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.
THE JOURNAL OF BONE AND JOINT SURGERY surface involved by necrosis in antero-posterior and lateral radiographs of the head, and adding the two angles (Fig. 1). The extent was considered large when the sum was 200 degrees or more and small when 160 degrees or less. The figures so obtained were: large, 47 per cent: medium, 38 per cent; and small, 15 per cent.
1. Idiopathic necrosis of the femoral head is generally considered to be a rare disease but it appears to be rather frequent in France in view of the fact that 139 cases were recorded in the orthopaedic clinic of H么pital Cochin between 1959 and 1963. Ninety cases treated by operation have been analysed in this paper. Men are nearly exclusively affected between the ages of eighteen and seventy, with the highest incidence between thirty and fifty years of age. Both hips are affected in 52 per cent of cases. 2. The etiology is unknown, but steroid therapy was noted in 36 per cent of the cases and some history of slight injury in 30 per cent. The sudden onset of pain in half the cases suggests the obliteration of one of the blood vessels supplying the femoral head. 3. Radiographs are often normal at the time of onset of the symptoms but later they show increased density of the head localised to the antero-superior aspect, and later still collapse of this weight-bearing region. The extent of the lesion appears to be determined from the very beginning rather than to be progressive. The superior joint space is never reduced and may in fact be widened. 4. Pathological examination of the head and neck confirms necrosis of the cancellous bone and the integrity of the overlying cartilage, but shows deep to the necrotic region a highly reactive zone characterised by hypervascularity and raised metabolism. These features have been demonstrated by injection of the blood vessels and also by the uptake of phosphorus 32 and by the succino-deshydrogenase test. 5. In six cases microscopic vascular lesions were found in the antero-lateral pedicle of the femoral head. 6. The high degree of activity of the tissue deep to the necrotic zone gives some hope for revascularisation of the necrotic segment. For this reason protection from pressure may be the way to prevent dramatic collapse of the head. Rest, medical treatment and freedom from weight bearing, however, do not achieve adequate protection. Varus or rotation osteotomy of the femoral neck not only gives relief from pain but appears to prevent collapse of the femoral head. 7. When destruction of the head has already taken place good results may be expected from the insertion of a metallic prosthesis, provided the acetabulum is sound. The results are less favourable when the acetabulum has been altered by secondary arthritic change, and arthrodesis may have to be considered if the disease is unilateral or when a prosthesis has been successfully inserted on the other side.
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