[Results of total knee prostheses with or without preservation of the posterior cruciate ligament]. / Résultats des prothèses totales de genou en fonction de la conservation ou du sacrifice du ligament croisé postérieur.

PURPOSE OF THE STUDY: This study was undertaken to assess the functional repercussion of retention or sacrifice of the posterior cruciate ligament in total knee replacement. MATERIAL: Two homogeneous randomised series of 24 cases were matched. They concerned primary total knee arthroplasty for osteoarthritis using the same prosthetic design. In case of sacrifice of the posterior cruciate ligament, the prosthesis included a substitution system constituting the only difference between the two types of implants (the design of trochlea, femoral condyle and tibial plateau were identical). METHODS: Functional assessment was performed according to the Hospital for Special Surgery score, at a minimal follow up of 12 months. The Student "t" Test was used for statistical analysis. RESULTS: In cases with posterior cruciate retention, the mean HSS score was 86.6. In postero-stabilised cases. this score was 87.7: a non significant difference. The mean range of flexion was 108 degrees for the retaining cases versus 113 degrees for the postero-stabilised ones: a non significant difference. DISCUSSION: The functional outcome seems to be the same whether a postero-stabilised or a posterior cruciate retaining total knee prosthesis was used. The latter technique requires more care for ligament balancing, tibial cuts and exposure. CONCLUSION: The authors believe that there is no benefit to expect at mid-term follow up from retaining the posterior cruciate ligament in total knee replacement.

[Fracture of the ceramic head in total hip prosthesis. Apropos of 2 cases]. / Fracture des têtes en céramique dans les prothèses totales de hanche. A propos de deux cas.

Fracture of the ceramic head of a replacement arthroplasty of the hip has been encountered in 2 patients. After studying the literature the causation of such fractures has been assessed. Defects in manufacture of the prosthesis, damage during its handling and incorrect use may be responsible, with the tapered neck being the principal instrument of failure. The use of a new head with a used tapered neck is not recommended. Care must be taken in placing the head on the neck and a precise fit is required with no interposition of soft tissue.

[Humeral lengthening after replantation of the upper limb]. / Allongement de l'humérus après réimplantation du membre supérieur.

INTRODUCTION: The authors have applied the method of progressive lengthening to correct upper limb discrepancy resulting from arm reimplantation in a young female adult. MATERIAL: Following a motor vehicle accident, a twenty one years old female had her right arm sectioned. Four hours after the accident, the limb was reimplanted with 10 cm shortening of the humeral shaft, to allow direct nerve suture. Sixteen months later, she had excellent functional recovery, but was annoyed by the aesthetic appearance of her short arm. Humeral lengthening was undertaken. METHOD: The authors used a special external fixation device Orthofix (Verona, Italy) and a proximal corticotomy was performed. RESULT: Progressive callus distraction allowed 10 cm lengthening without any loss of function in 10 months; aesthetic appearance was greatly improved. DISCUSSION: Limb reimplantation necessitates substantial bone shortening to protect soft tissue sutures. Functional recovery and aesthetic tolerance are classically good but in this case, aesthetic tolerance was poor. The progressive humeral lengthening was uneventful and allowed excellent outcome, in this young girl, despite distraction of the sutured nerve. CONCLUSION: This technique should be used prudently.

[Digastric trochanterotomy in reoperated total hip prostheses. Apropos of 53 cases]. / La trochantérotomie digastrique dans les reprises de prothèse totale de hanche. A propos de 53 cas.

A new technic of trochanteric osteotomy preserving the attachment of the vastus-lateralis is described: this procedure leads to mobilize the greater trochanter which becomes interposed between the gluteus-medius upward and the vastus-lateralis downward. A true digastric muscle is therefore realized where functional integrity is preserved. The biomechanical and vascular advantages of this surgical approach are used in revisions of total hip arthroplasties in which a large exposure is often required. This procedure, used in 53 consecutive cases, has allowed to suppress the trochanteric non unions which jeopardized the functional results of revision surgery, especially in high grade femoral loosenings.

[Osteoid osteoma of the sigmoid notch of the ulna]. / Ostéome ostéoïde de la petite cavité sigmoïde du cubitus.

We report one case of osteoid-osteoma (0.0.) developed in the radio-ulnar proximal joint in a young male adult. The initial diagnosis had been chronic epicondylitis evolving since two years. A surgical detachment of the muscle from the epicondylus lateralis humeri had even been performed with no result driving to contemplate again the initial diagnosis which was corrected by tomodensitometry and surgical exploration. Excision has obtained immediate pain relief and after a one year follow up there was no recurrence. The diagnostic problems raised by intra articular 0.0. of the elbow are discussed.

[The use of Müller acetabular rings in revision surgery of total hip prosthesis. Apropos of 141 cases with a minimal 5-year follow-up]. / Utilisation des anneaux endocotyloïdiens de Müller dans la chirurgie de révision des prothèses totales de hanche. A propos de 141 cas avec un recul minimum de 5 ans.

211 acetabular reinforcement rings of Müller have been implanted when revising total hip arthroplasties, 141 were followed up for more than 5 years. In 52 per cent of cases, an acetabular reconstruction using bone grafts was associated: in 51 cases, a bank allograft was used, one third of the grafts had only a role of filling. Theses rings remained remarkably stable and there were only 2 lacks of fixation: 1.4 per cent in cases non grafted. They allowed a quick weight bearing while warranting stabilisation and protection of the grafts and recentering the hip. So their use has become systematic in THR revisions except for stage IV acetabular loosenings in which the osteosynthesis of the acetabular transverse fracture can be preferred.

[Blood saving in bone prosthetic surgery. Apropos of 426 cases]. / Economie de sang en chirurgie osseuse prothétique. A propos de 426 observations.

Perioperative blood salvage during hip and knee prosthetic surgery have been evaluated in a series of 345 patients who underwent a total of 426 surgical procedures. In 85 per cent of the cases, no additional homologous transfusion was required. In the patients who benefited from autotransfusion the quantity of bank blood transfused was 10 times less than in patients who were not autotransfused.

[Screwed acetabulum: results of 72 cases with a mean follow-up of 5 years]. / Cotyles vissés: résultats de 72 cas avec un recul moyen de cinq ans.

Ninety-seven threaded acetabular prostheses (44 cups of Lord and 53 Motta, type cups) were implanted among which 72 were examined at an average follow-up of 5.9 years. After an initial phase of good tolerance, the results became rapidly degraded. Clinically, the lack of fixation was translated by a start up pain. On examination, the pain provoked by the opposed hip flexion was pathognomonic. A radiographic analysis of our checks allowed us to classify them in four types: Type I: painful hip, normal radiography or presence of a radiolucent line in one of the DeLee's zones; increased uptake at bone scanning. Type II: total radiolucent demarcation; Type III: axial migration; Type IV: migration and tilting; Finally analysis of our series with Kaplan-Meier method showed a survivorship rate at five years of 59.3 per cent. It is concluded that this kind of implant must be abandoned.

[External discoid menisci. Apropos of a familial series of 6 cases]. / Ménisques externes discoïdes. A propos d'une série familiale de six cas.

Discoid meniscus is a well-known meniscal dysmorphia affecting more often the lateral meniscus of the knee. Familial series are exceptional with only two reported instances. A new series of three bilateral symptomatic cases of lateral discoid menisci was reported in a family of three brothers and sisters, whom parents had never suffered from their knees. During operative procedure four complete and two incomplete types were found. Two complete and four partial meniscectomies have been performed followed by four good results in the five with sufficient follow-up. The origin of this malformation is unknown. The phylogenetic and ontogenetic studies give no explanation and genetic factors seem to have a minor role.

[Total hip arthroplasty using the Hardinge approach. Clinical results in 63 cases]. / Arthroplastie totale de hanche par voie de Hardinge. Résultat clinique de 63 cas.

The recently described Hardinge approach is currently widely used for implanting total hip prostheses. It is characterized by a dissociation of the fibers of the mid-gluteal, of which the anterior fibers remain continuous with the vastus lateralis. To assess the functional impact, a series of 63 prostheses implanted with the Hardinge approach was compared with an identical series performed with the posterior approach. Results show a lower frequency of dislocation with the Hardinge approach, but also a 33 p. cent residual functional deficiency of the mid-gluteal at one year, compared with 17 p. cent with the posterior approach. A modification of the technique is proposed to limit this phenomenon.

[Femoropatellar complications of 87 total condylar and Insall Burstein knee joint prostheses]. / Complications fémoro-patellaires de 87 prothèses total condylar et Insall Burstein.

In a group of 87 total knee joint prostheses with posterior stabilization, 18 femoro patellar complications happened. Fractures, loosening, dislocations and subluxations are relatively rare. The persistence of residual patellar pain was more frequent with a high proportion of femoro-patellar derangement syndrome (FPDS). This last complication was specific of posterior stabilization model (MK II) and its origin is related to the formation of a synovial pannus in front of intercondylar region. In one case, it was surgically removed. The existence of this "FPDS" is statistically correlated with lowering of the patella, posterior position of tibial tuberosity and excessive thickness of the patellar implant complex.