[Revision of infected total hip prostheses by ablation reimplantation of an uncemented prosthesis. 57 case reports]. / Reprise des prothèses totales de hanche infectées par ablation réimplantation d'une prothèse sans ciment. Expérience de 57 cas.

PURPOSE OF THE STUDY: 57 cases of infected total hip prosthesis treated by removal of the implant and implantation of unncemented prosthesis, were studied to evaluate functional and sepsis results. MATERIAL AND METHODS: 57 patients treated by reimplantation of an uncemented total hip prosthesis after removal of the infected prosthesis were observed. 16 patients underwent a single-stage exchange, 41 a two-stage reimplantation. 46 cases were analysed for infection findings (clinical, radiological and biological assessment) and only 34 cases for functional evaluation (PMA scale, Harris score) with a mean follow-up of 6.6 years. The antibiotic therapy was adapted to each patient but generally, the treatment was prolonged. RESULTS: At follow-up time (which might be too short in time), only 2 patients had a recurrence of infection. One had a single-stage exchange (reoperated by two stage exchange with a good final result at 6 years follow-up), the other a two-stage exchange. In both cases we found that postoperative antibiotic therapy was inadequate. Functional results were better with PMA scale (23 good results of 34) than with Harris score (14 excellent or good results only). 5 patients were reoperated for mechanical implant failure. DISCUSSION: Since 1991, we adopted a standardized procedure to treat chronic infected total hip prosthesis including: routine preoperative aspiration of symptomatic prosthesis; removal of the implant and around debridement followed at a later date (6 weeks) by reimplantation using uncemented implants (hydroxyapatite coated implant). Postoperative antibiotic therapy has to be massive (parenteral bitherapy for at least 21 days after each operative stage) and has to last 6 months after reimplantation. This procedure seems reliable and corroborate the validity of two-stage treatment. The using of uncemented implants allows a good bone reconstruction and does not seem to increase the risk of septic recurrence. CONCLUSION: It is quite difficult to find a hard and fast rule in infected prosthesis treatment, because many factors can influence results. The proposed procedure seems reliable, even if antibiotherapy is long and hard, but requires a strong collaboration between bacteriologist infectiologist and surgeon.

CT arthrography and arthroscopy in chronic glenohumeral joint instability.

The authors evaluate the value of CT arthrography in glenohumeral joint instability. A study was conducted on a group of 16 patients with recurrent dislocation of the shoulder. All patients underwent CT arthrography and arthroscopy. The diagnostic accuracy of CT arthrography was rated for different types of lesions on the basis of arthroscopic confirmation of its findings. Our results, which include a statistical analysis, showed a diagnostic accuracy of 97.3% in Bankart lesions and 100% in Hill-Sachs lesions and loose bodies. Dilation of the subscapular bursa and injury of the glenoid labrum-IGHL complex were often identified, while chondritis and synovitis were less frequently diagnosed. The authors therefore conclude that CT arthrography may be considered an extremely reliable diagnostic test for obtaining an overall picture of injuries due to instability. Arthroscopy, on the other hand, should be reserved for cases in which surgery may be performed in the same stage as diagnosis.

Synovial ganglia of the central pivot of the knee.

Five patients with intraarticular synovial ganglia of the knee were treated by arthroscopic surgery. These synovial cysts were found in the intercondylar fossa and appeared to originate from the cruciate ligaments. In 3 patients the ganglia were the only pathologic finding, solely responsible for the pain and functional impairment. In the other 2 patients the ganglia were accompanied by other intraarticular lesions. The diagnostic procedure (radiography, arthrography, CT, MRI, arthroscopy), confirmed the validity of CT scan and MRI in detection, differential diagnosis, and location of the ganglia in all cases. Arthroscopy enabled us to directly observe, biopsy, and remove the ganglia, resulting in immediate disappearance of symptoms and no relapse after a minimum follow-up of 20 months.

Arthroscopy in the treatment of osteochondrosis dissecans of the talus.

This study consists of six cases of osteochondrosis dissecans of the talus (ODT) treated with arthroscopy, which was able to precisely evaluate the integrity of the articular surface; this exact evaluation confirmed in turn the inaccuracy of radiographic staging and often even the most sophisticated techniques (CAT scan and/or MRI). Arthroscopy allows treatment of osteochondral lesions and consensual reactive synovitis in both advanced stages and minor lesions, with recourse to transchondral perforation. Its low morbidity and short period of rehabilitation together with the subjective and objective outcome at the follow-up (4-33 months) make arthroscopy a valid alternative to arthrotomy for treating this type of lesion.

Cystic degeneration of the lateral meniscus. Pathogenesis and diagnostic approach.

Twelve patients with cystic degeneration of the lateral meniscus were submitted to magnetic resonance and arthroscopy. This study showed that mixoid degeneration is produced initially within the meniscal substance and subsequently progresses towards and may rupture through the outer margin, so producing the clinically detectable cyst on the outer margin of the joint. In the light of the information obtained from magnetic resonance and subsequent surgical verification, existing hypotheses regarding the pathogenesis and evolution of the lesion have been re-examined.