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Résultats fonctionnels et qualité de vie après prothèse totale de hanche : à propos de 93 cas
Abstract
Introduction
Hip arthroplasty is a frequent orthopedic surgery that revolutionized the treatment of degenerative and inflammatory joint diseases.
Objective
The purpose of this work is to know the functional outcome and to assess the quality of life after rehabilitation of a series of total hip arthroplasty and to compare them to literature.
Patients and methods
A prospective study involving 93 cases of total hip arthroplasty (including 15 bilateral) performed on 78 patients followed in the physical and rehabilitation medicine department at the university hospital Ibn Rochd of Casablanca in the postoperative outcome.
The evaluation was performed preoperatively, at 6 weeks and 3 months postoperatively, it consisted of an assessment of pain, active and passive joint mobility, function index Postel-Merle of Aubigné (PMA) and quality of life by Western Ontario and McMaster Universities Arthritis Index (WOMAC).
Results
It is about 49 women and 29 men, mean age 47.23 years (20–75 years). The mean VAS score pain decreased from 67/100 to 12/100, six months after surgery (P = 4 × 10−4). The score for Postel-Merle d’Aubigné varied from 7.2 to 14.8 (P = 5 × 10−3). The WOMAC score for quality of life was significantly improved from 89 to 36. This improvement seems well correlated with decreased pain and improved score of PMA.
Discussion–conclusion
Our results confirm the reduction of disability of hip disease after total hip arthroplasty which impacts positively on the quality of life of patients.
... Our results are relatively better than those of a Moroccan series treating the same subject, where the Womac functional score fell from 89 to 36 at 6 months of follow-up.The visual analog scale (VAS) went on average from 9 preoperatively to 1 at the mean follow-up with a statistically significant improvement without any significant difference between the mean follow-up and the last follow-up. These results are consistent with the results of the literature.[19] As for the quality of life, preoperatively, the composite mental score of SF36 had a more favourable average than the average of the combined physical score. ...
The Aim They are clarifying the epidemiological and clinical characteristics of patients requiring total hip prosthesis and assessing their functionality and quality of life (QOL). Methods This is a descriptive retrospective study concerning patients under 50 years old suffering from non-traumatic coxopathy between 01/01/2010 and 31/12/2020. 30 patients were collected, 5 of whom received bilateral prostheses. We used the Postel and Merle d'Aubigné (PMA) score, the Harris hip score (HHS), and the Womac index for the functional study. To study QOL, we used SF36. The results were divided into three evaluations: preoperative, 6-month follow-up, and a final follow-up in 2021. Results In this study, the mean age was 35±10.28 years, with a male predominance. Primary coxarthrosis was the most common etiology. Functional scores improved significantly at the 6-month and the last follow-up compared to the preoperative score regardless of patient characteristics. A significant improvement in the SF36 6 months after THA and at the last follow-up compared to the preoperative score was also noted. Conclusion The total hip prosthesis of the young adult improves the functional capacities and the QOL independently of the characteristics of the young population.
... Malgré l'utilisation des implants cimentés dans tous les cas, les résultats étaient satisfaisants en ce qui concerne la qualité de vie au recul moyen de 54,89 mois. Quant au résultat fonctionnel, l'étude menée par Kassimi et al sur une série de 93 PTH rapportait que l'évaluation visuelle analogique de douleur dans leur série passait de 67/100 à 12/100 après PTH, avec score PMA passait de 7,2 à 14,8/18 et une nette amélioration du score de qualité de vie WOMAC en fin de rééducation fonctionnelle [22]. Belvisi rapportait un score PMA moyen de 17,4 +/-1,7 après PTH à plus de 06 ans de recul [23]. ...
La prothèse totale de hanche (PTH) est une intervention fréquente et en progression constante dans les pays développés [1]. Etant donné la grande qualité des résultats de cette opération, les attentes des patients deviennent plus importantes, notamment en ce qui concerne leurs qualités de vie après PTH. L’objectif de cette étude est d’évaluer la qualité de vie des patients avant l’intervention chirurgicale et au recul minimum de 18 mois de la mise en place de PTH.
... Celle-ci doit donc utiliser une variété de stratégies afin de pallier ces difficultés. C'est en testant ses stratégies dans son environnement que la personne développe de nouvelles façons de faire dans le but de diminuer les impacts négatifs des incapacités physiques [2]. La notion de réadaptation est capitale car la personne handicapée est contrainte de s'adapter socialement, d'acquérir une nouvelle identité, des nouveaux rôles et statuts, de promouvoir des interactions et malheureusement de subir le poids de son stigmate, de la simple discrimination à l'exclusion [3]. ...
La qualité de vie d’une personne handicapée dépend certainement du degré d’incapacité, mais les facteurs environnementaux, sociaux et économiques jouent un rôle fondamental indépendamment de la sévérité du handicap. Le but de ce travail est de déterminer les différents paramètres objectifs qui interviennent sur la qualité de vie auprès d’un échantillon de sujets présentant des séquelles d’une lésion traumatique, vivant soit à domicile, soit dans le centre de réadaptation professionnelle des handicapés moteurs et des accidentés de la vie (CRPHMAV) de Manouba.
Résumé
La mise en place prothèse totale de hanche (PTH) est une intervention chirurgicale dont l’efficacité et la régularité des résultats sont remarquables en assurant : le soulagement des douleurs, l’amélioration de la fonction, et l’amélioration de la qualité de vie. L’objectif de notre travail est de comparer le résultat fonctionnel et la qualité de vie des patients après la mise d’une prothèse totale de hanche selon l’indication : coxopathies dégénératives ou coxopathies inflammatoires.
Matériel et méthodes
Étude prospective portant sur 140 patients ayant bénéficié de la mise en place d’une prothèse totale de hanche (35 bilatérale), suivis au sein du service de médecine physique et réadaptation fonctionnelle de janvier 2011 à décembre 2015. Tous les patients ont bénéficié d’une évaluation préopératoire, à un mois d’intervention et à 2 mois de l’opération, avec prise des amplitudes articulaire, l’échelle visuelle analogique de la douleur (EVA douleur), l’indice de Postel-Merle d’Aubigné et l’indice de WOMAC.
Résultats
Notre étude comporte 140 patients, dont 83 femmes (59,28 %), et 57 hommes (40,71 %), l’âge moyen de nos patients était 51,19 ans, 79 patients (56,42 %) étaient suivis pour coxopathies inflammatoires et 61 patients (43,57 %) étaient suivis pour coxopathies dégénératives. Tous les patients ont eu un gain satisfaisant dans toutes les amplitudes articulaires, avec des résultats nettement supérieurs pour les patients suivis pour coxopathies dégénératives. EVA douleur a passé de 8,5 à 3,5, avec une amélioration aussi bien de l’indice de PMA que de l’indice de WOMAC.
Discussion – Conclusion
La prothèse totale de la hanche donne de très bons résultats fonctionnels dans la coxopathie dégénératif, et des résultats inférieurs dans la pathologie inflammatoire, avec une amélioration significative de la qualité de vie (l’indice de WOMAC) dans les deux groupes.
L'arthroplastie de la hanche est un moyen fiable dans le traitement des affections de la hanche. En lui rendant sa mobilite sa stabilite et son indolence. Cependant cette chirurgie prothetique expose au risque de la survenue des complications qui peuvent engager le pronostic fonctionnel. Nous avons realise une etude retrospective sur une duree de 8 ans de janvier 2004 au janvier 2012 au service de traumatologie-orthopedie de CHU HASSAN II FEZ. Pendant cette periode nous avons opere 240 patients pour PTH. Apres un recul moyen de 5 ans nous avons note chez 42 (17,4%) patients une complication tardive. Nous note 13 cas de descellement aseptique soit 5,4%. Cette complication a ete survenue dans notre serie sur une prothese cimentee dans 8 cas et non cimentee dans 5 cas. Le traitement que nous avons adopte dans notre serie a ete une reprise de PTH sans greffe osseuse ni anneau de reconstruction dans 4 cas, reprise avec mise en place d'anneau de Kerboull dans 7 cas et reprise avec greffe osseuse et anneau de kerboull dans 2 cas. Nous avons trouve 11 cas de sepsis tardive soit 4,6% des cas. Nous avons le diabete comme facteur de risque chez 3 malades. L'agent causal a ete staphylococcus epdermidis dans 5 cas, colibacille dans 2 cas et association staphylococcus-BGN dans 1 cas. Les differentes modalites que nous avons utilise pour traiter l'infection dans notre ont ete un lavage simple, systeme d'irrigation-drainage et reimplantation simple en un seul temps ou en 2 temps avec couverture systematique par une antibiotherapie adaptee selon l'antibiogramme. Nous avons note egalement 11 cas de fracture sur PTH interessant dans tous les cas le femur, nous avons traite ce type de fracture dans notre serie par une tige femorale prothetique longue dans 4 cas, une plaque vissee cerclee dans 3 cas et cerclage simple dans 4 cas. La consolidation a ete obtenue chez 9 patients avec 2 cas de pseudarthrose. Nous avons note 7 cas de luxation tardive de PTH. Comme facteur de risque dans notre serie nous avons trouve le sexe feminin et le surpoids. Sur le plan technique la malposition de cotyle a ete constituee l'etiologie principale avec 4 cas. Nous avons traite les cas de luxation par reduction simple avec traction dans 3 cas et une reprise chirurgicale pour corriger la malposition de cotyle dans 4 cas. Nos resultats sont comparables avec ceux de la litterature. Selon les resultats de la litterature le descellement aseptique constitue la complication la plus frequente. Pour traiter cette complication les 2 modalites la plus frequemment utilisees dans a litterature sont la reprise avec des greffes et anneaux de reconstruction ou fixer la nouvelle cupule sur os sain de neocotyle cree par descellement. Le resultat de la litterature objective aussi la responsabilite de staphylococcus comme agent causal la plus frequent. Il montre egalement l'efficacite de traitement chirurgical par reimplantation de la prothese en un seul ou en 2 temps. L'etude de la litterature objective aussi que La prise en charge des fractures sur PTH est difficile en raison de l'âge souvent avance et de la fragilite des patients, de l'osteoporose, et de la menace que ces fractures font peser sur la fixation de la prothese parfois deja defaillante. Les complications tardives de PTH sont frequentes et sont causes de reprises de chirurgie prothetique et rendent leur prise en charge tres difficile. Elles peuvent transformer les legitimes espoirs fonctionnels en catastrophe invalidante.
Purpose of the studyTo highlight the congruence of clinical and posturographic tests in patients undergoing hip arthroplasty.Material and methodsTen patients (six males and four females) were included in this study and tested when at admission and discharge from the rehabilitation department (12 and 27 days after surgery respectively). The patients were asked to stand undisturbed in the upright position, eyes closed on a system composed of two force platforms. Five successive 32s trials (sampled at 64 Hz) were conducted with rest intervals of similar duration between trials. The plantar center of pressure (CP), displacements, and resultant CP (CPRes) were then computed and analyzed in various ways. In parallel, various clinical tests, including muscular force, hip range of motion, walking speed, functional independence, pain, sensitivity, lateral reach, and get up and go aimed at evaluating global coordination. Correlations, using the non-parametric Spearman coefficient, were computed from the differences between clinical and posturographic parameters obtained at admission and discharge from the rehabilitation department.ResultsCertain statistically significant differences in postural behavior was observed both for clinical and posturographic tests between admission and discharge. Body weigh distribution over the two legs was largely asymmetric at onset and, though it declined, persisted at discharge. There was not difference for the mean positions of both the plantar CP and the resultant of the CP movements. On the contrary, it was noteworthy that the variances of CP displacements (data dispersion) were initially larger on the sound leg along the anteroposterior axis and that this compensatory feature disappeared at the end of the stay. At discharge, the variances computed from the sound and the prosthetic limb became equivalent. All the clinical tests demonstrated statistically significant improvements in results at discharge compared with admission. Several significant correlations involving clinical tests and mean positions along the anteroposterior axis, the degree of body weight asymmetry and variances along both the mediolateral and anteroposterior axes were found.DiscussionThese results enable a better understanding of strategies used by hip arthroplasty patients to keep balance. Even though their sensitivity was quite different, both clinical and posturographic measurements demonstrated their ability to assess reco-very from surgery. These two evaluation techniques are complementary.
To highlight the congruence of clinical and posturographic tests in patients undergoing hip arthroplasty.
Ten patients (six males and four females) were included in this study and tested when at admission and discharge from the rehabilitation department (12 and 27 days after surgery respectively). The patients were asked to stand undisturbed in the upright position, eyes closed on a system composed of two force platforms. Five successive 32s trials (sampled at 64 Hz) were conducted with rest intervals of similar duration between trials. The plantar center of pressure (CP), displacements, and resultant CP (CPRes) were then computed and analyzed in various ways. In parallel, various clinical tests, including muscular force, hip range of motion, walking speed, functional independence, pain, sensitivity, lateral reach, and get up and go aimed at evaluating global coordination. Correlations, using the non-parametric Spearman coefficient, were computed from the differences between clinical and posturographic parameters obtained at admission and discharge from the rehabilitation department.
Certain statistically significant differences in postural behavior was observed both for clinical and posturographic tests between admission and discharge. Body weigh distribution over the two legs was largely asymmetric at onset and, though it declined, persisted at discharge. There was not difference for the mean positions of both the plantar CP and the resultant of the CP movements. On the contrary, it was noteworthy that the variances of CP displacements (data dispersion) were initially larger on the sound leg along the anteroposterior axis and that this compensatory feature disappeared at the end of the stay. At discharge, the variances computed from the sound and the prosthetic limb became equivalent. All the clinical tests demonstrated statistically significant improvements in results at discharge compared with admission. Several significant correlations involving clinical tests and mean positions along the anteroposterior axis, the degree of body weight asymmetry and variances along both the mediolateral and anteroposterior axes were found.
These results enable a better understanding of strategies used by hip arthroplasty patients to keep balance. Even though their sensitivity was quite different, both clinical and posturographic measurements demonstrated their ability to assess recovery from surgery. These two evaluation techniques are complementary.
Ankylosing Spondylarthritis (AS) involves by its frequency and its repercussion on the functional capacity an important handicap and deterioration of the patients quality of life.
To evaluate the handicap and the quality of life during the AS and to seek the predictive factors of the deterioration of this quality of life.
A prospective study relating to 50 patients recruited in the Department of Rheumatology of F. B. Hospital of Monastir during 6 months period (Mars to September 2008). The studied parameters were the quality of life evaluated by a specific sore (ASQOL) and a generic score (SF-12). Also the physical, social and economic felt handicap was evaluated using a qualitative scale. Predictive factors (clinical, biological and radiological) of the quality of life were carried out.
Our patients are divided in 42 men and 8 women with an average age of 38.9 ± 10.7 years. The average duration of AS is of 11.9 ± 7.6 years. The average of ASQOL is of 11.9 ± 4 (extremes: 0- 17). The average of physical SF12 is of 29.8 ± 6 (21.7-53.2) and of mental SF-12 of 35.3 ± 6.6 (22.5-55.8). The physical, social and economic felt handicap was considered to be average or important in respectively 88%, 72% and 86% of the cases. The predictive factors of a high ASQOL (faded quality of life) are absence of occupation, high BASMI, a high number of painful articulations and high BASFI, BASDAI, BASG, BASRI and EVA total pain. The factors associated to the alteration of the quality of life according to SF-12'S are male sex, professional statute, high number of painful articulations and high BASDAI, BASFI and BASRI.
Our study shows the important deterioration of the quality of life in AS patients. The existence of the predictive factors of quality of life primarily related to the functional capacity of the patients and to the disease activity implicates an early and adequate disease management in order to decrease this repercussion.
Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis.
Arthroplasty registers provide rates of implant survival in large populations based on implant revision. In an unrevised prosthesis population, some patients may have implants with clinically poor outcome or radiographic failure. We therefore evaluated medium-term clinical and radiographic results in patients with charnley hip arthroplasties and compared our results with data from the Norwegian Arthroplasty Register (NAR).
From 1989 through 1991, 138 Charnley arthroplasties with plain Palacos cement were performed in 123 patients who were 50-70 years old. At follow-up after 13 (12-15) years, 26 patients had died (28 hips). The 84 unrevised patients (93 hips) were interviewed and underwent clinical and radiographic assessment. Prosthesis survival was estimated by the Kaplan- Meier method.
At follow-up, 83% of the patients were completely satisfied with their hip replacement. Mean Harris hip score (HHS) was 83 (SD 15), mean EQ-5D index was 0.75 (SD 0.24) and mean EQ-VAS score was 69 (SD 21). Most clinical assessments had poorer scores for Charnley category C (n = 47) than for Charnley category A + B (n = 46). Function, according to Charnley's modified Merle d'Aubigne and Postel scoring system, was improved compared to preoperative values. The survival at 10 years was 89% (95% CI: 84-95) and at 13 years it was 85% (95% CI: 79-92) with revision for any reason as endpoint. In addition to 20 revised hips, 8 implants were radiographically loose and 13 hips had HHS < 70, giving a clinical success rate of 76%. Only 4 primary operations (0.8%) had not been reported to the NAR, but all revisions had been reported.
Clinical follow-up studies give essential information that is additional to that gained from revision-based outcome studies. To fully appreciate the clinical effectiveness of an implant, specific hip function, patient satisfaction, quality of life, and radiographic analysis must also be considered. The functional status of the patient has an important influence on the clinical outcome after hip replacement.
Physical component summary (PCS) and mental component summary (MCS) measures make it possible to reduce the number of statistical comparisons and thereby the role of chance in testing hypotheses about health outcomes. To test their usefulness relative to a profile of eight scores, results were compared across 16 tests involving patients (N = 1,440) participating in the Medical Outcomes Study. Comparisons were made between groups known to differ at a point in time or to change over time in terms of age, diagnosis, severity of disease, comorbid conditions, acute symptoms, self-reported changes in health, and recovery from clinical depression. The relative validity (RV) of each measure was estimated by a comparison of statistical results with those for the best scales in the same tests. Differences in RV among scales from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were consistent with those in previous studies. One or both of the summary measures were significant for 14 of 15 differences detected in multivariate analyses of profiles and detected differences missed by the profile in one test. Relative validity coefficients ranged from .20 to .94 (median, .79) for PCS in tests involving physical criteria and from .93 to 1.45 (median, 1.02) for MCS in tests involving mental criteria. The MCS was superior to the best SF-36 scale in three of four tests involving mental health. Results suggest that the two summary measures may be useful in most studies and that their empiric validity, relative to the best SF-36 scale, will depend on the application. Surveys offering the option of analyzing both a profile and psychometrically based summary measures have an advantage over those that do not.
La polyarthrite rhumatoïde est un rhumatisme destructeur des articulations. Le pronostic fonctionnel spontané est rapidement mis en jeu. La réadaptation et la rééducation articulaire figurent parmi les stratégies des traitements proposées. Ses principaux objectifs sont le traitement de la douleur et de l’inflammation, la prévention et la limitation des déformations, l’entretien ou la récupération de la mobilité et de la stabilité articulaire, le maintien de la trophicité musculaire et de la capacité aérobie et l’adaptation à l’évolution du handicap. L’évaluation préthérapeutique est indispensable et doit être pluridisciplinaire. Elle comporte un examen clinique et des explorations paracliniques. Les traitements physiques font appel aux techniques de rééducation et de réadaptation incluant la kinésithérapie, l’ergothérapie, l’appareillage, l’aménagement de l’environnement et le changement des habitudes du patient ainsi que de son entourage. Cette prise en charge doit être adaptée à notre société tunisienne et à nos moyens matériels.
Introduction
Les questionnaires pour les patients comme le Pationnaire et le Womac mesurent la situation clinique. Le Womac est un questionnaire spécifique pour l’arthrose de la hanche et le Pationnaire mesure dix symptômes et les handicaps de la vie quotidienne indépendant de la pathologie. Avec cette étude, nous avons voulu quantifier le bénéfice après prothèse totale de hanche (PTH) mesuré avec ces deux questionnaires.
Patients et méthode
Les patients avec coxarthrose ont été « évalués » avec les questionnaires Pationnaire et Womac avant et six mois après PTH. Le critère d’inclusion était coxarthrose primitive et les critères d’exclusion : coxarthrose secondaire ou dossiers incomplets.
Résultats
Soixante-seize patients traités consécutivement en 2007 ont été inclus. Tous les patients ont bénéficié d’une PTH avec une réduction significative (p < 0,05) du score global du Pationnaire (28 à 9) et du Womac (45 à 8). Les critères du Pationnaire « douleurs durant activité », « mobilité » et « force musculaire » ont demontré les plus grands bénéfices (−72 %, −66 % et −52 %). Dans la vie quotidienne, les plus grandes améliorations après PTH étaient dans les domaines « activités sociales (−77 %) », « être debout (−55 %) », « dormir (−33 %) » et « marcher (−33 %) ». Pour les 33 patients avec double pathologie (rachis lombaire et hanche), le bénéfice était plus grand que chez les patients avec une coxarthrose isolée (significatif pour les domaines des handicaps, Kruskal-Wallis).
Discussion
L’état clinique peut être mesuré avec les questionnaires Pationnaire et Womac, et le bénéfice après PTH se laisse documenter. Le Pationnaire mesure plus volontiers des domaines comme la réduction de la mobilité et de la force musculaire et il montre une amélioration significative dans ces critères. Le bénéfice après PTH est plus grand pour les patients avec une pathologie de localisation double (rachis lombaire et coxarthrose) que pour ceux avec une pathologie monofocale (coxarthrose).
Hip disorders usually cause walking perturbation due to pain, stiffness and muscular deficiency at variable degrees, depending on the disease history. Palliative surgery is proposed for slightly arthrosic dysplasia; the rehabilitation includes first maintenance while waiting for consolidation, then a rehabilitation aimed at muscular reinforcement and walking. In case of advanced-stage arthrosis or destructive rheumatic disease, arthroplasty is mandatory. Rehabilitation is guided by the disease history, the pre-operative clinical status, the selected surgical technique and the surgeon’s instructions. A program is elaborated from accurate clinical check-up and analysis of observations, and then adapted according to the evolution of preliminary objectives. Such rehabilitation is essentially manual and individual, with periodical reassessments and a particular attention for complications. Rehabilitating an operated hip is based on some rules and on an individual procedure specifically adapted to the patient’s hip rather than on a systematic protocol. It is not useful in case of first-line arthroplasty in primitive hip arthrosis, but the rehabilitation of patients with de-arthrodesis or complicated surgery require initiation in a specialized centre prior to external physiotherapy.
Objective
To assess the need to clarify indications for transfer to a rehabilitation center after hip arthroplasty, we sought to determine the number of hip prostheses placed in the year 2000 in southwestern France (PACA region), the frequency of transfer for inpatient rehabilitation after total hip arthroplasty, and the factors associated with transfer. We also examined the differences between private and public hospitals and between hip replacement due to fracture and those for other reasons.
Methods
We searched the database of the regional medical information systems program (MPSI) to identify short term hospitalizations for orthopedic surgery during the year 2000 in the region's public and private hospitals.
Results
In all, 4705 hospitalizations included hip arthroplasty, and 46% of the patients were subsequently transferred to a rehabilitation center. Multivariate analysis showed that the following factors were associated with this transfer: age (older patients), sex (women), hospital status (public hospital) and district of residence (the three Alpine districts). Public hospitals performed arthroplasties were more frequently due to femoral fractures and in patients with psychiatric or mental disorders.
Conclusion
Hip replacement is a common surgical procedure that frequently leads to discharge to a rehabilitation center. This transfer is not related to the complexity of the surgery or the duration of hospitalization. The differences observed between public and private hospitals and between the districts within the region demonstrate the need for guidelines to harmonize practices.
Objectifs
Élaborer des recommandations concernant la prise en charge en rééducation après arthroplastie totale de hanche. Préciser l'intérêt de la rééducation postopératoire en structure de médecine physique et de réadaptation (MPR) après arthroplastie totale de hanche.
Méthode
La méthodologie utilisée, proposée par la Société française de médecine physique et réadaptation (Sofmer), associe une revue systématique de la littérature, un recueil des pratiques professionnelles et une validation par un panel pluridisciplinaire d'experts. Les critères de jugement concernent les déficiences, l'incapacité fonctionnelle, l'incidence médicoéconomique et les complications postopératoires.
Résultats
La réalisation de la rééducation en structure de MPR après arthroplastie totale de hanche est recommandée pour les patients présentant en préopératoire des capacités fonctionnelles altérées associées à des comorbidités et pour ceux qui ont développé des complications postopératoires. Pour les malades, chez qui, une rééducation soutenue ne s'impose pas, mais dont l'indépendance à domicile n'est pas assurée, un séjour en établissement de soins de suite non différencié peut être recommandé. La réalisation d'une rééducation postopératoire en structure de MPR après arthroplastie de hanche pourrait avoir un intérêt pour réduire la durée de séjour en chirurgie et pour améliorer le bénéfice fonctionnel des patients présentant des comorbidités. Le coût global comparatif des différentes modalités de prise en charge en rééducation après arthroplastie de hanche n'est actuellement pas évalué.
Conclusion
Il est nécessaire d'entreprendre des études prospectives contrôlées de type bénéfice–coût dans le système de soins Français.
This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.
In osteoarthritic patients aged 80 years or older, total hip arthroplasty (THA) offers well-established benefits; however this selective group of population is known to carry a high morbidity rate.
The higher morbidity rate carried by this group does benefit more from identification of risk factors than from improved surgical and anesthesia techniques.
Seventy-two patients, operated between October 2003 and December 2006, were retrospectively analyzed. The interventions performed on the traction table, through an anterior approach, involved implantation of a cemented total prosthesis combined to a retentive, cemented acetabular component.
At an average delay of 31 months (minimum 5 months, maximum 54 months), no patient was lost to follow-up and no prosthesis had to be revised. In total, 19 patients presented 27 complications, which were not influenced by their American Society of Anesthesiology (ASA) score (p>0.1) nor by the presence of co-morbidities (p>0.5). No perioperative deaths or infection occurred. Twenty-eight patients required blood products transfusion. ASA score (p<0.03) and body mass index<25 (p=0.01) appeared to be risk factors for transfusion. Seventeen patients were pain-free and walked without restriction, and 19 had a Merle d'Aubigné score under 15. We noted two isolated dislocations (2.6%). Eleven patients were hindered in their walking ability by an associated orthopaedic condition and five by unrelated medical problems. Although preoperative ASA score did not seem to be of predictive value to the quality of surgical outcome (p>0.5), the occurrence of an associated orthopaedic condition (p<0.001) and, even more the patient's categorization in Charnley class B or C (p<0.001) strongly correlated to this outcome quality.
While THA for the treatment of osteoarthritis in patients older than 80 years exposed them to a complication rate of 27%, no specific risk factor was identified. Other neuro-orthopaedic disorders hampered the quality of the functional outcome. The use of a retentive cup could not eliminate the occurrence of two dislocations (2.6%). Level of evidence IV: retrospective therapeutic study.
To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery.
Pragmatic randomized controlled trial with blinded 6-month follow-up.
Acute-care private hospital.
People (n=65) undergoing primary hip or knee arthroplasty (average age, 69.6+/-8.2y; 30 men).
Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy.
Strength, gait speed, and functional ability at day 14.
At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (P=.001) or water exercise (P=.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention.
A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.
Total hip replacement is an extremely frequent operation for the treatment of degenerative joint disease. Indication for surgery must take into account the patient's general status, associated diseases, multiple joint involvement, and the efficacy and tolerance to medical treatments. The decision to operate is taken together by the physician and the patient. The degree of functional impairment and the patient's age are important factors. The patient must be informed that the period of hospitalization will be approximately 15 days and that good results are obtained in approximately 98% of the cases. Preoperative consultation with the anesthesist will focus on associated diseases with special attention to possible infectious foyers. Early post operative care includes a 48 hour antibiotic reginien, thromboprophylaxy with low molecular weight heparin for 3 days followed by anti-vitamin K for 6 weeks, and non-steroid antiinflammatory drugs for 5 days of up to 6 weeks in case of suspected risk of ossification. At mid-term, complications may include hematomas, infection and luxation. The fixation may also fail in certain cases where transtrochanter access was used. Long-term follow-up monitors for possible late onset infection and late luxations which usually result from prosthesis wear and more rarely from muscular causes.
A total of 93 Harris-Galante Porous I (HGP- I) prostheses were analyzed with a mean follow-up of 10.2 years. Thigh pain (28 hips) correlated with unstable fixation (P<.005), female gender (P<.045), young age (P<.05), poor distal femoral fill (P<.002), subsidence (P<.0001), and osteolysis (P<.05). Thirteen stems and 6 metallic shell cups were revised. Kaplan-Meier analysis showed 13-year survival rates of 92.5% +/- 5.8% for the metallic shell cup, 79.7% +/- 13% for the HGP-I cup, and 76.3% +/- 14.0% for the stem. Five polyethylene liners were changed because of wear >1 mm. Radiographic loosening occurred in 8 cups. Radiographic bone ingrowth was present in 54 stems, stable fibrous fixation was present in 24 stems, and unstable fixation was present in 15 stems. The mean polyethylene wear was 0.17 mm/y. Eleven hips (11.8%) had acetabular osteolysis, and 24 (25.8%) had femoral osteolysis, the latter being more frequent in unstable stems (P<.007). The HGP-I metallic cup shows better clinical and radiographic results than the stem, which frequently is associated with pain, unstable fixation, and osteolysis. Excessive polyethylene wear is frequent.
The results of 340 patients who underwent arthroplasty from 1948 – 1952 for trauma or osteoarthritis using an acrylic Judet prosthesis are reviewed. Early results (< 2 years) indicate the importance of restoration of the normal mechanics of the hip joint by the preservation or the restoration of normal length of the femoral neck, the exact correction of the anteversion, and the precise fit of the prosthetic head into the acetabulum. Late results show deterioration of the functional results in 20% of patients that appears to be caused by bone absorption around the Judet prosthesis and consequent loosening of the prosthesis. Use of a new type of cervicocapital prosthesis is proposed that aims to decrease the incidence and effects of bone absorption by better distribution of pressure on the bone, and particularly to decrease mobility of the prosthesis.
To assess the need to clarify indications for transfer to a rehabilitation center after hip arthroplasty, we sought to determine the number of hip prostheses placed in the year 2000 in southwestern France (PACA region), the frequency of transfer for inpatient rehabilitation after total hip arthroplasty, and the factors associated with transfer. We also examined the differences between private and public hospitals and between hip replacement due to fracture and those for other reasons.
We searched the database of the regional medical information systems program (MPSI) to identify short term hospitalizations for orthopedic surgery during the year 2000 in the region's public and private hospitals.
In all, 4705 hospitalizations included hip arthroplasty, and 46% of the patients were subsequently transferred to a rehabilitation center. Multivariate analysis showed that the following factors were associated with this transfer: age (older patients), sex (women), hospital status (public hospital) and district of residence (the three Alpine districts). Public hospitals performed arthroplasties were more frequently due to femoral fractures and in patients with psychiatric or mental disorders.
Hip replacement is a common surgical procedure that frequently leads to discharge to a rehabilitation center. This transfer is not related to the complexity of the surgery or the duration of hospitalization. The differences observed between public and private hospitals and between the districts within the region demonstrate the need for guidelines to harmonize practices.
Réé de la hanche opéré
- A Darnault
- R Nizard
- Guillemain
- Jl
Darnault A, Nizard R, Guillemain JL. Réé de la hanche opéré. EMC Med Phys Readapt 2005;1:1–32.
Les complications tardives de prothèse totale de la hanche : a ` propos de 42 cas
- M Azarkane
- H Boussakri
- M Shimi
- A Elibrahimi
- Elmrini
Azarkane M, Boussakri H, Shimi M, Elibrahimi A, Elmrini A. Les complications tardives de prothèse totale de la hanche : a ` propos de 42 cas. Pan Afr Med J 2013;14:17. E.H. Kassimi et al. Journal de ré mé 2014;xxx:1-6 JRM-286; No of Pages 6