At first intention on a simple or dysplasic hip
We use the double mobility cup for all indications for more than 30 years in orthopedics and traumatology;
The first indication of THA is coxarthrosis.
The frequency in the western population is in the range of 3 to 6 % in subjects over 55 years. It is bilateral in nearly 45 to 50 % of cases, at least after a few years of evolution.
Whatever the clinical forms of the coxarthrosis: Typical, beginner, infra-radiological, posterior or rapid destructive, it is the disabling clinical evolution and the age of the patient that allow to ask the operative indication.
Coxarthrosis is, in the long run, the unfortunate convergence of most hip diseases. Even when it is considered primitive, it is linked to many factors, not all of which are known.
- Congenital dysplasia and dislocation
- The Coxa Vara
- Congenital acetabular protrusions
- The dysmorphic features acquired as Coxa Plana, the sequelae of inflammatory or hemophilic coxopathies
- The aftermath of ostéochondromatose, villonodular synovitis, chondrocalcinosis, Paget or post-radix disease.
- The old traumas even the simple bruises
- Some very young competition sports
- High Impact work
- Genetic factors
- Major static disorders
- Excess weight
The osteonecrosis of the femoral head is the second cause of hip pathology requiring THA (about one necrosis for seven to ten osteoarthritis)
- Idiopathic necrosis represents about 30 %.
- The causes are: Trauma: fracture, dislocation or simple contusion, barotrauma and sickle cell anemia homozygous.
- The risk factors are: alcoholism and corticotherapy, especially at high or irregular doses; Hypertriglyceridemia, rarely pregnancy, sometimes Gaucher disease and HIV.
Overall, except for exceptions, treatments, both medical and physical, allow an acceptable function for 5 to 10 years. THA is indicated, in principle beyond 50 years, in coxopathies resistant to conservative treatment. The key to the decision is not the radiographic aspect, but the clinical state: degree of pain, functional impotence, the importance of stiffness and vicious attitude.
On the technical level, the installation of a total hip prosthesis will depend on normal or abnormal morphology (dysplasia, vicious callus).