The influence of the analgesic model on postoperative pain in major knee surgery.

Total primary knee arthroplasty represents a model of severe pain for major orthopedic surgery. A good management of postoperative pain is important both for the patient and for a good functional surgery outcome because early knee mobilisation is pain limited. This study is a review of the main analgesic methods used in total primary knee arthroplasty and their influence on pain and on the functional recovery of the knee.The comparative analysis of the analgesic models shows the advantages and the adverse effects of each one, the evolution in time of analgesia techniques and guides us in the use of evidence-based-medicine Which is the most appropriate analgesic model is a choice of the orthopedic surgeon anesthesiologist and kineto therapist team who are able to individualize for each patient good functional outcome parameters of the new knee joint.

[Is knee osteotomy still indicated in knee osteoarthritis?]. / L'ostéotomie du genou est-elle encore indiquée dans la gonarthrose?

This study was undertaken to investigate whether high tibial osteotomy (HTO) still had a role in the treatment of osteoarthritis of the knee joint. The author has performed photoelasticity studies which confirmed abnormal stress distribution over the joint, as soon as its mechanical axis was deviated and the joint line had an obliquity over 10 degrees. High tibial osteotomy to correct varus or valgus deformity restores a symmetrical stress distribution and represents the only etiological treatment of secondary osteoarthritis of the knee. Two hundred and fifty HTO's were performed between 1971 and 1985 for osteoarthritis of the knee. The short-term result was good or very good in 75%, fair in 20% and poor in 5%. Fair and poor results were related to insufficient correction, to infection or mostly to incorrect indications. In 152 cases with a good or very good short term result, a further evaluation was made between 8 years and 15 years after operation. It was noted that osteoarthritis had been arrested in 105 cases (69%) whereas it had deteriorated in 47 cases. The main factors associated with further deterioration were insufficient correction and persistence of joint line obliquity. Provided on optimal correction is achieved (3 degrees to 6 degrees hypercorrection in valgus osteotomy, 0 degree in varus osteotomy) and provided a horizontal joint line is restored, HTO performed in good indications (Ahlback grade I or II) may provide good results for at least 10 to 15 years.

[The role of paraclinical studies in the diagnosis of hypomagnesemia spasmophilia]. / Rolul explorarilor paraclinice în diagnosticarea spasmofiliei hipomagneziemice.

Assuming that Ca+2 and Mg+2 play an important role in the cell (especially the neuronal and muscular ones) membrane excitability, this paper presents the place that the paraclinical specific investigations have in the proper diagnose of normal calcium serum level hypo-magnesium spasmophilia. A number of 52 patients presenting significant clinical spasmophilia, of age between 21 and 55 years old, from different professions and social classes, were selected for this study. Paraclinical investigations (spectrophotometry) showed a normal serum calcium level (an average of 9.22 mg%); also, a decrease of Mg+2 serum level (an average of 1.41 mg%) and normal levels for Na+ (3.04 g/l) and K+ (0.21 g/l). The electrophysiological investigations (EMG, EEG, VCN m, EKG) performed showed, on the EMG recordings, in 85% of the cases the presence of the typical spasmophilic repetitive discharges, increased when using compression ischemia and 3 minutes hyperventilation, while on the EEG recordings, most patients demonstrated the presence of diffuse or mainly frontal lobe cortical bioelectrical activity alteration, either in spontaneous conditions or after specific stimulation (3 minutes hyperventilation or SLI). The muscle bioelectrical activity was analyzed by mean of EMG recordings--a decrease of VCN m was detected on the SPE nerve (34.4 m/s) and also on the SPI nerve (34.2 m/s) The EKG recordings performed showed in 5% of the cases the presence of the ventricular repolarization disturbances (flat T waves). After receiving a proper treatment which included oral administration of calcium and magnesium gluconolactate, magnesium gluconolactate with B6 vitamin or Trimagant, there were important changes of all the studied parameters and so, as a specific therapy, we recommend the use of Mg+2 compounds, because it demonstrates a significant improvement of the clinical symptoms in spasmophilia and has no danger to precipitate in the body as Ca+2 exceeding does.

[The surgical treatment of haemophilic arthropathy (author's transl)]. / Indications du traitement chirurgical dans l'arthropathie hémophilique.

The authors have operated on 13 haemophilic joints. The operation included 5 knee synovectomies of the knee, 2 corrective osteotomies, 4 soft tissue procedures on the knee or foot (tendon lengthening, capsulotomy), 1 arthrodesis of knee and 1 excision of heterotopic ossification. The type of operation needed varied with the degree of involvement. Indications for associated haematological treatment are given. The indications were both preventive and curative. The results were gratifying, although two cases of post-operative infection were seen.

[Possibilities of surgical treatment in hemophiliac arthropathy]. / Posibilitatile tratamentului chirurgical în artropatia hemofilica.

The possibilities are discussed of the surgical treatment in haemophiliac arthropathies. The cases that have been treated totalled 11 patients with type A haemophilia and one patient with type B haemophilia. The treatment was aimed either at an arrest of deterioration in the involved joint (in the early, I and II stages), or at correcting the vicious positions that had developed in the late stages (III and IV).

[Orthopedic treatment of Scheuermann's juvenile kyphosis]. / Consideratii asupra tratamentului ortopedic al cifozei juvenile Scheuermann

The authors establish some indications, depending on several criteria, of the treatment of cases of juvenile kyphosis of the Scheuermann type. These are based on their experience acquired in the therapy of 26 cases of juvenile kyphosis in which orthopaedic procedures have been applied -- plaster cast for recovery in two stages, followed by an orthopaedic corset and careful follow-up for at least one year after the end of the treatment. The criteria suggested as being important are: the severity of the kyphosis, the mobility of the spine, the severity of the kyphosis, the mobility of the spine, the severity of the vertebral structural lesions and the bone age. In cases of kyphosis under 40 degrees with a mobile spine, with minimal radiological lesions, detected before the end of growth, kinesitherapy is indicated and repeated clinico-radiological follow-up. The progression of the kyphosis under treatment or the existance of important vertebral structural lesions make necessary the performance of an orthopaedic treatment, the same as the severe cases of kyphosis, over 40 degrees, with median or severe vertebral lesions.