Etude Biomécanique du Couple de Frottement Céramique-Céramique dans les Prothèses Totales de Hanche sans Ciment
The purpose of the work in this thesis was to deepen the knowledge on the use of the friction torque ceramic-ceramic in modern cementless hip implant. The clinical study of 100 total hip arthroplasties without cement with a decline of 9 years has shown the reliability of ceramic friction torque in terms of wear, biocompatibility and osseointegration. Thereafter, the comparison of the method of implantation of the implants (with or without impaction of adding additional screws) showed that the rigidity of the ceramic is not inconsistent with a single impaction, for patients who do not exhibit bone fragility. We then studied a particular complication of ceramic grinding or squeaking. An in vitro study of the phenomenon, allowed to reproduce this phenomenon in conditions of optimum lubrication, with the presence of a third metal body between the friction surfaces, suggesting the importance of lubrication in the genesis of the phenomenon. The explant analysis confirmed our hypothesis, highlighting the importance of drawing implants to avoid conflicts that generate prosthetic metal particles. Finally, the analysis of the long-term phenomenon of squeaking showed its low impact on implant survival and quality of life of patients. This work, which involved clinical and biomechanical analysis confirms us in the use of ceramics as frictional torque in total hip arthroplasty without cement, emphasizes the importance of the design and positioning of implants to avoid complications may occur and provides insight into the problem of squeaking and its consequences.