps an information leaflet should be incorporated into current hip fracture pathways?