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.