One hundred and forty eight hybrid total hip arthroplasties in patients less than seventy years old were randomised to metal on polyethylene or alumina on alumina bearing surfaces. At two to seven years of follow-up, no significant difference was found on hip scores or survivorship of the implants. No specific complication associated to alumina components like fracture or malpositionning of the acetabular insert were observed. Alumina on alumina bearing surfaces give early clinical and radiological results similar to metal on polyethylene, suggesting that they have a potential to become good bearing surfaces in hip arthroplasty for young patients. The excellent results obtained with metal-polyethylene (M-P) bearing surfaces in total hip arthroplasty (THA) are still limited by the production of polyethylene wear debris, osteolysis and aseptic loosening. Because of it superior tribologic properties and bioinert composition, alumina-alumina (AL-AL) bearing surfaces are proposed to improve survival of THA but previously reported early complications prevented widespread use of alumina ceramic. This study compares early results and complication with Ceraver M-P and AL-AL THA. One hundred forty-eight Ceraver hybrid THA in patients less than seventy years old were randomised to M-P or AL-AL bearing surfaces. We present the clinical and radiological results for patients two to seven years after their surgery. No significant difference was found on W.O.M.A.C. and Merle D’Aubigné Postel scores. No specific complication associated with alumina components like fracture or malpositionning of the acetabular insert were observed in this study. Documented complications were: infection 4 AL-AL/2 M-P; dislocation 1 AL-AL/4 M-P; and heterotopic ossification 47% AL-AL/24% M-P. No aseptic loosening was observed. Ceraver AL-AL bearing surfaces give early clinical and radiological results similar to M-P. Our results are in accordance with studies suggesting that AL-AL have a potential to become good bearing surfaces in THA in the young patients.
We have undertaken a randomized clinical trial comparing two methods of reconstruction of the anterior cruciate ligament in patients with chronic instability. We used an ipsilateral bone-patellar-tendon-bone autograft in 27 patients and the Ligament Advancement Reinforcement System (LARS) artificial ligament in 26. Assessment before and at two, six, 12 and 24 months after surgery, included the history, physical examination, a modified International Knee Documentation Committee (IKDC) score, the Tegner score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and instrumented laxity testing. There were no cases of reactive synovitis or of infection of the knee, and there was no difference regarding the failure rate between the two groups. The IKDC showed no significant differences between the two groups at any stage of the follow-up. The KOOS evaluation showed consistently better results in all subscales for the LARS group during the first year of follow-up. After 24 months these differences were no longer evident. Instrument-tested laxity was greater in the LARS group at all stages of follow-up, but the differences were not significant at 24 months. Our findings suggest that at follow-up at 24 months the LARS ligament seems to be a satisfactory treatment option, especially when an early return to high levels of activity is demanded.
