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2. Ex vivo estimation of cementless femoral stem stability using an instrumented hammer

Author

Lomami, Hugues Albini, Damour, Camille, Rosi, Giuseppe, Poudrel, Anne-Sophie, Dubory, Arnaud, Flouzat-Lachaniette, Charles-Henri, and Haiat, Guillaume

Subjects
Physics - Medical Physics
Abstract

Background 15 The success of cementless hip arthroplasty depends on the primary stability of the femoral stem. It remains difficult to assess the optimal number of impacts to guarantee the femoral stem stability while avoiding bone fracture. The aim of this study is to validate a method using a hammer instrumented with a force sensor to monitor the insertion of femoral stem in bovine femoral samples. Methods 20 Different cementless femoral stem were impacted into five bovine femur samples, leading to 99 configurations. Three methods were used to quantify the insertion endpoint: the impact hammer, video motion tracking and the surgeon proprioception. For each configuration, the number of impacts performed by the surgeon until he felt a correct insertion was noted Nsurg. The insertion depth E was measured through video motion tracking, and the impact number Nvid corresponding to the end of the insertion was estimated. Two indicators, noted I and D, 25 were determined from the analysis of the time variation of the force, and the impact number Nd corresponding to a threshold reached in D variation was estimated. Findings The pullout force of the femoral stem was significantly correlated with I (R${}^2$=0.81). The values of Nsurg, Nvid and Nd were similar for all configurations. 30 Interpretation The results validate the use of the impact hammer to assess the primary stability of the femoral stem and the moment when the surgeon should stop the impaction procedure for an optimal insertion, which could lead to the development of a decision support system. Abstract: 248 words. Main text: 4658 words

Published
2020
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5. Monitoring cementless femoral stem insertion by impact

Author

Tijou, Antoine, Rosi, Giuseppe, Vayron, Romain, Lomami, Hugues, Hernigou, Philippe, Flouzat-Lachaniette, Charles-Henri, and Haiat, Guillaume

Subjects
Physics - Medical Physics, Physics - Classical Physics
Abstract

The primary stability of the femoral stem (FS) implant determines the surgical success of cementless 15 hip arthroplasty. During the insertion, a compromise must be found for the number and energy of 16 impacts that should be sufficiently large to obtain an adapted primary stability of the FS and not too high 17 to decrease fracture risk. The aim of this study is to determine whether a hammer instrumented with a 18 force sensor can be used to monitor the insertion of FS. 19 Cementless FS of different sizes were impacted in four artificial femurs with an instrumented hammer, 20 leading to 72 configurations. The impact number when the surgeon empirically felt that the FS was fully 21 inserted was noted Nsurg. The insertion depth E was assessed using video motion tracking and the impact 22 number Nvid corresponding to the end of the insertion was estimated. For each impact, two indicators 23 noted I and D were determined based on the analysis of the variation of the force as a function of time. 24 The pull-out force F was significantly correlated with the indicator I (R${}^2$ =0.67). The variation of D was 25 analyzed using a threshold to determine an impact number Nd, which is shown to be closely related to 26 Nsurg and Nvid, with an average difference of around 0.2. This approach allows to determine i) the moment 27 when the surgeon should stop the impaction procedure in order to obtain an optimal insertion of the FS 28 and ii) the FS implant primary stability. This study paves the way towards the development of a decision 29 support system to assist the surgeon in hip arthroplasty., Comment: Journal of mechanical behavior of biomedical materials, Elsevier, 2018

Published
2019

6. Modular versus monobloc dual mobility components for primary cementless total hip arthroplasty: a systematic review and meta-analysis of implants' survival, complication rates, clinical and radiographic outcomes.

Author

Giovanoulis, Vasileios, Koutserimpas, Christos, Kenanidis, Eustathios, Tsiridis, Eleftherios, Lustig, Sébastien, Dubory, Arnaud, Flouzat-Lachaniette, Charles-Henri, and Hernigou, Philippe

Subjects
HIP joint radiography, HIP joint dislocation, TOTAL hip replacement, COMPLICATIONS of prosthesis, SURGERY, PATIENTS, PROSTHESIS-related infections, FUNCTIONAL assessment, TREATMENT effectiveness, META-analysis, DESCRIPTIVE statistics, AGE distribution, SURGICAL complications, SYSTEMATIC reviews, MEDLINE, REOPERATION, MEDICAL databases, HEALTH outcome assessment, ONLINE information services, COMPARATIVE studies, PROSTHESIS design & construction, PERIPROSTHETIC fractures
Abstract

Purpose: The dual mobility cup (DMC) reduces the dislocation rates in total hip arthroplasty (THA). DMC systems include anatomical (non-modular or monoblock) (ADM) and modular dual mobility (MDM) components (Stryker Orthopaedics, Mahwah, NJ, USA). This review aims to assess differences between these two types of DMC implants concerning dislocation and revision rates, as well as patient-reported outcomes. Methods: This systematic review and meta-analysis of studies reports data from patients undergoing primary THA using MDM and/or ADM implants. Following the PRISMA guidelines, we analyzed articles from Science Direct/Scopus, PubMed, and the Cochrane Database of Systematic Reviews. We compared dislocation rates, revisions for any reason, aseptic loosening, infections, fractures, and functional outcomes between ADM and MDM components. Results: Eleven studies were considered eligible for further analysis. A total of 3369 patients (mean age = 65.4 years) underwent primary THA, including 3386 DMC implants. The mean follow-up for the MDM and ADM groups was 2.9 years and 3.9 years, respectively. The study revealed one dislocation in the MDM and none in the ADM. By proportion metanalysis, the review did not show statistical differences in all-cause revisions (p = 0.93, [CI [0.01;0.02]) or periprosthetic fractures (p = 0.18, CI [0.01;0.02]). Conclusions: MDM and ADM systems, both, represent safe DM options regarding dislocation, all-causes revisions and functional outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Early efficacy evaluation of mesenchymal stromal cells (MSC) combined to biomaterials to treat long bone non-unions

Author

Gómez-Barrena, Enrique, Padilla-Eguiluz, Norma, Rosset, Philippe, Gebhard, Florian, Hernigou, Philippe, Baldini, Nicola, Rouard, Helène, Sensebé, Luc, Gonzalo-Daganzo, Rosa-María, Giordano, Rosaria, García-Rey, Eduardo, Cordero-Ampuero, José, Rubio-Suárez, Juan Carlos, García-Simón, Marta Dominguez, Stanovici, Julien, Ehrnthaller, Christian, Huber-Lang, Markus, Flouzat-Lachaniette, Charles Henri, Chevallier, Nathalie, Donati, Davide Maria, Spazzoli, Benedetta, Ciapetti, Gabriela, Fleury, Sandrine, Fernandez, Manuel-Nicolás, Cabrera, José-Rafael, Avendaño-Solá, Cristina, Montemurro, Tiziana, Panaitescu, Carmen, Veronesi, Elena, Rojewski, Markus Thomas, Lotfi, Ramin, Dominici, Massimo, Schrezenmeier, Hubert, and Layrolle, Pierre

Published
2020
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18. Feasibility and safety of treating non-unions in tibia, femur and humerus with autologous, expanded, bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials in a multicentric, non-comparative trial

Author

Gómez-Barrena, Enrique, Rosset, Philippe, Gebhard, Florian, Hernigou, Philippe, Baldini, Nicola, Rouard, Helène, Sensebé, Luc, Gonzalo-Daganzo, Rosa M., Giordano, Rosaria, Padilla-Eguiluz, Norma, García-Rey, Eduardo, Cordero-Ampuero, José, Rubio-Suárez, Juan Carlos, Stanovici, Julien, Ehrnthaller, Christian, Huber-Lang, Markus, Flouzat-Lachaniette, Charles Henri, Chevallier, Nathalie, Donati, Davide Maria, Ciapetti, Gabriela, Fleury, Sandrine, Fernandez, Manuel-Nicolás, Cabrera, José-Rafael, Avendaño-Solá, Cristina, Montemurro, Tiziana, Panaitescu, Carmen, Veronesi, Elena, Rojewski, Markus Thomas, Lotfi, Ramin, Dominici, Massimo, Schrezenmeier, Hubert, and Layrolle, Pierre

Published
2019
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19. Mesenchymal Stem Cell Therapy for Bone Repair of Human Hip Osteonecrosis with Bilateral Match-Control Evaluation: Impact of Tissue Source, Cell Count, Disease Stage, and Volume Size on 908 Hips.

Author

Hernigou, Philippe, Homma, Yasuhiro, Hernigou, Jacques, Flouzat Lachaniette, Charles Henri, Rouard, Helène, and Verrier, Sophie

Subjects
MESENCHYMAL stem cells, ARTIFICIAL hip joints, STEM cell treatment, OSTEONECROSIS, REPAIRING, BONE cells, DISEASE progression
Abstract

We investigated the impact of mesenchymal stem cell (MSC) therapy on treating bilateral human hip osteonecrosis, analyzing 908 cases. This study assesses factors such as tissue source and cell count, comparing core decompression with various cell therapies. This research emphasizes bone repair according to pre-treatment conditions and the specificities of cell therapy in osteonecrosis repair, indicating a potential for improved bone repair strategies in hips without femoral head collapse. This study utilized a single-center retrospective analysis to investigate the efficacy of cellular approaches in the bone repair of osteonecrosis. It examined the impact on bone repair of tissue source (autologous bone marrow concentrate, allogeneic expanded, autologous expanded), cell quantity (from none in core decompression alone to millions in cell therapy), and osteonecrosis stage and volume. Excluding hips with femoral head collapse, it focused on patients who had bilateral hip osteonecrosis, both pre-operative and post-operative MRIs, and a follow-up of over five years. The analysis divided these patients into seven groups based on match control treatment variations in bilateral hip osteonecrosis, primarily investigating the outcomes between core decompression, washing effect, and different tissue sources of MSCs. Younger patients (<30 years) demonstrated significantly better repair volumes, particularly in stage II lesions, than older counterparts. Additionally, bone repair volume increased with the number of implanted MSCs up to 1,000,000, beyond which no additional benefits were observed. No significant difference was observed in repair outcomes between different sources of MSCs (BMAC, allogenic, or expanded cells). The study also highlighted that a 'washing effect' was beneficial, particularly for larger-volume osteonecrosis when combined with core decompression. Partial bone repair was the more frequent event observed, while total bone repair of osteonecrosis was rare. The volume and stage of osteonecrosis, alongside the number of injected cells, significantly affected treatment outcomes. In summary, this study provides comprehensive insights into the effectiveness and variables influencing the use of mesenchymal stem cells in treating human hip osteonecrosis. It emphasizes the potential of cell therapy while acknowledging the complexity and variability of results based on factors such as age, cell count, and disease stage. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Liste des auteurs

Author

Adam, Philippe, primary, Selmi, Tarik AÏT SI, additional, Assi, Chahine, additional, Aurelle, Jean-Luc, additional, Basselot, Frédéric, additional, Batailler, Cécile, additional, Baulot, Emmanuel, additional, Benad, Kevin, additional, Bertho, Pierre, additional, Bonnin, Michel, additional, Bonnomet, François, additional, Boyer, Bertrand, additional, Breton, Yann, additional, Bulaïd, Yassine, additional, Caton, Jacques, additional, Chatelet, Jean-Christophe, additional, Chaudier, Philippe, additional, Chavane, Hervé, additional, Chiron, Philippe, additional, Chouteau, Julien, additional, Clavé, Arnaud, additional, Colombier, Michel, additional, Dehl, Massinissa, additional, Delalande, Jean-Luc, additional, Deroche, Philippe, additional, Desmarchelier, Romain, additional, Dubory, Arnaud, additional, Ehlinger, Matthieu, additional, Epinette, Jean-Alain, additional, Farizon, Frédéric, additional, Ferreira, André, additional, Fessy, Michel-Henri, additional, Flouzat-lachaniette, Charles-Henri, additional, Fournier, Yohann, additional, Frésard, Pierre-Luc, additional, Gavira, Nathaly, additional, Geringer, Jean, additional, Gicquel, Thomas, additional, Girard, Julien, additional, Gouin, François, additional, Gras, Laure-Lise, additional, Guissou, Isaac, additional, Guyen, Olivier, additional, Hamadouche, Moussa, additional, Hernigou, Philippe, additional, Hulet, Christophe, additional, Huten, Denis, additional, Jacquot, Laurent, additional, Jarnouen de villartay, Henry, additional, Lafuma, Antoine, additional, Langlois, Jean, additional, Leclercq, Sylvain, additional, Lustig, Sébastien, additional, Marmonier, Philippe, additional, Martz, Pierre, additional, Massin, Philippe, additional, Mertl, Patrice, additional, Meunier, Antoine, additional, Migaud, Henri, additional, Musset, Thierry, additional, Neri, Thomas, additional, Noyer, Daniel, additional, Pasquier, Gilles, additional, Philippot, Rémi, additional, Prudhon, Jean-Louis, additional, Putman, Sophie, additional, Reina, Nicolas, additional, Rigoulot, Guillaume, additional, Rochcongar, Goulven, additional, Roche, Olivier, additional, Rollier, Jean-Charles, additional, Roubineau, François, additional, Roy, Christophe, additional, Sappey-marinier, Elliot, additional, Tracol, Philippe, additional, Vandenbussche, Éric, additional, Vidalain, Jean-Pierre, additional, Viste, Anthony, additional, Wegrzyn, Julien, additional, and Yammine, Kaissar, additional

Published
2018
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50. Detection of periprosthetic fractures around the femoral stem by resonance frequency analysis: An in vitro study.

Author

Poudrel, Anne-Sophie, Rosi, Giuseppe, Nguyen, Vu-Hieu, Housset, Victor, Flouzat-Lachaniette, Charles-Henri, and Haiat, Guillaume

Abstract

Periprosthetic femoral bone fractures are frequent complications of Total Hip Arthroplasty (THA) and may occur during the insertion of uncemented Femoral Stems (FS), due to the nature of the press-fit fixation. Such fracture may lead to the surgical failure of the THA and require a revision surgery, which may have dramatic consequences. Therefore, an early detection of intra-operative fractures is important to avoid worsening the fracture and/or to enable a peroperative treatment. The aim of this in vitro study is to determine the sensitivity of a method based on resonance frequency analysis of the bone-stem-ancillary system for periprosthetic fractures detection. A periprosthetic fracture was artificially created close to the lesser-trochanter of 10 femoral bone mimicking phantoms. The bone-stem-ancillary resonance frequencies in the range (2–12) kHz were measured on an ancillary instrumented with piezoelectric sensors, which was fixed to the femoral stem. The measurements were repeated for different fracture lengths from 4 to 55 mm. The results show a decrease of the resonance frequencies due to the fracture occurrence and propagation. The frequency shift reached up to 170 Hz. The minimum fracture length that can be detected varies from 3. 1 ± 1. 7 mm to 5. 9 ± 1. 9 mm according to the mode and to the specimen. A significantly higher sensitivity (p = 0.011) was obtained for a resonance frequency around 10.6 kHz, corresponding to a mode vibrating in a plane perpendicular to the fracture. This study opens new paths toward the development of non-invasive vibration-based methods for intra-operative periprosthetic fractures detection. [ABSTRACT FROM AUTHOR]

Published
2023
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