Minimum 10-year follow-up results of ALPINA cementless hydroxyapatite-coated anatomic unicompartmental knee arthroplasty.

One hundred and one unicompartmental knee arthroplasties (UKA) were done between 1996 and 2000 with ALPINA(®) UNI, a cementless hydroxyapatite-coated anatomic prosthesis. Sixty-five knees were available for the long-term follow-up at a mean of 11 years. The mean IKS improved from 119.3 ± 16.8 points preoperatively to 171.4 ± 25.3 at the latest follow-up (p < 0.0001). Eighty-nine percentage of the knees were rated good and excellent. The mean knee flexion has significantly improved from 120°5 preoperatively to 127°3 at the latest follow-up (p < 0.01). Eleven revision procedures were done: 1 for early knee degeneration on rheumatoid arthritis, 1 for degeneration of osteoarthritis in the opposite compartment of the knee, 1 for unexplained pain and 1 for late ACL rupture, all these 4 cases were replaced by total knee arthroplasties; 3 revisions by another UKA were done due to polyethylene insert fracture; and 4 partial revision were done for bearing exchange due to severe polyethylene wear. When revision for any reason was defined as the end point, the 13-year Kaplan-Meier survival rate was 88 % (95 % CI 81-95 %) and when revision due to implant mechanical failure (excluding degeneration of osteoarthritis in the opposite compartment of the knee and bearing exchange only) was defined as the end point, the 13-year survival rate was 94 % (95 % CI 89.1-99.1 %).

Partial or total replacement of a unicompartmental knee prosthesis by another unicompartmental knee prosthesis: a reasonable option? About 22 cases.

Twenty-two patients who received primary unicompartmental knee arthroplasties (21 medial and 1 lateral) were reoperated between 2001 and 2010 for partial or total replacement of their implant without using a TKA. Of the 21 patients (1 bilateral) reoperated for PE insert wear (11), PE fracture (3), infection (2), and loosening or malposition (6), 3 patients died and 2 were lost to follow up. The remaining 17 cases had their clinical scores significantly improved. Only one re-revision occurred and consisted of a simple change of PE insert at 9 years, on a very heavy and very active patient. It therefore seems possible and reasonable for now to continue partial or total replacement of unicompartmental knee arthroplasty by another unicompartmental knee arthroplasty without using a TKA.

Survival of cementless dual mobility socket with a mean 17 years follow-up.

PURPOSE OF THE STUDY: As part of the 2006 symposium of the French Hip and Knee Society devoted to the dual mobility socket, we report a retrospective multicentric series of 438 first-intention total hip prostheses with a dual mobility socket at a mean 17 years follow-up. The purpose of our report was to ascertain the 15-year survival of this socket and analyze failures. MATERIAL AND METHODS: The series included 438 primary replacements. This was a homogeneous multicentric series. The cementless sockets were 80 Novae-1 titanium Serf cups and 358 Novae-1 stainless steel Serf cups. All stems were inserted without cement: 185 Pf((R)) stainless steel screwed Serf stems, 228 PRO titanium screwed Serf stems, and 25 Corail stems. The mobile polyethylene insert was retaining. All of the heads were 22.2-mm chromium-cobalt heads. Degenerative hip disease was the main etiology and mean follow-up was 17 years (range, 12-20). Mean age at implantation was 54.8 years (range, 23-87). The actuarial method with a 95% confidence interval was used to determine the 15-year cup survival rate. RESULTS: At the last follow-up, none of the patients had presented an episode of early or late instability. Analysis of the socket at last follow-up showed 13 aseptic loosenings, 23 intraprosthetic dislocations, and seven replacements of the polyethylene insert for wear. The overall 15-year prosthesis survival rate was 89.2+/-8.7%. The overall 15-year socket survival rate was 96.3+/-3.7%. DISCUSSION: The fact that, at last follow-up, none of the implants had shown instability confirms the long-term stability of the dual mobility socket. The results in terms of 15-year survival confirm earlier reports. The main cause of failure was cup fixation, which is the weak point of this technique with the initial Novae cup design, which did not have hydroxyapatite coating. The second leading cause was intraprosthetic dislocation, which can be divided into three main categories. The first is intraprosthetic dislocation in a context of pure wear with normal function of the dual mobility socket; the retaining feature of the insert loses its efficacy due to wear. The second category is intraprosthetic dislocation in a context of cup loosening with a third-body effect and increased retention wear, in which case we consider that cup loosening is the primary event leading to rapid secondary wear and subsequent intraprosthetic dislocation. The third category is intraprosthetic dislocation caused by a blockage in a context of fibrosis or impingement involving severe heterotopic ossifications. We had only two femoral failures related to aseptic loosening, most certainly related to use of noncemented implants, which limits the extension of granulomas to the polyethylene. Studying the three series from Saint-Etienne more specifically, where three different configurations were used, it would appear that the titanium cup has a better survival rate and that the titanium used for the thinner necks may be an unfavorable factor for intraprosthetic dislocation.

[Survival of dual mobility socket with a mean 17 years follow-up]. / Etude d'une série de 438 cupules non cimentées à double mobilité

PURPOSE OF THE STUDY: Within the framework of the 2007 symposium of the French Hip and Knee Society devoted to the dual mobility socket, we report a retrospective multicentric series of 438 first-intention total hip prostheses with a dual mobile socket at 17 years mean follow-up. The purpose of our report was to ascertain the 15-year survival and analyze failures. MATERIAL AND METHODS: The series included 438 first-intention prostheses. This was a homogeneous multicentric series. Sockets were: 80 Novae-1 titanium Serf cups and 358 Novae-1 stainless steel Serf cups. All stems were inserted without cement: 185 Pf) stainless steel screwed Serf stems, 228 PRO titanium screwed Serf stems, 25 Corail stems. The mobile polyethylene insert was retaining. All of the heads were 22.2mm chromium-cobalt heads. Degenerative hip disease was the main etiology and mean follow-up was 17.18 years (range: 12-20). Mean age at implantation was 54.8 years (range: 23-87). The actuarial method with 95% interval of confidence was used to determine the 15-year cup survival. RESULTS: At last follow-up, none of the patients had presented an episode of early or late instability. Analysis of the socket at last follow-up showed: 13 aseptic loosenings, 23 intraprosthetic dislocations, and seven replacements of the polyethylene insert for wear. The overall 15-year prosthesis survival was 89.2+/-8.7%. The overall 15-year socket survival was 96.3+/-3.7%. DISCUSSION: The fact that at last follow-up none of the implants had exhibited instability confirms the long-term stability of the dual mobility socket. The results in terms of 15-year survival confirm earlier reports. The main cause of failure was cup fixation, which is the weak point of this technique with the initial Novae cup, which did not have hydroxyapatite coating. The second leading cause was intraprosthetic dislocation, which can be divided into three main categories. The first is intraprosthetic dislocation in a context of pure wear with normal function of the dual mobility; the retaining feature of the insert looses its efficacy due to wear. The second category is intraprosthetic dislocation in a context of cup loosening with a third-body effect and increased retention wear, in which case we consider that the cup loosening is the primary event leading to secondary rapid wear and subsequent intraprosthetic dislocation. The third category is intraprosthetic dislocation cause by a cam effect in a context of fibrosis or impingement involving a large calcification. We have had only two femoral failures by aseptic loosening, most certainly related to use of noncemented implants, which limits the extension of granulomas to the polyethylene. Studying more specifically the three series from Saint-Etienne where three different configurations were used, it would appear that the titanium cup has a better survival and that the titanium used for the thinner necks would be an unfavorable factor for intraprosthetic dislocation.

[Joint prosthesis infection with Staphyococcus lugdunensis: 7 cases]. / Infections à Staphylocoque lugdunensis sur prothèses articulaires: à propos de 7 cas.

Staphylococcus lugdunensis was described in Lyon in 1988. This coagulase-negative staphylococcus is the cause of diverse infections which are often severe, particularly in the field cardiology where numerous publications are available for reference. The severity of S. lugdunensis infection is related to specific virulence factors associated with significant adherence properties despite good sensitivity to antibiotics. Publications dealing with joint prosthesis infections are sparse and the reports available have noted failure of treatment unless the prosthesis is removed. S. lugdunensis can easily be identified with an Api Id 32 Staph battery from BioMerieux. We analyzed seven cases of joint prosthesis infections with S. lugdunensis observed between 1991 and 2005. Four chronic infections were managed using the classical schema of implant removal then reimplantation, using a two-stage procedure for three and a single stage for one. Combined with adequate antibiotic treatment, this method was successful in all four cases. We did however have three cases of failure (two were secondary to a probable hematogenic infection and the other an early postoperative infection); these cases were operated on by early lavage and antibiotic therapy without success.

[Intra-prosthetic dislocation of the Bousquet dual mobility socket]. / Luxation intra-prothétique dans la cupule à double mobilité de Bousquet. A propos de 7 cas.

PURPOSE OF THE STUDY: The Bousquet system is a dual mobility head-polyethylene polyethylene-metal cup socket. The polyethylene insert retaining the femoral head moves in the noncemented metal cup, increasing both mobility and stability. MATERIAL AND METHOD: Between 1989 and 1997, seven cases of intra-prosthetic dislocation (six patients) were observed. The femoral head escaped from the polyethylene insert due to wear. On the average, this complication occurred ten Years after implantation. Risk of dislocation was high in six of the seven hips. All patients had a large sized stem screwed into the femoral neck. There was a characteristic radiological aspect with loss of the concentric head metal cup configuration. The head was applied against the upper wall of the metal cup. RESULTS: Surgical replacement was undertaken early in six patients by simply changing the insert without modifying the other stable components. Outcome remained good at three to eight Years. One patient underwent late surgery. The insert and the cup were replaced with a classical implant. Functional outcome was good but recurrent dislocation occurred. DISCUSSION: At mid-term, intra-prosthetic dislocation of dual mobility sockets appears to be exceptional. Dislocation results from polyethylene wear leading to failure of the insert to retain the prosthetic head. Wear is favored by direct phenomena (direct contact between neck and insert which can occur early if there is a small difference in the head and neck diameters) or indirect phenomena (factors limiting polyethylene metal-cup mobility). Surgical treatment is necessary. If undertaken early, replacement with a modular head and insert can be sufficient if the prosthesis has not loosened but the metal cup may have to be replaced in the event of metal-metal contact between the head and the cup. Prosthesis loosening, wear of the metal cup, or an identified cause of dislocation imply replacing the failing implants. Implantation of the dual mobility system is particularly interesting for patients with a high risk of dislocation or a chronically unstable hip prosthesis. Careful technique is required to reduce or retard the risk of intra-prosthetic dislocation. CONCLUSION: Intra-prosthetic dislocation of a dual mobility socket is an exceptional complication at mid-term. Surgical treatment is required but may be limited to simple insert replacement. Systematic use of this type of implant in young subjects must be carefully examined, but for us, the risk of dislocation does not outweigh the advantages of this original concept of dual mobility. This type of socket remains an useful preventive technique for high-risk hips or for curative treatment of recurrent dislocation.

[Ten-year surveillance of nosocomial surgical site infections in an orthopedic surgery department]. / Bilan de 10 ans de surveillance du taux d'infections du site opératoire dans un service d'orthopédie.

PURPOSE OF THE STUDY: Surveillance of nosocomial surgical site infections was instituted in our department in June 1991. We report our first nine years experience. MATERIAL AND METHODS: This study concerned the first 9 years (June 1991-June 2000) of a surveillance program designed to monitor nosocomial surgical site infections in our orthopedic surgery department. During this period 9,696 patients underwent surgery, including 2745 for hip replacements and 1016 for knee replacements. The diagnosis of infection was based on the Centers of Disease Control criteria. Beginning in 1997, the program was widened to include all indications for prophylactic antibiotics, being limited before that time to indications for arthroplasty and spinal surgery. RESULTS: The overall rate of infection was 1.25%; 0.55% for hip arthroplasty and 1.77% for knee arthroplasty. The rate of infection among hip surgery patients over the last 5 years was much higher for prosthesis revision (2.37%) than for first-intention implantations (0.16%). The majority of the isolated strains were Gram-positive (84%) including Staphylococcus sp. found in 65% of the cases. Multiple-strains were found in 23% of the infections. The rate of infection improved very significantly over the last five years both for knee arthroplasty and spinal surgery. The rate remained unchanged for hip arthroplasty. DISCUSSION: This 10-year survey enabled us to analyze the difficulties encountered and pinpoint errors or insufficiencies in data recording. We were also able to identify measures to be taken concerning patient follow-up. The improvement in the rate of infection over time appears to be multifactorial, undoubtedly related to wider use of prophylactic antibiotics, progress in hygiene and sterilization methods with institution of a quality assurance program, and team awareness. CONCLUSION: Surveillance of nosocomial infections is a recommended practice. We have found that the information provided can be beneficial if the data is statistically sound, pointing out the need for progress in patient follow-up.

The long-term outcome of primary osteochondritis of the hip (Legg-Calvé-Perthes' disease).

We have previously reported on 57 patients (60 hips) with a past history of Legg-Calvé-Perthes' disease at a mean of 34 years after the onset of symptoms. From this original group, 48 patients (51 hips) were also available for review after a mean of 50.2 years. We consider that the best prognostic indicator for the hip is the shape of the femoral head at skeletal maturity. Normal or flattened spherical heads present few problems. Irregular or very irregular heads are associated with a poor outcome.

[Traction-mobilization in 2-stage treatment of infected total knee prosthesis. Apropos of 12 cases]. / Traction-mobilisation dans les changements en deux temps des prothèses totales de genou infectées. A propos de 12 cas.

INTRODUCTION: A two stages reimplantation is advised by most authors in salvage of infected total knee arthroplasty. This treatment is more difficult, but seems more successful in controlling infection. It set the problem of the attitude between the two operative stages: an antibiotic cement spacer is usually used, but articular mobilization is not possible, except with an articulating spacer. MATERIAL AND METHODS: Since 1989, we use traction-mobilisation between the two operative stages, with mobilization under traction up to 50 degrees, and on edge of bed up to 70-90 degrees, till the reimplantation. We used this method on 12 cases of chronic infection in total knee arthroplasty. The reimplantation was done 34 to 47 days later. The reimplantation was more easy and more comfortable in approach and exposition, and post operative mobilisation easier. RESULTS: We did not have any recurrence of infection in this patients, but the follow up is too short for some of them. One prosthesis was removed for mechanical failure. The mean range of motion is 86 degrees at two months, 96 degrees at one year. DISCUSSION: The antibiotic cement spacer presents the disadvantage of leaving material in a potentially infected environment. It does not allow mobilisation, except using an articulating spacer. Traction-mobilisation keep articular flexion, allows mobilization, and does not leave any material in articulation. But this method has the disadvantage of requiring an hospital care between the two stages: that is reasonable if the delay is short. CONCLUSION: Traction mobilization seems to be an alternative to cement spacer. It makes the reimplantation easier, facilitates post operative recovery of mobility, and does not seem to increase recurrence of infection.

[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.

[Troublesome radiologic changes after reconstructive fixation of the anterior cruciate ligament with resorbable interference screws]. / Evolution radiologique inquiétante après fixation des plasties de ligament croisé antérieur par vis d'interférence résorbables.

The authors report worrisome radiological changes which were noted after implantation of absorbable interference screws in ligamentoplasty at the knee joint. Seventeen screws were implanted between September 1995 and July 1996, in eleven patients (average age 27) who were operated upon for chronic anterior knee instability. They underwent a modified Kenneth Jones procedure using autografts with absorbable interference screws (Acufex in 2 cases and Bio-interférix in 9 cases). Significant enlargement of bone tunnels and bony sclerosis of their edges were noted in every patient, but without any modification in the positioning of the graft. No clinical instability was observed in any of the patients, with one to two years follow-up. Publications on this topic are scarce except for one author who reported enlargement of bone tunnels after using bone-patellar tendon-bone allografts. Resorption of absorbable screws probably induces a marked inflammatory reaction, with radiological changes reminiscent of those sometimes observed after tendon allografts. Although the radiological changes reported here may not affect the graft fixation, the authors have reverted to using metallic interference screws.

[Long-term results of Insall's total condylar knee prosthesis (10-to-13-year follow-up)]. / Résultats à long terme de la prothèse totale du genou total condylard'Insall (recul de 10 à 13 ans).

We have studied 10 to 13 years postoperatively the first 105 total knee arthroplasties using the Total Condylar, a semiconstrained prosthesis with sacrifice of the cruciate ligaments, inserted between 1979 and 1983, in 99 patients (6 were bilateral). The average age of these patients was 73.5 years at the time of arthroplasty. At the time of this review, 46 patients had died (49 prostheses) and 10 were lost to follow-up. Five knees had failed (4 infections), requiring prosthesis removal in three cases. The other 38 patients (41 knees) survived: 35 were available for detailed clinical and roentgenographic evaluation, 6 knees had only a clinical, x-ray, questionnaire or telephone evaluation. To evaluate the results of these prostheses, we used 3 different rating systems the SOFCOT rating system the Hospital for Special Surgery rating system the new scoring system of the Knee Society. The results with the HSS system were excellent or good in 80% of the cases. The rate of satisfactory results, somewhat lower than those of North American studies, is probably explained by the advanced age of our patients. All these prostheses were cemented. There was no aseptic loosening at 10 to 13 years follow-up. In assessing these results we can confirm the reliability of the first model of the Insall prosthesis, in spite of a small range of sizes, and of a rudimentary ancillary, which resulted in important positioning mistakes. We can confirm that a cemented knee prosthesis with sacrifice of the cruciate ligaments is reliable at more than 10 years of follow-up. The technical advancements: larger range of component sizes metal backed tibial plates better ancillary, which permits exact and reproducible placement posterially-stabilized system should yield even better long-term results, approaching those of total hip arthroplasty.

[Long-term result of lumbar disk chemonucleolysis (a 8-12 years follow-up)]. / Résultat à long terme de la chimionucléolyse discale (8 à 12 ans de recul).

INTRODUCTION: This study is an attempt to assess the effects of chemonucleolysis over an extended period of time (8 to 12 years follow-up). MATERIAL AND METHODS: From 1981 to 1985, chemonucleolysis using Chymopapain was performed on 134 patients for the relief of radicular pain from herniated lumbar discs. The long term results were evaluated in 110 patients. This represented a total follow-up rate of 82 per cent. 24 patients were lost to follow-up. RESULTS: Of the 110 patients who had been reviewed at 8 to 12 years follow-up: 76 patients did not need other treatment than the initial chemonucleolysis. The results were excellent or good in 69 patients (63 per cent) and fair in 7 patients (6 per cent). 34 required surgery (31 per cent). This rate does not reflect the real failure rate of chemonucleolysis: 7 patients underwent early surgery and corresponded with the beginning of our experience with chemonucleolysis. 7 patients needed surgical treatment after a successful initial result for two to nine years. The real failure rate concerned 19 patients (17 per cent). These patients did not have any pain relief following chemonucleolysis. Surgical treatment was undertaken on the average 18 months after chemonucleolysis. One patient had suffered from radicular pain 6 years following the first chemonucleolysis. In this case, iterative chemonucleolysis had been done on the same lumbar level. It was effective on the radicular pain but not on the back pain. Chemonucleolysis had been effective in 70 per cent of the patients. DISCUSSION: Our study showed that the long term results following chemonucleolysis were effective and the mortality rate was low. (No severe complication in this study). This study is compared with the literature, studying the results of chemonucleolysis patients, or comparing patients treated by chymopapain or surgical discectomy. CONCLUSION: We conclude that chemonucleolysis is an effective and safe method for treating sciatica by herniated lumbar discs.

[Posterior luxation of the tibia on total knee prosthesis: apropos of 6 cases]. / Luxation postérieure du tibia sur prothèse totale du genou: à propos de 6 cas.

PURPOSE OF THE STUDY: Posterior dislocation of Total knee arthroplasty is an infrequent but serious complication. Six cases of this complication were treated from 1979 to december 1993, all occurring on primary arthroplasties. MATERIAL AND METHODS: Knee arthroplasty was performed once for rheumatoid arthritis, five times for osteoarthritis. All cases occurred with a semi constrained prosthesis sacrifying posterior cruciate ligament: 2 Total condylar without posterior stabilisation, and 4 posterior stabilised prosthesis. In one case the dislocation occurred on a very severe rheumatoid arthritis: the patient, confined in a wheel chair, was not reoperated. In two patients, the dislocation was due to rotatory malposition of the tibial component. In the last three cases, we did not found any cause to the dislocation, except ligament laxity: 2 of these patients had, pre operatively, a valgus deformity. In 6 cases, we found only 2 problems on extensor system (one patellar dislocation and one patellectomy). RESULTS: 5 patients required a surgical treatment In 2 cases, we used a more constrained prosthesis, with poor results, but the knee was stable. Once, by changing the position of the tibial component, and using a thicker plate. In 2 patients we only put a thicker tibial polyethylene component. These 3 patients had a good stability: 2 have an excellent result with H.S.S. rating system, the third one has a poor result explained by patellar pseudoarthrosis occurring after traumatic patellar fracture. DISCUSSION: With our patients and cases published in North American works, we have studied the different mechanisms of such a posterior dislocation: rotatory disorder on tibial component, ligament laxity in flexion, extensor system deficiency, valgus deformity with important postero lateral release. CONCLUSION: The causes of posterior dislocation on Total knee arthroplasties must be known: we have to try to prevent such a complication. If it occurs, a precise analysis will permit a logical curative treatment, which must avoid constrained prosthesis.

[Long-term development of primary osteochondritis of the hip (Legg-Perthes-Calvé). Apropos of 60 hips with a follow-up of more than 30 years]. / Evolution á long terme de l'ostéochondrite primitive de la hanche (Legg-Perthes-Calvé). A propos de 60 hanches revues avec plus de 30 ans de recul.

This study concerns 60 hips in 57 patients aged between 33 and 56 years with a follow-up of 30 to 44 years since the onset of the disease. The progress of the condition was assessed by objective and subjective clinical criteria and radiographic criteria including roundness of the head, head height, head cover, abnormal head shape and the presence of arthrosis. The main prognostic feature was found to be the eventual shape of the femoral head. Normal heads (7 cases) and round heads with some flattening (20 cases) had few problems at the time of follow-up. Irregular heads (7 cases) and, most of all, very irregular heads (20 cases) progressed badly. Pain was common, often severe and the patients were disabled. Fourteen of them had consulted a doctor and seven had already been treated surgically. Arthrosis as a consequence of osteochondritis seemed to be due to joint incongruence. We consider that the prognosis can be made at the end of the progressive phase of the disease, since remodelling plays no part in the roundness of the head. These findings indicate the need for care in recommending treatment in the residual phase of the disease and suggest that it is difficult to determine what surgical treatment should be considered in adult life.

[Osteogenesis imperfecta treated during growth by intramedullary nailing by the Sofield method. Outcome in adults]. / Ostéogénèses imparfaites traitées en cours de croissance par enclouage diaphysaire selon Sofield. Devenir à l'âge adulte.

Since 1985 we have used the early surgical treatment of osteogenesis imperfecta described by Sofield, even in the most severe forms of the disease. Twenty-six patients who had reached adult age have been reviewed. Whilst the functional prognosis is relatively favourable in Sillence type I cases, it is not the same for severe type III cases. In these forms, the spine and chest deformities can affect the prognosis for life. The functional state of these patients in adult life is disappointing and many of them subside progressively into the comfort of a wheelchair. Nevertheless, this assessment at the end of growth has confirmed the principles of a surgical approach, even if, at the present time, our attitude is more reserved in severe cases. Very considerable progress in treatment has resulted from telescopic rods. The improvement in prognosis seems now to depend on taking account of the spinal problem in osteogenesis imperfecta. Early surgery on a spine that is, as yet, slightly deformed should be considered in severe forms of the disease.

[The treatment of genu recurvatum (author's transl)]. / Le genu recurvatum et son traitement par ostéotomie tibiale.

50 cases of genu recurvatum were classified into three types: osseous (malunion, epiphysiodesis), capsular and ligamentous (congenital hyper-extension, sequelae of old ligament rupture) and combination of the two types. The author's have analysed the results of 44 surgical procedures. The main procedure practised has been an opening wedge osteotomy of the upper end of the tibia above the level of the tibial tubercle with a graft to fill the gap. It is important to avoid distal displacement of the patella by detachment of the tibial tubercle and reattachment more proximally at the end of the surgical procedure. Osteotomy is always indicated but should be combined with a capsular repair or combined types. The results are satisfactory especially in cases due to premature closure of the growth plate.