Cementless revisions of failed aseptic cemented and cementless total hip arthroplasties. 284 cases.

Over the past 13 years, 284 revisions of aseptic total hip arthroplasty failures have been performed with cementless implants. There were 213 cases involving cemented implant failures and 71 involving cementless ones. Considered as salvage procedures, these revisions provided a satisfactory result in about 70% of the reviewed patients after five years. A biologic fixation by bony ingrowth can be expected under certain conditions from decorticated living bone, a tight mechanical fitting, and a retentive corrugated surface of the implant. A prosthetic reimplantation, safely done without cement, appears more economical for the bone stock and prevents the long-term complications related with cement. Bone grafts are often required but cannot ensure the incoming osteogenic fixation of the implant. Long-term results and complications mandate harmless extractability of the revisional implant, a forged stem, an easy exchange of the plastic liner (in a two-part acetabular component), and an updated low-friction system (high-density polyethylene wear being a potential long-term problem).

[Madreporic, polarized total arthroplasties of the hip. Apropos of 2688 cases]. / Arthroplasties totales de hanche madréporiques et polarisées. A propos de 2688 observations.

This paper reports an experience over ten years with cementless total hip arthroplasty in a series of 2688 personal cases commencing in 1975. Stress is laid on the results over a period greater than 5 years and up to 10 years as much on the long-term effects on the host bone as on the implant itself. The causes of failure of biological anchorage by endosteal osteogenesis are analysed. Various phenomena, particularly the reaction of the cortices to stress, several cases of bony resorption with debris due to wear and fatigue fractures of the stem of the prosthesis have been seen. These and the problems posed by the occasional need for extraction have led to the progressive development of the prosthesis, resulting in 1983 in a new type of anchorage with a polarised surface and a better-balanced prosthesis in relation to stress and extractability.

Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis. 10-year experience with 2,384 cementless Lord madreporic prostheses.

To separate the respective effects of sterile air and antibiotic prophylaxis in orthopedic surgery, the authors reviewed 2,384 cementless total hip replacements performed from 1975 to 1984 for incidence of deep sepsis. During this period, a conventionally ventilated room (100 particle-forming units (pfu)/m3) and a laminar vertical flow (1 pfu/m3) were alternately used, without significant difference in the sepsis rate. Beginning in 1979, a prophylactic antibiotic regimen was added, which from 1979 to 1984 reduced the incidence of deep sepsis from 2.78% to 0.52%. There was also a change in common infecting organisms, from sensitive to resistant strains, which is not an insignificant consequence.

[Air decontamination and preventive antibiotic therapy in orthopedic surgery]. / Aérodécontamination et antibiothérapie préventive en chirurgie orthopédique.

In a private 160-bed orthopedic hospital, the effect of air decontamination and antibiotic prophylaxis on postoperative infections was studied. From 1971 to 1978, 5 016 orthopedic procedures were performed without antibiotic prophylaxis. Postoperative infection rate was 2% with the conventional operating room and 1.9% with the sterile room. The beneficial effect of vertical laminar air flow thus appears doubtful. From 1979 to 1982, prophylactic therapy with a cephalosporin was used for total hip replacements. Rate of postoperative deep infection fell from 3.3% in 811 hip replacements without antibiotics to 0.5% in 1 172 replacements with antibiotic prophylaxis. Our findings suggest that cephalosporin prophylaxis is more effective than vertical laminar air flow for preventing postoperative hospital-acquired infection.

[Preventive antibiotic therapy and postoperative infection in orthopedic surgery. 1983 total hip prostheses]. / Antibiothérapie préventive et infection post-opératoire en chirurgie orthopédique. 1983 prothèses totales de hanche.

In a previous paper the authors studied the role of aerobio-contamination in the rate of post-operative infections. In the present study, the results of 1,172 total hip prostheses performed between 1979/1982 with prophylactic antibiotics were compared with those obtained in 811 cases performed before 1979 without antibiotics. In the 1979/1982 series, there was 0,5 p. 100 of post-operative infection and in the pre- 1979 series, 3,3 p. 100. During the two periods the peri-operative environment was identical and the surgical technique was the same. The rate of infection in more than 8,000 other surgical procedures performed in the same hospital remained the same. The use of prophylactic antibiotics appears to be a valid approach. They should be used only in high-risk procedures to avoid the selective production of resistant organisms.

[Chiari's osteotomy in adults. Apropos of 72 cases]. / Ostéotomie de Chiari chez l'adulte. A propos de 72 observations.

The authors have performed 65 Chiari osteotomies in adults. The results have been studied with a follow-up ranging from one to 12 years. Details of the surgical technique are described. Fifty-three cases have had satisfactory results. Forty-five cases have a follow-up of more than 5 years and among these, 38 still have a very satisfactory result. It is concluded that Chiari osteotomy may stop the development of early arthrosis clinically as well as radiologically in more than two-thirds of dysplasias or subluxations in patients younger than 50 years. When there is associated femoral dysplasia it should be corrected either simultaneously or preceding the osteotomy.

[Comparative results of hip resection and coaptation for septic arthritis. Apropos of 36 cases]. / Résultats comparés des résections et coaptations de hanche pour arthrite septique. A propos de 36 cas.

The Girdlestone procedure was performed in 36 cases of septic arthritis of the hip, most of which arose following operation. In 21 instances, the greater trochanter was inserted into the acetabulum and the hips were fixed by external fixators. In 15 instances a standard operation was performed followed by traction. The results were better after simple procedures; there was less pain and more mobility but the hip was more unstable. It is concluded that the simple procedure is preferable especially when it is planned to perform a further arthroplasty later.

[Replacement of loose cemented total prosthesis of the hip by cementless prosthesis of the madreporic type (author's transl)]. / Reprise par prothèses madréporiques sans ciment des descellements d'arthroplasties totales cimentées. A propos de 77 observations.

The authors have inserted 77 cementless prosthesis of the madreporic type in cases of loosening of previously-inserted cemented prosthesis. 66 p. 100 of satisfactory results have been obtained with a follow up of one to six years. The analysis have shown that those with good results achieved stability in the course of time. The technique is fully described. In some cases bone grafting was necessary. In five cases a fracture of the femur was done during the operation. The possibility of a flare-up of infection is discussed. The authors consider that the absence of cement diminishes the liability to septic complications.

[Combined fracture-dislocation of both bones of the forearm at the elbow (author's transl)]. / La fracture-luxation conjointe de l'extrémité supérieure des deux os de l'avant-bras.

The authors have studied a particular type of traumatic lesion of the elbow which combines a fracture of the olecranon with a dislocation of both bones of the forearm, the radius and ulna remaining normally aligned to one another. The displacement was either forward (4 cases) or backward (6 cases). In some cases a partial fracture of the radial head or the lateral condyle of the humerus was also present and resulted in considerable instability. Internal fixation should always be tried but was not always possible. In one case a pedicle transplant of the medial epicondyle was made to restore a fractured coronoid process.

[Total ankle replacement (author's transl)]. / L'arthroplastie totale de cheville. Expérience sur 10 ans, à propos de 25 observations personnelles.

The authors have analysed the results of 25 total ankle replacements, either tibio-calcaneal or tibio-talar. 12 cases failed and only 7 could be considered to be satisfactory. The authors have ceased to use the procedure and consider that, at the present time, ankle arthrodesis is more reliable.

[Airborne contamination and post-operative infection (author's transl)]. / Aérobiocontamination et infection post-opératoire. A propos des 14 000 interventions en 8 ans dont 1020 sous flux vertical.

The authors have studied the rate of infection after 14000 orthopaedic interventions performed in the same hospital during the period between 1971 and 1978. 1020 of these were performed in a vertical air flow enclosure with a clearance of air at a rate of 425 times per hour. The others were performed in the conventional operating theatre with an air clearance of 22 times per hour. The density of particles was found to be 50 to 100 times lower at the level of the incision in cases operated on under vertical flow. Depsite this, the rate of infection was 0.7p. 100 in the conventional theatre and 1.4p. 100 in the vertical flow theatre. However, if the study was limited to hip prostheses (1382 cases), the rate of infection was about the same: 2,9p. 100 in conventional theatres and 3,2p. 100 in vertical flow enclosures. It is concluded that the role of a vertical air flow enclosure in decreasing the rate of post-operative infection in doubtful. The authors recall the effects of previous operations on liability to infection and consider that the use of cement may increase the incidence of infection. They advocate the use of cementless, self-locking total prostheses.

[The stress in femoral prosthesis: a study of the importance of the diaphyseal support and horizontal setting (author's transl)]. / Valeur de l'assise horizontale et de l'appui diaphysaire dans la répartition des contraintes du femur prothésé: etude comparative des contraintes exercées en charge sur le fémur normal et sur le femur porteur d'une porthèse à appui trochantéro-diaphysaire madréporique.

This study by strain-guauge methods trends to estimate relative stress in the fresh, adult human cadaver femur, before and after implantation of a cement-free (madreporique) prosthesis with a trochantero-diaphyseal support. In contrast with Blaimont, Oh and Harris statements (after insertion of a conventional femoral component with an oblique setting over the femoral neck and a short stem, the pattern of strain in the proximal part of the femur is reversed compared with that in the intact femur, the maximum strain occuring around the tip of the prosthesis rather than at the calcar femorale), the Authors found that a dihedral foundation--with an horizontal setting of the prosthesis over the calcar--, and a long stem do not reverse the normal pattern of strain in the femur. This biological balance is necessary to bone-ingrowth development for implant anchoring. This "in vitro" study does not deal with this bony fixation but intends to approximate the initial static requirements, just after the uncemented prosthetic insertion, for such a bone ingrowth.

[Simultaneous bilateral traumatic dislocation of the hip. Report of a case (author's transl)]. / Luxation traumatique bilatérale et simultanée de la hanche. A propos d'un cas de double luxation iliaque.

A case of simultaneous bilateral traumatic dislocation of the hip is reported. A review of the literature shows that this lesion is rare and impressive but that its treatment is not particularly difficult.

[Subtalar dislocations with medial or lateral displacement (author's transl)]. / Les luxations sous-astragaliennes internes et externes. A propos de 20 cas.

The authors have observed 20 cases of subtalar dislocation, 16 with medial displacement and 4 with lateral displacement. The treatment given and the results are described. An experimental study has also been made which confirms that in medial dislocations the talo-navicular joint dislocates first whilst in lateral dislocations the talo-navicular joint dislocates last. The severity of assoicated lesions is emphasised. It is concluded that in severe displacement with complete extrusion of the talus, tibio-calcaneal arthrodesis gave better results than excision of the talus.

[Upper tibial osteotomy for degenerative arthritis of the knee with varus deformity.-A review of 250 cases. (author's transl)]. / Ostéotomies tibiales de valgisation: choix d'une technique et des gestes associés a propos de 250 cas.

The authors have reviewed 250 cases of upper tibial osteotomy for varus deformity of the knee with degenerative arthritis of the medial compartment. Most of the osteotomies (136) were closing osteotomies, the remainder being opening osteotomies using a bone graft. Closing osteotomy is recommended together with an arthrolysis of the upper tibio-fibular joint instead of a fibular osteotomy. Hyper-correction appeared to be beneficial in cases with lateral ligament laxity. The authors do not recommend intra-articular cartilage shaving or meniscectomy. They advocate surgical release of the patella by division of the lateral patellar retinacula or by anterior displacement of the tibial tuberosity.