[Long-term results of condylar reconstruction using patella as vascularized graft]. / Résultats lointains des reconstructions condyliennes par la rotule pédiculée.

PURPOSE OF THE STUDY: In 1966, R. Merle d'Aubigné published 4 cases of unicondylar destructions (due to trauma or tumor) reconstructed with the patella replacing the joint surface. Since this time the same technique has been used in 6 other cases. The results of these 10 patients are studied. MATERIAL AND METHOD: Six of the examined patients were treated initially for a giant cell tumor, 1 for a low-grade osteosarcoma, and 3 for post traumatic arthritis. The patellar transplant remains vascularized by it's supero-medial vascular bundle. The femoral condyle was affected in 9 cases, the tibial plateau in one. RESULTS: The long term follow-up of these 10 patients revealed unexpected satisfactory results. None of the operated knees was clinically "excellent", due to instability or axial deterioration, but function remained correct, with a good range of motion, active professional possibilities, and, often, regular practice of some sports, like skiing or tracking. Function was not correlated with radiological aspect. The arthritic remodeling of the knee was obvious in all of the cases, and regularly increasing. Five of the 10 knees had to be reoperated (one or several times): 3 during the first months of follow-up (1 for sepsis, 2 for supracondylar fractures), 5 during the first years, to improve function (2 arthrolysis, 2 valgus osteotomies, 1 loose bodies removal). Three patellar plasties had to be converted into a total knee prosthesis, after 8, 27 and 40 years. The follow-up of the 7 patients still walking on their patellar plasty is of 2, 4, 17, 19, 24, 24 and 25 years. DISCUSSION AND CONCLUSION: Condylar reconstruction using a vascularized patellar transplant is mechanically speaking an approximative, obsolete and rather rough procedure. Nowadays one would prefer a knee prosthesis, with or without auto or allografts, preserving the patella. The immediate functional result would certainly be better, but the future remains uncertain. The patellar plasty can delay for 10, 20 years or even more the time of a prosthesis. This technique might also be useful in countries where prosthetic implants are not easily available.

[Hip arthrodeses for septic arthritis. Critical study]. / Les arthrodèses de hanche pour arthrite septique. Etude critique.

Twenty-eight cases of septic arthritis of the hip were treated by arthrodesis and reviewed after 2 years. Fusion of the hip was obtained in only 11 cases, four of which were still draining but healed after removal of metallic devices and curettage. Five cases had an acceptable result without drainage despite incomplete fusion. Of the 12 remaining cases, 3 were lost to follow-up and 9 had to be operated on again. Four became fused and dry, 4 were still mobile but dry and the last was a complete failure, being both mobile and draining. One case of dry incomplete fusion was successfully treated by a total prosthesis. These results show that fusion is difficult to obtain and that it is neither a necessary nor an adequate means of obtaining a good result in infection. The possibility of preserving the joint motion should be discussed.

[The medius gluteus with 1-legged stance. Geometric variations on the theme of femoral and pelvic osteotomies]. / Moyen fessier et appui unipodal. Variations géométriques sur le thème des ostéotomies fémorales et pelviennes.

The work of Pauwels has supplied evidence of the pressure applied to the hip by the contraction of the gluteus medius as its acts to maintain the pelvis in equilibrium when weight is born on one limb. The force exerted by the gluteus medius is greater the larger the distance separating the gluteus medius from the centre of the femoral head compared with the distance separating the femoral head from the centre of gravity. It is this force that mechanical procedures such as osteotomy of the femur or pelvis attempt to diminish. A study was made in depth of the variations in the activity of the gluteus medius with regard to various parameters including not only the gluteus medius distance (parameter of Pauwels) but also of the direction of the muscle and the angle formed by the cephalo-trochanteric line below and the iliac wing above the ilio-trochanteric angle. Using routine radiographs to act as a geometric model, a method was devised based on a combination of geometric construction, an experimental study and trigonometric calculation. Curves have been established determining the value of the force exerted by the gluteus medius in relation to the ilio-trochanteric angle. The smallest force exerted by the gluteus medius corresponds to the lower pole of the curve and arises when the cephalo-trochanteric line is perpendicular to the direction of the muscle; the force is greatest in the highest and lowest positions of the tip of the great trochanter, that is to say on either side of the lower pole of the curve. Since the position of the greater trochanter is, in practice, always lower, it can be said that, as a general rule, angulation into varus diminishes the tension of the gluteus medius whilst angulation into valgus increases it. However, contrary to current opinion, the effect produced on the force applied by the gluteus medius is not proportional to the ammount of varisization. The effectiveness of a varisization is greater the more the hip is in valgus and there is a critical zone with increasing varus where the effect becomes minimal. Displacement of the femoral shaft (McMurray's operation) has little effect. In Chiari's operation, diminution of the ilio-trochanteric angle and shortening of the medial lever with lengthening of the lateral lever by medial transposition of the point of application of the femoral head diminishes the force required of the gluteus medius very effectively. In particular, the effect of Chiari's operation is greater when the hip is displaced or there is coxa valga. The method described allows a precise calculation to be made on a tracing of the patient's radiograph of the effect to the proposed operation on the force required by the gluteus medius. The different parameters could be applied to a computer and thus allows statistical definition of anthropometric date concerning the force of contraction of the gluteus medius.

[The treatment of septic non-union of femoral shaft fractures (author's transl)]. / Traitement des pseudarthroses infectées de la diaphyse fémorale.

The authors describe their views of management of septic non-union in fractures of the femoral shaft. Since 1967 they have used the same procedures: 1. Surgical clearance of debris in the region of the fracture focus and from sinuses. This clearance must be complete but not too extensive. 2. Closure of the wound with suction drainage or continuous irrigation with antibiotics. 3. Immobilization of the fracture by external fixation. 4. Secondary cancellous bone grafting, in most cases by grafts placed on the medial aspect of the bone. Twenty-eight cases were treated in this way and 27 united. The results are analysed with special reference to residual sinuses, shortening, knee stiffness and functional rehabilitation.

[Giant cell tumors. Follow-up of 85 cases. Clinical experiences of the Department of Orthopedics at the Cochin Hospital]. / Tumeurs à cellules géantes. 85 observations suivies. Expérience de la clinique orthopédique de l'hôpital Cochin

The results of a series of 86 cases with a follow-up of 2 to 23 years are presented. Treatment was surgical in all cases except in spine and pelvis. 24 cases were treated by curetage, 51 by resection in some cases after curetage. Block resection nearly suppresses the recurrences and, when used as the first treatment, may avoid secondary malignant degeneration.