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Who must I contact to be operated from my knee or my hip ?

You must contact representatives at :

Who is going to operate me ?

Dr Alain CAZENAVE ( MD ) specialist in orthopaedics surgery is going to operate you.

How will procedure be conducted ?

Management of duration of stay may be discussed but 7 days in orthopaedic ward and then, 7 days rehabilitation center for THA and 14 days for TKA before travel back home are regular post operative cares.

Do the surgeon use a minimal invasive technique ?

YES - minimally invasive TKR and less invasive THA are regularly used.

If so, can you describe advantages/benefits

It allowes less blood loss, less pain, a shorter length of hospitalisation stay and an earlier return to function.

What kind of implant/prosthesis is required for TKA?

A mobile-bearing TKA allowes increasing implant conformity and substantially increases contact area, reduces contact stresses, and lowers polyethylene wear . This is supported by in vitro testing and the excellent long-term clinical results with minimal loosening reported in numerous studies with 20 year follow-up.
It improves control of anteroposterior translation with reduced paradoxical anterior femoral translation and self- aligning behavior to maintain large, centrally located surface contact areas at the femorotibial articulation during both flexion-extension and axial rotation of the knee which is much more difficult to achieve in fixed-bearing TKA designs.
The rotational freedom provided by rotating-platform TKA designs assists in maintaining self-alignment of both the patellofemoral and femorotibial articulations throughout knee flexion, lessens polyethylene surface stresses, and reduces polyethylene wear by decoupling multidirectional motions to more monodirectional motion patterns at 2 differing interfaces,
thus reducing cross- shear stresses and wear.

I use cementless implant for femoral component, and cementless or cimented tibial component according to bone osteoporosis.

What kind of implant/prosthesis is required for THA ?

A modular hip prosthesis ( stem, neck & head in 3 separate components instead of only one component ) is used because of numerous advantages :
- a better adaptation of the length and orientation of the femoral neck during the primary or revision surgery.
- an easy revision in case of changing insert socket ( Polyéthylene or ceramic, or metal insert) or femoral head without removing the femoral stem well anchored : it is a small operation.

It is a safe device implanted for 20 years without any breakage or dislocation of the modular components.

I use cementless acetabular ( better results than with cimented polyethylene) and cementless femoral components.

I use generaly to mplant a classical polyethylene liner associated with a metallic head, or less often a ceramic-ceramic THA ( to prevent wear in young patients) . In that case I use only a 32mm head diameter to prevent breakage.
This choice has to be discussed with the patients before operation but also with the GHT managers as the price of the ceramic/ceramic device is more expensive.

Does it require general anaesthetic ?

No obligation - according to anaesthesiologic possibilities.

Can local/epidural anaesthetic be used ?

Yes : whatever could be the operation ( THA or TKA) we prefer it rather than general anesthesia.

Does surgery require blood transfusion ?

NO; we use During operation and during the next two post-operative hours a blood recycling system that aspirates blood through filters so that to retransfuse the autologus blood lost by the patient while the patient is surveyed in post-op CCU ( avoiding any risk of blood transfusion from an other person).

How long is surgery procedure in minutes ?

THA = 35 to 40mn
TKA = 40 to 50 mn

How long is patient in post-op CCU ?

2 hours

How long is patient in post-operative ward ?

5 to 7 days.

How long is patient in recuperative centre ?

For THA = 7 DAYS before travelling back home
For TKA = 14 days before travelling back home

How many hours physiotherapy treatment ?

2H00 twice a day.

How long must short/long haul patient stay in country after release from hospital ?

In case of sucessfull operation the patient is able to come back home in his country immediatly after the rehabilitation center period : 2 weeks after THA and 3 weeks after TKA.

What are required from patients before operation ?

In case the outpatient is not performed directly by the surgeon and the anesthesthetist, surgical examination forms for the surgeon and anaesthetic form for the anaesthetist must be filled by your doctor. Biologicala nd Rx exams are to sent.

What are required conditions of patient for surgery ?

The only operation performed at now are : Primary arthroplasty of knee or hip.

Neither revision arthroplasty, nor septic surgery, nor previous infection of the affected joint will be accepted.

Medical or personnel problems may be a reason for not being accepted :
- patient refusing any blood transfusion ( Jehova witness )
- cardiovascular desease: heart attack-arythmy with anticoagulation treatment
- previous recent deep veinous thrombosis ( 6 months) with anticoagulation treatment
- Alzheimer desease - parkinson ( risk >>> dislocation after THA )
- neurologic desease: paralysis, previous cerebro-vascular accident
- diabetes Insulino Dependent
- patients ASA 3

How many of these procedures does hospital conduct per annum ?

See the french top ten rating published every year comparison between the 700 french private and public hospitals :
Personal average year activity :
- Knee arthroplasties : 210
- Hip arthrolasties : 130

What is success rate for procedure? How many unplanned revisions arise each year ?

Personal stats over 2400 arthroplasties in the last 6 years :
- 4 infections
- 5 hip dislocation/ 910 last THA procedures
- 6 arthroscopic arthrolysis for stiffness + 3 secondary patella resurfacing over 1300 TKA

Will patients need prescription/drugs after leaving ?

Some of them still need antalgic medication - they will receive advices for continuing training ( forms ready) and anticoagulation medication.

Do you provide full medical notes / CD for patients to carry home ?

- a complete medical report from entrance to transfer + X-RAYS
- CD or paper forms ( as wanted ) will be given before leaving the Institute CALOT

Last updated : 9/12/2007
orthopale in french